FINAL CUMULATIVE PSYCH TEST - all duplicates taken out

The nurse is interviewing a newly admitted psychiatric client. Which is an example of offering a "general lead?" "Do you know why you are here?" "Are you feeling depressed or anxious?" "Yes, I see. Go on." "Can you tell me the specific events that led to your admission?"

"Yes, I see. Go on."

The family of a client diagnosed with anorexia nervosa has canceled the last two family counseling sessions. Which of the following could be reasons for this noncompliance? Select all that apply. 1. The family is fearful of the social stigma of having a family member with emotional problems. 2. The family is dealing with feelings of guilt because of the perception that they have contributed to the disorder. 3. There may be a pattern of conflict avoidance, and the family fears conflict would surface in the sessions. 4. The family may be attempting to maintain family equilibrium by keeping the client in the sick role. 5. The client is now maintaining adequate nutrition, and the sessions are no longer necessary.

1, 2, 3, 4

12. Which of the following are effective ways to identify a substance-impaired nurse? Select all that apply. 1. A nurse who frequently administers medications to other nurses' clients. 2. High absenteeism if the substance source is outside of the work area. 3. Denial of substance abuse problems. 4. A high incidence of incorrect narcotic counts. 5. Poor concentration and difficulty in meeting deadlines.

1, 2, 3, 4, 5

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1.Mirror checking 2.Excessive grooming 3.History of an eating disorder 4.History of delusional thinking 5.Skin picking

1, 2, 5

The nurse is teaching about factors that influence eating patterns. Which statements indicate that learning has occurred? Select all that apply. 1. "Factors such as taste and texture can affect appetite." 2. "The function of my digestive organs affects my eating behaviors." 3. "High socioeconomic status determines nutritious eating patterns." 4. "Social interaction contributes little to eating patterns." 5. "Society and culture influence eating patterns."

1, 2, 5

12. Which of the following signs and symptoms supports a diagnosis of depression in an adolescent? Select all that apply. 1. Poor self-esteem. 2. Insomnia and anorexia. 3. Sexually acting out and inappropriate anger. 4. Increased serotonin levels. 5. Exaggerated psychosomatic complaints.

1, 2. 3. 5

23. A client in treatment for alcohol use disorder enters the ED complaining of head and neck pain, dizziness, sweating, and confusion. BP 100/60 mm Hg, pulse 130, and respirations 26. Which question should the nurse ask to assess this situation further? 1. "Are you currently on any medications for the treatment of alcohol use disorder?" 2. "How long have you been abstinent from using alcohol?" 3. "Are you currently using any illegal street drugs?" 4. "Have you had any diarrhea or vomiting?"

1. "Are you currently on any medications for the treatment of alcohol use disorder?"

A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response? 1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended." 2. "You must have misunderstood. An MAOI like Emsam always has dietary restrictions." 3. "Only oral MAOIs require dietary restrictions." 4. "All transdermal MAOIs do not require dietary modifications."

1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended."

A geriatric nurse is teaching the client's family about the possible cause of delirium. Which statement by the nurse is most accurate? 1. "Taking multiple medications may lead to adverse interactions or toxicity." 2. "Age-related cognitive changes may lead to alterations in mental status." 3. "Lack of rigorous exercise may lead to decreased cerebral blood flow." 4. "Decreased social interaction may lead to profound isolation and psychosis."u

1. "Taking multiple medications may lead to adverse interactions or toxicity." ANS: 1 Rationale: The nurse should identify that taking multiple medications that may lead to adverse reactions or toxicity is a risk factor for the development of delirium in older adults. Symptoms of delirium include difficulty sustaining and shifting attention. The client with delirium is disoriented to time and place and may also have impaired memory.

Which individual would be at highest risk for obesity? 1. A poor black woman. 2. A rich white woman. 3. A rich white man. 4. A well-educated black man.

1. A poor black woman.

Which anorexia nervosa symptom is physical in nature? 1. Dry, yellow skin. 2. Perfectionism. 3. Frequent weighing. 4. Preoccupation with food.

1. Dry, yellow skin.

By which biological mechanism does EMDR achieve its therapeutic effect? 1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown. 2. EMDR achieves its therapeutic effect by causing a decrease in imagery vividness. 3. EMDR achieves its therapeutic effect by causing an increase in memory access. 4. EMDR achieves its therapeutic effect by decreasing trauma associated anxiety.

1. EMDR achieves its therapeutic effect, but the exact biological mechanism is unknown.

A client on an in-patient psychiatric unit has been diagnosed with borderline personality disorder. Using intrapersonal theory, which intervention would assist the client in understanding how the client's feelings affect relationships? 1. Encourage the client to keep a journal. 2. Set limits to assist client in developing healthy ego. 3. Hold a family education session about personality disorders. 4. On the client's admission, discuss consequences for acting out in group therapy.

1. Encourage the client to keep a journal.

Although there are differences among the three personality disorder clusters, there also are some traits common to all individuals diagnosed with personality disorders. Which of the following are common traits? Select all that apply. 1. Failure to accept the consequences of their own behavior. 2. Self-injurious behaviors. 3. Reluctance in taking personal risks. 4. Cope by altering environment instead. 5. Lack of insight.

1. Failure to accept the consequences of their own behavior. 4. Cope by altering environment instead. 5. Lack of insight.

A client diagnosed with anorexia nervosa has a nursing diagnosis of disturbed body image. Which nursing intervention addresses this problem? 1. Help client to realize that perfection is unrealistic. 2. Stay with client during mealtime and for at least 1 hour after meals. 3. Help the client to identify and set weight loss goals. 4. Explain to client that privileges and restrictions will be based on weight gain.

1. Help client to realize that perfection is unrealistic.

Match the treatment goal with the appropriate medication. Heroin withdrawal? 1. Methadone (Dolophine) 2. Naloxone (Narcan) 3. Bupropion (Zyban) 4. Chlordiazepoxide (Librium) 5. Disulfiram (Antabuse)

1. Methadone (Dolophine)

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Neuroleptic medications 2. Anti-manic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

1. Neuroleptic medications Rationale: The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette's syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy.

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome? 1. Neuroleptic/antipsychotic medications 2. Anti-manic medications 3. Tricyclic antidepressant medications 4. Monoamine oxidase inhibitor medications

1. Neuroleptic/antipsychotic medications Rationale: The nurse should recognize that neuroleptic (antipsychotic) medications are effective in the treatment of Tourette's syndrome. These medications are used to reduce the severity of tics and are most effective when combined with psychosocial therapy.

A client diagnosed with an eating disorder has a nursing diagnosis of low self-esteem. Which nursing intervention would address this client's problem? 1. Offer independent decision-making opportunities. 2. Review previously successful coping strategies. 3. Provide a quiet environment with decreased stimulation. 4. Allow the client to remain in a dependent role throughout treatment.

1. Offer independent decision-making opportunities.

1. A newly admitted client with a long history of alcohol use disorder complains of burning and tingling sensations of the feet. The nurse would recognize these symptoms as indicative of which condition? 1. Peripheral neuropathy. 2. Alcoholic myopathy. 3. Wernicke's encephalopathy. 4. Korsakoff's psychosis.

1. Peripheral neuropathy

A nurse recognizes which treatment as most commonly used for AD and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Fluoxetine (Prozac); to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Lorazepam (Ativan); a first-line treatment to address symptoms of anxiety

1. Psychotherapy; to examine the stressor and confront unresolved issues

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1. Risk for injury R/T central nervous system stimulation Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

A client diagnosed with borderline personality disorder superficially cut both wrists, is disruptive in group, and is "splitting" staff. Which nursing diagnosis would take priority? 1. Risk for self-mutilation R/T need for attention. 2. Ineffective coping R/T inability to deal directly with feelings. 3. Anxiety R/T fear of abandonment AEB "splitting" staff. 4. Risk for suicide R/T past suicide attempt.

1. Risk for self-mutilation R/T need for attention.

A client diagnosed with borderline personality disorder superficially cut both wrists, is disruptive in group, and is "splitting" staff. Which nursing diagnosis would take priority? 1. Risk for self-mutilation R/T need for attention. 2. Ineffective coping R/T inability to deal directly with feelings. 3. Anxiety R/T fear of abandonment AEB "splitting" staff. 4. Risk for suicide R/T past suicide attempt.

1. Risk for self-mutilation R/T need for attention.

A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness

A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect? 1. Sarcastically states, "That group is only for crazy people with problems." 2. Scornfully states, "No, can't you see that I'm having a séance with my mom?" 3. Suspiciously states, "No, that room has been bugged." 4. Hesitantly states, "OK, but only if I can sit next to you."

1. Sarcastically states, "That group is only for crazy people with problems."

16. Using the principles of biological theory, what contributing factor puts a client at risk for the diagnosis of alcohol use disorder? 1. The client is a child of a parent diagnosed with alcohol use disorder. 2. The client is fixated in the oral stage of psychosocial development. 3. The client is highly self-critical and has unconscious anxiety. 4. The client is unable to relax or defer gratification.

1. The client is a child of a parent diagnosed with alcohol use disorder

A nurse is counseling a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa, should the nurse provide? 1. The emesis produced during purging is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries

1. The emesis produced during purging is acidic and corrodes the tooth enamel

A client is experiencing gamophobia. Which fear would the nurse expect to assess? 1) Fear of strangers 2) Fear of marriage 3) Fear of numbers 4) Fear of insanity

2) Fear of marriage Xenophobia is the fear of strangers. Gamophobia is the fear of marriage. Numerophobia is the fear of numbers. Dementophobia is the fear of insanity.

In evaluating learning, the nurse asked the client to answer the following statement: "When used in combination with anxiolytic medication, alcohol leads to _____________ effects and caffeine leads to _______________ effects." 1) Increased; increased 2) Increased; decreased 3) Decreased; decreased 4) Decreased; increased

2) Increased; decreased Anxiolytic medications work through depression of certain CNS functions. Alcohol, which is a CNS depressant, would increase/potentiate their effects. Caffeine, which is a CNS stimulant, would decrease/inhibit their effects.

19. Order the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe. ________ Delusional disorder ________ Schizotypal personality disorder ________ Schizophrenia ________ Brief psychotic disorder ________ Psychotic disorder associated with another medical condition ________ Catatonic disorder associated with another medical condition ________ Schizoaffective disorder ________ Schizophreniform disorder ________ Substance-induced psychotic disorder

2, 1, 9, 3, 5, 6, 8, 7, 4

According to the DSM-IV-TR, which of the following diagnostic criteria define borderline personality disorder? Select all that apply. 1. Arrogant, haughty behaviors or attitudes 2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 4. Unrealistic preoccupation with fears of being left to take care of self. 5. Chronic feelings of emptiness.

2, 3, 5

After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the anger stage of grieving over the loss of my son." How would the nurse assess this statement, and in what phase of the nursing process would this occur? 1. Assessment phase; nursing actions have been successful in achieving the objectives of care. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving the objectives of care.

2. Evaluation phase; nursing actions have been successful in achieving the objectives of care.

15. What substance stimulates the central nervous system? 1. Vodka. 2. "Crack." 3. Lorazepam (Ativan). 4. Triazolam (Halcion).

2. "Crack."

After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

2. "How many packs of cigarettes do you smoke daily?"

15. A client has been diagnosed with a cluster A personality disorder. Which client statement would reflect cluster A characteristics? 1. "I'm the best chef on the East Coast." 2. "My dinner has been poisoned." 3. "I have to wash my hands 10 times before eating." 4. "I just can't eat when I'm alone."

2. "My dinner has been poisoned."

A client has been diagnosed with a cluster A personality disorder. Which of the following client statements would reflect cluster A characteristics? Select all that apply. 1. "I'm the best chef on the East Coast." 2. "My dinner has been poisoned." 3. "I have to wash my hands 10 times before eating." 4. "I just can't eat when I'm alone." 5. "When my mom died, her spirit entered my cat."

2. "My dinner has been poisoned." 5. "When my mom died, her spirit entered my cat."

22. Three days after surgery to correct a perforated bowel, a client begins to display signs and symptoms of tremors, increased blood pressure, and diaphoresis. What should the nurse suspect? 1. Concealed hemorrhage. 2. Alcohol or other central nervous system depressants induced withdrawal. 3. Malignant hyperpyrexia. 4. Neuroleptic malignant syndrome.

2. Alcohol or other central nervous system depressants induced withdrawal.

A client diagnosed with anorexia nervosa has a short-term outcome that states, "The client will gain 2 pounds in 1 week." Which nursing diagnosis reflects the problem that this outcome addresses? 1. Ineffective coping R/T lack of control. 2. Altered nutrition: less than body requirements R/T decreased intake. 3. Self-care deficit: feeding R/T fatigue. 4. Anxiety R/T feelings of helplessness.

2. Altered nutrition: less than body requirements R/T decreased intake.

9. Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establishing personal contact with family members 2. Being reliable, honest, and consistent during interactions 3. Sharing limited personal information 4. Sitting close to the client to establish rapport

2. Being reliable, honest, and consistent during interactions

4. A client diagnosed with a narcissistic personality disorder has a grandiose sense of selfimportanceand entitlement. When confronted, the client states, "Contrary to what everyone believes, I do not think that the whole world owes me a living." This client isusing what defense mechanism? 1. Minimization. 2. Denial. 3. Rationalization. 4. Projection.

2. Denial.

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

2. Depression can generate somatic symptoms that can mask actual physical disorders.

A client with cachexia states, "I don't care what you say, I am horribly fat and will continue to diet." The client is experiencing arrhythmias and bradycardia. Based on this client's symptoms, which nursing diagnosis takes priority? 1. Ineffective denial. 2. Imbalanced nutrition: less than body requirements. 3. Disturbed body image. 4. Ineffective coping.

2. Imbalanced nutrition: less than body requirements.

7. A client with a long history of alcohol use disorder 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).

The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms? 1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia) 4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby)

3. Which factors does Mahler attribute to the etiology of attention-deficit/hyperactivity disorder? 1. Genetic factors. 2. Psychodynamic factors. 3. Neurochemical factors. 4. Family dynamic factors.

2. Psychodynamic factors.

Which behavioral approach should a nurse use when caring for children diagnosed with disruptive behavior disorders? 1. Involving parents in designing and implementing the treatment process 2. Reinforcing positive actions to encourage repetition of desirable behaviors 3. Providing opportunities to learn appropriate peer interactions 4. Administering psychotropic medications to improve quality of life

2. Reinforcing positive actions to encourage repetition of desirable behaviors Rationale: The nurse should reinforce positive actions to encourage repetition of desirable behaviors when caring for children diagnosed with disruptive behavior disorder. Behavior therapy is based on the concepts of classical conditioning and operant conditioning.

5. A client diagnosed with borderline personality disorder ingratiatingly requests diazepam (Valium). When the emergency department physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? 1. Undoing. 2. Splitting. 3. Altruism. 4. Reaction formation.

2. Splitting.

3. A client has been diagnosed with Wernicke-Korsakoff syndrome. Which describes this client's use of confabulation? 1. The client has difficulty keeping thoughts focused and on the topic. 2. The client clearly discussed a field trip, when in reality no field trip occurred. 3. The client jumps from one topic to another. 4. The client lies about anxiety level rating to receive more anxiolytics.

2. The client clearly discussed a field trip, when in reality no field trip occurred.

20. A client who is exhibiting symptoms of alcohol induced withdrawal is admitted to the substance abuse unit for detox. One of the nursing diagnoses for this client is ineffective health maintenance. Which is a correctly written long-term outcome for this nursing diagnosis? 1. The client will agree to attend nutritional counseling sessions. 2. The client will exhibit reduced medical complications related to alcohol use disorder within 6 months. 3. The client will identify at least three effects of alcohol on the body by day 2 of hospitalization. 4. The client will remain free from injury while withdrawing from alcohol.

2. The client will exhibit reduced medical complications related to alcohol use disorder within 6 months.

A client with a history of cerebrovascular accident (CVA) is brought to an emergency department experiencing memory problems, confusion, and disorientation. Based on this client's assessment data, which diagnosis would the nurse expect the physician to assign? 1. Delirium due to adverse effects of cardiac medications 2. Vascular neurocognitive disorder 3. Altered thought processes 4. Alzheimer's disease

2. Vascular neurocognitive disorder Vascular NCD often has an abrupt onset. Progression of this disease often occurs in a fluctuating pattern.

A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1.Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2.Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3.Risk for suicide R/T powerlessness AEB insomnia and anorexia 4.Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2.Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that teaching has been effective? 1.Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2.Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3.Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4.Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

2.Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years.

Which nursing intervention takes priority for a client experiencing moderate anxiety? 1) Explore the etiology of the anxiety. 2) Investigate decompensation behaviors. 3) Focus on anxiety reduction. 4) Accept the level of anxiety.

3) Focus on anxiety reduction. Reducing anxiety to a tolerable level should be the nurse's first priority. After reassuring the client of his or her safety and security, the nurse should convey an accepting attitude to facilitate trust. Once the anxiety level has decreased, the client can then begin exploring the triggers that induce anxiety.

24. A child diagnosed with autistic disorder has a nursing diagnosis of impaired social interaction R/T shyness and withdrawal into self. Which of the following nursing interventions would be most appropriate to address this problem? Select all that apply. 1. Prevent physical aggression by recognizing signs of agitation. 2. Allow the client to behave spontaneously, and shelter the client from peers. 3. Remain with the client during initial interaction with others on the unit. 4. Establish a procedure for behavior modification with rewards to the client for appropriate behaviors. 5. Explain to other clients the meaning behind some of the client's nonverbal gestures and signals.

3, 4, 5

Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response? 1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."

3. "Focus on the feelings generated by the hallucinations and present reality."

21. The nurse has given a client information on alcohol use disorder recovery. Which client statement indicates that learning has occurred? 1. "Once I have detoxed, my recovery is complete." 2. "I understand that the goal of recovery is to decrease my drinking." 3. "I realize that recovery is a lifelong process that comes about in steps." 4. "Al-Anon can assist me in my recovery process."

3. "I realize that recovery is a lifelong process that comes about in steps."

The nurse educator is lecturing a group of nursing students on depression in adolescents. Which statement indicates that teaching has been effective? 1. "Adolescents are not likely to suffer from depression." 2. "Depressed adolescents always seek immediate treatment." 3. "Many symptoms are attributed to normal adjustments of adolescents." 4. "Suicide is not common among depressed adolescents."

3. "Many symptoms are attributed to normal adjustments of adolescents."

A nursing instructor is teaching about personality disorder characteristics. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with personality disorders need frequent hospitalizations." 2. "Clients perceive their behaviors as uncomfortable and disorganized." 3. "Personality disorders cannot be cured or controlled successfully with medication." 4. "Practitioners have a good understanding about the etiology of personality disorders."

3. "Personality disorders cannot be cured or controlled successfully with medication."

A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "The voices must sound scary, but the devil is not talking to you. This is part of your illness." 4. "The devil only talks to people who are receptive to his influence."

3. "The voices must sound scary, but the devil is not talking to you. This is part of your illness."

A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range? 1. 5 to 10 years old. 2. 10 to 14 years old. 3. 18 to 22 years old. 4. 40 to 45 years old.

3. 18 to 22 years old.

A client is leaving the in-patient psychiatric facility after 1 month of treatment for anorexia nervosa. Which outcome is appropriate during discharge planning for this client? 1. Client will accept refeeding as part of a daily routine. 2. Client will perform nasogastric tube feeding independently. 3. Client will verbalize recognition of "fat" body misperception. 4. Client will discuss importance of monitoring weights daily.

3. Client will verbalize recognition of "fat" body misperception.

When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? 1.Open-ended membership; circle of chairs; group size of 5 to 10 members 2.Open-ended membership; chairs around a table; group size of 10 to 15 members 3.Closed membership; circle of chairs; group size of 5 to 10 members 4.Closed membership; chairs around a table; group size of 10 to 15 members

3. Closed membership; circle of chairs; group size of 5 to 10 members

A paranoid client diagnosed with schizophrenia spectrum disorder states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? 1. Magical thinking; administer an antipsychotic medication. 2. Persecutory delusions; orient the client to reality. 3. Command hallucinations; warn the psychiatrist. 4. Altered thought processes; call an emergency treatment team meeting.

3. Command hallucinations; warn the psychiatrist.

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving 4. Altered sensory perception

3. Complicated grieving

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? 1. The side effects of medications 2. Deep breathing techniques to decrease stress 3. How to make eye contact when communicating 4. How to be a leader

3. How to make eye contact when communicating

Which structure of the brain contains the appetite regulation center? 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Medulla.

3. Hypothalamus.

13. A child diagnosed with mild to moderate mental retardation is admitted to the medical/ surgical floor for an appendectomy. The nurse observes that the child is having difficulty making desires known. Which nursing diagnosis reflects this client's problem? 1. Ineffective coping R/T developmental delay. 2. Anxiety R/T hospitalization and absence of familiar surroundings. 3. Impaired verbal communication R/T developmental alteration. 4. Impaired adjustment R/T recent admission to hospital.

3. Impaired verbal communication R/T developmental alteration.

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.

Which statement accurately differentiates mild NCD from major NCD? 1. Major NCD involves disorientation that develops suddenly, whereas mild NCD develops more slowly. 2. Major NCD involves impairment of abstract thinking and judgment, whereas mild NCD does not. 3. Major NCD criteria requires substantial cognitive decline from a previous level of performance, and mild NCD requires modest decline. 4. Major NCD criteria requires decline from a previous level of performance in three of the listed domains, and mild NCD requires only one.

3. Major NCD criteria requires substantial cognitive decline from a previous level of performance, and mild NCD requires modest decline.

A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations

A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Restlessness and muscle rigidity 4. Reports of hearing disturbing voices

3. Restlessness and muscle rigidity An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A client diagnosed with NCD is disoriented and ataxic and wanders. Which is the priority nursing diagnosis? 1. Disturbed thought processes 2. Self-care deficit 3. Risk for injury 4. Altered health-care maintenance

3. Risk for injury The client who is ataxic suffers from motor coordination deficits and is at an increased risk for falls. Clients that wander are at a higher risk for injury.

15. A child diagnosed with an autistic disorder makes no eye contact; is unresponsive to staff members; and continuously twists, spins, and head bangs. Which nursing diagnosis would take priority? 1. Personal identity disorder R/T poor ego differentiation. 2. Impaired verbal communication R/T withdrawal into self. 3. Risk for injury R/T head banging. 4. Impaired social interaction R/T delay in accomplishing developmental tasks.

3. Risk for injury R/T head banging.

4. Which is the priority diagnosis for a client experiencing alcohol induced withdrawal? 1. Ineffective health maintenance. 2. Ineffective coping. 3. Risk for injury. 4. Dysfunctional family processes: alcohol use disorder.

3. Risk for injury.

7. A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client? 1. Disturbed sensory perception 2. Altered thought processes 3. Risk for violence: directed toward others 4. Risk for injury

3. Risk for violence: directed toward others The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

A client diagnosed with AD exhibits progressive memory loss, diminished cognitive functioning, and verbal aggression upon experiencing frustration. Which nursing intervention is most appropriate? 1. Organize a group activity to present reality. 2. Minimize environmental lighting. 3. Schedule structured daily routines. 4. Explain the consequences for aggressive behaviors.

3. Schedule structured daily routines. A structured routine will reduce frustration and thereby reduce verbal aggression.

A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize? 1. Respirations of 22 beats/minute 2. Weight gain of 8 pounds in 2 months 3. Temperature of 104F (40C) 4. Excessive salivation

3. Temperature of 104F (40C) Rationale: A temperature this high may indicate neuroleptic malignant syndrome, a life-threatening side effect of antipsychotic medications.

22. A child diagnosed with a conduct disorder is disruptive and noncompliant with rules in the milieu. Which outcome, related to this client's problem, should the nurse expect the client to achieve? 1. The child will maintain anxiety at a reasonable level by day 2. 2. The child will interact with others in a socially appropriate manner by day 2. 3. The child will accept direction without becoming defensive by discharge. 4. The child will contract not to harm self during this shift.

3. The child will accept direction without becoming defensive by discharge.

A client diagnosed with passive-aggressive personality disorder has a nursing diagnosis of altered sleep pattern R/T impending divorce. The client is prescribed oxazepam (Serax) PRN. Which is an appropriate outcome for the nursing diagnosis? 1. The client verbalizes a decrease in tension and racing thoughts. 2. The client expresses understanding about the medication side effects by day 2. 3. The client sleeps 4 to 6 hours a night by day 3. 4. The client notifies the nurse when the medication is needed.

3. The client sleeps 4 to 6 hours a night by day 3.

A client diagnosed with an avoidant personality disorder has the nursing diagnosis of social isolation R/T severe malformation of the spine AEB "I can't be around people, looking like this." Which short-term outcome is appropriate for this client's problem? 1. The client will see self as straight and tall by the time of discharge. 2. The client will see self as valuable after attending assertiveness training courses. 3. The client will be able to participate in one therapy group by end of shift. 4. The client will join in a charade game to decrease social isolation.

3. The client will be able to participate in one therapy group by end of shift.

4. Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response? 1."Tell him to stop discussing the voices." 2."Ignore what he is saying, while attempting to discover the underlying cause." 3."Focus on the feelings generated by the hallucinations and present reality." 4."Present objective evidence that the voices are not real."

3. The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception.

A nurse administers 100 percent oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles

A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out neurocognitive disorder 4. To rule out personality disorder

3. To rule out neurocognitive disorder

Jennifer is a 25-year-old woman of average height and weight who reports to the mental health clinic with complaints that she has been unable to go to work for the last 2 weeks because she can't get her "appearance right." She reports that she repetitively checks the mirror and has to redo her make-up every 5 or 10 minutes. Jennifer is most likely experiencing which of these disorders? 1) Social anxiety disorder 2) Panic disorder 3) Eating disorder 4) Body dysmorphic disorder

4) Body Dysmorphic disorder

A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1.Symptoms lasting for a minimum of two years 2.Numerous periods with manic symptoms 3.Possible comorbid diagnosis of a delusional disorder 4.Symptoms cause clinically significant impairment in important areas of functioning 5.Depressive symptoms that do not meet the criteria for major depressive episode

4, 5

Eye movement desensitization and reprocessing (EMDR) has been empirically validated for which disorder? 1. Adjustment disorder 2. Generalized anxiety disorder 3. Panic disorder 4. Posttraumatic stress disorder

4. Posttraumatic stress disorder

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects insight related to this disorder? 1. "Skaters need to be thin to improve their daily performance." 2. "All the skaters on the team are following an approved 1200-calorie diet." 3. "The exercise of skating reduces my appetite but improves my energy level." 4. "I am angry at my mother. I can only get her approval when I win competitions."

4. "I am angry at my mother. I can only get her approval when I win competitions."

Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from LSD use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

An inexperienced agency nurse is assigned to an in-patient psychiatric unit. Which client should this nurse be assigned? 1. A client diagnosed with antisocial personality disorder. 2. A client diagnosed with paranoid personality disorder. 3. A client diagnosed with borderline personality disorder. 4. A client diagnosed with avoidant personality disorder.

4. A client diagnosed with avoidant personality disorder.

8. The nurse on an in-patient pediatric psychiatric unit is admitting a client diagnosed with an autistic disorder. Which would the nurse expect to assess? 1. A strong connection with siblings. 2. An active imagination. 3. Abnormalities in physical appearance. 4. Absence of language.

4. Absence of language.

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? 1. Odd beliefs and magical thinking. 2. Grandiose sense of self-importance. 3. Preoccupation with orderliness and perfection. 4. Attention-seeking flamboyance.

4. Attention-seeking flamboyance.

Match the treatment goal with the appropriate medication. Alcohol withdrawal? 1. Methadone (Dolophine) 2. Naloxone (Narcan) 3. Bupropion (Zyban) 4. Chlordiazepoxide (Librium) 5. Disulfiram (Antabuse)

4. Chlordiazepoxide (Librium)

Which etiology for anorexia nervosa is from a neuroendocrine perspective? 1. Anorexia nervosa is more common among sisters and mothers of clients with the disorder than among the general population. 2. Dysfunction of the thalamus is implicated in the diagnosis of anorexia nervosa. 3. There is a higher than expected frequency of mood disorders among first-degree relatives of clients diagnosed with anorexia nervosa. 4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

4. Clients diagnosed with anorexia nervosa have elevated cerebrospinal fluid cortisol levels and possible alterations in the regulation of dopamine.

A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Thought insertion 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

4. Delusions of reference

5. A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Thought insertion 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

4. Delusions of reference A client that believes he or she receives messages through the radio is experiencing delusions of reference.

According to the DSM-IV-TR, which diagnostic criterion describes schizotypal personality disorder? 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Is preoccupied with unjustified doubts about the loyalty or trustworthiness of friends or associates. 3. Considers relationships to be more intimate than they actually are. 4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

Which diagnostic criterion describes a characteristic of schizotypal personality disorder? 1. Neither desires nor enjoys close relationships, including being part of a family. 2. Is preoccupied with unjustified doubts about the loyalty of friends and associates. 3. Considers relationships to be more intimate than they actually are. 4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

4. Exhibits behavior or appearance that is odd, eccentric, or peculiar.

A nurse should recognize that a decrease in norepinephrine levels would play a significant role in which mental illness? 1. Bipolar disorder: mania 2. Schizophrenia spectrum disorder 3. Generalized anxiety disorder 4. Major depressive episode

4. Major depressive episode

A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Avoidant personality disorder. 3. Schizotypal personality disorder. 4. Narcissistic personality disorder.

4. Narcissistic personality disorder.

Using the DSM-IV-TR, which statement is true as it relates to the diagnosis of obesity? 1. Obesity is a diagnosis classified on Axis I similar to other eating disorders. 2. Obesity is not classified as an eating disorder because medical diagnoses are not classified in the DSM-IV-TR. 3. Obesity is currently evaluated for all clients as a "psychological factor affecting medical conditions." 4. Obesity is not classified as an eating disorder, but can be placed on Axis III as a medical condition.

4. Obesity is not classified as an eating disorder, but can be placed on Axis III as a medical condition.

A nurse is discharging a client diagnosed with narcissistic 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.

4. Prison warden.

Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

4. Provide personal space to respect the client's boundaries. Rationale: The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

19. Which is the priority nursing diagnosis for a client experiencing alcohol induced intoxication? 1. Pain. 2. Ineffective denial. 3. Ineffective coping. 4. Risk for aspiration.

4. Risk for aspiration.

A client diagnosed with schizoid personality disorder chooses solitary activities, lacks close friends, and appears indifferent to criticism. Which nursing diagnosis would be appropriate for this client's problem? 1. Anxiety R/T poor self-esteem AEB lack of close friends. 2. Ineffective coping R/T inability to communicate AEB indifference to criticism. 3. Altered sensory perception R/T threat to self-concept AEB magical thinking. 4. Social isolation R/T discomfort with human interaction AEB avoiding others.

4. Social isolation R/T discomfort with human interaction AEB avoiding others.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? 1. Antagonist therapy 2. Deterrent therapy 3. Codependency therapy 4. Substitution therapy

4. Substitution therapy

A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications 2. Agranulocytosis treated by administration of clozapine (Clozaril) 3. Extrapyramidal symptoms treated by administration of benztropine (Cogentin) 4. Tardive dyskinesia treated by discontinuing antipsychotic medications

4. Tardive dyskinesia treated by discontinuing antipsychotic medications The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medication.

A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder? 1. The 60-year-old, because of memory deficits 2. The 60-year-old, because of decreased cognitive processing ability 3. The 20-year-old, because of limited cognitive experiences 4. The 20-year-old, because of lack of developmental maturity

4. The 20-year-old, because of lack of developmental maturity

A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis? 1. The client worries continually and appears nervous and jittery. 2. The client complains of a depressed mood, is tearful, and feels hopeless. 3. The client is belligerent, violates others' rights, and defaults on legal responsibilities. 4. The client complains of many physical ailments, refuses to socialize, and quits her job.

4. The client complains of many physical ailments, refuses to socialize, and quits her job.

19. Which short-term outcome would take priority for a client who is diagnosed with moderate mental retardation, and who resorts to self-mutilation during times of peer and staff conflict? 1. The client will form peer relationships by end of shift. 2. The client will demonstrate adaptive coping skills in response to conflicts. 3. The client will take direction without becoming defensive by discharge. 4. The client will experience no physical harm during this shift.

4. The client will experience no physical harm during this shift.

When planning care for a depressed client, which correctly written outcome should be a nurse's first priority? 1. The client will promise not to physically harm self. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

4. The client will remain safe during hospital stay.

A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do what I need to do." Which short-term outcome is appropriate for this client? 1. The client will refrain from hand washing during a 3-hour period after admission to unit. 2. The client will wash hands only at appropriate intervals; that is, bathroom and meals. 3. The client will refrain from hand washing throughout the night. 4. The client will verbalize signs and symptoms of escalating anxiety within 72 hours of admission.

4. The client will verbalize signs and symptoms of escalating anxiety within 72 hours of admission.

1. Which predisposing factor would be implicated in the etiology of paranoid personality disorder? 1. The individual may have been subjected to parental demands, criticism, and perfectionistic expectations. 2. The individual may have been subjected to parental indifference, impassivity, or formality. 3. The individual may have been subjected to parental bleak and unfeeling coldness. 4. The individual may have been subjected to parental antagonism and harassment.

4. The individual may have been subjected to parental antagonism and harassment.

Which predisposing factor would be implicated in the etiology of paranoid personality disorder? 1. The individual may have been subjected to parental demands, criticism, and perfectionistic expectations. 2. The individual may have been subjected to parental indifference, impassivity, or formality. 3. The individual may have been subjected to parental bleak and unfeeling coldness. 4. The individual may have been subjected to parental antagonism and harassment.

4. The individual may have been subjected to parental antagonism and harassment.

A client diagnosed with schizophrenia was released from a state mental hospital aftr 20yrs of institutionalization. Which characteristic that is likely to be exhibited by this client? A. The client is likely to be compliant with treatment because of institutional dependency. B. The client is likely to find a variety of community support services to aid in the transition. C. The client is likely to adjust to the community environment if given sufficient support. D. The client is likely to be admitted at some time to an acute care unit for psychiatric treatment.

D. The client is likely to be admitted at some time to an acute care unit for psychiatric treatment.

5. A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? A. The therapeutic technique of "giving advice" B. The therapeutic technique of "defending" C. The nontherapeutic technique of "presenting reality" D. The nontherapeutic technique of "giving false reassurance"

D. The nontherapeutic technique of "giving false reassurance" Giving false reassurance indicates to the client that there is no cause for anxiety, thereby devaluing the client's feelings.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

D. These programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

11. What is the purpose of a nurse providing appropriate feedback? A. To give the client good advice B. To advise the client on appropriate behaviors C. To evaluate the client's behavior D. To give the client critical information

D. To give the client critical information Feedback should not be used to give advice or evaluate behaviors.

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of A. standard antipsychotic medication. B. tricyclic antidepressant medication. C. anticholinergic medication. D. a short-acting benzodiazepine medication.

D. a short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

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

D. can be learning situations to prolong sobriety. Relapses can point out problems to be resolved and can result in renewed efforts for change

Schizophrenia is best characterized as A. split personality. B. multiple personalities. C. ambivalent personality. D. deteriorating personality.

D. deteriorating personality. marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to A. protect the nurse legally. B. establish the nursing diagnoses of priority. C. obtain information about the client's psychosocial background. D. determine whether the anxiety is primary or secondary in origin.

D. determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.

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

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

The major distinction between fear and anxiety is that fear A. is a universal experience; anxiety is neurotic. B. enables constructive action; anxiety is dysfunctional. C. is a psychological experience; anxiety is a physiological experience. D. is a response to a specific danger; anxiety is a response to an unknown danger.

D. is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger.

Delusionary thinking is a characteristic of A. chronic anxiety. B. acute anxiety. C. severe anxiety. D. panic level anxiety.

D. panic level anxiety. Panic level anxiety is the most extreme level and results in markedly disturbed thinking.

Nurse does a 45 min education group, whats an appropriate topic?

Stress management

Lithium: patient teaching

Take with mealsNEVER stop abruptlyMonitor blood lithium levelsContraindicated in renal failure

Working phase

What phase when client incorporates alternative behaviors; clients insight & perception of reality

A client taking the drug disulfiram (Antabuse) is admitted to the ER. Which clinical manifestations are most indicative of recent alcohol ingestion? Vomiting, heart rate 120, chest pain Nausea, mild headache, bradycardia Respirations 16, heart rate 62, diarrhea Temp 101°F, tachycardia, respirations 20

a Vomiting, heart rate 120, chest pain

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling the situation in a healthy manner? a. "I know that it was not my fault." b. "If I don't put myself in a dating situation, I won't be at risk." c. "My boyfriend has trouble controlling his sexual urges." d. "Next time I will think twice about wearing a sexy dress."

a. "I know that it was not my fault."

A nurse is assessing a client diagnosed with paranoid schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of "making observations?" a. "I notice that you are talking to someone who I do not see." b. "Please tell me what they are telling you." c. Why do you continually look up at the ceiling?" d. I understand that you see someone in the hall, but I do not see anyone."

a. "I notice that you are talking to someone who I do not see." This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

A client diagnosed with Alzheimer's Disease (AD) is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which is the appropriate nursing response? a. "This medication delays the destruction of acetycholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

a. "This medication delays the destruction of acetycholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease."

Elisa says to the nurse, "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which of the following is an empathetic response by the nurse?" a. "You are very angry now. This is a normal response to your loss." b. "I know what you mean. Men can be very insensitive." c. "I understand completely. My husband divorced me, too." d. "You are depressed now, but you will better in time."

a. "You are very angry now. This is a normal response to your loss."

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to Alcoholics Anonymous (AA), would be most appropriate for a nurse to discuss with the client during discharge teaching? Select one: a. After discharge, the client will immediately attend 90 AA meetings in 90 days. b. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. c. After discharge, the client will incorporate family in AA attendance. d. After discharge, the client will seek appropriate deterrent medications through AA.

a. After discharge, the client will immediately attend 90 AA meetings in 90 days. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

Symptoms of depression are related to which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

a. Anorexia b. Bulimia

Symptoms may be related to genetics in which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

a. Anorexia b. Bulimia c. Obesity

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. Which leadership style has the nurse demonstrated? a. Autocratic b. Democratic c. Laissez-faire d. Bureaucratic

a. Autocratic

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? a. Autonomy b. beneficence c. non malfeasance d. justice

a. Autonomy

Which of the following situations is UNLIKELY to lead to PTSD in a client? a. Home invasion while away on vacation. b. Purse snatching in the mall parking lot. c. Battering by spouse. d. Burst of nearby dam while sleeping, resulting in loss of home and belongings.

a. Home invasion while away on vacation.

Which nursing intervention takes priority when working with a newly admitted client experiencing suicidal ideations?a. a. Monitor the client at close, but irregular intervals. b. Encourage the client to participate in group therapy. c. Enlist friends and family to assist the client in remaining safe after discharge. d. Remind the client that it takes 6-8 weeks for anti-depressants to be fully effective.

a. Monitor the client at close, but irregular intervals.

When attempting to provide health-care related services to the homeless, what should be a realistic concern for a nurse? a. Most individuals that are homeless relocate frequently. b. Most individuals that are homeless are suspicious of anyone who offers help. c. Most individuals that are homeless reject help. d. Most individuals that are homeless are proud and will refuse charity.

a. Most individuals that are homeless relocate frequently.

A psychiatrist prescribes a MAOI for a client. When teaching the client about the effects of tyramine, which foods will the nurse caution the client to avoid? a. Pepperoni pizza and red wine b. Bagels with cream cheese and tea c. Apple pie and coffee d. Potato chips and diet coke

a. Pepperoni pizza and red wine

A client with Antisocial Personality Disorder is verbally threatening to the staff. Select the best, initial nursing intervention for this behavior. a. Set firm limits on client's behavior. b. Medicate the client c. Ignore the client's threats d. Call a Code

a. Set firm limits on client's behavior.

Relapse is most likely to happen when the client? a.. returns to the same people, places and things after treatment. b. refuses to attend after care treatment. c. has a dual diagnosis. d. within the first month following discharge.

a.. returns to the same people, places and things after treatment. The nurse should recognize this as potential problems in the client's sobriety.

The client with Alzheimer's disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is exhibiting: Agnosia Apraxia Anomia Aphasia

b Apraxia

Refuses to enter into a relationship because of fear of rejection

b Avoidant personality disorder

A client is admitted to the acute care unit. Initial laboratory values reveal serum sodium of 170 mEq/L. What behavior changes would be most common for this client? a Anger b Mania c Depression d Psychosis

b Mania

A client has a history of abusing barbiturates. Which of the following is a sign of mild barbiturate intoxication? Rapid speech Nystagmus Anisocoria Polyphagia

b Nystagmus

A client tells the nurse that she takes St. John's wort (hypericum perforatum) three times a day for mild depression. The nurse should tell the client that: St. John's wort seldom relieves depression. She should avoid eating aged cheese. Skin reactions increase with the use of sunscreen. The herbal is safe to use with other antidepressants.

b She should avoid eating aged cheese.

A client with schizophrenia has become disruptive and requires seclusion to help him regain control of his behavior. Which staff member can institute seclusion? a The security guard b The registered nurse c The licensed practical nurse d The nursing assistant

b The registered nurse

Which of the following medications would be an appropriate prn medication for an individual with anxiety symptoms? a)Buspirone b)Alprazolam c)Fluoxetine d)Sertraline

b)Alprazolam •Alprazolam is a benzodiazepine, a CNS depressant to produce quick-acting effects of relaxation. •Buspirone has delayed effect & should not be used on a prn basis. •Fluoxetine & sertraline may be used on long-term basis w/individuals who have anxiety disorders, not effective on a prn basis for anxiety symptoms.

Which nursing statement about the concept of neuroses is most accurate? a. "An individual experiencing neurosis is unaware that he or she is experiencing distress." b. "An individual experiencing neurosis feels helpless to change his or her situation." c. "An individual experiencing neurosis is aware of psychological causes of his or her behavior." d. "An individual experiencing neurosis has a loss of contact with reality."

b. "An individual experiencing neurosis feels helpless to change his or her situation."

Sharon has a history of of bulimia. Which of the following symptoms would be congruent with her diagnosis? a. Binging, purging, obesity, hyperkalemia. b. Binging, purging, normal weight, hypokalemia. c. Binging, purging, severe weight loss, hyperkalemia. d. Binging, laxative abuse, amenorrhea, severe weight loss.

b. Binging, purging, normal weight, hypokalemia.

A man diagnosed with alcohol use disorder experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now I have been sober for 15 years." Which of Yalom's curative factors does this illustrate? a. Imparting of information b. Instillation of hope c. Catharsis d. Universality

b. Instillation of hope

When the nurse shows unconditional acceptance of an individual as a worthwhile and unique human being, he or she is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

b. Respect

Which nursing statement about the concept of neurosis is most accurate? a. An individual experiencing neurosis is unaware that he or she is experiencing distress b. an individual experiencing neurosis feels helpless to change his or her situation c. an individual experiencing neurosis is aware of psychological causes of his or her behavior d. an individual experiencing neurosis has a loss of contact with reality

b. an individual experiencing neurosis feels helpless to change his or her situation

Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) a. Client outcomes are specifically formulated by nurses. b. Client outcomes are not restricted by time frames. c. Client outcomes are specific and measurable. d. Client outcomes are realistically based on client capability. e. Client outcomes are formally approved by the psychiatrist.

c. Client outcomes are specific and measurable. d. Client outcomes are realistically based on client capability.

Symptoms of alcohol withdrawal include? a. period euphoria, hyperactivity, insomnia, b. Depression, suicidal ideation, and hyperinsomnia c. Diaphoresis, nausea, vomiting & tremors. d. Unsteady gait, nystagmus, and profound disorientation

c. Diaphoresis, nausea, vomiting & tremors.

Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder? a. Schizoid personality disorder b. Obsessive-compulsive personality disorder c. Histrionic personality disorder d. Paranoid personality disorder

c. Histrionic personality disorder

Electroconvulsive therapy is most commonly prescribed for which of the following? a. Bipolar disorder, manic b. Paranoid schizophrenia c. Major depression d. Obsessive-compulsive disorder

c. Major Depression

Symptoms of a fixed in oral stage of development are related to which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

c. Obesity

A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by the nurse as indicative of which defense mechanism? a. Displacement b. Projection c. Reaction Formation d. Sublimation

c. Reaction Formation

When a home health nurse administers an outpatient's injection of haloperidol decanoate (Haldol decanoate), which level of care is the nurse providing? a. Primary prevention level of care b. Secondary prevention of care c. Tertiary prevention level of care d. Case management level of care

c. Tertiary prevention level of care

A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse should be familiar with what information about this type of crisis? a. This type of crisis is precipitated by unexpected external stressors. b. This type of crisis is precipitated by preexisting psychopathology. c. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

c. This type of crisis is precipitated by normal life-cycle transitions that overwhelm the client.

A client is admitted to an emergency department experiencing some memory deficits and decreased motor function. What alteration in brain chemistry should a nurse correlate with the production of these symptoms? a. Abnormal levels of serotonin b. Decreased levels of dopamine c. Increased levels of norepinephrine d. Decreased levels of acetylcholine

d. Decreased levels of acetylcholine

A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? a. Paroxetine (Paxil) b. Sertraline (Zoloft) c. Citalopram (Celexa) d. Fluoxetine (Prozac)

d. Fluoxetine (Prozac)

A nurse is working with a client who has just been prescribed bupropion Wellbutrin. Which statement by the client indicates that further education is necessary? a. I will begin using sunblock when outdoors. b. I will only discontinue the medication under the guidance of my position. c. I would use caution when driving an using dangerous machinery. d. If I miss a dose, I will just take 2 pills the next day to catch up.

d. If I miss a dose, I will just take 2 pills the next day to catch up.

A client tells the nurse, "When I was a waiter, I used to spit in the dinners of the annoying customers." This statement would be associated with which personality trait? a. Paranoid personality trait b. Schizoid personality trait c. Antisocial personality trait d. Passive-aggressive personality trait

d. Passive-aggressive personality trait

Crises occur when an individual: a. is exposed to a precipitating stressor. b. perceives a stressor to be threatening. c. has no support systems. d. experiences a stressor and perceives coping strategies to be ineffective.

d. experiences a stressor and perceives coping strategies to be ineffective.

Which statement should a nurse identify as correct regarding a client's right to refuse treatment? a. Clients can refuse pharmacologic but not physiological treatment b. Clients can refuse treatment at anytime c. clients can refuse only electroconvulsive therapy (ECT) d. professionals can override treatment refusal by an actively suicidal or homicidal client

d. professionals can override treatment refusal by an actively suicidal or homicidal client

Which member of the interdisciplinary team (IDT) manage is the therapeutic milieu you on a 24 hour basis? a. Chaplin b. mental health technician c. psychiatrist d. psychiatric nurse

d. psychiatric nurse

A nurse is planning to teach a client diagnosed with a gora phobia about this disorder. Which fact should the nurse include in the teaching plan? a. The origin of agoraphobia is lack of control over life situations b. the origin of agoraphobia is a change in body functioning resulting from inner conflict c. the origin of agoraphobia is the direct physiological effect of a substance d. the origin of agoraphobia is the true fear of being separated from a source of security

d. the origin of agoraphobia is the true fear of being separated from a source of security

10. A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? A. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." B. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." C. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." D. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

A. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder."

Within the nurse's scope of practice, which function is exclusive to the advanced practice psychiatric nurse? 1. Teaching about the side effects of neuroleptic medications 2. Using psychotherapy to improve mental health status 3. Using milieu therapy to structure a therapeutic environment 4. Providing case management to coordinate continuity of health services

ANS: 2 Rationale: The advanced practice psychiatric nurse is authorized to use psychotherapy to improve mental health. This includes individual, couples, group, and family psychotherapy. Education, case management, and milieu therapy can be provided by registered psychiatric mental health nurses.

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance addiction? 1. Narcotic pain medication is contraindicated for all clients with active substance use disorders. 2. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control. 3. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. 4. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment.

ANS: 2 Rationale: The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug.

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

ANS: 2 Rationale: The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

Which statement regarding nursing interventions should a nurse identify as accurate? 1. Nursing interventions are independent from the treatment teams goals. 2. Nursing interventions are solely directed by written physician orders. 3. Nursing interventions occur independently but in concert with overall treatment team goals. 4. Nursing interventions are standardized by policies and procedures.

ANS: 3 Rationale: The nurse should understand that nursing interventions occur independently but in concert with overall treatment goals. Nursing interventions should be developed and implemented in collaboration with other health-care professionals involved in the client's care.

1. A nurse discovers a client's suicide note that details the time, place, and means to commit suicide. What should be the priority nursing action, and why? 1. Administer lorazepam (Ativan) prn, because the client is angry about plan exposure. 2. Establish room restrictions, because the client's threat is an attempt to manipulate the staff. 3. Place client on one-to-one suicide precautions, because specific plans likely lead to attempts. 4. Call an emergency treatment team meeting, because the client's threat must be addressed.

ANS: 3 Rationale: The priority nursing action should be to place this client on one-to-one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. Cognitive Level: Analysis Integrated Process: Implementation

6. A new psychiatric nurse states, "This client's use of defense mechanisms should be eliminated." Which is a correct evaluation of this nurse's statement? A. Defense mechanisms can be self-protective responses to stress and need not be eliminated. B. Defense mechanisms are a maladaptive attempt of the ego to manage anxiety and should always be eliminated. C. Defense mechanisms, used by individuals with weak ego integrity, should be discouraged and not eliminated

ANS: A

2. During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who excuses clients from the group has demonstrated an autocratic leadership style. An autocratic leadership style may be useful in certain situations that require structure and limit setting. Democratic leaders focus on the members of the group and group-selected goals. Laissez-faire leaders provide no direction to group members. PTS: 1 REF: 193-194 KEY: Cognitive Level: Application | Integrated Process: Implementation

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

ANS: C In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

5. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. According to learning theory, what is the cause of this client's symptoms? A. Depression is a result of anger turned inward. B. Depression is a result of abandonment. C. Depression is a result of repeated failures. D. Depression is a result of negative thinking.

ANS: C Learning theory describes a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed.

A client diagnosed with alcohol abuse joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

ANS: C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

20. A nursing instructor is teaching about psychodrama, a specialized type of therapeutic group. Which student statement indicates that further teaching is necessary? A. "Psychodrama provides a safe setting in which to discuss painful issues." B. "In psychodrama, the client is the protagonist." C. "In psychodrama, the client observes actor interactions from the audience." D. "Psychodrama facilitates resolution of interpersonal conflicts."

ANS: C The nurse should educate the student that in psychodrama the client plays the role of himself or herself in a life-situation scenario and is called the protagonist. During psychodrama, the client does not observe interactions from the audience. Other group members perform the role of the audience and discuss the situation they have observed, offer feedback, and express their feelings. Leaders of psychodrama must have specialized training to become a psychodramatist. PTS: 1 REF: 194-195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert)

ANS: C The nurse should teach the client that sibutramine (Meridia) is an anorexiant medication prescribed for morbidly obese clients. The mechanism of action in the control of appetite appears to occur by inhibiting the neutotransmitters serotonin and norepinephrine. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

ANS: C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.

9. Prayer group members at a local Baptist church are meeting with a poor, homeless family they are supporting. Which member statement is an example of Yalom's curative group factor of altruism? A. "I'll give you the name of a friend that rents inexpensive rooms." B. "The last time we helped a family, they got back on their feet and prospered." C. "I can give you all of my baby clothes for your little one." D. "I can appreciate your situation. I had to declare bankruptcy last year."

ANS: C Yalom's curative group factor of altruism occurs when group members provide assistance and support to each other creating a positive self-image and promoting self-growth. Individuals increase self-esteem through mutual caring and concern. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

A nurse is interviewing a client in an outpatient substance-abuse clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? A. The client will identify one person to turn to for support. B. The client will give up all old drinking buddies. C. The client will be able to verbalize the effects of alcohol on the body. D. The client will correlate life problems with alcohol use.

ANS: D To promote the recovery process the nurse should expect that the client would initially correlate life problems with alcohol use. Acceptance of the problem is the first step of the recovery process.

Which client statements demonstrate acknowledgment of the effects of psychological pressures associated with schizophrenia? (Select all that apply.) A "I just want to get back to what I was doing and put this whole episode behind me." B "If I can't stand the side effects, how will I ask my prescriber to change my medication?" C "I'm going to look for a job where I can use my college degree but have less day-to-day stress." D "Next month, my sister and I are going to write a grant proposal for a psychiatric day treatment/social center." E "I have designed a weekly schedule so that I can get tasks done and have planned time to relax."

B,C,E

20. A client presents in the emergency department with complaints of overwhelming anxiety. Which of the following is a priority for the nurse to assess? A. Risk for suicide B. Cardiac status C. Current stressors D. Substance use history

B. Cardiac status

23. A client has the following symptoms: preoccupation with imagined defect, verbalizations that are out of proportion to actual physical abnormalities, and numerous visits to plastic surgeons to seek relief. Which nursing diagnosis would best describe the problems evidenced by these symptoms? A. Ineffective coping B. Disturbed body image C. Complicated grieving D. Panic anxiety

B. Disturbed body image

The initial nursing action for a newly admitted anxious client is to A. assess the client's use of defense mechanisms. B. assess the client's level of anxiety. C. limit environmental stimuli. D. provide antianxiety medication.

B. assess the client's level of anxiety. Correct The priority nursing action is the assessment of the client's anxiety level.

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

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

A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds, A. "You need to calm yourself." B. "What is it that you would like me to do to help you?" C. "Can you tell me what you were feeling just before your attack?" D. "I will get you some medication to help calm you."

C. "Can you tell me what you were feeling just before your attack?" A response that helps the client identify the precipitant stressor is most therapeutic.

Which statement reflects a truth about rape? A. Some women want to be raped. B. Rapists are oversexed. C. Most rapes are planned. D. Most women are raped by strangers.

C. Most rapes are planned. Many myths about rape exist. Most rapes are not impulsive, spur-of-the-moment acts, but are carefully planned and orchestrated.

1. A nursing instructor is teaching about the Community Health Centers Act of 1963. What was a deterring factor to the proper implementation of this act? A. Many perspective clients did not meet criteria for mental illness diagnostic-related groups. B. Zoning laws discouraged the development of community mental health centers. C. States could not match federal funds to establish community mental health centers. D. There was not a sufficient employment pool to staff community mental health centers.

C. States could not match federal funds to establish community mental health centers.

Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? Select one: a. Haloperidol (Haldol) and fluoxetine (Prozac) b. Carbamazepine (Tegretol) and donepezil (Aricept) c. Disulfiram (Antabuse) and lorazepan (Ativan) d. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant.

Which of the following client statements demonstrates the major symptoms of schizophrenia? A "I had too much to drink last night, started feeling all-powerful, and stupidly drove my truck into a tree." B "I've been depressed ever since our house was destroyed by fire." C "'A stitch in time saves nine' means that prevention is easier than fixing a real problem." D "You can read my mind. This light of mine will shine, fine; blinding world will end at nine."

D "You can read my mind. This light of mine will shine, fine; blinding world will end at nine."

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? A. Tara and Aaron have the same expectation of a poor long-term prognosis. B. Tara will experience more positive signs of schizophrenia such as hallucinations. C. Aaron will be more likely to hold a job and live a productive life. D. Tara has a better chance for positive outcomes because of later onset.

D, Tara has a better chance for positive outcomes because of later onset. Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier.

Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days.

D. Client will initiate interaction with one peer during free time within 2 days.

10. A mother who has learned that her child was killed in a tragic car accident states, I cant bear to go on with my life. Which nursing statement conveys empathy? A. This situation is very sad, but time is a great healer. B. You are sad, but you must be strong for your other children. C. Once you cry it all out, things will seem so much better. D. It must be horrible to lose a child; Ill stay with you until your husband arrives.

D. It must be horrible to lose a child; Ill stay with you until your husband arrives.

Which therapeutic communication technique is being used in this nurse-client interaction?Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids."Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

D. Making observations

1. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I get angry, I get into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are smiling as you talk about this physical violence." A. Encouraging comparison B. Exploring C. Formulating a plan of action D. Making observations

D. Making observations noting that the client smiles when talking about physical violence. The technique of making observations encourages the client to compare personal perceptions with those of the nurse.

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T. experiences panic anxiety when she encounters snakes. B. Ms. T refuses to fly in an airplane. C. Ms. T. Will not eat in public places. D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder

D. Narcissistic personality disorder is associated body dysmorphic disorder. Associated symptoms of hoarding disorder include: perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing.

8. A cab driver stuck in traffic is suddenly lightheaded, tremulous, and diaphoretic and experiences tachycardia and dyspnea. An extensive workup in an emergency department reveals no pathology. Which medical diagnosis is suspected, and what nursing diagnosis takes priority? A. Generalized anxiety disorder and a nursing diagnosis of fear B. Altered sensory perception and a nursing diagnosis of panic disorder C. Pain disorder and a nursing diagnosis of altered role performance D. Panic disorder and a nursing diagnosis of panic anxiety

D. Panic disorder and a nursing diagnosis of panic anxiety

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? A. Darken the room to reduce stimuli in order to prevent seizures. B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system. D. Teach the negative effects of alcohol on the body.

ANS: B Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.

A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? Select one: a. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." b. "I cannot control my use of heroin. It's stronger than I am." c. "I'm going to get all my children back. They need their mother." d. "Once I deal with my childhood physical abuse, recovery should be easy."

B A client who admits that he or she is addicted to a substance and has a loss of control may have a positive prognosis. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? Select one: a. 50 mg/dL b. 100 mg/dL c. 250 mg/dL d. 300 mg/dL

B The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of A. a rude awakening. B. normal anxiety. C. trait anxiety. D. altruism.

B.normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

Which nursing diagnosis would be most useful for clients with anxiety disorders? A. Excess fluid volume B. Disturbed body image C. Ineffective role performance D. Disturbed personal identity

C. Ineffective role performance Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting.

Symptoms of alcohol withdrawal include: A) Euphoria, hyperactivity, and insomnia B) Depression, suicidal ideation, and hypersomnia C) Diaphoresis, n/v, and tremors D) Unsteady gait, nystagmus, and profound disorientation

C) Diaphoresis, n/v, and tremors

You overhear a family member discussing medication adherence with your client. Which of the following statements do you want to encourage the family member to reiterate? A "Your children are getting tired of watching you get sick every time you stop your meds." B "If you stop taking your medication, I'll take custody of your children." C "You should let these health care providers get you well. Why do you fight that?" D "Your support group encourages you to make healthy choices. Taking your meds is a healthy thing you can do every day, just like brushing your teeth."

D

(SSRIs)?

Widely used, first line antidepressants (no psychosis)4-6wks

Increased levels of dopamine, serotonin and norepinephrine are associated with which mental illness? a. Schizophrenia b. Depression c. Alzheimer's Disease d. Alcoholism

a. Schizophrenia

Symptoms of substance is related to which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

b. Bulimia

Believes she is entitled to special privileges others do not deserve.

d Narcissistic personality disorder

A college student is unable to take a final exam owing to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Non-adherence R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

ANS: C Rationale: The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that will improve the client's healthy coping skills and reduce anxiety.

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

ANS: C The nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

ANS: C When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

Match the treatment goal with the appropriate medication. Morphine overdose? 1. Methadone (Dolophine) 2. Naloxone (Narcan) 3. Bupropion (Zyban) 4. Chlordiazepoxide (Librium) 5. Disulfiram (Antabuse)

2. Naloxone (Narcan)

How long is the crisis intervention stage for rape?

6-8 weeks

The nurse should recognize which acronym as representing problem-oriented charting? 1. SOAPIE 2. APIE 3. DAR 4. PQRST

ANS: 1 Rationale: The acronym SOAPIE represents problem-oriented charting, which reflects the subjective, objective, assessment, plan, implementation, and evaluation format. Used in nursing, nursing diagnoses (problems) are identified on a written plan of care, with appropriate nursing interventions described for each.

A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."

ANS: A Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.

23. A client is admitted with a diagnosis of persistent depressive disorder. Which client statement would describe a symptom consistent with this diagnosis? A. "I am sad most of the time and I've felt this way for the last several years." B. "I find myself preoccupied with death." C. "Sometimes I hear voices telling me to kill myself." D. "I'm afraid to leave the house."

ANS: A Persistent depressive disorder is characterized by depressed mood for most of day, for more days than not, for at least 2 years. Thoughts of death would be more consistent with major depressive disorder; hearing voices is more consistent with a psychotic disorder; and fear of leaving the house is more consistent with a phobia.

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol use disorder B. History of personality disorder C. History of schizophrenia D. History of hypertension

ANS: A Rationale: The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances.

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.

ANS: A The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

24. A student nurse is learning about the appropriate use of touch when communicating with clients diagnosed with psychiatric disorders. Which statement by the instructor best provides information about this aspect of therapeutic communication? A. "Touch carries a different meaning for different individuals." B. "Touch is often used when deescalating volatile client situations." C. "Touch is used to convey interest and warmth." D. "Touch is best combined with empathy when dealing with anxious clients."

ANS: A Touch can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction.

A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

ANS: A Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.

30 A client who has been diagnosed with a phobic disorder asks the nurse if there are any medications that would be beneficial in treating phobic disorders. Which of the following would be accurate responses by the nurse? Select all that apply. A. Some antianxiety agents have been successful in treating social phobias. B. Some antidepressant agents have been successful in diminishing symptoms of agoraphobia and social anxiety disorder (social phobia). C. Specific phobias are generally not treated with medication unless accompanied by panic attacks. D. Beta-blockers have been used successfully to treat phobic responses to public performance.

ANS: A, B, C, D

28. A 20-year-old female has a diagnosis of premenstrual dysphoric disorder. Which of the following should a nurse identify as consistent with this diagnosis? Select all that apply. A. Symptoms are causing significant interference with work, school, and social relationships. B. Patient-rated mood is 2/10 for the past 6 months C. Mood swings occur the week before onset of menses D. Patient reports subjective difficulty concentrating E. Patient manifests pressured speech when communicating

ANS: A, C, D Diagnostic criteria for a premenstrual dysphoric disorder include that symptoms must be associated with significant distress, occur in the week before onset of menses, and improve or disappear in the week post-menses

27. A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? Select all that apply. A. Fatigue B. Anorexia C. Hyperventilation D. Insomnia E. Irritability

ANS: A, D, E

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity

ANS: B Based on Maslow's hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.

27. A newly admitted client diagnosed with major depressive disorder states, "I have never considered suicide." Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply? A. "There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all your options prior to taking this action.

ANS: B By admitting to the staff a suicide plan, this client has taken responsibility for possible personal actions and expresses trust in the nurse. Therefore, the client may be receptive to continuing a safety plan. Recognition of this achievement reinforces this adaptive behavior.

26. A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Low self-esteem

ANS: B Lack of attention to grooming and hygiene is the only behavioral symptom presented. Lack of energy, low self-esteem, and feelings of helplessness and hopelessness (all common symptoms of depression) contribute to lack of attention to activities of daily living, including grooming and hygiene.

15. The nurse should utilize which group function to help an extremely withdrawn, paranoid client increase feelings of security? A. Socialization B. Support C. Empowerment D. Governance

ANS: B The nurse should identify that the group function of support would help an extremely withdrawn, paranoid client increase feelings of security. Support assists group members in gaining a feeling of security from group involvement. PTS: 1 REF: 190 KEY: Cognitive Level: Application | Integrated Process: Implementation

26. After fasting from 10 p.m. the previous evening, a client finds out that the blood test has been canceled. The client swears at the nurse and states, "You are incompetent!" Which is the nurse's best response? A. "Do you believe that I was the cause of your blood test being canceled?" B. "I see that you are upset, but I feel uncomfortable when you swear at me." C. "Have you ever thought about ways to express anger appropriately?" D. "I'll give you some space. Let me know if you need anything."

ANS: B This is an example of the appropriate use of feedback. Feedback should be directed toward behavior that the client has the capacity to modify.

32. Which nursing statement is a good example of the therapeutic communication technique of offering self? A. "I think it would be great if you talked about that problem during our next group session." B. "Would you like me to accompany you to your electroconvulsive therapy treatment?" C. "I notice that you are offering help to other peers in the milieu." D. "After discharge, would you like to meet me for lunch to review your outpatient progress?"

ANS: B This is an example of the therapeutic communication technique of offering self. Offering self makes the nurse available on an unconditional basis, increasing client's feelings of self-worth. Professional boundaries must be maintained when using the technique of offering self. PTS: 1 REF: 153 KEY: Cognitive Level: Application | Integrated Process: Implementation

28. A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be most commonly used in the treatment of phobias? Select all that apply. A. Benzodiazepine therapy B. Systematic desensitization C. Imploding (flooding) D. Assertiveness training E. Aversion therapy

ANS: B, C

4. The nurse is interviewing a newly admitted psychiatric client. Which nursing statement is an example of offering a "general lead"? A. "Do you know why you are here?" B. "Are you feeling depressed or anxious?" C. "Yes, I see. Go on." D. "Can you chronologically order the events that led to your admission?"

ANS: C Offering a general lead encourages the client to continue sharing information.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy

ANS: D A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.

26. Order the following stages of the codependency recovery process according to Cermak. ________ The Core Issues Stage ________ The Reintegration Stage ________ The Survival Stage ________ The Reidentification Stage

ANS: The correct order is 3, 4, 1, 2 Rationale: Cermak in 1986 identified four stages in the recovery process for individuals with codependent personality: During the survival stage, the codependent must begin to let go of denial. During the reidentification stage, the individual begins to glimpse their true selves. During the core issues stage, the individual must face the fact that relationships cannot be managed by force or will. During the reintegration stage, control is achieved through self-discipline and self-confidence. 1. The Survival Stage 2. The Reidentification Stage 3. The Core Issues Stage 4. The Reintegration Stage

The concept of _______________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

ANS: codependency Rationale: The concept of codependency arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person. The term has been expanded to include all individuals from families that harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of body dysmorphic disorder.

ANS: narcissistic Rationale: Traits associated with schizoid, obsessive-compulsive, and narcissistic personality disorders are not uncommon in clients with the diagnosis of BDD

From which of the following symptoms might the nurse identify a chronic cocaine user? A) Clear, constricted pupils B) Red, irritated nostrils C) Muscles aches D) Conjunctival redness

ANSWER B: B) Red, irritated nostrils

What parental/adult behaviors might indicate neglect?

Appears indifferent to the child; seems apathetic or depressed; behaves irrationally; is abusing alcohol or other drugs

2. A wife brings her husband to an emergency department after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, I cant function any longer under all this stress. Which type of crisis is the client experiencing? A. Maturational/developmental crisis B. Psychiatric emergency crisis C. Anticipated life transition crisisD . Traumatic stress crisis

B. Psychiatric emergency crisis

What is the best rationale for including the client's family in therapy within the inpatient milieu? A. To structure a program of social and work-related activities B. To facilitate discharge from the hospital C. To provide a concrete demonstration of caring D. To encourage the family to model positive behaviors

B. To facilitate discharge from the hospital

It can be said that the onset of most anxiety disorders occurs A. before the age of 20 years. B. before the age of 40 years. C. after the age of 40 years. D. scattered throughout the life span.

B. before the age of 40 years. Epidemiology reports indicate that the onset of most anxiety disorders occurs before age 40 years.

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg Valium qid B. Group therapy with other agoraphobics C. Facing her fear in gradual step progression D. Hypnosis

C. Facing her fear in gradual step progression

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

22. Warren's college roommate actively resists going out with friends whenever they invite him. He says he can't stand to be around other people and confides to Warren "They wouldn't like me anyway." Which disorder is Warren's roommate likely suffering from? A. Agoraphobia B. Mysophobia C. Social anxiety disorder (social phobia) D. Panic disorder

C. Social anxiety disorder (social phobia)

Democratic

Clients discuss problems & situations

17. A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? A. Sublimation B. Dissociation C. Rationalization D. Intellectualization

D. Intellectualization

Anticipatory teaching of a rape victim should include information that a common survivor problem that often develops during the long-term reorganization phase of rape trauma syndrome is A. denial of the event. B. headaches and fatigue. C. shock and numbness. D. intrusive thoughts.

D. intrusive thoughts. Just as in posttraumatic stress disorder, intrusive thoughts haunt the rape victim in the weeks and months during which long-term reorganization is occurring. Knowing that this is a common occurrence is reassuring to the client, who often is frightened by the symptom.

What behavior is a characteristic of a thought disorder?

Disorganized speech

Name the three major elements of informed consent.

Knowledge:The client has received adequate information on which to base his or her decision. Competency:The individual's cognition is not impaired to an extent that would interfere with decision making or, if so, that the individual has a legal representative. Free will:The individual has given consent voluntarily without pressure or coercion from others.

A client with a history of three suicide attempts has been taking fluoxetine (Prozac) for 1 month. The client suddenly presents with a bright affect, rates mood at 9/10, and is much more communicative. Which action should be the nurse's priority at this time? a. Give the client off-unit privileges as positive reinforcement. b. Increase frequency of client observation. c. Encourage the client to share mood improvement in group. d. Request that the psychiatrist reevaluate the current medication protocol.

b. Increase frequency of client observation.

Three predominant client populations have been identified as benefiting most from psychiatric home health care. Which of the following is not included among this group? a. elderly individuals b. individuals living in poverty c. individuals with severe and persistent mental illness d. individuals in acute crisis situations

b. individuals living in poverty

Believes he has a "sixth sense" and knows what others are thinking

c Schizotypal personality disorder

Under stress, he often decompensates and demonstrates psychotic behaviors.

c Schizotypal personality disorder

When there is congruence between what is felt and what is expressed, the nurse is exhibiting which of the following characteristics? a. Trust b. Respect c. Genuineness d. Empathy

c. Genuineness

Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? a. CIWA scale b. GGT c. MMSE d. CAPS scale

c. MMSE

In which phase of the Cycle of Battering does the victim just try to stay out of the perpetrator's way? a. Honeymoon phase b. Acute battering phase c. Tension building phase d. Separation phase

c. Tension building phase

Therapy group

closed, circle, 5-10 members is best

Crisis occur when an individual? a. is exposed to a preceipitating stressor. b. Perceives a stressor to be threatening. c. Has no support system. d. Experiences a stressor and perceives coping strategies to be ineffective

d. Experiences a stressor and perceives coping strategies to be ineffective

Indicators of sexual abuse

difficulty walking/sitting; suddenly refuses to change for gym or participate in physical activities; reports nightmares or bedwetting; sudden change in appetite; has unusual sexual knowledge/behavior; pregnant; venereal disease; runs away; reports sexual abuse;

Suspect abuse when the parent or caregiver:

offers conflicting, unconvincing, or no explanation for injury; describes child as evil; uses harsh physical discipline; has hx of abuse as a child; has hx of abusing animals or pets

11. A client experiencing alcohol withdrawal is prescribed lorazepam (Ativan) 0.5 mg qid. The physician has ordered a CIWA to be completed every 4 hours. Additional prn lorazepam is based on the following scale: CIWA score of 7 to 12: administer 0.5 mg of lorazepam. CIWA score of >12: administer 1 mg of lorazepam. The client's CIWA score at 0400 was 6, at 0800 was 14, at 1200 was 8, at 1600 was 10, at 2000 was 14, and at 2400 was 6. How many milligrams of lorazepam did the client receive in 1 day? ______ mg.

0.5 mg × 4 = 2 mg (standing dose) 3 mg + 2 mg = 5 mg/day

Gary is admitted to the mental health center for treatment of obsessive-compulsive disorder. He tells the nurse that he has a repetitive fear that he has forgotten to lock the doors to his home. Which symptom of this disorder is Gary describing? 1) An obsession 2) A compulsion 3) Auditory hallucinations 4) Claustrophobia

1) An obsession An obsession is a recurrent, intrusive, stressful thought, and this is what Gary is describing in the scenario. A compulsion is repetitive, ritualistic behavior Hallucinations are false perceptual experiences Claustrophobia is an irrational fear of closed spaces.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) spends 1 hour packing and unpacking and folding and refolding personal belongings. What is the most likely reason for this behavior? 1) It relieves anxiety. 2) It fosters organizational skills. 3) It delays meeting unfamiliar people in the dayroom. 4) It makes the client feel good.

1) It relieves anxiety. OCD is characterized by recurrent thoughts or ideas (obsessions) that an individual is unable to put out of his or her mind and actions that an individual is unable to refrain from performing (compulsions).

The nurse is assessing a client for side effects of electroconvulsive therapy (ECT). Which side effects are common and to be expected? 1) Temporary disorientation 2) Enduring memory loss 3) Residual seizure disorder 4) Cardiovascular complications

1) Temporary disorientation Temporary memory loss and confusion are common side effects of ECT.

Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1.Avoid excessive use of beverages containing caffeine. 2.Maintain a consistent sodium intake. 3.Consume at least 2,500 to 3,000 mL of fluid per day. 4.Restrict sodium content. 5.Restrict fluids to 1,500 mL per day.

1, 2, 3

What age group is rape most prevalent in?

16-34

3. A client diagnosed with borderline personality disorder coyly requests diazepam (Valium). When the physician refuses, the client becomes angry and demands to see another physician. What defense mechanism is the client using? 1. Undoing. 2. Splitting. 3. Altruism. 4. Reaction formation.

2. Splitting.

A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1."Treatment is compromised when clients can't sleep." 2."Treatment is compromised when irritability interferes with social interactions." 3."Treatment is compromised when clients have no insight into their problems." 4."Treatment is compromised when clients choose not to take their medications."

4."Treatment is compromised when clients choose not to take their medications."

Delirium

A mental state characterized by disturbance of cognition, which is manifested by confusion, excitement, disorientation, and a clouding of consciousness. Hallucinations and illusions are common.

What is Lithium? Levels?

A mood stabilizer; prototypical drug indicated for acute manic phase of bipolar disorder & maintenance. Blood levels 1.5-2 mEq/L Active:0.8-1.2 mEq/L Maintenance: 0.4-1.3 mEq/L

Abuse occurs most often in which population?

Abuse affects all populations equally

Antianxiety drugs are also called ______________________ and minor tranquilizer

Anxiolytics

As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include?

Avoid excess caffeine maintain consistent sodium intake consume at least 2500-3k mL of fluid per day

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? Select one: a. Antagonist therapy b. Deterrent therapy c. Codependency therapy d. Substitution therapy

D CNS depressants are additive with one another. When a CNS depressant is used in combination with alcohol, the depressive effects are compounded. There may be cross-dependence in which one drug can prevent withdrawal symptoms of another drug.

Kantianism

Duty must be followed; people must do what is "right."

Who else would you include in clients therapy to facilitate discharge

Family

What are indicators of neglect?

Frequent absences from school; begs or steals food/money; lacks medical/dental/vision care; is consistently dirty or has severe body odor; lacks warm clothing; abuses alcohol/drugs; states there's no one at home to provide care

There is some speculation that anorexia nervosa may be associated with a primary dysfunction of which brain structure?

Hypothalamus

Laissez-faire

Lazy, no leadership

Autocratic

Leader makes decision w/o asking group

Panic

Loss of control

Depression neurotransmitter

Low serotonin

Mental Illness

Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are in-congruent with the local and cultural norms and interfere with the individual's functioning

Write the definition of mental illness according to your textbook author, Mary Townsend

Maladaptive responses to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are incongruent with the local and cultural norms, and interfere with the individuals social, occupational, and or physical functioning

What maternal prenatal activity has been associated with attention-deficit/hyperactivity disorder (ADHD) in children?

Maternal smoking during pregnancy

AA meetings who runs the groups

Members and alternate leadership role

Preintroductory phase

Nurse should clarify beliefs/feelings about client

What are some family behaviors that have been implicated as influential in the development of separation anxiety disorder?

Overattachment to the mother; overprotective parents; transfer of fears and anxieties from parents to children

What are the primary psychosocial predisposing factors to avoidant personality disorder?

Parental rejection and censure, which is often reinforced by peers.

What are some of the types of family dynamics that may predispose a person to antisocial personality disorder?

Physical abuse, absence of parental discipline, extreme poverty, removal from the home, growing up without parental figures of both genders, erratic and inconsistent methods of discipline, being "rescued" each time they are in trouble, maternal deprivation

A client diagnosed with Neurocognitive Disorder (NCD) is ataxic, disoriented and wanders. Which is the priority nursing diagnosis? Disturbed thought process Self-care deficit Risk for trauma Altered health-care maintenance

Risk for trauma

20. ___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).

Schizoaffective

What behaviors are seen in expressed response pattern (to rape)?

Survivor expresses feelings of fear, anger, anxiety through such behaviors as crying, sobbing, restlessness, and tension

Counter-transference refers to a nurse's behavioral and emotional response to a client. These responses may be related to unresolved feelings toward significant others from the nurse's past. True False

T

Mental illness is defined as maladaptive responses to stressors from the internal or external environment evidenced by thoughts, feelings, and behaviors that are in concurrent with local and cultural norms and interfere with the individuals functioning? T/F

T

termination phase

The final, integral phase of the nurse-patient relationship.

How should a nurse care for the self-inflicted wounds of a client with borderline personality disorder?

The wounds should be treated in a matter-of-fact manner. Care should be taken not to give positive reinforcement to this behavior by offering sympathy or additional attention.

What is a silent rape reaction?

This occurs in the long term, where the survivor tells no one about the assault, anxiety is suppressed, and the burden may become overwhelming

Lithium toxicity S/S

Toxicity, WT GAIN Gastric Irritation (Initial Sign) Slurred Speech, Course tremors Hallucination, Tinnitus Strabismus / Nystagmus, Seizure Oligura / Anuria, Death

The deinstitutionalization movement closed state mental hospitals and caused the discharge of individuals with mental illness? T/F

True

Chronic feelings of depression are common

a Borderline personality disorder

Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply) a. Avoid excessive use of beverages containing caffeine. b. Maintain a consistent sodium intake. c. Consume at least 2,500 to 3,000 mL of fluid per day. d. Restrict sodium content. e. Restrict fluids to 1,500 mL per day.

a, b, c

10. Which of the following issues have been identified as contributing to the rise in the population ofthose who are homeless? (Select all that apply.) a. Poverty b. Lack of affordable health care c. Substance abuse d. Severe and persistent mental illnesse. Growth in the number of family members living together

a, b, c, d

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? a. Valproic Acid (Depakote) b. Sertraline (Zoloft) c. Trazodone (Desyrel) d. Paroxetine (Paxil)

a. Valproic Acid (Depakote)

Which of the following represents a nursing intervention at the tertiary level of prevention? a. serving as case manager for a mentally ill homeless client b. leading a support group for newly retired men c. teaching prepared childbirth classes d. caring for a depressed widow in the hospital

a. serving as case manager for a mentally ill homeless client

Which of the following represents a nursing intervention at the primary level of prevention? a. teaching a class in parent effectiveness training b. leading a group of adolescents in drug rehab c. referring a married couple for sex therapy d. leading a support group for battered women

a. teaching a class in parent effectiveness training

Alzheimer's neurotransmitters

acetylcholine decreased

Autonomy ch.3

allowing client to choose to attend group therapy or take meds (unless suicidal or harming someone else then we can medicate w/o consent)

Defense mechanisms - Intellectualization

an attempt to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis

Defense mechanisms - Identification

an attempt to increase self-worth by acquiring certain attributes and characteristics of an individual one admires

The diagnosis of __________________ ___________________includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat

anorexia nervosa

Defense mechanisms - rationalization

attempting to make excuses or formulate logical reasons to justify unacceptable feelings or behaviors

Defense mechanisms - projection

attributing feelings or impulses unacceptable to one's self to another person

In planning care for a woman who presents as a survivor of domestic abuse, a nurse should be aware of which of the following data? (select all that apply) a. Economic factors rarely play a role in the decision to stay. b. Women in abusive relationships usually feel isolated and unsupported. c. It often takes several attempts before a woman leaves an abusive situation. d. Until children reach school age, they are usually not affected by abuse between their parents. e. Substance abuse is a common factor in abusive relationships.

b, c, e woman substance it often

At what point should the nurse determined that a client is at risk for developing a mental illness? a. With thoughts, feelings, and behaviors are not reflective of the American psychiatric Association b. when maladaptive responses to stress or coupled with the interference of daily functioning c. when a client communicates significant distress d. client uses defense mechanisms as eagle protection

b. when maladaptive responses to stress or coupled with the interference of daily functioning

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? Select one: a. "Why do you assume responsibility for his behaviors?" b. "Codependency is a typical behavior of spouses of alcoholics." c. "Your husband needs to deal with the consequences of his drinking." d. "Do you understand what the term enabler means?"

c. "Your husband needs to deal with the consequences of his drinking." confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior.

Emotional abuse might be suspected when the adult:

constantly blames, belittles, or berates the child; is unconcerned about the child and refuses offers of help for the child's problem; overtly rejects the child

Defense mechanisms - Compensation

covering up a real or perceived weakness by emphasizing a trait one considers more desirable

Requires a great deal of praise and becomes angry at the slightest criticism from others

d Narcissistic personality disorder

Hildegard Peplau identified seven subroles within the role of the nurse. She believed the emphasis in psychiatric nursing was on which of the subroles? a. The resource person b. The teacher c. The surrogate d. The counselor

d. The counselor

Believes everyone must follow the rules and that the rules can be "bent" for no one—ever.

f Obsessive-compulsive personality disorder

Has a devotion to productivity to the exclusion of personal pleasure.

f Obsessive-compulsive personality disorder

Accepts a job he does not want to do, then does a poor job and delays past the deadline. Is negative and hostile toward others

g Personality disorder trait specified

Suspicious of all others with whom he comes in contact.

g Personality disorder trait specified

Defense mechanisms - introjection

integrating the beliefs and values of another individual into one's own ego structure

Defense mechanisms - repression

involuntarily blocking unpleasant feelings and experiences from one's awareness

Emotional brain

limbic system

Defense mechanisms - reaction formation

preventing unacceptable or undesirable thoughts or behaviors from being expressed by exaggerating opposite thoughts or types of behavior

Defense mechanisms - sublimation

rechanneling of drives or impulses that are personally or socially unacceptable into activities that are constructive

Defense mechanisms - Denial

refusing to acknowledge the existence of a real situation or the feelings associated with it

Defense mechanisms - regression

retreating in response to stress to an earlier level of development and the comfort measures associated with that level of functioning

Minimal goal for client in crisis is?

return to pre-crisis state

Defense mechanisms - isolation

separating a thought or memory from the feeling tone, or emotion associated with it

Defense mechanisms - undoing

symbolically negating or canceling out an experience that one finds intolerable

Describe the onset and s/s of vascular NCDs (as opposed to Alzheimer's)

the client may seem to improve only to deteriorate further.

Defense mechanisms - displacement

the transfer of feelings from one target to another that is considered less threatening or that is neutral

Defense mechanisms - suppression

the voluntary blocking of unpleasant feelings and experiences from one's awareness

Parental/adult behaviors that may indicate sexual abuse:

unduly protective of the child or severely limits the child's contact with other children; secretive and isolated; jealous or controlling with other family members

Observing coworkers bad behavior and doing nothing out of fear of retaliation is still?

unethical

S/S of physical abuse in children:

unexplained burns, bites, bruises, broken bones, black eyes, fading bruises or marks after absence from school, frightened of parents and adults, reports injury by a parent/adult, abuses animals or pets

Can a pt refuse meds from a home health nurse?

yes, respect it document it

A 27-year-old client was diagnosed 5 years ago with schizophrenia. What course of treatment should the nurse expect to be implemented? A. Eventual admission for long-term care in a psychiatric facility B. Community-based care with numerous brief hospitalizations C. Case management in the community with few relapses D. Occasional contact with outpatient counselors and psychiatrists

B. Community-based care with numerous brief hospitalizations

4. The theory of family dynamics has been implicated as contributing to the etiology of conduct disorders. Which of the following are factors related to this theory? Select all that apply. 1. Frequent shifting of parental figures. 2. Birth temperament. 3. Father absenteeism. 4. Large family size. 5. Fixation in the separation individuation phase of development.

1, 3, 4

Which of the following would contribute to a client's excessive weight gain? (Select all that apply.) 1. A hypothalamus lesion 2. Hyperthyroidism 3. Diabetes mellitus 4. Cushing's disease 5. Low levels of serotonin

1, 3, 4

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

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

A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? a. Sore throat, fever, and malaise b. Akathesia and hypersalivation c. Akinesia and insomnia d. Dry mouth and urinary retention

a. Sore throat, fever, and malaise Intervene immediately, Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur, leading to infection.

The priority nursing intervention for an abuse victim in the emergency department is: a. Tending to the immediate care of the wounds b. Providing the victim with information about a safe place to stay c. Administering the prn tranquilizer ordered by the physician d. Explaining how they may go about bringing charges against their abuser

a. Tending to the immediate care of the wounds

An impatient client with a known history of violence suddenly begins to pace. Which additional client behavior should alert the nurse to escalating anger in aggression? a. The client requests PRN medications b. the client has a tense facial expression and body language c. the client refuses to eat lunch d. the clients it's in Group with his back to his peers b. the client has a tense facial expression and body language

b. the client has a tense facial expression and body language

A client with schizophrenia is receiving depot injections of Haldol Decanoate (haloperidol decanoate). The client should be told to return for his next injection in: One week Two weeks Four weeks Six weeks

c Four weeks

Who on the ID team, is responsible for diagnosis and treatment of mental disorders; prescribes medication and other somatic therapies

Psychiatrist

Who does psychological testing/diagnosing?

Psychologist

Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1.Medication adherence 2.Empowerment of the consumer 3.Total absence of symptoms 4.Improved psychosocial relationships

2.Empowerment of the consumer

What societal influences are thought to play a part in predisposition to abuse?

Relative deprivation: poverty is a powerful predictor of homicide and violent crime. Decreased social capital is associated with increased firearm homicide

The physician ordered alprazolam (Xanax), 0.25 mg AM daily, for a client diagnosed with an anxiety disorder. On hand are 0.5-mg tablets. How many tablets will the nurse administer per dose? ___________ tablets.

0.25 mg/X tab = 0.5mg/1 tab 0.5X = 0.25 X = 0.5 tablets

Disruption in identity and disruption in memory that are rooted in psychological traumas are examples of dissociative responses. Psychodynamic theory would describe these responses in which of the following ways? 1) An ego defense in the face of overwhelming anxiety 2) A cognitive distortion 3) A learned behavior 4) Factitious

1) An ego defense in the face of overwhelming anxiety Psychodynamic theory views dissociative responses as defense mechanisms used by the ego to protect oneself from overwhelming anxiety. Cognitive distortions-negative thinking patterns that, contribute to illness. Factitious disorder is conscious, intentional feigning of symptoms. Dissociative= not conscious or intentional

Which one of the following clients is most likely to develop acute respiratory distress syndrome? A 20-year-old with fractures of the tibia A 36-year-old who is HIV positive A 40-year-old with duodenal ulcers A 32-year-old with barbiturate overdose

A 32-year-old with barbiturate overdose

MSE

mental status exam

A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

2. "These clients have a panic level of fear that is overwhelming and unreasonable." Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response.

Which is associated with the etiology of Tourette's disorder from a biochemical perspective? 1. An inheritable component, as suggested by monozygotic and dizygotic twin studies. 2. Abnormal levels of several neurotransmitters. 3. Prenatal complications, including low birth weight. 4. Enlargement of the caudate nucleus of the brain.

2. Abnormal levels of several neurotransmitters.

26. A child diagnosed with oppositional defiant disorder begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? 1. Administer PRN medication to decrease acting-out behaviors. 2. Accompany the child to a quiet area to decrease external stimuli. 3. Institute seclusion following agency protocol. 4. Allow the child to stay in group therapy to monitor the situation further.

2. Accompany the child to a quiet area to decrease external stimuli.

A physician orders methylphenidate (Ritalin) for a child diagnosed with ADHD. Which information about this medication should the nurse provide to the parents? 1. If one dose of Ritalin is missed, double the next dose. 2. Administer Ritalin to the child after breakfast. 3. Administer Ritalin to the child just prior to bedtime. 4. A side effect of Ritalin is decreased ability to learn.

2. Administer Ritalin to the child after breakfast. Rationale: The nurse should instruct the parents to administer Ritalin to the child after breakfast. Ritalin is a central nervous system stimulant and can cause decreased appetite. Central nervous system stimulants can also temporarily interrupt growth and development.

2. A client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 3 nights and a 12-lb. weight loss over the past 2 weeks. Which should be this client's priority nursing diagnosis? 1. Knowledge deficit R/T bipolar disorder AEB concern about symptoms 2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss 3. Risk for suicide R/T powerlessness AEB insomnia and anorexia 4. Altered sleep patterns R/T mania AEB insomnia for the past 3 nights

2. Altered nutrition: less than body requirements R/T hyperactivity AEB weight loss

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establishing personal contact with family members 2. Being reliable, honest, and consistent during interactions 3. Sharing limited personal information 4. Sitting close to the client to establish rapport

2. Being reliable, honest, and consistent during interactions

8. Which drug would a nurse recognize as appropriate in assisting a client with recovery from long-standing heroin use disorder? 1. Acamprosate calcium (Campral). 2. Buprenorphine/naloxone (Suboxone). 3. Disulfiram (Antabuse). 4. Haloperidol (Haldol).

2. Buprenorphine/naloxone (Suboxone).

14. A client on the substance use disorder unit states, "I used to be able to get a 'buzz on' with a few beers. Now it takes a six-pack." How should the nurse, in the role of teacher, address this remark? 1. By assessing the client's readiness for learning and reviewing the criteria for alcohol induced withdrawal. 2. By explaining the effects of tolerance and telling the client that this is a sign of alcohol use disorder. 3. By presenting the concept of minimization and how this affects a realistic view of the problems precipitated by alcohol use disorder. 4. By confronting the client with the client's use of the defense mechanism of rationalization.

2. By explaining the effects of tolerance and telling the client that this is a sign of alcohol use disorder.

2. Using interpersonal theory, which statement is true regarding development of paranoid personality disorder? 1. Studies have revealed a higher incidence of paranoid personality disorder among relatives of clients with schizophrenia. 2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment. 3. There is an alteration in the ego development so that the ego is unable to balance the id and superego. 4. During the anal stage of development, the client diagnosed with paranoid personality disorder has problems with control within his or her environment.

2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment.

3. Using interpersonal theory, which statement is true regarding development of paranoid personality disorder? 1. Studies have revealed a higher incidence of paranoid personality disorder among relativesof clients with schizophrenia. 2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment. 3. There is an alteration in the ego development so that the ego is unable to balance the id and superego.

2. Clients diagnosed with paranoid personality disorder frequently have been family scapegoats and subjected to parental antagonism and harassment.

When using a behavioral modification approach to the treatment of eating disorders, which nursing intervention would be most likely to produce positive results? 1. A matter-of-fact, directive approach with the input of the entire treatment team. 2. Clients should perceive that they are in control of clearly communicated treatment choices. 3. Appropriate treatment choices are presented to the client's family for consideration. 4. The treatment team develops a system of rewards and privileges that can be earned by the client.

2. Clients should perceive that they are in control of clearly communicated treatment choices.

10. A client is admitted to a psychiatric unit with the diagnosis of catatonic schizophrenia. Which of the client's neurotransmitters should a nurse expect to be elevated? 1. Serotonin 2. Dopamine 3. Gamma-aminobutyric acid (GABA) 4. Histamine

2. Dopamine Rationale: The nurse should expect that elevated dopamine levels might be an attributing factor to the client's current level of functioning. Dopamine functions include regulation of movements and coordination, emotions, and voluntary decision-making ability.

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.

Which of the following diagnostic criteria describe the characteristics of borderline personality disorder? Select all that apply. 1. Arrogant, haughty behaviors or attitudes. 2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 4. Unrealistic preoccupation with fears of being left to take care of self. 5. Chronic feelings of emptiness.

2. Frantic efforts to avoid real or imagined abandonment. 3. Recurrent suicidal and self-mutilating behaviors. 5. Chronic feelings of emptiness.

A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

2. Hamilton Depression Rating Scale Rationale: One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale.

A nursing student is studying the historical aspects of personality disorder. Which entry on the examination indicates that learning has occurred? 1. Zeus, in the 3rd century, identified and applied the theory of object relations. 2. Hippocrates, in the 4th century B.C., identified four fundamental personality styles. 3. Narcissus, in 923 A.D., introduced the word "personality" from the Greek term "persona." 4. Achilles, in 866 A.D., described the pathology of personality as a complex behavioral phenomenon.

2. Hippocrates, in the 4th century B.C., identified four fundamental personality styles.

Peculiarities of ideation, appearance, and behavior and deficits in interpersonal relationships is to schizotypal personality disorder as a pervasive pattern of excessive emotionality and attention-seeking behavior is to: 1. Borderline personality disorder. 2. Histrionic personality disorder. 3. Paranoid personality disorder. 4. Passive-aggressive personality disorder.

2. Histrionic personality disorder.

Which nursing intervention would directly assist a hospitalized client diagnosed with bulimia nervosa to avoid the urge to purge after discharge? 1. Locking the door to the client's bathroom. 2. Holding a mandatory group after mealtime to assist in exploration of feelings. 3. Discussing preplanned meals to decrease anxiety around eating. 4. Educating the family to recognize purging side effects.

2. Holding a mandatory group after mealtime to assist in exploration of feelings.

The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) 1. Hyperaphia 2. Hypothyroidism 3. Hypoadrenalism 4. Hyperadrenalism 5. Hyperthyroidism

2. Hypothyroidism 3. Hypoadrenalism 4. Hyperadrenalism 5. Hyperthyroidism

. A client exhibiting passive-aggressive personality traits continuously complains to the marriage counselor about a nagging husband who criticizes her indecisiveness. Which nursing diagnosis reflects this client's problem? 1. Social isolation R/T decreased self-esteem. 2. Impaired social interaction R/T inability to express feelings openly. 3. Powerlessness R/T spousal abuse. 4. Self-esteem disturbance R/T unrealistic expectations of husband.

2. Impaired social interaction R/T inability to express feelings openly.

A client diagnosed with passive-aggressive personality disorder continually complains to the marriage counselor about a nagging husband who criticizes her indecisiveness. Which nursing diagnosis reflects this client's problem? 1. Social isolation R/T decreased self-esteem. 2. Impaired social interaction R/T inability to express feelings openly. 3. Powerlessness R/T spousal abuse. 4. Self-esteem disturbance R/T unrealistic expectations of husband.

2. Impaired social interaction R/T inability to express feelings openly.

A client diagnosed with major NCD is exhibiting behavioral problems on a daily basis. At change of shift, the client's behavior escalates from pacing to screaming and flailing. Which action should be a nursing priority? 1. Consult the psychologist regarding behavior-modification techniques. 2. Medicate the client with prn antianxiety medications. 3. Assess environmental triggers and potential unmet needs. 4. Anticipate the behavior and restrain when pacing begins.

2. Medicate the client with prn antianxiety medications.

Which statement accurately differentiates NCD from pseudodementia (depression)? 1. NCD has a rapid onset, whereas pseudodementia does not. 2. NCD symptoms include disorientation to time and place, and pseudodementia does not. 3. NCD symptoms improve as the day progresses, but symptoms of pseudodementia worsen. 4. NCD causes decreased appetite, whereas pseudodementia does not.

2. NCD symptoms include disorientation to time and place, and pseudodementia does not. ANS: 2 Rationale: NCD has a slow progression of symptoms, whereas pseudodementia has a rapid progression of symptoms. NCD symptoms include disorientation to time and place, and pseudodementia does not. NCD symptoms' severity worsens as the day progresses, whereas in pseudodementia, symptoms improve as the day progresses. In NCD the appetite remains unchanged. whereas in pseudodementia, the appetite diminishes.

1. A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? 1. Assess for medication nonadherence. 2. Note escalating behaviors and intervene immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors.

2. Note escalating behaviors and intervene immediately. The nurse should note escalating behaviors and intervene immediately, to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority? 1. Administer tranquilizing drugs. 2. Observe client frequently. 3. Encourage client to verbalize hostile feelings. 4. Explore alternative ways of handling frustration.

2. Observe client frequently.

A client diagnosed with paranoid personality disorder needs information regarding medications. Which nursing intervention would assist this client in understanding prescribed medications? 1. Ask the client to join the medication education group. 2. Provide one-on-one teaching in the client's room. 3. During rounds, have the physician ask if the client has any questions. 4. Let the client read the medication information handout.

2. Provide one-on-one teaching in the client's room.

A client diagnosed with a personality disorder insists that a grandmother, through reincarnation, has come back to life as a pet kitten. The thought process described is reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Schizotypal personality disorder. 3. Borderline personality disorder. 4. Schizoid personality disorder.

2. Schizotypal personality disorder.

Which intervention describes an important component in the treatment of clients diagnosed with personality disorders? 1. Psychotropic medications are prescribed to reduce hospitalizations. 2. Self-awareness by the nurse is necessary to ensure a therapeutic relationship. 3. Group therapy, not individual therapy, is the preferred approach. 4. Addressing comorbid issues is not indicated.

2. Self-awareness by the nurse is necessary to ensure a therapeutic relationship

A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

2. Social isolation R/T poor self-esteem AEB secluding self in room

A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS). Which side effect of antipsychotic medications led to the use of this assessment tool? 1. Dystonia 2. Tardive dyskinesia 3. Akinesia 4. Akathisia

2. Tardive dyskinesia Rationale: The AIMS is a rating scale that was developed in the 1970s by the National Institute of Mental Health to measure involuntary movements associated with tardive dyskinesia.

A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

2. The client has experienced auditory hallucinations for the past 3 hours. Rationale: This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month.

15. A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

2. The client has experienced auditory hallucinations for the past 3 hours. This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month.

An 18-year-old female client weighs 95 pounds and is 70 inches tall. She has not had a period in 4 months and states, "I am so fat!" Which statement is reflective of this client's symptoms? 1. The client meets the criteria for an Axis I diagnosis of bulimia nervosa. 2. The client meets the criteria for an Axis I diagnosis of anorexia nervosa. 3. The client needs further assessment to be diagnosed using the DSM-IV-TR. 4. The client is exhibiting normal developmental tasks according to Erikson.

2. The client meets the criteria for an Axis I diagnosis of anorexia nervosa.

18. Which of the following sociocultural factors increase a client's risk for the diagnosis of alcohol use disorder? Select all that apply. 1. The client's twin sister has been diagnosed with alcohol use disorder. 2. The client was raised in a home where alcohol use was the norm. 3. The client is from a family that culturally accepts the use of alcohol. 4. The client experiences pleasure when using alcohol and subsequently repeats the use. 5. The client is influenced by morphine-like substances produced during alcohol use.

2. The client was raised in a home where alcohol use was the norm. 3 The client is from a family that culturally accepts the use of alcohol. 4. The client experiences pleasure when using alcohol and subsequently repeats the use.

A suicidal client is diagnosed with borderline personality disorder. Which correctly written short-term outcome is most beneficial for the client? 1. The client will be free from self-injurious behavior. 2. The client will express feelings without inflicting self-injury by discharge. 3. The client will socialize with peers in the milieu by day 3. 4. The client will acknowledge his or her role in altered interpersonal relationships.

2. The client will express feelings without inflicting self-injury by discharge.

A suicidal client is diagnosed with borderline personality disorder. Which short-term outcome is most beneficial for the client? 1. The client will be free from self-injurious behavior. 2. The client will express feelings without inflicting self-injury by discharge. 3. The client will socialize with peers in the milieu by day 3. 4. The client will acknowledge the client's role in altered interpersonal relationships.

2. The client will express feelings without inflicting self-injury by discharge.

13. A client diagnosed with alcohol use disorder states that his wife complains about his drinking but stocks his bar with gin. The nurse suspects codependency. Which of the following characteristics would the nurse expect the wife to exhibit? Select all that apply. 1. The wife has a long history of egocentric tendencies. 2. The wife is a "people pleaser" and would do almost anything to gain approval. 3. The wife does not feel responsible for making her husband happy. 4. The wife has an accurate understanding regarding her own identity. 5. The wife experiences a profound sense of powerlessness.

2. The wife is a "people pleaser" and would do almost anything to gain approval. 5. The wife experiences a profound sense of powerlessness.

A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of AD, within what time frame should the nurse expect the client to exhibit symptoms? 1. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident. 2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident. 3. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident. 4. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

2. To meet the DSM-5 criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident.

25. A child diagnosed with an autistic disorder withdraws into self and, when spoken to, makes inappropriate nonverbal expressions. The nursing diagnosis impaired verbal communication is documented. Which intervention would address this problem 1. Assist the child to recognize separateness during self-care activities. 2. Use a face-to-face and eye-to-eye approach when communicating. 3. Provide the child with a familiar toy or blanket to increase feelings of security. 4. Offer self to the child during times of increasing anxiety.

2. Use a face-to-face and eye-to-eye approach when communicating.

A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

2. Valproic acid (Depakote) Rationale: The nurse should anticipate that the physician may prescribe valproic acid in order to increase this client's medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss.

A nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates that teaching has been effective? 1."How clients perceive events and view the world affect their response to trauma." 2."The psychic numbing in PTSD is a result of negative reinforcement." 3."The individual becomes addicted to the trauma owing to an endogenous opioid response." 4."Believing that the world is meaningful and controllable can protect an individual from PTSD."

2."The psychic numbing in PTSD is a result of negative reinforcement."

5. A client has been assigned a nursing diagnosis of complicated grieving related to the death of multiple family members in a motor vehicle accident. Which intervention should the nurse initially employ? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Encourage attending a grief therapy group.

2.Assess for the stage of grief in which the client is fixed.

A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1.Increase the dosage of fluoxetine. 2.Discontinue the fluoxetine and rethink the client's diagnosis. 3.Order benztropine (Cogentin) to address extrapyramidal symptoms. 4.Order olanzapine (Zyprexa) to address altered thoughts.

2.Discontinue the fluoxetine and rethink the client's diagnosis.

A nursing student diagnosed with acute test anxiety is prescribed propranolol (Inderal). What is the rationale for this treatment? 1) Inderal is a mood stabilizer that will decrease situational anxiety. 2) Inderal is an antihypertensive medication. Question this order. 3) Inderal has potent effects on the somatic manifestations of anxiety. 4) Inderal is an anxiolytic used specifically for generalized anxiety.

3) Inderal has potent effects on the somatic manifestations of anxiety.

A client experiencing numbness of the extremities, trembling, fear of dying, and dizziness is admitted to the emergency room with a diagnosis of panic disorder. Which nursing intervention takes priority? 1) Discuss functional coping mechanisms. 2) Determine the source of the problem. 3) Quickly administer an anxiolytic medication. 4) Establish a trusting nurse-client relationship.

3) Quickly administer an anxiolytic medication.

A despondent college student, being treated for a panic disorder, tells the nurse, "I've had it! For no reason, my heart pounds and I can't seem to breathe. It's not worth it." Based on this information, which nursing diagnosis takes priority? 1) Ineffective Airway Clearance 2) Ineffective Coping 3) Risk for Suicide 4) Knowledge Deficit

3) Risk for Suicide

A woman who has been widowed recently is unable to cope with the tasks of daily living because a hurricane has completely destroyed her home. She is unable to identify any available family support. The nurse identifies that the client is experiencing which type of crisis? 1) Dispositional crisis 2) Life transitions crisis 3) Traumatic stress crisis 4) Maturational/developmental crisis

3) Traumatic stress crisis

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

3, 1, 4, 2

After a routine dental examination on an adolescent, the dentist reports to the parents that bulimia nervosa suspected. On which of the following assessment data would the dentist base this determination? Select all that apply. 1. Extreme weight loss. 2. Amenorrhea. 3. Discoloration of dental enamel. 4. Bruises of the palate and posterior pharynx. 5. Dental enamel dysplasia.

3, 4, 5

A diabetic client admitted to a medical floor for medication stabilization has a history of antisocial personality disorder. Which documented behaviors would support this Axis II diagnosis? 1. "Labile mood and affect and old scars noted on wrists bilaterally." 2. "Appears younger than stated age with flamboyant hair and makeup." 3. "Began cursing when confronted with drug-seeking behaviors." 4. "Demands foods prepared by personal chef to be delivered to room."

3. "Began cursing when confronted with drug-seeking behaviors."

23. Which charting entry would document an appropriate nursing intervention for a client diagnosed with profound mental retardation? 1. "Rewarded client with lollipop after independent completion of self-care." 2. "Encouraged client to tie own shoelaces." 3. "Kept client in line of sight continually during shift." 4. "Taught the client to sing the alphabet 'ABC' song."

3. "Kept client in line of sight continually during shift."

A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

3. "Weight gain is a common, but troubling, side effect."

23. Which client situation requires the nurse to prioritize the implementation of limit setting? 1. A client making sexual advances toward a staff member. 2. A client telling staff that another staff member allows food in the bedrooms. 3. A client verbally provoking another client who is paranoid. 4. A client refusing medications to receive secondary gains.

3. A client verbally provoking another client who is paranoid.

After one week of continuous mental confusion, an older African American client is admitted with a preliminary diagnosis of AD. What should cause the nurse to question this diagnosis? 1. AD does not typically occur in African American clients. 2. The symptoms presented are more indicative of Parkinsonism. 3. AD does not develop suddenly. 4. There has been no T3- or T4-level evaluation ordered.

3. AD does not develop suddenly. The onset of AD symptoms is slow and insidious. The disease is generally progressive and deteriorating.

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? 1. According to psychoanalytic theory, depression is a result of negative perceptions. 2. According to object-loss theory, depression is a result of overprotection. 3. According to learning theory, depression is a result of repeated failures. 4. According to cognitive theory, depression is a result of anger turned inward.

3. According to learning theory, depression is a result of repeated failures.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol Chlordiazepoxide is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal to reduce life-threatening complications.

14. A child diagnosed with severe mental retardation displays failure to thrive related to neglect and abuse. Which nursing diagnosis would best reflect this situation? 1. Altered role performance R/T failure to complete kindergarten. 2. Risk for injury: self-directed R/T poor self esteem. 3. Altered growth and development R/T inadequate environmental stimulation. 4. Anxiety R/T ineffective coping skills.

3. Altered growth and development R/T inadequate environmental stimulation.

A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client's symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)? 1. Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not. 2. Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not. 3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4. Catatonic features may be associated with BPD, whereas SIPD has no catatonic features.

3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. Rationale: The diagnosis of SIPD is made when symptoms are directly attributable to substance intoxication or withdrawal. The symptoms are more excessive and more severe than those usually associated with the intoxication or withdrawal syndrome. Hallucinations and delusions are associated with both SIPD and BPD. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.

Irresponsible, guiltless behavior is to a client diagnosed with cluster B personality disorder as avoidant, dependent behavior is to a client diagnosed with a: 1. Cluster A personality disorder. 2. Cluster B personality disorder. 3. Cluster C personality disorder. 4. Cluster D personality disorder.

3. Cluster C personality disorder. Cluster C includes dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders.

11. A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1. During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2. During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4. During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

3. During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania.

A client diagnosed with paranoid personality disorder is prescribed risperidone (Risperdal). The client is noted to have restlessness and weakness in lower extremities and is drooling. Which nursing intervention would be most important? 1. Hold the next dose of risperidone, and document the findings. 2. Monitor vital signs, and encourage the client to rest in room. 3. Give the ordered PRN dose of trihexyphenidyl (Artane). 4. Get a fasting blood sugar measurement because of potential hyperglycemia.

3. Give the ordered PRN dose of trihexyphenidyl (Artane).

10. When admitting a child diagnosed with a conduct disorder, which symptom would the nurse expect to assess? 1. Excessive distress about separation from home and family. 2. Repeated complaints of physical symptoms such as headaches and stomachaches. 3. History of cruelty toward people and animals. 4. Confabulation when confronted with wrongdoing.

3. History of cruelty toward people and animals.

During her aunt's wake, a 4-year-old child runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? 1.Complicated grieving 2.Altered family processes 3.Ineffective coping 4.Body image disturbance

3. Ineffective coping

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.

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

3. Long-term treatment with buspirone Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

9. A client receives lorazepam (Ativan) because of a high Clinical Institute Withdrawal Assessment (CIWA) score. What is the rationale for this pharmacological intervention? 1. Lorazepam is a medication that decreases cravings in clients who are experiencing alcohol induced withdrawal. 2. Lorazepam is a deterrent therapy that helps to motivate clients to maintain alcohol abstinence. 3. Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms. 4. Lorazepam is a central nervous system stimulant that decreases the CIWA score.

3. Lorazepam is a substitution therapy to decrease the intensity of withdrawal symptoms.

2. A client with a long history of alcohol use disorder recently has been diagnosed with Wernicke-Korsakoff syndrome. Which of the following symptoms should the nurse expect to assess? Select all that apply. 1. A sudden onset of muscle pain with elevations of creatine phosphokinase. 2. Signs and symptoms of congestive heart failure. 3. Loss of short-term and long-term memory and the use of confabulation. 4. Inflammation of the stomach and gastroesophageal reflux disorder. 5. Lab values that document severe thiamine deficiency.

3. Loss of short-term and long-term memory and the use of confabulation. 5. Lab values that document severe thiamine deficiency.

27. A child newly admitted to an in-patient psychiatric unit with a diagnosis of major depressive disorder has a nursing diagnosis of high risk for suicide R/T depressed mood. Which nursing intervention would be most appropriate at this time? 1. Encourage the child to participate in group therapy activities daily. 2. Engage in one-on-one interactions to assist in building a trusting relationship. 3. Monitor the child continuously while no longer than an arm's length away. 4. Maintain open lines of communication for expression of feelings.

3. Monitor the child continuously while no longer than an arm's length away.

9 A client diagnosed with a personality disorder tells the nurse, "When I was a waiter I use to spit in the dinners of annoying customers." This statement would be associated with which personality disorder? 1. Paranoid personality disorder. 2. Schizoid personality disorder. 3. Passive-aggressive personality disorder. 4. Antisocial personality disorder.

3. Passive-aggressive personality disorder. dependent, avoidant, obsessive-compulsive, and passive-aggressive personality disorders.

A client tells the nurse, "When I was a waiter I used to spit in the dinners of annoying customers." This statement would be associated with which personality trait? 1. Paranoid personality trait. 2. Schizoid personality trait. 3. Passive-aggressive personality trait. 4. Antisocial personality trait.

3. Passive-aggressive personality trait.

A client is diagnosed in stage seven of AD. To address the client's symptoms, which nursing intervention should take priority? 1. Improve cognitive status by encouraging involvement in social activities. 2. Decrease social isolation by providing group therapies. 3. Promote dignity by providing comfort, safety, and self-care measures. 4. Facilitate communication by providing assistive devices.

3. Promote dignity by providing comfort, safety, and self-care measures. Stage is characterized by severe cognitive decline in which the client is unable to recognize family members and is most commonly bedfast and aphasic.

Which should be the priority nursing intervention when caring for a child diagnosed with conduct disorder? 1. Modify environment to decrease stimulation and provide opportunities for quiet reflection. 2. Convey unconditional acceptance and positive regard. 3. Recognize escalating aggressive behavior and intervene before violence occurs. 4. Provide immediate positive feedback for appropriate behaviors.

3. Recognize escalating aggressive behavior and intervene before violence occurs. Rationale: Priority nursing intervention with conduct disorder should be to recognize escalating aggressive behavior and to intervene before violence occurs. This intervention serves to keep the client as well as others safe, which is the priority nursing concern.

A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Restlessness and muscle rigidity 4. Reports of hearing disturbing voices

3. Restlessness and muscle rigidity An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

16. A foster child diagnosed with oppositional defiant disorder is spiteful, vindictive, and argumentative, and has a history of aggression toward others. Which nursing diagnosis would take priority? 1. Impaired social interaction R/T refusal to adhere to conventional social behavior. 2. Defensive coping R/T unsatisfactory child-parent relationship. 3. Risk for violence: directed at others R/T poor impulse control. 4. Noncompliance R/T a negativistic attitude.

3. Risk for violence: directed at others R/T poor impulse control.

A client diagnosed with a dependent personality disorder has a nursing diagnosis of social isolation R/T parental abandonment AEB fear of involvement with individuals not in the immediate family. Which nursing intervention would be appropriate? 1. Address inappropriate interactions during group therapy. 2. Recognize when client is playing one staff member against another. 3. Role-model positive relationships. 4. Encourage client to discuss conflicts evident within the family system.

3. Role-model positive relationships.

A client diagnosed with a dependent personality disorder has a nursing diagnosis of social isolation R/T parental abandonment AEB fear of involvement with individuals not in the immediate family. Which nursing intervention would be appropriate? 1. Address inappropriate interactions during group therapy. 2. Recognize when client is playing one staff member against another. 3. Role-model positive relationships. 4. Encourage client to discuss conflicts evident within the family system.

3. Role-model positive relationships.

21. Which short-term outcome would be considered a priority for a hospitalized child diagnosed with a chronic autistic disorder who bites self when care is attempted? 1. The child will initiate social interactions with one caregiver by discharge. 2. The child will demonstrate trust in one caregiver by day 3. 3. The child will not inflict harm on self during the next 24-hour period. 4. The child will establish a means of communicating needs by discharge.

3. The child will not inflict harm on self during the next 24-hour period.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. The client gained two pounds in one week. 2. The client focused conversations on nutritious food. 3. The client demonstrated healthy coping mechanisms that decreased anxiety. 4. The client verbalized an understanding of the etiology of the disorder

3. The client demonstrated healthy coping mechanisms that decreased anxiety.

A client diagnosed with an avoidant personality disorder has the nursing diagnosis of social isolation R/T severe malformation of the spine AEB "I can't be around people, looking like this." Which correctly written short-term outcome is appropriate for this client's problem? 1. The client will see self as straight and tall by the time of discharge. 2. The client will see self as valuable after attending assertiveness training courses. 3. The client will be able to participate in one therapy group by end of shift. 4. The client will join in a charade game to decrease social isolation.

3. The client will be able to participate in one therapy group by end of shift.

A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client's plan of care? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

3. The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge.

A client diagnosed with bulimia nervosa has responded well to citalopram (Celexa). Which is the possible cause for this response? 1. There is an association between bulimia nervosa and dilated blood vessels and inactive alpha-adrenergic and serotoninergic receptors. 2. There is an association between bulimia nervosa and the neurotransmitter dopamine. 3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine. 4. There is an association between bulimia nervosa and a malfunction of the thalamus.

3. There is an association between bulimia nervosa and the neurotransmitters serotonin and norepinephrine.

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms? 1. Mood disorders, which often accompany the diagnosis of bulimia nervosa. 2. Nutritional deficits, which are characteristic of bulimia nervosa. 3. Vomiting, which may lead to dehydration and electrolyte imbalance. 4. Binging, which causes abdominal discomfort.

3. Vomiting, which may lead to dehydration and electrolyte imbalance.

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1.Teach deep breathing relaxation exercises. 2.Place the client in a Trendelenburg position. 3.Have the client breathe into a paper bag. 4.Administer the ordered prn buspirone (BuSpar).

3.Have the client breathe into a paper bag.

A client threatens to kill himself, his wife, and their children if the wife follows through with divorce proceedings. During the pre-interaction phase of the nurse-client relationship, which action by the nurse is most appropriate? 1) Acknowledging the client's actions and encouraging alternative behaviors 2) Establishing rapport and developing treatment goals 3) Providing community resources on aggression management 4) Exploring personal thoughts and feelings that may adversely affect the provision of care

4) Exploring personal thoughts and feelings that may adversely affect the provision of care Acknowledging the client's actions and encouraging subsequent alternative behaviors would take place during the working, not pre-interaction, phase of the nurse-client relationship. The orientation phase is the time for establishing trust and setting the framework for client therapy. Because there is no client contact during the pre-interaction phase, these nursing actions cannot occur. Providing community resources on aggression management would be done during the termination phase of the relationship. Because there is no client contact during the pre-interaction phase, this nursing action cannot occur. In the pre-interaction phase, the nurse must clarify personal attitudes, values, and beliefs to become aware of how these might affect the nurse's ability to care for various clients. This occurs before the nurse meets the client.

In which phase of the nurse-client relationship do clients often experience feelings of sadness and loss related to their relationship with the nurse? 1) Pre-interaction phase 2) Orientation phase 3) Working phase 4) Termination phase

4) Termination phase The pre-interaction phase is a time for the nurse to reflect on personal values and feelings that might affect the nurse-client relationship. Because the nurse and client have no contact during the pre-interaction phase, feelings of loss and sadness would not be generated. The orientation phase is the time for setting the framework for the therapy. Nurse and client are just getting acquainted during this phase and, therefore, feelings of sadness and loss are not typically generated. It is during the working phase that the nurse assists the client to examine difficult issues and feelings and then to develop more adaptive behaviors. Because the nurse and client continue to process through problems during this phase, feelings of sadness and loss are not typically generated. At termination, the nurse and client end their therapeutic relationship. Often clients experience feelings of sadness and loss during this phase.

A noncompliant client has a nursing diagnosis of "Social Isolation related to anxiety evidenced by remaining in room during group activities." Which short-term outcome is appropriate for this client? 1) The client will attend three group sessions. 2) The client will understand and accept social withdrawal as a personality trait. 3) The client will remain safe throughout the hospital stay. 4) The client will request as needed (prn) anxiety medication prior to attending group sessions.

4) The client will request as needed (prn) anxiety medication prior to attending group sessions. Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation.

1. A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which is the most accurate documentation of this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood euthymic. Exhibiting magical thinking. Restless." 3. "Mood labile. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

A client newly admitted to an in-patient psychiatric unit is diagnosed with schizotypal personality disorder. The client states, "I can't believe you are not afraid of the monsters coming after us all." Which is the most appropriate nursing response? 1. "I don't know what monsters you are talking about." 2. "The monsters? Can you please tell me more about that?" 3. "I was wondering if you want to come to group to talk about that."

4. "I can see your thoughts are bothersome. How can I help?"

A client newly admitted to an in-patient psychiatric unit is diagnosed with schizotypal personality disorder. The client states, "I envision my future death by fire." Which is the most appropriate nursing response? 1. "I don't know what you mean by envisioning your future death." 2. "Your future death? Can you please tell me more about that?" 3. "I was wondering if you want to come to group to talk about that." 4. "I can see your thoughts are bothersome. How can I help?"

4. "I can see your thoughts are bothersome. How can I help?"

A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "I don't have a green thumb. Any old fool can grow a rose."

4. "I don't have a green thumb. Any old fool can grow a rose."

A nursing student is learning about narcissistic personality disorder. Which of the following student statements indicate that learning has occurred? Select all that apply. 1. "These clients have peculiarities of ideation." 2. "These clients require constant approval and affirmation." 3. "These clients are impulsive and self-destructive." 4. "These clients express a grandiose sense of self-importance." 5. "These clients have a deep need for admiration."

4. "These clients express a grandiose sense of self-importance."

A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse asks the nurse how Zyprexa works. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

A client diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "My parents watch me like a hawk and never let me out of their sight." Which nursing diagnosis would take priority at this time? 1. Altered nutrition less than body requirements 2. Altered social interaction 3. Impaired verbal communication 4. Altered family processes

4. Altered family processes

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which intervention takes priority? 1. Assessment of family issues and health concerns. 2. Assessment of early disturbances in mother-infant interactions. 3. Assessment of the client's knowledge of selective serotonin reuptake inhibitors used in treatment. 4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

4. Assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems.

A client diagnosed with AD has impairments of memory and judgment and is incapable of performing activities of daily living. Which nursing intervention should take priority? 1. Present evidence of objective reality to improve cognition. 2. Design a bulletin board to represent the current season. 3. Label the client's room with name and number. 4. Assist with bathing and toileting.

4. Assist with bathing and toileting. A client who is incapable of performing activities of daily living requires assistance in these areas to ensure health and safety.

When assessing a client diagnosed with histrionic personality disorder, the nurse might identify which characteristic behavior? 1. Odd beliefs and magical thinking. 2. Grandiose sense of self-importance. 3. Preoccupation with orderliness and perfection. 4. Attention-seeking flamboyance.

4. Attention-seeking flamboyance.

Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine withdrawal delirium? 1. Haloperidol (Haldol) and fluoxetine (Prozac) 2. Carbamazepine (Tegretol) and donepezil (Aricept) 3. Disulfiram (Antabuse) and lorazepan (Ativan) 4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

4. Chlordiazepoxide (Librium) and phenytoin (Dilantin) Rationale: The nurse should anticipate that a physician would order chlordiazepoxide and phenytoin for a client who has a history of benzodiazepine withdrawal delirium. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin is an anticonvulsant used to prevent seizures.

Personality disorders are grouped in clusters according to their behavioral characteristics. In which cluster are the disorders correctly matched with their behavioral characteristics? 1. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious or fearful characteristic behaviors. 2. Cluster A: avoidant, dependent, obsessive-compulsive disorders; odd or eccentric characteristic behaviors. 3. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramatic, emotional, or erratic characteristic behaviors. 4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

Personality disorders are grouped in clusters according to their behavioral characteristics. In which cluster are the disorders correctly matched with their behavioral characteristics? 1. Cluster C: antisocial, borderline, histrionic, narcissistic disorders; anxious or fearful characteristic behaviors. 2. Cluster A: avoidant, dependent, obsessive-compulsive disorders; odd or eccentric characteristic behaviors. 3. Cluster A: antisocial, borderline, histrionic, narcissistic disorders; dramatic, emotional, or erratic characteristic behaviors. 4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

4. Cluster C: avoidant, dependent, obsessive-compulsive disorders; anxious or fearful characteristic behaviors.

A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Thought insertion 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

4. Delusions of reference Rationale: The nurse is assessing for the potential symptom of delusions of reference. A client that believes he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward him- or herself.

What symptoms should a nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD.

4. Depersonalization is commonly seen in panic disorder and absent in GAD. clients diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

A nurse is planning care for a 13 -year-old who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexipro)

4. Escitalopram (Lexipro) Fluoxetine (Prozac) has been approved by the FDA to treat depression in children and adolescents, and escitalopram was approved in 2009 for treatment of depression in adolescents aged 12 to 17 years. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity R/T unmet dependency needs AEB the inability to be alone. Which nursing intervention would be appropriate? 1. Ask the client directly, "Have you thought about killing yourself ?" 2. Maintain a low level of stimuli in the client's environment. 3. Frequently orient the client to reality and surroundings. 4. Help the client identify values and beliefs.

4. Help the client identify values and beliefs.

A client diagnosed with a borderline personality disorder is given a nursing diagnosis of disturbed personal identity R/T unmet dependency needs AEB the inability to be alone. Which nursing intervention would be appropriate? 1. Ask the client directly, "Have you thought about killing yourself?" 2. Maintain a low level of stimuli in the client's environment. 3. Frequently orient the client to reality and surroundings. 4. Help the client identify values and beliefs.

4. Help the client identify values and beliefs.

Which etiological implication for obesity is from a physiological perspective? 1. Eighty percent of offspring of two obese parents become obese. 2. Individuals who are obese have unresolved dependency needs and are fixed in the oral stage of development. 3. Hyperthyroidism interferes with metabolism and may lead to obesity. 4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

4. Lesions in the appetite and satiety centers in the hypothalamus lead to overeating and obesity.

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements R/T altered body perception AEB client's being 5 feet 4 inches tall and weighing 75 pounds. Which nursing intervention would address this client's problem? 1. Encourage the client to keep a diary of food intake. 2. Plan exercise tailored to individual choice. 3. Help the client to identify triggers to self-induced purging. 4. Monitor physician-ordered nasogastric tube feedings.

4. Monitor physician-ordered nasogastric tube feedings.

Which is the reason for the proliferation of the diagnosis of NCDs? 1. Increased numbers of neurotransmitters has been implicated in the proliferation of NCD. 2. Similar symptoms of NCD and depression lead to misdiagnoses, increasing numbers of NCD. 3. Societal stress contributes to the increase in this diagnosis. 4. More people now survive into the high-risk period for neurocognitive disorders.

4. More people now survive into the high-risk period for neurocognitive disorders. Rationale: The proliferation of NCD has occurred because more people now survive into the high-risk period for neurocognitive disorder, which is middle age and beyond..

A nurse is discharging a client diagnosed with narcissistic 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.

4. Prison warden.

Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

4. Provide personal space to respect the client's boundaries.

8. Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

4. Provide personal space to respect the client's boundaries. The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence. The nurse should observe the patient while carrying out routine tasks.

When assessing a client diagnosed with passive-aggressive personality disorder, the nurse might identify which characteristic behavior? 1. Exhibits behaviors that attempt to "split" the staff. 2. Shows reckless disregard for the safety of self or others. 3. Has unjustified doubts about the trustworthiness of friends. 4. Seeks subtle retribution when feeling others have wronged them.

4. Seeks subtle retribution when feeling others have wronged them.

An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

An older client has recently moved to a nursing home. The client has trouble concentrating and socially isolates. A physician believes the client would benefit from medication therapy. Which medication should the nurse expect the physician to prescribe? 1. Haloperidol (Haldol) 2. Donepezil (Aricept) 3. Diazepam (Valium) 4. Sertraline (Zoloft)

4. Sertraline (Zoloft) Rationale: The nurse should expect the physician to prescribe sertraline to improve the client's social functioning and concentration levels. Sertraline is an selective serotonin reuptake inhibitor (SSRI) antidepressant. Depression is the most common mental illness in older adults and is often misdiagnosed as a neurocognitive disorder.

A client diagnosed with schizoid personality disorder chooses solitary activities, lacks close friends, and appears indifferent to criticism. Which nursing diagnosis would be appropriate for this client's problem? 1. Anxiety R/T poor self-esteem AEB lack of close friends. 2. Ineffective coping R/T inability to communicate AEB indifference to criticism. 3. Altered sensory perception R/T threat to self-concept AEB magical thinking. 4. Social isolation R/T discomfort with human interaction AEB avoiding others.

4. Social isolation R/T discomfort with human interaction AEB avoiding others.

A client diagnosed with AD can no longer ambulate, does not recognize family members, and communicates with agitated behaviors and incoherent verbalizations. The nurse recognizes these symptoms as indicative of which stage of the illness? 1. Stage 4: Mild-to-Moderate Cognitive Decline 2. Stage 5. Moderate Cognitive Decline 3. Stage 6. Moderate-to-Severe Cognitive Decline 4. Stage 7. Severe Cognitive Decline

4. Stage 7. Severe Cognitive Decline. Rationale: The nurse should recognize that a client exhibiting these symptoms is in the severe cognitive decline, seventh stage, of AD.

Which outcome indicates that the client's problem of impaired body image has improved? 1. The client has gained up to 80% of body weight for age and size. 2. The client is free of symptoms of malnutrition and dehydration. 3. The client has not attempted to self-induce vomiting. 4. The client has acknowledged that perception of being "fat" is incorrect.

4. The client has acknowledged that perception of being "fat" is incorrect.

A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis? 1. The client is disheveled and malodorous. 2. The client refuses to interact with others and isolates self in room. 3. The client is unable to feel any pleasure. 4. The client has maxed-out charge cards and exhibits promiscuous behaviors.

4. The client has maxed-out charge cards and exhibits promiscuous behaviors.

7. A client has been diagnosed with an IQ level of 60. Which client social/ communication capability would the nurse expect to observe? 1. The client has almost no speech development and no socialization skills. 2. The client may experience some limitation in speech and social convention. 3. The client may have minimal verbal skills, with acting-out behavior. 4. The client is capable of developing social and communication skills.

4. The client is capable of developing social and communication skills.

When assessing a client exhibiting passive-aggressive personality traits, which characteristic behavior might the nurse identify? 1. The client exhibits behaviors that attempt to "split" the staff. 2. The client shows reckless disregard for the safety of self or others. 3. The client has unjustified doubts about the trustworthiness of friends. 4. The client seeks subtle retribution when feeling others have wronged him or her.

4. The client seeks subtle retribution when feeling others have wronged him or her.

A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety? 1. His wife works from home in telecommunication. 2. The client has worked the nightshift his entire career. 3. His wife has minimal family support. 4. The client smokes one pack of cigarettes per day.

4. The client smokes one pack of cigarettes per day.

During an admission assessment, a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? 1. Haloperidol (Haldol), because it is used only in older patients 2. Clozapine (Clozaril), because it is incompatible with desipramine 3. Risperidone (Risperdal), because it exacerbates symptoms of depression 4. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

4. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines Rationale: The nurse should know that thioridazine would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine and thioridazine are both classified as phenothiazines.

A client diagnosed with an obsessive-compulsive personality disorder has a nursing diagnosis of anxiety R/T interference with hand washing AEB "I'll go crazy if you don't let me do that." Which correctly written short-term outcome is appropriate for this client? 1. During a 3-hour period after admission to the unit, the client will refrain from hand washing. 2. The client will wash hands only at appropriate bathroom and meal intervals. 3. The client will refrain from hand washing throughout the night. 4. Within 72 hours of admission, the client will notify staff when signs and symptoms of anxiety escalate.

4. Within 72 hours of admission, the client will notify staff when signs and symptoms of anxiety escalate.

A nursing instructor is teaching students about self-help groups like AA. Which student statement indicates that learning has occurred?1."There is little research to support AA's effectiveness." 2."Self-help groups used to be the treatment of choice, but their popularity is waning." 3."These groups have no external regulation, so clients need to be cautious." 4."Members themselves run the group, with leadership usually rotating among the members."

4."Members themselves run the group, with leadership usually rotating among the members."

The nurse is providing education to a client diagnosed with anxiety. Which statement by the client indicates that teaching has been effective? 1."There is nothing that I can do to that will reduce anxiety." 2."Medication is available, but only for those who have had anxiety for a year or more." 3."If I ignore the symptoms of anxiety, it will go away." 4."Practicing yoga or meditation may help reduce my anxiety."

4."Practicing yoga or meditation may help reduce my anxiety."

1. Traume & Stressor Related disorders A nursing instructor is teaching about trauma and stressor-related disorders. Which statement by one of the students indicates that further instruction is needed? 1."The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2."The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3."After exposure to a traumatic event, only 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4."Research shows that PTSD is more common in men than in women."

4."Research shows that PTSD is more common in men than in women."

A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1.Symptoms indicate consumption of foods high in tyramine. 2.Symptoms indicate lithium carbonate discontinuation syndrome. 3.Symptoms indicate the development of lithium carbonate tolerance. 4.Symptoms indicate lithium carbonate toxicity.

4.Symptoms indicate lithium carbonate toxicity.

A client has a history of drinking one pint of bourbon per day for the past 6 months. He is brought to an emergency department by family members who report that his last drink was 1 hour ago. It is now 12 a.m. When should a nurse expect this client to begin experiencing withdrawal symptoms? Select one: a. Between 3 a.m. and 11 a.m. b. Shortly after a 24-hour period. c. At the beginning of the third day. d. Withdrawal is individualized and cannot be predicted.

A The nurse should expect that the client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

A client is experiencing a panic attack. He states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority? 1) Stay with the client and offer support. 2) Distract the client by redirecting him to physical activities. 3) Teach about the etiology and management of panic disorders. 4) Encourage the client to express his feelings.

1) Stay with the client and offer support.

9. Which is a DSM-IV-TR criterion for the diagnosis of attention-deficit/ hyperactivity disorder? 1. Inattention. 2. Recurrent and persistent thoughts. 3. Physical aggression. 4. Anxiety and panic attacks

1. Inattention.

A morbidly obese client is prescribed an anorexiant medication. The nurse should expect to teach the client about which medication? 1. Phentermine (Mirapront) 2. Dexfenfluramine (Redux) 3. Sibutramine (Meridia) 4. Pemoline (Cylert)

1. Phentermine (Mirapront)

17. Which individual would have the lowest potential for being diagnosed with alcohol use disorder? 1. A 32 year-old male Finn. 2. A 20 year-old Asian woman. 3. A 60 year-old Irishman. 4. An 18 year-old Native American.

2. A 20 year-old Asian woman.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? 1. Assess for medication nonadherance. 2. Note escalating behaviors and intervene immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors

2. Note escalating behaviors and intervene immediately. to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

The nurse is assessing a client with a body mass index of 35. The nurse would suspect this client to be at risk for which of the following conditions? Select all that apply. 1. Hypoglycemia. 2. Rheumatoid arthritis. 3. Angina. 4. Respiratory insufficiency. 5. Hyperlipidemia.

3, 4, 5

Which client situation requires the nurse to prioritize the implementation of limit setting? 1. A client making sexual advances toward a staff member. 2. A client telling a staff member that another staff member allows food in the bedrooms. 3. A client verbally provoking another patient who is paranoid. 4. A client refusing medications to receive secondary gains.

3. A client verbally provoking another patient who is paranoid.

Match the treatment goal with the appropriate medication. Nicotine withdrawal? 1. Methadone (Dolophine) 2. Naloxone (Narcan) 3. Bupropion (Zyban) 4. Chlordiazepoxide (Librium) 5. Disulfiram (Antabuse)

3. Bupropion (Zyban)

Which symptom should a nurse identify that differentiates clients diagnosed with NCDs from clients diagnosed with mood disorders? 1. Altered sleep 2. Altered concentration 3. Impaired memory 4. Impaired psychomotor activity

3. Impaired memory

Which client would a nurse recognize as being at highest risk for the development of an adjustment disorder? 1.A young married woman 2.An elderly unmarried man 3.A young unmarried woman 4.A young unmarried man

3.A young unmarried woman

A nursing instructor is teaching about bipolar disorders. Which statement differentiates the DSM-5 diagnostic criteria of a manic episode from a hypomanic episode? 1.During a manic episode, clients may experience an inflated self-esteem or grandiosity, and these symptoms are absent in hypomania. 2.During a manic episode, clients may experience a decreased need for sleep, and this symptom is absent in hypomania. 3.During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania. 4.During a manic episode, clients may experience flight of ideas and racing thoughts, and these symptoms are absent in hypomania.

3.During a manic episode, clients may experience psychosis, and this symptom is absent in hypomania.

A nursing student is learning about narcissistic personality disorder. Which student statement indicates that learning has occurred? 1. "These clients have peculiarities of ideation." 2. "These clients require constant affirmation of approval." 3. "These clients are impulsive and are self-destructive." 4. "These clients express a grandiose sense of self-importance."

4. "These clients express a grandiose sense of self-importance."

A nurse is planning care for a 13-year-old client who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

4. Escitalopram (Lexapro) Fluoxetine (Prozac)

Order the eight-phase process of eye movement desensitization and reprocessing (EMDR). ________ Instillation ________ Body scan ________ Closure ________ Reevaluation ________ Preparation ________ History and treatment planning ________ Desensitization ________ Assessment

5, 6, 7, 8, 2, 1, 4, 3

15. Which of the following have been assessed as the most common types of mental illness identified among homeless individuals? (Select all that apply.)A. Schizophrenia B. Body dysmorphic disorder C. Antisocial personality disorder D. Neurocognitive disorder E. Conversion disorder

A, C, D

A possible outcome criterion for a client diagnosed with anxiety disorder is A. Client demonstrates effective coping strategies. B. Client reports reduced hallucinations. C. Client reports feelings of tension and fatigue. D. Client demonstrates persistent avoidance behaviors.

A. Client demonstrates effective coping strategies. Correct Option A is the only desirable outcome listed.

21. A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol dependence B. History of personality disorder C. History of schizophrenia D. History of hypertension

A. History of alcohol dependence

Which client response should a nurse expect during the working phase of the nurseclient relationship? A. The client gains insight and incorporates alternative behaviors. B. The client and nurse establish rapport and mutually develop treatment goals. C. The client explores feelings related to reentering the community. D. The client explores personal strengths and weaknesses that impact behaviors.

A. The client gains insight and incorporates alternative behaviors.

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

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

A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.

A. The individual is experiencing psychological dependency. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

10. After assertiveness training, a formerly passive client appropriately confronts a peer in group therapy. The group leader states, "I'm so proud of you for being assertive. You are so good!" Which communication technique has the leader employed? A. The nontherapeutic technique of giving approval B. The nontherapeutic technique of interpreting C. The therapeutic technique of presenting reality D. The therapeutic technique of making observations

A. The nontherapeutic technique of giving approval Giving approval implies that the nurse has the right to pass judgment on whether the client's ideas or behaviors are "good" or "bad." This creates a conditional acceptance of the client.

The most common course of schizophrenia is an initial episode followed by A. recurrent acute exacerbations and deterioration. B. recurrent acute exacerbations. C. continuous deterioration. D. complete recovery.

A. recurrent acute exacerbations and deterioration. Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

The following NANDA-I nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? 1. The client is receiving ECT and is diagnosed with Parkinsonism. 2. The client has a history of four suicide attempts in adolescence. 3. The client expresses hopelessness and helplessness and isolates self. 4. The client has disorganized thought processes and delusional thinking.

ANS: 1 Rationale: The nurse should identify that a client receiving ECT and who is diagnosed with Parkinsonism is at risk for injury. History of suicide, hopelessness, and disorganized thoughts would not lead the nurse to formulate a nursing diagnostic stem of Risk for injury.

14. Which of the following instructions regarding lithium therapy should be included in a nurse's discharge teaching? (Select all that apply.) 1. Avoid excessive use of beverages containing caffeine. 2. Maintain a consistent sodium intake. 3. Consume at least 2,500 to 3,000 mL of fluid per day. 4. Restrict sodium content. 5. Restrict fluids to 1,500 mL per day.

ANS: 1, 2, 3 Page: 434, 439-440 Feedback 1. The nurse should instruct the client taking lithium to avoid excessive use of caffeine. 2. The nurse should instruct the client taking lithium to maintain a consistent sodium intake. 3. The nurse should instruct the client taking lithium to consume at least 2,500 to 3,000 mL of fluid per day. 4. Fluid restriction can impact lithium levels. 5. Sodium restriction can impact lithium levels.

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would most likely decrease because of the therapeutic effect of this medication? (Select all that apply.) 1. Somatic delusions 2. Social isolation 3. Gustatory hallucinations 4. Flat affect 5. Clang associations

ANS: 1, 3, 5 Rationale: The nurse should expect that risperidone would be effective treatment for the positive symptoms of somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression which would result in the above symptoms.

13. Which of the following clients should a nurse recommend for a structured day program? (Select all that apply.) A. An acutely suicidal teenager B. A chronically mentally ill woman who has a history of medication non-adherence C. A socially isolated older individual D. A depressed individual who is able to contract for safety E. A client who is hearing voices that tell the client to harm others

B, E

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Buspirone must be taken daily to be effective."

The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."

B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." Panic disorder is characterized by recurrent panic attacks, the onset of which is UNPREDICTABLE. The symptoms come on unexpectedly, not before or on exposure to a situation that usually causes anxiety.

A community health nurse is teaching a class to expectant parents. All participants lack infant care knowledge. A student nurse asks, "If you had to assign a nursing diagnosis to this group, what would it be?" What is the best nursing reply? A. "I would assign the nursing diagnosis of cognitive deficit." B. "I would assign the nursing diagnosis of knowledge deficit." C. "I would assign the nursing diagnosis of altered family processes." D. "I would assign the nursing diagnosis of risk for caregiver role strain."

B. "I would assign the nursing diagnosis of knowledge deficit."

6. A client diagnosed with post-traumatic stress disorder is admitted to an inpatient psychiatric unit for evaluation and medication stabilization. Which therapeutic communication technique used by the nurse is an example of a broad opening? A. "What occurred prior to the rape, and when did you go to the emergency department?" B. "What would you like to talk about?" C. "I notice you seem uncomfortable discussing this." D. "How can we help you feel safe during your stay here?"

B. "What would you like to talk about?" technique of giving broad openings. Using a broad opening allows the client to take the initiative in introducing the topic and emphasizes the importance of the client's role in the interaction.

6. A client refuses to go on a cruise to the Bahamas with his spouse because of fearing that the cruise ship will sink and all will drown. Using a cognitive theory perspective, the nurse should use which of these statements to explain to the spouse the etiology of this fear? A. "Your spouse may be unable to resolve internal conflicts, which result in projected anxiety." B. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation." C. "Your spouse may have a genetic predisposition to overreacting to potential danger." D. "Your spouse may have high levels of brain chemicals that may distort thinking."

B. "Your spouse may be experiencing a distorted and unrealistic appraisal of the situation."

A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this client's problem?A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion

B. Altered sensory perception

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

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

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia? A. Excessive sleeping with disturbing dreams B. Hearing voices telling him to hurt his roommate C. Withdrawal from college because of failing grades D. Chaotic and dysfunctional relationships with his family and peers

B. Hearing voices telling him to hurt his roommate nosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? A. Brainstem B. Hypothalamus-pituitary-adrenal system C. Frontal lobe Incorrect D. Limbic system

B. Hypothalamus-pituitary-adrenal system Correct Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal.

8. A nurse maintains an uncrossed arm and leg posture. This nonverbal behavior is reflective of which letter of the SOLER acronym for active listening? A. S B. O C. L D. E E. R

B. O The nurse should identify that maintaining an uncrossed arm and leg posture is nonverbal behavior that reflects the "O" in the active-listening acronym SOLER. The acronym SOLER includes sitting squarely facing the client (S), open posture when interacting with the client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

2. At what point should the nurse determine that a client is at risk for developing a mental disorder? A. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria B. When maladaptive responses to stress are coupled with interference in daily functioning C. When the client communicates significant distress D. When the client uses defense mechanisms as ego protection

B. When maladaptive responses to stress are coupled with interference in daily functioning

26. A client is taking chlordiazepoxide (Librium) for generalized anxiety disorder symptoms. In which situation should a nurse recognize that this client is at greatest risk for drug overdose? A. When the client has a knowledge deficit related to the effects of the drug B. When the client combines the drug with alcohol C. When the client takes the drug on an empty stomach D. When the client fails to follow dietary restrictions

B. When the client combines the drug with alcohol

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal A. a history of childhood trauma. B. a sibling with the disorder. C. an eating disorder. D. a phobia as well.

B. a sibling with the disorder. Correct Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general

A nursing intervention directed at the psychological needs of an abused woman is to A. encourage the client to immediately leave the abuser. B. affirm that the client did not deserve or cause the abuse. C. provide a referral to social services for economic problems. D. facilitate contact with law enforcement to take legal action.

B. affirm that the client did not deserve or cause the abuse. Abused clients often believe that they are deserving of the abuse and, in some way, prompt the abuser to attack. They need specific reassurance that they did not deserve to be abused and they did not cause the attack.

When the nurse believes the cycle of abuse is escalating and that a woman may be in severe physical danger, the priority nursing intervention is to A. advise her to enter counseling at the mental health center. B. assist her to develop a plan to go to a shelter in case of a crisis. C. suggest she leave the abuser and go to a trusted friend's home. D. teach her to counter verbal abuse with assertive replies.

B. assist her to develop a plan to go to a shelter in case of a crisis. Every victim of abuse should have an escape plan, but one is particularly important when the nurse believes the client is in severe danger.

When there is reason to suspect that a child is being abused, the nurse must initially A. call the local police to report it. B. follow agency policy for reporting. C. confront the parent or parents. D. interrogate the child to obtain proof.

B. follow agency policy for reporting. Nurses are mandated reporters of child abuse. They must follow the rules set forth by the state regarding the steps to take to report child abuse.

Selective inattention is first noted when experiencing anxiety that is A. mild. B. moderate. C. severe. D. panic.

B. moderate. Correct When moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is A. projection. B. repression. C. displacement. D. reaction formation.

B. repression. Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness.

When treatment for injuries sustained during an incident of abuse is sought from the primary physician, the client is receiving A. primary prevention. B. secondary prevention. C. tertiary prevention. D. stop-gap therapy.

B. secondary prevention. Secondary prevention is synonymous with treatment

What can be said about the comorbidity of anxiety disorders? A. Anxiety disorders generally exist alone. B. A second anxiety disorder may coexist with the first. C. Anxiety disorders virtually never coexist with mood disorders. D. Substance abuse disorders rarely coexist with anxiety disorders.

B.A second anxiety disorder may coexist with the first. In many instances, when one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

An elderly woman who has been abused by her caregiver daughter tells the nurse, "You don't have to worry about me. My daughter cried and apologized. She promised me she will never hit me again." The nurse can assess that this is the stage in the cycle of violence known as A. tension building. B. acute battering. C. honeymoon. D. escalation.

C. honeymoon. During the honeymoon stage, the perpetrator apologizes, promises never to abuse again, and tries to make up for the violence. This stage is usually brief.

Which medication is FDA approved for treatment of anxiety in children? A. Lorazepam (benzodiazepine) B. Fluoxetine (selective serotonin reuptake inhibitor) C. Clomipramine (tricyclic antidepressant) D. None of the above

D.None of the above There are no medications with FDA approval for children with anxiety disorders; however, medications approved for other age groups are often prescribed. None of the other options are FDA approved to treat anxiety in children (see the previous sentence). Cognitive Level: Understand (Comprehension) Nursing Process: Planning NCLEX: Physiological Integrity

Which behavior would be characteristic of an individual who is displacing anger? A. Lying B. Stealing C. Slapping D. Procrastinating

D.Procrastinating Correct A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.

Which of the following diagnostic criteria describe the characteristics of borderline personality disorder? (Select all that apply) a. Arrogant, haughty behaviors or attitudes. b. Frantic efforts to avoid real or imagined abandonment. c. Recurrent suicidal and self-mutilating behaviors. d. Unrealistic preoccupation with fears of being left to take care of self. e. Chronic feelings of emptiness.

b, c, e

A group of nursing students is receiving instruction from a nurse educator about neurotransmitters. Which process best explains how neurotransmitters released into the synaptic cleft may return to the presynaptic neuron? a. Regeneration b. Reuptake c. Recycling d. Retransmission

b. Reuptake

Which treatment should a nurse identify as most appropriate for clients diagnosed with general anxiety disorder (GAD)? a. Long-term treatment with diazepam (Valium) b. Acute symptom control with citalopram (Celexa) c. Long-term treatment with buspirone (BuSpar) d. Acute symptom control with ziprasidone (Geodon)

c. Long-term treatment with buspirone (BuSpar)

What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? a. Mood b. Perception c. Orientation d. Affect

c. Orientation

A nursing instructor is teaching about suicide. Which student statement indicates that learning has occurred? a. "Suicidal threats and gestures should be considered manipulative and/or attention-seeking." b. "Suicide is the act of a psychotic person." c. "All suicidal individuals are mentally ill." d. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

d. "Between 50 and 80 percent of all people who kill themselves have a history of a previous attempt."

A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of what personality disorder? a. Obsessive-compulsive personality disorder b. Avoidant personality disorder c. Schizotypal personality disorder d. Narcissistic personality disorder

d. Narcissistic personality disorder

The most common side effects of ECT are: a. Permanent memory loss and brain damage b. Fractured and dislocated bones c. Myocardial infarction and cardiac arrest d. Temporary memory loss and confusion

d. Temporary memory loss and confusion

Priority nursing care for a 16 year old Anorexic female would be: a. provide her with extra snacks to stash for later when she might be hungry. b. coaxing her to each as much as she can. c. rewarding her when she increases her caloric intake. d. sitting at the table with her for all meals and for 1 hour after meals.

d. sitting at the table with her for all meals and for 1 hour after meals.

A nurse is assessing a client who, over the past 3 years, has experienced feelings of sadness related to the death of a beloved aunt. The client sleeps and eats little and isolate themselves. How should the nurse interpret the clients behaviors? a. The clients functional impairment indicates a need for psychiatric commitment b. the clients behaviors are part of the normal grief process c. the clients behaviors are not congruent with cultural norms d. the clients functional impairment indicates potential mental illness

d. the clients functional impairment indicates potential mental illness

A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms might the nurse expect to assess? (Select all that apply.) 1. Feelings of guilt that precipitate social isolation 2. Aggressive behavior that affects job performance 3. Relationship problems 4. High levels of anxiety 5. Escalating symptoms lasting less than one month

1, 2, 3, 4

Which of the following nursing evaluations of a client diagnosed with anorexia nervosa would lead the treatment team to consider discharge? Select all that apply. 1. The client participates in individual therapy. 2. The client has a body mass index of 16. 3. The client consumes adequate calories as determined by the dietitian. 4. The client is dependent on mother for most basic needs. 5. The client states, "I realize that I can't be perfect."

1, 3, 5

5. Which intervention takes priority when dealing with a client experiencing Wernicke-Korsakoff syndrome? 1. Monitor parenteral vitamin B1. 2. Increase fluid intake. 3. Provide prenatal vitamins. 4. Encourage foods high in vitamin C.

1. Monitor parenteral vitamin B1.

A nurse encourages an angry client to attend group therapy. Knowing that the client has been diagnosed with a cluster B personality disorder, which client response might the nurse expect? 1. Sarcastically states, "That group is only for crazy people with problems." 2. Scornfully states, "No, can't you see that I'm having a séance with my mom?" 3. Suspiciously states, "No, that room has been bugged." 4. Hesitantly states, "OK, but only if I can sit next to you."

1. Sarcastically states, "That group is only for crazy people with problems."

A client diagnosed with anorexia nervosa has a nursing diagnosis of imbalanced nutrition: less than body requirements. Which long-term outcome indicates that the client's problem has improved? 1. The client's body mass index will be 20 by the 6-month follow-up appointment. 2. The client will be free of signs and symptoms of malnutrition and dehydration. 3. The client will use one healthy coping mechanism during a time of stress by discharge. 4. The client will state an understanding of a previous dependency role by the 3-month follow-up appointment.

1. The client's body mass index will be 20 by the 6-month follow-up appointment.

A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

1. Thyroid-stimulating hormone (TSH) level of 25 U/mL

An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four-point restraints will be applied? 1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions."

2) "Restraints are a means of providing safety for you and others on the unit." It is important to provide safeguards in order to protect clients who are out of control. The nurse is educating the client in a nonjudgmental, objective manner.

16. Order the goals of the levels of prevention as they progress through the public health model set forth by Gerald Caplan. 1. ________ Interventions aimed at minimizing early symptoms of psychiatric illness and directed toward reducing the prevalence and duration of the illness 2. ________ Services aimed at reducing the residual defects that are associated with severe and persistent mental illness 3. ________ Services aimed at reducing the incidence of mental disorders within the population

2, 3, 1

A nurse is working with a client who has just been prescribed buproprion (Wellbutrin). Which statement by the client indicates that further education is necessary? 1. "I will begin using sunblock when outdoors." 2. "If I miss a dose, I will just take two pills the next day to catch up." 3. "I will only discontinue the medication under the guidance of my physician." 4. "I will use caution when driving and using dangerous machinery."

2. "If I miss a dose, I will just take two pills the next day to catch up."

2. Which is a predisposing factor in the diagnosis of autism? 1. Having a sibling diagnosed with mental retardation. 2. Congenital rubella. 3. Dysfunctional family systems. 4. Inadequate ego development.

2. Congenital rubella.

After being treated in the ED for self-inflicted lacerations to wrists and arms, a client with a diagnosis of borderline personality disorder is admitted to the psychiatric unit. Which nursing intervention takes priority? 1. Administer tranquilizing drugs. 2. Observe client frequently. 3. Encourage client to verbalize hostile feelings. 4. Explore alternative ways of handling frustration.

2. Observe client frequently.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia.

2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. Positive symptoms of schizophrenia= paranoid delusions, neologisms, and echolalia. Negative symptoms=flat affect, anhedonia, and anergia. Positive symptoms=distortion of normal functions. Negative symptoms=diminution or loss of normal functions.

A preschool child is admitted to a psychiatric unit with the diagnosis autistic spectrum disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client's plan of care? 1. Encourage and reward peer contact. 2. Provide consistent caregivers. 3. Provide a variety of safe daily activities. 4. Maintain close physical contact throughout the day.

2. Provide consistent caregivers. Rationale: The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autistic spectrum disorder. Children diagnosed with autistic spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security.

A client diagnosed with paranoid personality disorder needs information regarding medications. Which nursing intervention would best assist this client in understanding prescribed medications? 1. Ask the client to join the medication education group. 2. Provide one-on-one teaching in the client's room. 3. During rounds, have the physician ask if the client has any questions. 4. Let the client read the medication information handout.

2. Provide one-on-one teaching in the client's room

30. A child diagnosed with an autistic disorder has a nursing diagnosis of impaired social interaction. The child is currently making eye contact and allowing physical touch.Which of the following statements addresses the evaluation of this child's behavior? 1. The nurse is unable to evaluate this child's ability to interact socially based on the observed behaviors. 2. The child is experiencing improved social interaction as evidenced by making eye contact and allowing physical touch. 3. The nurse is unable to evaluate this child's ability to interact socially because the child has not experienced these behaviors for an extended period. 4. The child's making eye contact and allowing physical touch are indications of improved personal identity, not improved social interaction.

2. The child is experiencing improved social interaction as evidenced by making eye contact and allowing physical touch.

Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder? 1. The child has a history of antisocial behaviors. 2. The child's mother is diagnosed with an anxiety disorder. 3. The child previously had an extroverted temperament. 4. The child's mother and father have an inconsistent parenting style.

2. The child's mother is diagnosed with an anxiety disorder. Some parents instill anxiety in their children by being overprotective or by exaggerating dangers. Research studies speculate that there is a hereditary influence in the development of separation anxiety disorder.

A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

2. The client has experienced auditory hallucinations for the past 3 hours.

Both situational and intrapersonal factors most likely contribute to an individual's stress response. Which factor would a nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

3. Degree of flexibility

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate? 1. "Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications." 2. "Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not." 3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." 4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life."

3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I may experience drowsiness or dizziness while taking this medication." 3. "I do not need to quit smoking." 4. "I will stop drinking alcohol now that I am taking this medication."

3. "I do not need to quit smoking."

A nurse sitting with a client diagnosed with anorexia nervosa notices that the client has eaten 80% of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse? 1. "I'm Italian, so I really enjoy a large plate of spaghetti." 2. "I'll weigh you after your meal." 3. "Let's focus on your continued improvement. You ate 80% of your lunch." 4. "Why do you always talk about food? Let's talk about swimming."

3. "Let's focus on your continued improvement. You ate 80% of your lunch."

An instructor is teaching a nursing student facts related to clients diagnosed with a personality disorder. Which student statement indicates that learning has occurred? 1. "Clients diagnosed with personality disorders need frequent hospitalizations 2. "Clients perceive their behaviors as uncomfortable and disorganized." 3. "Personality disorders cannot be cured or controlled successfully with medication." 4. "Practitioners have a good understanding about the etiology of personality disorders."

3. "Personality disorders cannot be cured or controlled successfully with medication."

An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3. "Rise slowly when you change position from lying to sitting or sitting to standing." Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension.

13. An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3. "Rise slowly when you change position from lying to sitting or sitting to standing." The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension.

Which medication is used most often in the treatment of clients diagnosed with anorexia nervosa? 1. Fluphenazine decanoate (Prolixin Decanoate). 2. Clozapine (Clozaril). 3. Fluoxetine (Prozac). 4. Methylphenidate (Ritalin).

3. Fluoxetine (Prozac).

A client's altered body image is evidenced by claims of "feeling fat," even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will perceive personal ideal body weight and shape as normal. 4. The client will not express a preoccupation with food.

3. The client will perceive personal ideal body weight and shape as normal.

11. The nursing instructor is preparing to teach nursing students about oppositional defiant disorder (ODD). Which fact should be included in the lesson plan? 1. Prevalence of ODD is higher in girls than in boys. 2. The diagnosis of ODD occurs before the age of 3. 3. The diagnosis of ODD occurs no later than early adolescence. 4. The diagnosis of ODD is not a developmental antecedent to conduct disorder.

3. The diagnosis of ODD occurs no later than early adolescence.

2. The nurse is assessing a client diagnosed with borderline personality disorder. According to Mahler's theory of object relations, which describes the client's unmet developmental need? 1. The need for survival and comfort. 2. The need for awareness of an external source for fulfillment. 3. The need for awareness of separateness of self. 4. The need for internalization of a sustained image of a love object/person.

3. The need for awareness of separateness of self. Phase 3 (5 to 36 months)

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

4. Depressed mood, tearfulness, and hopelessness

6. Which developmental characteristic would be expected of an individual with an IQ level of 40? 1. Independent living with assistance during times of stress. 2. Academic skill to 6th grade level. 3. Little, if any, speech development. 4. Academic skill to 2nd grade level.

4. Academic skill to 2nd grade level.

A male client diagnosed with a personality disorder boasts to the nurse that he has to fight off female attention and is the highest paid in his company. These statements are reflective of which personality disorder? 1. Obsessive-compulsive personality disorder. 2. Passive-aggressive personality disorder. 3. Schizotypal personality disorder. 4. Narcissistic personality disorder.

4. Narcissistic personality disorder.

Match the treatment goal with the appropriate medication. Alcohol abstinence? 1. Methadone (Dolophine) 2. Naloxone (Narcan) 3. Bupropion (Zyban) 4. Chlordiazepoxide (Librium) 5. Disulfiram (Antabuse)

5. Disulfiram (Antabuse)

A client diagnosed with depression and substance abuse has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? Select one: a. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. b. Sedative-hypnotics are expensive and have numerous side effects. c. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. d. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

A The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological dependence.

A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? Select one: a. Psychological dependency b. Physical dependency c. Substance dependency d. Social dependency

A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort.

Dan, who has been admitted to the alcohol rehab unit after being fired for "drinking on the job", states "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my co-workers." The defense mechanism that Dan is using is: A) Denial B) Projection C) Displacement D) Rationalization

A) Denial

Mr. White is admitted to the hospital after and extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Lab reports reveal he has a blood alcohol level of 250mg/dL. He is placed on a chemical dependency unit for detoxification. When would the 1st signs of alcohol withdrawal symptoms be expected to occur? A) Several hours after the last drink B) 2-3 days after the last drink C) 4-5 days after the last drink D) 6-7 hours after the last drink

A) Several hours after the last drink

Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

A. "We've discussed past coping skills. Let's see if these coping skills can be effective now."

A client is experiencing a panic attack. The nurse can be most therapeutic by A. telling the client to take slow, deep breaths. B. verbalizing mild disapproval of the anxious behavior. C. asking the client what he means when he says "I am dying." D. offering an explanation about why the symptoms are occurring

A. telling the client to take slow, deep breaths. Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.

8. During a group discussion, members freely interact with each other. Which member statement is an example of Yalom's curative group factor of imparting information? A. "I found a Web site explaining the different types of brain tumors and their treatment." B. "My brother also had a brain tumor and now is completely cured." C. "I understand your fear and will be by your side during this time." D. "My mother was also diagnosed with cancer of the brain."

ANS: A Yalom's curative group factor of imparting information involves sharing knowledge gained through formal instruction as well as by the sharing of advice and suggestions by other group members. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100 mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense? A. 25 mL B. 20 mL C. 15 mL D. 10 mL

ANS: C Twenty mg of Prozac multiplied by three results in the calculated 60 mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL.

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? A) Increased heart rate and blood pressure B) Tremors, insomnia, and seizures C) Incoordination and unsteady gait D) Nausea and vomiting, diarrhea, and diaphoresis

ANSWER: D D) Nausea and vomiting, diarrhea, and diaphoresis

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority? Select one: a. Tactile hallucinations b. Blood pressure of 180/100 mm Hg c. Mood rating of 2/10 on numeric scale d. Dehydration

B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol abuse.

The defense mechanisms that can only be used in healthy ways include A. suppression and humor. B. altruism and sublimation. C. idealization and splitting D. reaction formation and denial.

B altruism and sublimation. Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.

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

B. Stimulation and anesthetic effects Cocaine exerts two main effects on the body, both anesthetic and stimulant.

An important question to ask during the assessment of a client diagnosed with anxiety disorder is A. "How often do you hear voices?" B. "Have you ever considered suicide?" C. "How long has your memory been bad?" D. "Do your thoughts always seem jumbled?"

B."Have you ever considered suicide?" Correct The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any client with higher levels of anxiety.

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

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

Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because: A. Jerry may become addicted faster than younger patients. B. Jerry is at risk for falls. C. Jerry has a history of nonadherence with medications. D. Jerry should be treated with cognitive therapies rather than medication because of his advanced age.

B.Jerry is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a patient who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly patients become addicted faster than younger patients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels. Cognitive Level: Apply (Application) Nursing Process: Implementation NCLEX: Physiological Integrity

Neuroimaging brain studies in children with Tourette's disorder have been consistent in finding dysfunction in what area of the brain?

Basal ganglia

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

C. "Most over-the-counter cough syrups are safe for me to use." The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol.

7. A newly admitted homeless client diagnosed with schizophrenia states, "I have been living in a cardboard box for two weeks. Why did the government let me down?" Which is an appropriate nursing response? A. "Your discharge from the state hospital was done prematurely. Had you remained in the state hospital longer, you would not be homeless. "B. "Your premature discharge from the state hospital was not intended for patients diagnosed with chronic schizophrenia. C. "Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success.

C. "Your discharge from the state hospital was based on firm principles; however, the resources were not available to make the transition a success.

12. A client is experiencing a severe panic attack. Which nursing intervention would meet this client's immediate need? A. Teach deep breathing relaxation exercises B. Place the client in a Trendelenburg position C. Stay with the client and offer reassurance of safety D. Administer the ordered prn buspirone (BuSpar)

C. Stay with the client and offer reassurance of safety

25. A client diagnosed with generalized anxiety states, "I know the best thing for me to do now is to just forget my worries." How should the nurse evaluate this statement? A. The client is developing insight. B. The client's coping skills are improving. C. The client has a distorted perception of problem resolution. D. The client is meeting outcomes and moving toward discharge.

C. The client has a distorted perception of problem resolution.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to A. ascertain how long ago the trauma occurred. B. find out if the client uses acting-out behavior. C. determine use of chemical substances for anxiety relief. D. establish whether the client has chronic hypertension related to high anxiety.

C. determine use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

5. When intervening with a married couple experiencing relationship discord, which nursing action reflects an intervention at the secondary level of prevention? A. Teaching assertiveness skills in order to meet assessed needs B. Supplying the couple with guidelines related to marital seminar leadership C. Teaching the couple about various methods of birth control D. Counseling the couple related to open and honest communication skills

D. Counseling the couple related to open and honest communication skills

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

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

What do you see in a controlled response pattern?

Feelings are masked or hidden, person is calm, composed, or a subdued affect is seen

Which of the following nursing interventions fall within the standards of psychiatric mental health clinical nursing practice for a nurse generalist? (Select all that apply.) a. Assist the client to perform activities of daily living. b. Consult with other clinicians to provide services for clients and effect system change. c. Encourage the client to discuss triggers for relapse. d. Use prescriptive authority in accordance with state and federal laws. e. Educate the family about signs and symptoms of alcohol dependence and withdrawal.

a, c, e a. Assist the client to perform activities of daily living. c. Encourage the client to discuss triggers for relapse. e. Educate the family about signs and symptoms of alcohol dependence and withdrawal.

A decrease in which of the following neurotransmitters has been implicated in depression? a. GABA, acetylcholine, and asparate b. Norepinephrine, serotonin, and dopamine c. Somatostatin, substance P, and glycine d. Glutamate, histamine, and opioid peptides

b. Norepinephrine, serotonin, and dopamine

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? a. Haloperidol (Haldol) to address the negative symptom. b. Clonazepam (Klonopin) to address the positive symptom. c. Risperidone (Risperdal) to address the positive symptom. d. Clozapine (Clozaril) to address the negative symptom.

c. Risperidone (Risperdal) to address the positive symptom. listening to unseen others is an example of experiencing an auditory hallucination which is a positive symptom and Risperidone is an antipsychotic medication for this purpose.

A kindergarten student is frequently violent towards other children. A school nurse notices bruises and burns on a child's face and arms. What other symptoms should indicate to the nurse that the child may have been physically abused? a. The child is frequently absent from school. b. The child begs or steals food or money. c. The child is delayed in physical and emotional development. d. The child shrinks at the approach of adults.

d. The child shrinks at the approach of adults.

An older, emaciated client is brought to an emergency department by the client's caregiver. The client has bruises and abrasions on shoulders and back in multiple stages of healing. When directly asked about these symptoms, which type of client response should a nurse anticipate? a. The client may have forgotten what caused the injuries. b. The client will ask to be placed in a nursing home. c. The client will honestly reveal the nature of the injuries. d. The client may deny or minimize the injuries.

d. The client may deny or minimize the injuries.

The nurse is assessing a patient who is diagnosed with obsessive-compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion? 1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done."

1) "I can't stop washing my hands." A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior.

Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply. 1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins

1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education

Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following? 1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution

1) Cognitive distortion Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions. Sublimation - channels unacceptable impulses into activities that are more tolerable or constructive.

A nurse is conducting an assessment in the emergency department with a patient who is diagnosed with schizophrenia and is expressing paranoid ideation. Which of the following actions would promote the development of a trusting relationship with this patient? Select all that apply. 1) Conveying a sense of interest in hearing the patient's concerns, even when he expresses delusional thinking. 2) Gently touching the patient's shoulder and telling him that everyone on the team is on his side. 3) Observing the patient but minimizing communication since communication with a patient who is experiencing paranoia will only worsen the problem. 4) Simply and clearly providing reasons for interventions being conducted by the nurse. 5) Being reliable in following through with interventions that have been communicated to the patient.

1) Conveying a sense of interest in hearing the patient's concerns, even when he expresses delusional thinking. 4) Simply and clearly providing reasons for interventions being conducted by the nurse. 5) Being reliable in following through with interventions that have been communicated to the patient. Feedback 1: Conveying a sense of warmth and caring is essential to establishing trust. Feedback 2: Use of touch with a patient who is acutely paranoid may be interpreted as a threat and could interfere with development of trust, so this action should be avoided. Feedback 3: Trust cannot be developed by avoiding communication with a patient, and the patient's perception that people are avoiding him could increase his suspiciousness. Feedback 4: Providing clear instructions and reasons for interventions conveys a desire to be open and honest. Both of these traits promote development of trust. Feedback 5: Following through with things that have been promised to the patient conveys reliability, and this is an important trait in establishing trust.

Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders? 1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms. 3) Use behavioral therapies such as systematic desensitization and implosion. 4) Conduct psychological tests to support proper diagnosis of the anxiety disorder.

1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. Self-awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. The nurse generalist plays a key role in helping clients develop this awareness and insight.

Which characteristic is most essential for the nurse to communicate when establishing a trusting therapeutic nurse-client relationship? 1) Genuineness 2) Confrontation 3) Catharsis 4) Giving advice

1) Genuineness Genuineness is a characteristic that involves honesty and sincerity. It is the basis for the establishment of trust in a therapeutic nurse-client relationship. Confrontation is a technique that the nurse may use to present the reality of a situation that the client may wish to avoid. This should not be used until a trusting therapeutic relationship has been established. Catharsis is a curative factor of group therapy in which a client expresses both positive and negative feelings in a nonthreatening atmosphere. This should not be used until a trusting therapeutic relationship has been established. Giving advice is a nontherapeutic communication blocker. It encourages client dependence and may impede the establishment of a trusting nurse-client relationship.

Which of the following are steps of the problem-solving model that a nurse uses in the context of a therapeutic relationship? Select all that apply. 1) Identifying and defining the problem 2) Identifying alternative solutions to the problem 3) Weighing advantages and disadvantages of each alternative 4) Trying all alternatives before making final decisions 5) Selecting an alternative

1) Identifying and defining the problem 2) Identifying alternative solutions to the problem 3) Weighing advantages and disadvantages of each alternative 5) Selecting an alternative Feedback 1: Identifying and defining the problem is the first step in the problem-solving model. Correct identification of a problem determines all other problem-solving actions. Feedback 2: Identifying alternative solutions to a problem is the next step of the problem-solving process. Exploring practical and achievable solutions is a step toward problem resolution. Feedback 3: Weighing advantages and disadvantages of chosen actions is a step in the problem-solving process that presents the reality of potential outcomes. Exploring these outcomes will help the client look realistically at potential risks and benefits of alternatives. Feedback 4: Trying all alternatives before making final decisions is not part of the problem-solving process. It would be impractical and time consuming to try all alternatives. Decisions need to be made after weighing all choices. Feedback 5: Selecting an alternative is a step in the problem-solving process. After weighing advantages and disadvantages of options, a choice should be made and then later evaluated.

After losing a child in a car accident, a client diagnosed with post-traumatic stress disorder (PTSD) asks the nurse, "Why did I live and my beautiful daughter die?" Which is the client experiencing? 1) Survivor's guilt 2) Anger 3) Denial 4) Suppression

1) Survivor's guilt The statement presented in the question indicates that the client is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others die and the individual survives.

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? 1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming

1) That there is a potential for dependence and tolerance Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.

As a last resort, an agitated, physically aggressive client is placed in four-point restraints. The client yells, "I'll sue you for assault and battery!" The unit manager determines that the nurses are protected under which condition? 1) The client is voluntarily committed and poses a danger to others on the unit. 2) The client is voluntarily committed and has a history of being a danger to others. 3) The client is involuntarily committed because of a history of violent behavior. 4) The client is involuntarily committed and is refusing treatment.

1) The client is voluntarily committed and poses a danger to others on the unit.

Which is the primary nursing goal when establishing a therapeutic relationship with a client? 1) To promote client growth 2) To develop the nurse's personal identity 3) To establish a purposeful social interaction 4) To develop communication skills

1) To promote client growth The goal of a therapeutic nursing interaction is to promote client insight and behavioral change directed toward client growth. The client is the primary focus of the nurse-client relationship. The purpose of the therapeutic relationship is to meet the needs of the client, not the nurse. The nurse must maintain professionalism and discourage social interactions with clients. The nature of the nurse-client relationship is therapeutic, not social. Developing communication skills is an important nursing intervention. The primary goal of establishing a therapeutic relationship with a client, however, is broader in nature and includes any area requiring client growth.

A 60-year-old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply. 1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status

1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) 1. Binge eating with a diagnosis of obesity 2. Bingeing and purging with a diagnosis of bulimia nervosa 3. Weight loss with a diagnosis of anorexia nervosa 4. Amenorrhea with a diagnosis of anorexia nervosa 5. Emaciation with a diagnosis of bulimia nervosa

1, 2

Which of the following rationales by a nurse explain to parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.)\ 1.Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2.Children are naturally active, energetic, and spontaneous. 3.Neurotransmitter levels vary considerably in accordance with age. 4.The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5.Genetic predisposition is not a reliable diagnostic determinant.

1, 2

A client diagnosed with an adjustment disorder says to the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing responses? (Select all that apply.) 1. "Medications can interfere with your ability to find a more permanent solution." 2. "Medications may mask the real problem at the root of this diagnosis." 3. "Adjustment disorders are not commonly treated with medications." 4. "Psychoactive drugs carry the potential for physiological and psychological dependence." 5. "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

1, 2, 3, 4

A client diagnosed with borderline personality disorder is admitted to a psychiatric unit with recent self-inflicted cuts to both arms. Which of the following would explain this behavior? Select all that apply. 1. Self-mutilation is a manipulative gesture designed to elicit a rescue response. 2. Self-mutilation is often attempted when a "safety" plan has been established. 3. Self-mutilation proposes that feeling pain is better than feeling nothing. 4. Self-mutilation results from feelings of abandonment following separation from significant others. 5. Self-mutilation is attempted when voices tell the client to do self-harm.

1, 2, 3, 4

A 15-year-old client living in a residential facility has a nursing diagnosis of ineffective coping R/T abuse AEB defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply. 1. Set limits on manipulative behavior. 2. Refuse to engage in controversial and argumentative encounters. 3. Obtain an order for tranquilizing medications. 4. Encourage the discussion of angry feelings. 5. Remove all dangerous objects from the client's environment.

1, 2, 4

A nurse recognizes which of the following as the best predictors of PTSD in Vietnam veterans? (Select all that apply.) 1. The severity of the stressor 2. The degree of ego strength 3. The degree of psychosocial isolation in the recovery environment 4. The attitudes of society regarding the experience 5. The presence of preexisting psychopathology

1, 3

Walt is admitted to the forensic psychiatry unit after assaulting a store clerk for waiting on another customer before him. He says the store clerk deserved to be hit "for being an idiot." He has previously been diagnosed with antisocial personality disorder and his current nursing diagnosis is defensive coping. Which of the following are recommended approaches in intervention for this diagnosis? Select all that apply. 1) Explain the rules of the unit and consequences for violation of the rules. 2) Offer special privileges to facilitate a bond of trust. 3) Use a matter-of-fact approach in communication.4) Provide positive feedback and rewards for acceptable behavior. 5) Repeatedly reinforce that antisocial people are a danger to society.

1, 3, 4,

A nursing instructor is teaching about the DSM-5 criteria for the diagnosis of binge-eating disorder. Which of the following student statements indicates that further instruction is needed? (Select all that apply.) 1. "In this disorder, binge eating occurs exclusively during the course of bulimia nervosa." 2. "In this disorder, binge eating occurs, on average, at least once a week for three months." 3. "In this disorder, binge eating occurs, on average, at least two days a week for six months." 4. "In this disorder, distress regarding binge eating is present." 5. "In this disorder, distress regarding binge eating is absent."

1, 3, 5

According to the DSM-IV-TR, which of the following diagnostic criteria define avoidant personality disorder? Select all that apply. 1. Does not form intimate relationships because of fear of being shamed or ridiculed. 2. Has difficulty making everyday decisions without reassurance from others. 3. Is unwilling to be involved with people unless certain of being liked. 4. Shows perfectionism that interferes with task completion. 5. Views self as socially inept, unappealing, and inferior.

1, 3, 5

Although there are differences among the three personality disorder clusters, there also are some traits common to all individuals diagnosed with personality disorders. Which of the following are common traits? Select all that apply. 1. Failure to accept the consequences of their own behavior. 2. Self-injurious behaviors. 3. Reluctance in taking personal risks. 4. Copes by altering environment instead of self. 5. Lack of insight.

1, 4, 5

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." 3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." Rationale: The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and the related symptoms.

The instructor is teaching nursing students about the psychodynamic influences of eating disorders. Which statement indicates that more teaching is necessary? 1. "Eating disorders result from very early and profound disturbances in father-infant interactions." 2. "Disturbances in mother-infant interactions result in retarded ego development." 3. "When the mother responds to the physical and emotional needs of the child by providing food, it contributes to ego development alterations." 4. "Poor self-image contributes to a perceived lack of control. The client compensates for this perceived lack of control by controlling behaviors related to eating.

1. "Eating disorders result from very early and profound disturbances in father-infant interactions."

28. A client diagnosed with oppositional defiant disorder has an outcome of learning new coping skills through behavior modification. Which client statement indicates that behavioral modification has occurred? 1. "I didn't hit Johnny. Can I have my Tootsie Roll?" 2. "I want to wear a helmet like Jane wears." 3. "Can I watch television after supper?" 4. "I want a puppy right now."

1. "I didn't hit Johnny. Can I have my Tootsie Roll?"

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

1. "I know it's frightening, but try to remind yourself that this will only last a short time." Panic attacks usually last minutes but can, rarely, last hours. When the nurse states that "Most people who experience panic attacks..." the nurse depersonalizes and belittles the client's feeling

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 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 geriatric nurse is teaching the client's family about the possible cause of delirium. Which statement by the nurse is most accurate? 1. "Taking multiple medications may lead to adverse interactions or toxicity." 2. "Age-related cognitive changes may lead to alterations in mental status." 3. "Lack of rigorous exercise may lead to decreased cerebral blood flow." 4. "Decreased social interaction may lead to profound isolation and psychosis."

1. "Taking multiple medications may lead to adverse interactions or toxicity." Rationale: The nurse should identify that taking multiple medications that may lead to adverse reactions or toxicity is a risk factor for the development of delirium in older adults. Symptoms of delirium include difficulty sustaining and shifting attention. The client with delirium is disoriented to time and place and may also have impaired memory.

A nursing instructor presents a case study in which a three-year-old child is in constant motion and is unable to sit still during story time. She asks a student to evaluate this child's behavior. Which student response indicates an appropriate evaluation of the situation? 1. "This child's behavior must be evaluated according to developmental norms." 2. "This child has symptoms of attention deficit-hyperactivity disorder." 3. "This child has symptoms of the early stages of autistic disorder." 4. "This child's behavior indicates possible symptoms of oppositional defiant disorder."

1. "This child's behavior must be evaluated according to developmental norms." Rationale: The student's evaluation of the situation is appropriate when indicating a need for the client to be evaluated according to developmental norms. The DSM-5 indicates that emotional problems exist if the behavioral manifestations are not age-appropriate, deviate from cultural norms, or create deficits or impairments in adaptive functioning.

A client diagnosed recently with AD is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which is the appropriate nursing response? 1. "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 2. "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." 3. "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." 4. "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

1. "This medication delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." Rationale: The most appropriate response by the nurse is to explain that donepezil delays the destruction of acetylcholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the AD. Some side effects include dizziness, headache, gastrointestinal upset, and elevated transaminase.

A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response? 1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions." 2. "Your child's hallucinations are caused by medication interactions." 3. "Your child has too little serotonin in the brain, causing delusions and hallucinations." 4. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions."

6. Which of the following are reasons for the success of 12-step programs such as Alcoholics Anonymous (AA)? Select all that apply. 1. 12-step programs break down denial in an atmosphere of support. 2. 12-step programs give clients a sense of community. 3. 12-step programs help clients recognize the power they have over their addiction. 4. 12-step programs provide clients with experts in the field of addiction. 5. 12-step programs provide sponsors who acclimate clients back into social settings.

1. 12-step programs break down denial in an atmosphere of support. 2. 12-step programs give clients a sense of community.

Which of the following medications that have been known to precipitate delirium? (Select all that apply.) 1. Antineoplastic agents 2. H2-receptor antagonists 3. Antihypertensives 4. Corticosteroids 5. Lipid-lowering agents

1. Antineoplastic agents 2. H2-receptor antagonists 3. Antihypertensives 4. Corticosteroids ANS: 1, 2, 3, 4 Rationale: Medications that have been known to precipitate delirium include anticholinergics, antihypertensives, corticosteroids, anticonvulsants, cardiac glycosides, analgesics, anesthetics, antineoplastic agents, antiparkinson drugs, H2-receptor antagonists (e.g., cimetidine), and others. There have been no reports of delirium ascribed to the use of lipid-lowering agents.

A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like that mean nurse who never lets us stay up later than 9 p.m." This statement would be associated with which personality disorder? 1. Borderline personality disorder. 2. Schizoid personality disorder. 3. Passive-aggressive personality disorder. 4. Paranoid personality disorder.

1. Borderline personality disorder.

A client diagnosed with a personality disorder states, "You are the very best nurse on the unit and not at all like that mean nurse who never lets us stay up later than 9 p.m." This statement would be associated with which personality disorder? 1. Borderline personality disorder. 2. Schizoid personality disorder. 3. Dependent personality disorder. 4. Paranoid personality disorder.

1. Borderline personality disorder.

A nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement delineates the difference between these two disorders? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not

1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

A client diagnosed with obsessive-compulsive personality disorder is admitted to a psychiatric unit in a highly agitated state. The physician prescribes a benzodiazepine. Which medication is classified as a benzodiazepine? 1. Clonazepam (Klonopin). 2. Lithium carbonate (lithium). 3. Clozapine (Clozaril). 4. Olanzapine (Zyprexa).

1. Clonazepam (Klonopin).

A client diagnosed with antisocial personality disorder is caught smuggling cigarettes into the nonsmoking clinical 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 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 husband has agreed to admit his spouse, diagnosed with Alzheimer's disease (AD), to a long-term care facility. He is expressing feelings of guilt and symptoms of depression. Which appropriate nursing diagnosis and subsequent intervention would the nurse document? 1. Dysfunctional grieving; AD support group 2. Altered thought process; AD support group 3. Major depressive episode; psychiatric referral 4. Caregiver role strain; psychiatric referral

1. Dysfunctional grieving; AD support group

Which of the following diagnostic criteria describe the characteristics of avoidant personality disorder? Select all that apply. 1. Fearing shame and/or ridicule, does not form intimate relationships. 2. Has difficulty making everyday decisions without reassurance from others. 3. Is unwilling to be involved with people unless certain of being liked. 4. Shows perfectionism that interferes with task completion. 5. Views self as socially inept, unappealing, and inferior.

1. Fearing shame and/or ridicule, does not form intimate relationships. 3. Is unwilling to be involved with people unless certain of being liked. 5. Views self as socially inept, unappealing, and inferior.

Which of the following conditions have been known to precipitate delirium in some individuals? (Select all that apply.) 1. Febrile illness 2. Seizures 3. Migraine headaches 4. Herniated brain stem 5. Temporomandibular joint syndrome

1. Febrile illness 2. Seizures 3. Migraine headaches ANS: 1, 2, 3 Rationale: Delirium most commonly occurs in individuals with serious medical, surgical, or neurological conditions. Some examples of conditions that have been known to precipitate delirium in some individuals include the following: systemic infections; febrile illness; metabolic disorders, such as hypoxia, hypercarbia, or hypoglycemia; hepatic encephalopathy; head trauma; seizures; migraine headaches; brain abscess; stroke; postoperative states; and electrolyte imbalance. A herniated brain stem would most likely result in death, not delirium. Temporomandibular joint syndrome is marked by limited movement of the joint during chewing, not delirium.

17. Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

1. Group therapy plays an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder. 2. Medication management plays an integral part of rehabilitative programs for clients 4. A supportive family therapy plays an integral part of rehabilitative programs 5. Social skills training plays an integral part of rehabilitative programs

For the past 3 days, a student has skipped classes, cried constantly, and experienced panic attacks. She is now exhibiting difficulty with short-term memory. What crucial information should the nurse initially obtain prior to planning interventions for this student? 1) The student's description of the precipitating stressor 2) The student's usual ability to cope with stress 3) The student's available support system 4) The student's access to community resources

1. It is important to assess the precipitating stressor that led to the student's behavioral symptoms. This information will be crucial when planning client care.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an ED with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium) 2. Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication 3. Dystonia treated by administering trihexyphenidyl (Artane) 4. Dystonia treated by administering bromocriptine (Parlodel)

1. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium) Neuroleptic malignant syndrome is a potentially fatal condition characterized by rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics because they ha

Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

1. On his or her side, to prevent aspiration

Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? 1.PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2.AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events. 3.Depressive symptoms occur in PTSD and not in AD. 4.Depressive symptoms occur in AD and not in PTSD.

1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events.

1. Which is a description of the etiology of autism from a genetic perspective? 1. Parents who have one child diagnosed with autism are at higher risk for having other children with the disorder. 2. Amygdala abnormality in the anterior portion of the temporal lobe is associated with the diagnosis of autism. 3. Decreased levels of serotonin have been found in individuals diagnosed with autism. 4. Congenital rubella is implicated in the predisposition to autistic disorders.

1. Parents who have one child diagnosed with autism are at higher risk for having other children with the disorder.

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation? 1. Psychological addiction 2. Physical addiction 3. Substance induced disorder 4. Social induced disorder

1. Psychological addiction A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure or avoid discomfort.

4. A client diagnosed with bipolar disorder: depressive episode intentionally overdoses on sertraline (Zoloft). Family members report that the client has experienced anorexia, insomnia, and recent job loss. Which nursing diagnosis should a nurse prioritize? 1. Risk for suicide R/T hopelessness 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T loss of employment

1. Risk for suicide R/T hopelessness

A 15 year-old client living in a residential facility has a nursing diagnosis of ineffective coping R/T abuse AEB defiant responses to adult rules. Which of the following interventions would address this nursing diagnosis appropriately? Select all that apply. 1. Set limits on manipulative behavior. 2. Refuse to engage in controversial and argumentative encounters. 3. Obtain an order for tranquilizing medications. 4. Encourage the discussion of angry feelings. 5. Remove all dangerous objects from the client's environment.

1. Set limits on manipulative behavior. 2. Refuse to engage in controversial and argumentative encounters. 4. Encourage the discussion of angry feelings.

A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? 1. Sore throat, fever, and malaise 2. Akathisia and hypersalivation 3. Akinesia and insomnia 4. Dry mouth and urinary retention

1. Sore throat, fever, and malaise Rationale: The nurse should intervene immediately if the client experiences signs of an infectious process, such as a sore throat, fever, and malaise, when taking the atypical antipsychotic drug clozapine. Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur, leading to infection.

Which behavior would the nurse expect to observe if a client is diagnosed with paranoid personality disorder? 1. The client sits alone at lunch and states, "Everyone wants to hurt me." 2. The client is irresponsible and exploits other peers in the milieu for cigarettes. 3. The client is shy and refuses to talk to others because of poor self-esteem. 4. The client sits with peers and allows others to make decisions for the entire group.

1. The client sits alone at lunch and states, "Everyone wants to hurt me."

Which scenario would the nurse expect to observe if the client were diagnosed with paranoid personality disorder? 1. The client sits alone at lunch and states, "Everyone wants to hurt me." 2. The client is irresponsible and exploits other peers in the milieu for cigarettes. 3. The client is shy and refuses to talk to others because of poor self-esteem. 4. The client sits with peers and allows others to make decisions for the entire group.

1. The client sits alone at lunch and states, "Everyone wants to hurt me."

20. A client diagnosed with moderate mental retardation suddenly refuses to participate in supervised hygiene care. Which short-term outcome would be appropriate for this individual? 1. The client will comply with supervised hygiene by day 3. 2. The client will be able to complete hygiene without supervision by day 3. 3. The client will be able to maintain anxiety at a manageable level by day 2. 4. The client will accept assistance with hygiene by day 2.

1. The client will comply with supervised hygiene by day 3.

18. The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) 1. Hyperthyroidism 2. Hypothyroidism 3. Hyperadrenalism 4. Hypoadrenalism 5. Hyperaphia

1. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders such as hyperthyroidism. 2. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypothyroidism. 3. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hyperadrenalism. 4. The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders, such as hypoadrenalism.

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? 1. The pharmacological action of Ritalin causes a decrease in appetite. 2. Hyperactivity seen in ADHD causes increased caloric expenditure. 3. Side effects of Ritalin cause nausea, and, therefore, caloric intake is decreased. 4. Increased ability to concentrate allows the client to focus on activities rather than food.

1. The pharmacological action of Ritalin causes a decrease in appetite. Rationale: The pharmacological action of Ritalin causes a decrease in appetite, which often leads to weight loss. Methylphenidate is a central nervous symptom stimulant that serves to increase attention span, control hyperactive behaviors, and improve learning ability.

Which symptoms should the nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1.Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2.Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3.Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4.Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

1.Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not.

A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. by the end of the week?" 1.Provide client with high-calorie finger foods throughout the day. 2.Accompany client to cafeteria to encourage adequate dietary consumption. 3.Initiate total parenteral nutrition to meet dietary needs. 4.Teach the importance of a varied diet to meet nutritional needs.

1.Provide client with high-calorie finger foods throughout the day.

A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented? 1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals.

2) Assess the client for organic causes of paralysis. The causative agent of the paralysis must first be identified, prior to any verbalization of feelings. Physical cause must be ruled out prior to assuming psychological involvement.

A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply. 1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

2) Exposure to the phobic stimulus provokes an immediate anxiety response. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

For the past year, a college student continually and unrealistically worries about academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis? 1) Post-traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive-compulsive disorder (OCD)

2) Generalized anxiety disorder (GAD) GAD excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety is generalized rather than specific & not associated with a specific object, as in phobia, or event, as in PTSD.

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply. 1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

2) Reduce stimuli in the immediate environment. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess? 1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span

2) Sweating and palpitations Intense fear and helplessness are cognitive, not physical, symptoms of a panic attack. Physical symptoms of a panic attack include sweating and palpitations.

Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply. 1) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely.

2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety.

The home health nurse has developed a close relationship with a depressed patient that she has been seeing for the past three months. Which of the following behaviors by the nurse are indications that professional boundaries have been jeopardized? Select all that apply. 1) The nurse touches the patient's hand when the patient is crying about the death of her spouse. 2) The nurse shares concerns with the patient about how short-staffed they are at the home health agency and reflects that her boss never listens to her concerns. 3) The nurse offers to take the patient out to lunch on her day off to encourage her to meet her nutritional needs. 4) The nurse takes over the management of the patient's checking account, including making deposits and withdrawals, because the patient states she lacks the energy to do it herself. 5) The nurse accepts a small cash gift from the patient, who states she is just grateful that the nurse has helped her with her finances.

2) The nurse shares concerns with the patient about how short-staffed they are at the home health agency and reflects that her boss never listens to her concerns. 3) The nurse offers to take the patient out to lunch on her day off to encourage her to meet her nutritional needs. 4) The nurse takes over the management of the patient's checking account, including making deposits and withdrawals, because the patient states she lacks the energy to do it herself. 5) The nurse accepts a small cash gift from the patient, who states she is just grateful that the nurse has helped her with her finances. Feedback 1: Caring touch can provide comfort and encouragement and is appropriate in this case as long as the patient does not express discomfort with touch. Feedback 2: Sharing personal or work concerns with a client is focusing on the nurse's needs rather than the patient's and jeopardizes professional boundaries. Feedback 3: Spending time with a patient outside of scheduled work hours is a breach of professional boundaries. Feedback 4: Managing a patient's personal affairs is beyond the scope of the professional nurse-patient relationship and is a boundary violation. Feedback 5: Accepting financial gifts from patients is considered a violation of professional boundaries and is an ethical concern as well.

The nurse, Robert, is conducting a relaxation group for patients at the mental health center who have been identified as struggling with anxiety disorders. He intends to implement a quality improvement initiative by using an anxiety screening tool to evaluate whether patients report less anxiety at the completion of the program. Which of these would be accepted, reliable tools for that purpose? Select all that apply. 1) Cosmopolitan's "How anxious are you?" quiz. 2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory 5) Folstein's Mini-Mental Status Exam

2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory

Oliver has been referred by his boss to the employee assistance program because of difficulties that have arisen in his relationships with coworkers. During the nurse's intake assessment, which of the following statements by Oliver are consistent with a diagnosis of paranoid personality disorder? Select all that apply. 1) "I work very hard at my job." 2) "I stay away from my co-workers because they'd love to see me fail." 3) "I would have my boss' job if administration promoted people fairly." 4) "I set a trap in my office so I can tell if my coworkers have opened my file cabinets." 5) "I feel bad for my boss, he's been so stressed this last year."

2, 3, 4

A family asks the nurse why their son was diagnosed with PTSD and others in the accident were not. Which of the following information should the nurse offer? (Select all that apply.) 1. An individual's religious affiliation can affect response to trauma. 2. Responses are affected by how an individual handled previous trauma. 3. Protectiveness of family and friends can help an individual deal with trauma. 4. Control over the possibility of recurrence can affect the response to trauma. 5. The time in which the trauma occurred can affect the individual's response.

2, 3, 4, 5

A client diagnosed with posttraumatic stress disorder (PTSD) states, "Why did my doctor prescribe an antidepressant rather than an antianxiety drug for me?" Which of the following are the most appropriate nursing responses? (Select all that apply.) 1. "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD." 2. "Antidepressants are now considered first-line treatment choice for PTSD." 3. "Many people have adverse reactions to antianxiety drugs." 4. "Because of their addictive properties, antianxiety drugs are less desirable." 5. "There have been no controlled studies on the effect of antianxiety drugs on PTSD."

2, 4, 5

A client receiving EMDR therapy says, "After only two sessions of my therapy, I am feeling great. Now I can stop and get on with my life." Which of the following nursing responses is most appropriate? 1. "I am thrilled that you have responded so rapidly to EMDR." 2. "To achieve lasting results, all eight phases of EMDR must be completed." 3. "If I were you, I would complete the EMDR and comply with doctor's orders." 4. "How do you feel about continuing the therapy?"

2. "To achieve lasting results, all eight phases of EMDR must be completed."

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI."

2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis."

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." 3. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

2. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve."

After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

2. "How many packs of cigarettes do you smoke daily?" Rationale: Imipramine is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect. Alcohol potentiates the effects of antidepressants. Tyramine is only an issue when MAOI medications are prescribed. Concomitant use of St. John's wort and SSRIs, not tricyclics, increases, not decreases the effects of the drug.

10. The nurse is planning a teaching session for a client who has recently been prescribed disulfiram (Antabuse) as deterrent therapy for alcohol use disorder. What statement indicates that the client has accurate knowledge of this subject matter? 1. "Over-the-counter cough and cold medication should not affect me while I am taking the Antabuse." 2. "I'll have to stop using my alcohol-based aftershave while I am taking the Antabuse." 3. "Antabuse should decrease my cravings for alcohol and make my recovery process easier." 4. "Antabuse is used as a substitute for alcohol to help me avoid alcohol withdrawal symptoms."

2. "I'll have to stop using my alcohol-based aftershave while I am taking the Antabuse."

29. A client diagnosed with Tourette's disorder has a nursing diagnosis of social isolation. Which charting entry documents a successful outcome related to this client's problem? 1. "Compliant with instructions to use bathroom before bedtime." 2. "Made potholder at activity therapy session." 3. "Able to distinguish right hand from left hand." 4. "Able to focus on TV cartoons for 30 minutes."

2. "Made potholder at activity therapy session."

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.) Select one or more: a. "A diet rich in protein will promote hepatic healing." b. "This condition results from a rise in serum ammonia leading to impaired mental functioning." c. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." d. "Neomycin and lactulose are used in the treatment of this condition." e. "This condition is caused by the inability of the liver to convert ammonia to urea."

A , C The nursing instructor should understand that further teaching is needed if the nursing students state that a diet rich in protein will promote hepatic healing and that this condition causes an excessive amount of fluid to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion. The nursing instructor should understand that further teaching is needed if the nursing students state that a diet rich in protein will promote hepatic healing and that this condition causes an excessive amount of fluid to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

Which nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with substance-abuse disorders? (Select all that apply.) Select one or more: a. "I am easily manipulated and need to work on this prior to caring for these clients." b. "Because of my father's alcoholism, I need to examine my attitude toward these clients." c. "I need to review the side effects of the medications used in the withdrawal process." d. "I'll need to set boundaries to maintain a therapeutic relationship." e. "I need to take charge when dealing with clients diagnosed with substance disorders."

A,B,D The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients. The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients. The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients.

9. A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing reply? A. "I know it's frightening, but try to remind yourself that this will only last a short time." B. "Death from a panic attack happens so infrequently that there is no need to worry." C. "Most people who experience panic attacks have feelings of impending doom." D. "Tell me why you think you are going to die every time you have a panic attack."

A. "I know it's frightening, but try to remind yourself that this will only last a short time."

16. A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? A. "I will need scheduled bloodwork in order to monitor for toxic levels of this drug." B. "I won't stop taking this medication abruptly, because there could be serious complications." C. "I will not drink alcohol while taking this medication." D. "I won't take extra doses of this drug because I can become addicted."

A. "I will need scheduled blood work in order to monitor for toxic levels of this drug."

4. A client at the mental health clinic tells the case manager, "I can't think about living another day, but don't tell anyone about the way I feel. I know you are obligated to protect my confidentiality." Which case manager response is most appropriate? A. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care. "B. "Let's discuss steps that will resolve negative lifestyle choices that may have increased your suicidal risk. "C. "You seem to be preoccupied with self. You should concentrate on hope for the future. "D. "This information is secure with me because of client confidentiality."

A. "The treatment team is composed of many specialists who are working to improve your ability to function. Sharing this information with the team is critical to your care.

17. Which example of a therapeutic communication technique would be effective in the planning phase of the nursing process? A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." B. "Please tell me in your own words what brought you to the hospital." C. "This new approach worked for you. Keep it up." D. "I notice that you seem to be responding to voices that I do not hear."

A. "We've discussed past coping skills. Let's see if these coping skills can be effective now." formulating a plan of action. By the use of this technique, the nurse can help the client plan in advance to deal with a stressful situation which may prevent anger and/or anxiety from escalating to an unmanageable level.

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." A helpful response for the nurse to make would be A. "What things have you done in the past that helped you feel more comfortable?" B. "Let's try to focus on that adorable little granddaughter of yours." C. "Why don't you sit down over there and work on that jigsaw puzzle?" D. "Try not to think about the feelings and sensations you're experiencing."

A. "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again.

7. A nurse is assessing a client diagnosed with schizophrenia for the presence of hallucinations. Which therapeutic communication technique used by the nurse is an example of making observations? A. "You appear to be talking to someone I do not see." B. "Please describe what you are seeing." C. "Why do you continually look in the corner of this room?" D. "If you hum a tune, the voices may not be so distracting."

A. "You appear to be talking to someone I do not see." This encourages the client to recognize specific behaviors and make comparisons with the nurse's perceptions.

Which of the following would be assessed as a negative symptom of schizophrenia? A. Anhedonia B. Hostility C. Agitation D. Hallucinations

A. Anhedonia Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

2. A client has a history of excessive fear of water. What is the term that a nurse should use to describe this specific phobia, and under what subtype is this phobia identified? A. Aquaphobia, a natural environment type of phobia B. Aquaphobia, a situational type of phobia C. Acrophobia, a natural environment type of phobia D. Acrophobia, a situational type of phobia

A. Aquaphobia, a natural environment type of phobia

During a therapeutic group, two clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both of the clients from the group. The nurse has demonstrated which leadership style? A. Autocratic B. Democratic C. Laissez-faire D. Bureaucratic

A. Autocratic

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A. Awareness training, B. Competing response training, C. Social support

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

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

The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol

A. Clomipramine, a tricyclic antidepressant, as well as SSRIs such as fluoxetine (Prozac), paroxetine (Paxil), sertraline (Zoloft) and fluvoxamine (Luvox) have been approved for treatment of OCD.

What reaction is most commonly displayed by rape victims in the immediate aftermath of the rape? A. Disorganization B. Philosophical acceptance C. Total withdrawal from reality D. Display of seductive actions

A. Disorganization The acute phase of rape trauma syndrome occurs immediately after the assault and may last for a few weeks. This stage is seen by emergency department personnel. Nurses are the ones most involved in dealing with these initial reactions. During this phase, a great deal of disorganization is common in the person's lifestyle and somatic symptoms.

Most cultures label behavior as mental illness on the basis of which of the following criteria? A. Incomprehensibility and cultural relativity B. Strength of character and ethics C. Goal directedness and high energy

A. Incomprehensibility and cultural relativity

Which statistic concerning rape is true? A. Most male rape victims do not report the crime. B. Male rape is perpetrated by homosexual men. C. The peak incidence of rape occurs in the 25 to 29 age group. D. Most rapes occur after abductions.

A. Most male rape victims do not report the crime. Option A is the only true statement.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability.

7. Arthur, who is diagnosed with obsessive-compulsive disorder, reports to the nurse that he can't stop thinking about all the potentially life threatening germs in the environment. What is the most accurate way for the nurse to document this symptom? A. Patient is expressing an obsession with germs. B. Patient is manifesting compulsive thinking. C. Patient is expressing delusional thinking about germs. D. Patient is manifesting arachnophobia of germs.

A. Patient is expressing an obsession with germs.

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A. Relieves her anxiety

2. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "My father spanked me often." Nurse: "Your father was a harsh disciplinarian." A. Restatement B. Offering general leads C. Focusing D. Accepting

A. Restatement Restatement involves repeating the main idea of what the client has said. The nurse uses this technique to communicate that the client's statement has been heard and understood.

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

A. Risk for injury R/T central nervous system stimulation

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.

A. Stay with the client and reassure safety

4. A nurse reviews the laboratory data of a 29-year-old client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the client's laboratory results indicate a high TSH level (normal range for this age group is 0.4 to 4.2 U/mL), which results from a low thyroid function, or hypothyroidism. In hypothyroidism metabolic processes are slowed, leading to depressive symptoms.

The causation of schizophrenia is currently understood to be A. a combination of inherited and non-genetic factors. B. deficient amounts of the neurotransmitter dopamine. C. excessive amounts of the neurotransmitter serotonin. D. stress related and ineffective stress management skills.

A. a combination of inherited and non-genetic factors.

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as A. a neologism. B. clang association. C. blocking. D. a delusion.

A. a neologism. A neologism is a newly coined word that has meaning only for the client.

Rape is best described as A. an act of violence using sex as the weapon. B. assault by a stranger on an unsuspecting victim. C. sexual desire satisfied inappropriately. D. an act prompted by early childhood neglect.

A. an act of violence using sex as the weapon.

A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will A. ask for validation of reality. B. describe content of hallucinations. C. demonstrate a cool, aloof demeanor. D. identify prodromal symptoms of disorder.

A. ask for validation of reality. Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

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

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

Panic attacks in Latin American individuals often involve repetitive involuntary actions. A. blushing. B. fear of dying. C. offensive vebalizations. D. Repetative invulontary action

A. fear of dying. Correct Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear

The emergency department nurse planning care for a rape victim must realize that the emotional reaction displayed by many rape victims during the initial assessment and treatment is A. fear. B. eagerness. C. suspicion. D. disinterest.

A. fear. Rape is an act of violence, and sex is the weapon used by the perpetrator. Rape engulfs its victims in fear and anxiety, resulting in withdrawal for some and causing severe panic reactions in others. After being traumatized, the person who has been raped often carries an additional burden of shame, guilt, fear, anger, distrust, and embarrassment.

Which statement would be an appropriate long-term outcome for a rape client? The client will A. integrate the rape event and resume an optimal level of functioning. B. identify and develop coping skills necessary to reduce level of anxiety. Incorrect C. blame the rapist rather than blame herself for the situation. D. repress feelings of shame, embarrassment, and self-blame.

A. integrate the rape event and resume an optimal level of functioning. This is the ideal long-term result of treatment for rape trauma syndrome, that life will go on and the client will return to the usual pre-trauma level of functioning.

When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination A. is a projection of the client's own feelings. B. derives from neuronal impulse misfiring. C. is a retained memory fragment. D. may signal seizure onset.

A. is a projection of the client's own feelings. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

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

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

Generally, ego defense mechanisms A. often involve some degree of self-deception. B. are rarely used by mentally healthy people. C. seldom make the person more comfortable. D. are usually effective in resolving conflicts.

A. often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception.

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of A. panic attacks with agoraphobia. B. obsessive-compulsive disorder. C. posttraumatic stress response. D. generalized anxiety disorder.

A. panic attacks with agoraphobia. Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.

Care planning for the rape victim is facilitated if the nurse understands that rape trauma syndrome is actually a variant of A. posttraumatic stress disorder. B. a maturational crisis. C. a dissociative disorder. D. generalized anxiety disorder.

A. posttraumatic stress disorder. Most of those who have been raped are eventually able to resume their previous lives after supportive services and crisis counseling. However, many carry with them a constant emotional trauma: flashbacks, nightmares, fear, phobias, and other symptoms associated with posttraumatic stress disorder.

The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy

A. psychoeducation about their disorder. This is the most likely INITIAL intervention. Treatment for hoarding disorder is most commonly a combination of cognitive-behavioral therapy and SSRIs. Decreased activity in the cingulate cortex IS associated with hoarding disorder (pg 540) but neuroimaging of the client's brain is unlikely to be ordered to diagnose/treat this disorder.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to A. suddenly tremble severely. B. exhibit stoic behavior. C. report both nausea and vomiting. D. laugh inappropriately.

A. suddenly tremble severely. Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity.

To provide discharge treatment and support, the nurse should realize that the most common sequela(e) of acquaintance rape is the development of A. symptoms of sexual distress. B. anxiety and fear of men. C. a paranoid psychosis. D. an eating disorder.

A. symptoms of sexual distress. Women who have been raped by acquaintances frequently develop symptoms that prevent them from participating in normal sexual relations. Sexual distress is more common among women who have been sexually assaulted by intimates; fear and anxiety are more common in those assaulted by strangers. Depression occurs in both groups.

A battered woman presents to the ED with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. The PRIORITY nursing intervention is: A. tending to the immediate care of her wounds B. providing her with information about a safe place to stay C. administering the prn tranquilizer ordered by the physician D. explaining how she may go about bringing charges against her husband

A. tending to the immediate care of her wounds

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

A. tremors. Tremors are an early sign of alcohol withdrawal

Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: A. with vague physical complaints such as insomnia or pain. B. with extreme anger and unpredictable behavior. C. with many family members there to support them. D, with psychosis and/or mania as a result of long-term abuse.

A. with vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint.

Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

ANS: 1 Rationale: A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions

9. A nurse reviews the laboratory data of a client suspected of having the diagnosis of major depressive episode. Which lab value would potentially rule out this diagnosis? 1. Thyroid-stimulating hormone (TSH) level of 25 U/mL 2. Potassium (K+) level of 4.2 mEq/L 3. Sodium (Na+) level of 140 mEq/L 4. Calcium (Ca2+) level of 9.5 mg/dL

ANS: 1 Rationale: A diagnosis of major depressive episode may be ruled out if the client's lab results reveal a TSH level of 25 U/mL. Normal levels of TSH range from 2 to 10 U/mL. High levels of TSH indicate low thyroid function. The client's high TSH value may indicate hypothyroidism, which can lead to depressive symptoms. The DSM-5 criteria for the diagnosis of major depressive episode states that this diagnosis must not be attributable to the direct physiological effects of another medical condition. Cognitive Level: Analysis Integrated Process: Evaluation

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

ANS: 1 Rationale: The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. This intervention is used when taking lithium (Eskalith) for the treatment of bipolar disorder. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.

The following outcome was developed for a client: Client will list five personal strengths by the end of day one. Which correctly written nursing diagnostic statement most likely generated the development of this outcome? 1. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements 2. Self-care deficit R/T altered thought process 3. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 4. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

ANS: 1 Rationale: The nurse should determine that altered self-esteem and self-deprecating statements would generate the outcome to list personal strengths by the end of day one. Self-care deficit, disturbed body image, and risk for disturbed self-concept would generate specific outcomes in accordance with specific needs and goals. The self-care deficit and risk for disturbed self-concept nursing diagnoses are incorrectly written.

A client diagnosed with major depressive episode and substance use disorder has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics are expensive and have numerous side effects. 3. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

ANS: 1 Rationale: The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction.

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which of the following statements about the complications of hepatic encephalopathy should indicate to the nursing instructor that further student teaching is needed? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: 1 Rationale: The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing. The treatment of hepatic encephalopathy requires abstention from alcohol and temporary elimination of protein from the diet.

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief

ANS: 1 Rationale: There is a correlation between pathological gambling and abnormalities in the serotonergic, noradrenergic, and dopaminergic neurotransmitter systems. This is not the case with non-pathological gambling. For a pathological gambler, the preoccupation with and impulse to gamble intensifies when the individual is under stress. This is not the case with non-pathological gambling. Pathological gambling occurs more commonly among men not women and generally runs a chronic not acute course.

16. Which of the following rationales by a nurse explain to parents why it is difficult to diagnose a child or adolescent exhibiting symptoms of bipolar disorder? (Select all that apply.) 1. Bipolar symptoms mimic attention deficit-hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitter levels vary considerably in accordance with age. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

ANS: 1, 2 Page: 424-425 Feedback 1. It is difficult to diagnose a child or adolescent with bipolar disorder, because bipolar symptoms mimic attention deficit hyperactivity disorder symptoms. 2. Children are naturally active, energetic, and spontaneous. 3. Neurotransmitters levels do not vary according to age. 4. Bipolar disorder can be diagnosed for the age of 18. 5. Genetic predisposition can be a reliable diagnostic determinant.

25. A nursing instructor is teaching about the new DSM-5 diagnostic category of disruptive mood dysregulation disorder (DMDD). Which of the following information should the instructor include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

ANS: 1, 2, 3 Rationale: The APA has included a new diagnostic category in the Depressive Disorders chapter of the DSM-5. This childhood disorder is called disruptive mood dysregulation disorder. Criteria for the diagnosis include, but are not limited to, the following. Verbal rages or physical aggression toward people or property; temper outbursts must be present in at least two settings (at home, at school, or with peers). DMDD is characterized by severe recurrent temper outbursts. The temper outbursts are manifested both behaviorally and/or verbally. Symptoms of DMDD must be present for 12, not 18 or more months to meet diagnostic criteria.

Which of the following risk factors, if noted during a family history assessment, should a nurse associate with the development of IDD? (Select all that apply.) 1. A family history of Tay-Sachs disease 2. Childhood meningococcal infection 3. Deprivation of nutrience and social contact 4. History of maternal multiple motor and verbal tics 5. A diagnosis of maternal major depressive disorder

ANS: 1, 2, 3 Rationale: The nurse should recognize a family history of Tay-Sachs disease, childhood meningococcal infections, and deprivation of nurturance and social contact as risk factors that would predispose a child to IDD. There are five major predisposing factors of IDD: hereditary factors, early alterations in embryonic development, pregnancy and perinatal factors, medical conditions acquired in infancy or childhood, and environmental influences and other mental disorders.

24. A client is prescribed phenelzine (Nardil). Which of the following statements by the client should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food and medication labels." 4. "I'm going to miss my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

ANS: 1, 2, 3, 5 Rationale: The nurse should evaluate that teaching has been successful when the client states that phenelzine should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is an MAOI that can have negative interaction with other medications. The client needs to tell other physicians about taking MAOIs, because of the risk of drug interactions. Cognitive Level: Application Integrated Process: Implementation

Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

ANS: 1, 2, 4 Rationale: The nurse should complete a cognitive process prior to caring for clients diagnosed with substance-abuse disorders. It is important for nurses to identify potential areas of need within their own cognitions that may affect their relationships with clients diagnosed with this problem.

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. Which of the following symptoms and/or behaviors is the nurse likely to assess? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anxiety and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Losing at gambling meets the client's need for self-punishment.

ANS: 1, 2, 4, 5 Rationale: In gambling disorder, the preoccupation with and impulse to gamble intensifies when the individual is under stress. Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. Winning brings feelings of special status, power, and omnipotence, not sexual satisfaction. The gambler increasingly depends on this activity to cope with disappointments, problems, and negative emotional states.

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

ANS: 1, 2, 5 Rationale: The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criteria for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as mirror checking, excessive grooming, skin picking, or reassurance seeking.

A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

ANS: 1, 3, 4, 5 Rationale: Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety and because not all situations are easily avoidable

Which of the following nursing interventions fall within the standards of psychiatric mental health clinical nursing practice for a nurse generalist? (Select all that apply.) 1. Assist the client to perform activities of daily living. 2. Consult with other clinicians to provide services for clients and effect system change. 3. Encourage the client to discuss triggers for relapse. 4. Use prescriptive authority in accordance with state and federal laws. 5. Educate the family about signs and symptoms of alcohol dependence and withdrawal.

ANS: 1, 3, 5 Rationale: Assisting the client to perform daily living activities, encouraging the client to discuss triggers, and educating the family are nursing interventions that fall within the standards of psychiatric clinical nursing practice for a nurse generalist. Psychiatric Mental health advanced practice registered nurses can consult with other clinicians and use prescriptive authority.

A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply.) 1. The client has a long history of focusing thoughts and behaviors on other people. 2. The client, as a child, experienced overindulgent and overprotective parents. 3. The client is a people pleaser and does almost anything to gain approval. 4. The client exhibits helpless behaviors but actually feels very competent. 5. The client can achieve a sense of control only through fulfilling the needs of others.

ANS: 1, 3, 5 Rationale: The codependent person has a long history of focusing thoughts and behavior on other people and is able to achieve a sense of control only through fulfilling the needs of others. Codependant clients are "people pleasers" and will do almost anything to get the approval of others. They usually have experienced abuse or emotional neglect as a child. They outwardly appear very competent, but actually feel quite needy, helpless, or perhaps nothing at all.

A nursing supervisor is offering an impaired staff member information regarding employee assistance programs. Which of the following facts should the supervisor include? (Select all that apply.) 1. A hotline number will be available in order to call for peer assistance. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients.

ANS: 1, 3, 5 Rationale: The peer assistance programs strive to intervene early, to reduce hazards to clients, and increase prospects for the nurse's recovery. Most states provide either a hotline number that the impaired nurse may call or phone numbers of peer assistance committee members, which are made available for the same purpose. Typically, a written, not verbal, contract is drawn up, detailing the method of treatment, which may be obtained from various sources, such as employee assistance programs, Alcoholics Anonymous, Narcotics Anonymous, private counseling, or outpatient clinics. Peer support is provided through regular contact with the impaired nurse, usually for a period of two years, not one year.

22. A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

ANS: 1, 4 Rationale: The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than two years. The essential feature of dysthymia is a chronically depressed mood, which can have an early or late onset. Cognitive Level: Application Integrated Process: Planning

A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? (Select all that apply.) 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

ANS: 1, 4, 5 Rationale: The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

12. A client has been diagnosed with major depressive episode. After treatment with fluoxetine (Prozac), the client exhibits pressured speech and flight of ideas. Based on this symptom change, which physician action would the nurse anticipate? 1. Increase the dosage of fluoxetine. 2. Discontinue the fluoxetine and rethink the client's diagnosis. 3. Order benztropine (Cogentin) to address extrapyramidal symptoms. 4. Order olanzapine (Zyprexa) to address altered thoughts.

ANS: 2 Page: 424-425 Feedback 1 Increasing the dosage would not help this client. 2 A full manic episode emerging during antidepressant treatment (medication, electroconvulsive therapy, etc.), but persisting beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis. It would be inappropriate to increase the dosage of fluoxetine. 3 The client is not having extrapyramidal symptoms. 4 The client is not having altered thoughts.

13. Which is the basic premise of a recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication adherence 2. Empowerment of the consumer 3. Total absence of symptoms 4. Improved psychosocial relationships

ANS: 2 Page: 433-434 Feedback 1 Medication adherence is not the basic premise of the recovery model for bipolar disorder. 2 The basic premise of a recovery model is empowerment of the consumer. The recovery model is designed to allow consumers primary control over decisions about their own care and to enable a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential. 3 Absence of symptoms is not the basic premise of the recovery model for bipolar disorder. 4 Improved psychosocial relationships is not the basic premise of the recovery model for bipolar disorder.

5. A client diagnosed with bipolar I disorder: manic episode refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which medication should a nurse anticipate that a physician may prescribe? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Trazodone (Desyrel) 4. Paroxetine (Paxil)

ANS: 2 Page: 435-438 Feedback 1 Sertraline (Zoloft) does not counteract the weight-increasing effects of lithium. 2 The nurse should anticipate that the physician may prescribe valproic acid in order to increase this client's medication adherence. Valproic acid is an anticonvulsant medication that can be used to treat bipolar disorder. One of the side effects of this medication is weight loss. 3 Trazodone (Desyrel) does not counteract the weight increasing effects of lithium. 4 Paroxetine (Paxil) does not counteract the weight increasing effects of lithium.

17. A number of assessment rating scales are available for measuring severity of depressive symptoms. Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

ANS: 2 Rationale: A number of assessment rating scales are available for measuring severity of depressive symptoms. Some are meant to be clinician administered, whereas others may be self-administered. Examples of self-rating scales include the Zung Self-Rating Depression Scale and the Beck Depression Inventory. One of the most widely used clinician-administered scales is the Hamilton Depression Rating Scale. The Abnormal Involuntary Movement Scale (AIMS) is a rating scale that measures involuntary movements associated with tardive dyskinesia. Cognitive Level: Application Integrated Process: Assessment

5. A client is diagnosed with major depressive episode. Which nursing diagnosis should a nurse assign to this client, to address a behavioral symptom of this disorder? 1. Altered communication R/T feelings of worthlessness AEB anhedonia 2. Social isolation R/T poor self-esteem AEB secluding self in room 3. Altered thought processes R/T hopelessness AEB persecutory delusions 4. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

ANS: 2 Rationale: A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive episode. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, curled-up position, and no attention to personal hygiene and grooming. Cognitive Level: Analysis Integrated Process: Diagnosis

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

ANS: 2 Rationale: An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and begin to gradually limit the time allowed for rituals

21. After 6 months of taking imipramine (Tofranil) for depressive symptoms, a client complains that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "Are you taking St. John's wort?"

ANS: 2 Rationale: Imipramine is a tricyclic antidepressant. Smoking should be avoided while receiving tricyclic therapy. Smoking increases the metabolism of tricyclics, requiring an adjustment in dosage to achieve the therapeutic effect. Alcohol potentiates the effects of antidepressants. Tyramine is only an issue when MAOI medications are prescribed. Concomitant use of St. John's wort and SSRIs, not tricyclics, increases, not decreases the effects of the drug. Cognitive Level: Application Integrated Process: Implementation

A nursing instructor is teaching about the impaired nurse and the consequences of this impairment. Which statement by a student indicates that further instruction is needed? 1. "The state board of nursing must be notified with factual documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Many state boards of nursing require an impaired nurse to successfully complete counseling treatment programs prior to a return to work." 4. "After a return to practice, a recovering nurse may be closely monitored for several years."

ANS: 2 Rationale: Several state boards of nursing have passed diversionary laws that allow impaired nurses to avoid disciplinary action by agreeing to seek treatment. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period. When a nurse is deemed safe to return to practice, he or she may be closely monitored for several years and required to undergo random drug screenings.

. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? 1. Medical history is of little significance and can be eliminated from the nursing assessment. 2. Assessment provides a holistic view of the client, including biopsychosocial aspects. 3. Comprehensive assessments can be performed only by advanced practice nurses. 4. Psychosocial evaluations are gained by subjective reports rather than objective observations.

ANS: 2 Rationale: The assessment of clients diagnosed with psychiatric problems should provide a holistic view of the client. A thorough assessment involves collecting and analyzing data from the client, significant others, and health-care providers, which may include the following dimensions: physical, psychological, sociocultural, spiritual, cognitive, functional abilities, developmental, economic, and lifestyle.

14. A nurse recently admitted a client to an inpatient unit after a suicide attempt. A health-care provider orders amitriptyline (Elavil) for the client. Which intervention, related to this medication, should be initiated to maintain this client's safety upon discharge? 1. Provide a 6-month supply of Elavil to ensure long-term compliance. 2. Provide a 1-week supply of Elavil, with refills contingent on follow-up appointments. 3. Provide pill dispenser as a memory aid. 4. Provide education regarding the avoidance of foods containing tyramine.

ANS: 2 Rationale: The health-care provider should provide no more than a 1-week supply of amitriptyline, with refills contingent on follow-up appointments, as an appropriate intervention to maintain the client's safety. Antidepressants, which are central nervous system depressants, can be used to commit suicide. Also these medications can precipitate suicidal thoughts during the initial use period. Limiting the amount of medication and monitoring the client weekly would be appropriate interventions to address the client's risk for suicide. Cognitive Level: Application Integrated Process: Implementation

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor response is most accurate? 1. High doses of tricyclic medications will be required for effective treatment of OCD. 2. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. 3. The dose of Luvox is low because of the side effect of daytime drowsiness. 4. The dose of this selective serotonin reuptake inhibitor (SSRI) is outside the therapeutic range and needs to be questioned.

ANS: 2 Rationale: The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness

11. What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive episode? 1. The attention during the assessment is beneficial in decreasing social isolation. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: 2 Rationale: The nurse should determine that a client with a diagnosis of major depressive episode needs a full physical health assessment, because depression can generate somatic symptoms that can mask actual physical disorders. Cognitive Level: Application Integrated Process: Implementation

16. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing response? 1. "This combination of drugs can lead to delirium tremens." 2. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." 3. "That's a good idea. There have been good results with the combination of these two drugs." 4. "The only disadvantage would be the exorbitant cost of the MAOI." ]

ANS: 2 Rationale: The nurse should explain to the client that combining an MAOI and fluvoxamine, an SSRI, can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches, with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread." Cognitive Level: Application Integrated Process: Implementation

How should a nurse prioritize nursing diagnoses? 1. By the established goal of care 2. By the life-threatening potential 3. By the physicians priority of care 4. By the clients preference

ANS: 2 Rationale: The nurse should prioritize nursing diagnoses related to their life-threatening potential. Safety is always the nurse's first priority.

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

ANS: 2 Rationale: The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use.

A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis, which was recently removed from the NANDA-I list, still accurately reflects this client's problem? 1. Disturbed thought processes 2. Disturbed sensory perception 3. Anxiety 4. Chronic confusion

ANS: 2 Rationale: The nursing diagnosis disturbed sensory perception accurately reflects the clients symptoms of hearing things that others do not. The nursing diagnosis describes the clients condition and facilitates the prescription of interventions.

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that learning has occurred? 1. Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4. Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

ANS: 2 Rationale: The onset of the symptoms of agoraphobia most commonly occurs in the 20s and 30s and persists for many years

What is the purpose of a nurse gathering client information? 1. It enables the nurse to modify behaviors related to personality disorders. 2. It enables the nurse to make sound clinical judgments and plan appropriate care. 3. It enables the nurse to prescribe the appropriate medications. 4. It enables the nurse to assign the appropriate Axis I diagnosis.

ANS: 2 Rationale: The purpose of gathering client information is to enable the nurse to make sound clinical judgments and plan appropriate care. The nurse should complete a thorough assessment of the client, including information collected from the client, significant others, and health-care providers.

18. The severity of depressive symptoms in the postpartum period varies from a feeling of the "blues," to moderate depression, to psychotic depression or melancholia. Which disorder is correctly matched with its presenting symptoms? 1. Maternity blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Postpartum melancholia (overprotection of infant, expresses concern about inability to care for baby, mysophobia) 4. Postpartum depressive psychosis (transient depressed mood, agitation, abnormal fear of child abduction, suicidal ideations)

ANS: 2 Rationale: The symptoms of the maternity blues include tearfulness, despondency, anxiety, and subjectively impaired concentration appearing in the early puerperium. Symptoms of postpartum depression are associated with fatigue, irritability, loss of appetite, sleep disturbances, loss of libido, and expressions of great concern about her inability to care for her baby. Both postpartum melancholia and postpartum depressive psychosis are characterized by a lack of interest in, or rejection of, the baby, or a morbid fear that the baby may be harmed. Other symptoms include depressed mood, agitation, indecision, lack of concentration, guilt, and an abnormal attitude toward bodily functions. Cognitive Level: Application Integrated Process: Assessment

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

ANS: 2, 3 Rationale: The nurse should explain to the client that systematic desensitization and imploding are the most common behavioral therapies used for treating phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time

23. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities that occur with age 2. Drastic temperature and barometric pressure changes 3. A seasonal increase in social interactions 4. Variations in serotonergic functioning 5. Inaccessibility of resources for dealing with life stressors

ANS: 2, 3, 4 Rationale: The nurse should identify drastic temperature and barometric pressure changes, a seasonal increase in social interactions, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November). Cognitive Level: Application Integrated Process: Evaluation

A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. The staff nurse is frequently absent from work. 2. The staff nurse experiences mood swings. 3. The staff nurse makes elaborate excuses for behavior. 4. The staff nurse frequently uses the restroom. 5. The staff nurse has a flushed face.

ANS: 2, 3, 4, 5 Rationale: A number of clues for recognizing substance impairment in nurses have been identified. They are not easy to detect and will vary according to the substance being used. There may be high absenteeism if the person's source is outside the work area, or the individual may rarely miss work if the substance source is at work. Some other possible signs are irritability, mood swings, tendency to isolate, elaborate excuses for behavior, unkempt appearance, impaired motor coordination, slurred speech, flushed face, inconsistent job performance, and frequent use of the restroom.

3. A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes in the exhibit? The following are the outcomes: 1. Maintains nutritional status. 2. Interacts appropriately with peers. 3. Remains free from injury. 4. Sleeps 6 to 8 hours a night. 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

ANS: 3 Page: 419-422 Feedback 1 The client's safety and physical health is the most important. 2 Safety is the priority. 3 The nurse should order client outcomes based on priority in the following order: Remains free of injury, maintains nutritional status, sleeps 6 to 8 hours a night, and interacts appropriately with peers. The nurse should prioritize the client's safety and physical health as most important 4 The nurse should always prioritize safety.

7. A client began taking lithium carbonate (Lithobid) for the treatment of bipolar disorder approximately 1 month ago. The client asks if it is normal to have gained 12 pounds in this time frame. Which is the appropriate nursing response? 1. "That's strange. Weight loss is the typical pattern." 2. "What have you been eating? Weight gain is not usually associated with lithium." 3. "Weight gain is a common, but troubling, side effect." 4. "Weight gain only occurs during the first month of treatment with this drug."

ANS: 3 Page: 427 Feedback 1 Weight loss is not typical with this drug. 2 Clients gain weight regardless of diet with Lithium therapy. 3 The nurse should explain to the client that weight gain is a common side effect of lithium carbonate. The nurse should educate the client on the importance of medication adherence and discuss concerns with the prescribing physician if the client does not wish to continue taking the medication. 4 Weight gain is a common side effect with this medication.

13. A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects a depressive disorder. What is the rationale for performing a mini-mental status exam? 1. To rule out bipolar disorder 2. To rule out schizophrenia 3. To rule out neurocognitive disorder 4. To rule out personality disorder

ANS: 3 Rationale: A mini-mental status exam should be performed to rule out neurocognitive disorder. The client may be experiencing reversible dementia, which can occur as a result of depression. Cognitive Level: Application Integrated Process: Evaluation

A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the students question? 1. You can use NIC, a standardized reference for nursing outcomes. 2. Look at your client's problems and set a realistic, achievable goal. 3. With client collaboration, outcomes should be based on client problems. 4. Copy your standard outcomes from a nursing care plan textbook.

ANS: 3 Rationale: Client outcomes are most realistic and achievable when there is collaboration among the interdisciplinary team members, the client, and significant others.

Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? 1. CIWA scale 2. GGT 3. MMSE 4. CAPS scale

ANS: 3 Rationale: The MMSE, or mini mental status exam, would be the appropriate tool to use to assess the mental acuity of a client prior to and immediately following ECT. The CIWA scale, or clinical institute withdrawal assessment scale, would be used to assess withdraw from substances such as alcohol. The CAPS refers to the clinician-administered PTSD scale and would be used to assess signs and symptoms of PTSD. The GGT test is a blood test used to assess gamma-glutamyl transferase levels, which may be an indication of alcoholism.

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the client's physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and sertraline (Zoloft) 4. Naltrexone (ReVia) and ziprasidone (Geodon)

ANS: 3 Rationale: The SSRIs and clomipramine have been used successfully in the treatment of pathological gambling as a form of obsessive-compulsive disorder. Lithium, carbamazepine, and naltrexone have also been shown to be effective. The antipsychotic medications clozapine, olanzapine, and ziprasidone are not treatments of choice for this disorder.

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

ANS: 3 Rationale: The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Codependency is a typical behavior of spouses of alcoholics. Partners of clients with substance addiction must come to realize that the only behavior they can control is their own.

A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? 1. Health teacher 2. Case manager 3. Milieu manager 4. Psychotherapist

ANS: 3 Rationale: The milieu manager implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. Health teaching involves promoting health in a safe environment. Case management is used to organize client care so that outcomes are achieved. Psychotherapy involves conducting individual, couples, group, and family counseling.

3. A nurse administers 100% oxygen to a client during and after electroconvulsive therapy treatment (ECT). What is the rationale for this procedure? 1. To prevent increased intracranial pressure resulting from anoxia. 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation. 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles. 4. To prevent blocked airway, resulting from seizure activity.

ANS: 3 Rationale: The nurse administers 100% oxygen during and after ECT to prevent anoxia resulting from medication-induced paralysis of respiratory muscles. Cognitive Level: Application Integrated Process: Implementation

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

ANS: 3 Rationale: The nurse can meet this client's physiological need by having the client breathe into a paper bag. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the client to breathe into a small paper bag held over the mouth and nose. Six to twelve natural breaths should be taken, alternating with short periods of diaphragmatic breathing.

What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? 1. Mood 2. Perception 3. Orientation 4. Affect

ANS: 3 Rationale: The nurse should ask the client to identify name, date, residential address, and situation to assess the clients orientation. Assessment of the clients orientation to reality is part of a mental status evaluation.

A client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." A nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Knowledge deficit 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

ANS: 3 Rationale: The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

10. A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? 1. According to psychoanalytic theory, depression is a result of negative perceptions. 2. According to object-loss theory, depression is a result of overprotection. 3. According to learning theory, depression is a result of repeated failures. 4. According to cognitive theory, depression is a result of anger turned inward.

ANS: 3 Rationale: The nurse should assess that, according to learning theory, this client's depressive symptoms may have resulted from repeated failures. The learning theory is a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed. Cognitive Level: Application Integrated Process: Assessment

8. A client with a history of suicide attempts has been taking fluoxetine (Prozac) for one month. The client suddenly presents with a bright affect, rates mood at 9 out of 10, and is much more communicative. Which action should be the nurse's priority at this time? 1. Give the client off-unit privileges as positive reinforcement. 2. Encourage the client to share mood improvement in group. 3. Increase the level of this client's suicide precautions. 4. Request that the psychiatrist reevaluate the current medication protocol.

ANS: 3 Rationale: The nurse should be aware that a sudden increase in mood rating and change in affect could indicate that the client is at risk for suicide. Suicide risk may occur early during treatment with antidepressants. The return of energy may bring about an increased ability to act out self-destructive behavior. Cognitive Level: Analysis Integrated Process: Implementation

A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: 3 Rationale: The nurse should explain to the client that when participating in systematic desensitization he or she will go through a series of increasingly anxiety-provoking steps that will gradually increase tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

6. A client diagnosed with major depressive episode hears voices commanding self-harm. Which should be the nurse's priority intervention at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal. 2. Conducting 15-minute checks to ensure safety. 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations. 4. Encouraging client to express feelings related to suicide.

ANS: 3 Rationale: The nurse's priority intervention when a depressed client hears voices commanding self-harm is to place the client on one-to-one observation while continuing to monitor suicidal ideations. By providing one-to-one observation, the nurse will be able to interrupt any attempts at suicide. Cognitive Level: Analysis Integrated Process: Implementation

A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB MNA, DFA, and daytime napping. Which is a correctly written and appropriate outcome for this client? 1. The client will avoid daytime napping and attend all groups. 2. The client will exercise, as needed, before bedtime. 3. The client will sleep seven uninterrupted hours by day four of hospitalization. 4. The clients sleep habits will improve during hospitalization.

ANS: 3 Rationale: The outcome The client will sleep seven uninterrupted hours by day four of hospitalization is accurately written and an appropriate outcome for a client diagnosed with insomnia. Nursing outcomes should be derived from the diagnosis, measurable, and include a time estimate for attainment. The outcome must also be realistic for the clients capabilities.

Which of the following characteristics of accurately developed client outcomes should a nurse identify? (Select all that apply.) 1. Client outcomes are specifically formulated by nurses. 2. Client outcomes are not restricted by time frames. 3. Client outcomes are specific and measurable. 4. Client outcomes are realistically based on client capability. 5. Client outcomes are formally approved by the psychiatrist.

ANS: 3, 4 Rationale: The nurse should identify that client outcomes should be specific, measurable, and realistically based on client capability. Outcomes should be derived from the diagnosis and should include a time estimate for attainment. Outcomes are most effective when formulated cooperatively by the interdisciplinary team members, the client, and significant others.

9. A nursing instructor is discussing various challenges in the treatment of clients diagnosed with bipolar disorder. Which student statement demonstrates an understanding of the most critical challenge in the care of these clients? 1. "Treatment is compromised when clients can't sleep." 2. "Treatment is compromised when irritability interferes with social interactions." 3. "Treatment is compromised when clients have no insight into their problems." 4. "Treatment is compromised when clients choose not to take their medications."

ANS: 4 Page: 426 Feedback 1 The most critical challenge is not when clients can't sleep. 2 The most critical challenge is not when irritability interferes with social interactions. 3 The most critical challenge is not when clients have no insight into their problems. 4 The nursing student is accurate when stating that the most critical challenge in the care of clients diagnosed with bipolar disorder is that treatment is often compromised when clients choose not to take their medications. Clients diagnosed with bipolar disorder feel most productive and creative during manic episodes. This may lead to purposeful medication nonadherence. Symptoms of bipolar disorder will reemerge if medication is stopped.

8. A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for one year. The client presents in an emergency department with a temperature of 101F (38C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? 1. Symptoms indicate consumption of foods high in tyramine. 2. Symptoms indicate lithium carbonate discontinuation syndrome. 3. Symptoms indicate the development of lithium carbonate tolerance. 4. Symptoms indicate lithium carbonate toxicity.

ANS: 4 Page: 434, 439 Feedback 1 These symptoms do not indicate consumption of foods high in tyramine. 2 These symptoms do not indicate lithium carbonate discontinuation syndrome. 3 These symptoms do not indicate development of lithium carbonate tolerance. 4 The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The initial signs of toxicity include ataxia, blurred vision, severe diarrhea, nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure proper dosage.

6. A client diagnosed with bipolar I disorder is exhibiting severe manic behaviors. A physician prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa). The client's spouse asks the nurse how Zyprexa works. Which is the appropriate nursing response? 1. "Zyprexa in combination with Eskalith cures manic symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms hyperactivity until the Eskalith takes effect."

ANS: 4 Page: 435-438 Feedback 1 Zyprexa calms hyperactivity. 2 Zyprexa does not prevent extrapyramidal side effects. 3 Zyprexa does not increase the effectiveness of the immune system. 4 The nurse should explain to the client's spouse that olanzapine can calm hyperactivity until the lithium carbonate takes effect. Lithium carbonate may take 1 to 3 weeks to begin to decrease hyperactivity. Monotherapy with the traditional mood stabilizers like lithium carbonate, or atypical antipsychotics like olanzapine, has been determined to be the first-line treatment for bipolar I disorder.

Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my cravings." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

ANS: 4 Rationale: A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program.

19. A staff nurse is counseling a depressed client. The nurse determines that the client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits because she thinks I don't care." 4. "I don't have a green thumb. Any old fool can grow a rose."

ANS: 4 Rationale: Examples of automatic thoughts in depression include: Personalizing: "I'm the only one who failed." All or nothing: "I'm a complete failure." Mind reading: "He thinks I'm foolish." Discounting positives: "The other questions were so easy. Any dummy could have gotten them right." Cognitive Level: Application Integrated Process: Assessment

12. A nurse is planning care for a 13 -year-old who is experiencing depression. Which medication is approved by the Food and Drug Administration (FDA) for the treatment of depression in adolescents? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4.Fluoxetine (Prozac

ANS: 4 Rationale: Fluoxetine (Prozac) has been approved by the FDA to treat depression in children and adolescents, and escitalopram was approved in 2009 for treatment of depression in adolescents aged 12 to 17 years. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents. Cognitive Level: Application Integrated Process: Planning

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? 1. To assess for emotional strength 2. To assess for Wernicke-Korsakoff syndrome 3. To assess for tachycardia 4. To assess for fine tremors

ANS: 4 Rationale: The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors.

Which medication orders should a nurse anticipate for a client who has a history of benzodiazepine withdrawal delirium? 1. Haloperidol (Haldol) and fluoxetine (Prozac) 2. Carbamazepine (Tegretol) and donepezil (Aricept) 3. Disulfiram (Antabuse) and lorazepan (Ativan) 4. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

ANS: 4 Rationale: The nurse should anticipate that a physician would order chlordiazepoxide and phenytoin for a client who has a history of benzodiazepine withdrawal delirium. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin is an anticonvulsant used to prevent seizures.

7. A nurse assesses a client suspected of having the diagnosis of major depressive episode. Which client symptom would rule out this diagnosis? 1. The client is disheveled and malodorous. 2. The client refuses to interact with others and isolates self in room. 3. The client is unable to feel any pleasure. 4. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: 4 Rationale: The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior is exhibiting signs of mania. The DSM-5 criteria state that there must never have been a manic episode or a hypomanic episode to meet the criteria for the diagnosis of major depressive episode. Cognitive Level: Application Integrated Process: Assessment

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: 4 Rationale: The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client, seeking medication increase, and locking the client's room are not appropriate interventions, because they do not help the client gain insight.

. A nurse is interviewing a client in an outpatient addiction clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? 1. The client will identify one person to turn to for support. 2. The client will give up all old drinking buddies. 3. The client will be able to verbalize the effects of alcohol on the body. 4. The client will correlate life problems with alcohol use.

ANS: 4 Rationale: The nurse should expect that the client would initially correlate life problems with alcohol addiction. Acceptance of the problem is the first part of the recovery process.

A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? 1. Sublimation 2. Dissociation 3. Rationalization 4. Intellectualization

ANS: 4 Rationale: The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual process of logic, reasoning, and analysis.

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety

ANS: 4 Rationale: The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror

15. An older client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). A nurse assesses that the client is experiencing restlessness, tachycardia, diaphoresis, and tremors. Which complication should a nurse suspect, and why? 1. Neuroleptic malignant syndrome; caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) 2. Neuroleptic malignant syndrome; caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) 3. Serotonin syndrome; possibly caused by ingestion of an SSRI and an MAOI 4. Serotonin syndrome; possibly caused by ingestion of two different SSRIs

ANS: 4 Rationale: The nurse should suspect that the client is suffering from serotonin syndrome; possibly caused by ingesting two different SSRI's (sertraline and paroxetine). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor. Cognitive Level: Application Integrated Process: Assessment

2. In planning care for a suicidal client, which correctly written outcome should be a nurse's first priority? 1. The client will not physically harm self. 2. The client will express hope for the future by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will remain safe during hospital stay.

ANS: 4 Rationale: The nurse's first priority should be that the client will remain safe during the hospital stay. Client safety should always be the nurse's first priority. Outcomes should be client-centered, specific, realistic, measureable, and must also include a time frame. Cognitive Level: Analysis Integrated Process: Planning

15. A nurse is assessing an adolescent client diagnosed with cyclothymic disorder. Which of the following DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

ANS: 4, 5 Page: 420-421 Feedback 1. Symptoms last at least one year. 2. Clients have numerous periods with hypomanic episodes. 3. The symptoms are not better accounted for by schizoaffective disorder and are not superimposed on schizophrenia, schizophreniform disorder, delusional disorder, or psychotic disorder not elsewhere classified. 4. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 5. Depressive symptoms that do not meet the criteria for a major depressive episode.

24. A client diagnosed with major depressive disorder was raised in a strongly religious family where bad behavior was equated with sins against God. Which nursing intervention would be most appropriate to help the client address spirituality as it relates to his illness? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills.

ANS: A A client raised in an environment that reinforces one's inadequacy may be at risk for experiencing guilt, shame, low self-esteem, and hopelessness, which can contribute to depression. Assisting the client to bring these feelings into awareness allows the client to realistically appraise distorted responsibility and dysfunctional guilt.

13. A client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolation

ANS: A A client with depression has difficulty concentrating and may be overwhelmed by activity overload or the expectation of independent decision making. A simple, structured daily schedule with limited choices of activities is more appropriate.

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

ANS: A The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.

ANS: A The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

18. A 10-week, prenuptial counseling group composed of five couples is terminating. At the last group meeting, a nurse notices that the two most faithful and participative couples are absent. When considering concepts of group development, what might explain this behavior? A. They are experiencing problems with termination, leading to feelings of abandonment. B. They did not think any new material would be covered at the last session. C. They were angry with the leader for not extending the length of the group. D. They were bored with the material covered in the group.

ANS: A The nurse should determine that the clients' absence from the final group meeting may indicate that they are experiencing problems with termination. The termination phase of group development may elicit feelings of abandonment and anger. Successful termination may help members develop skills to cope with future unrelated losses. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Assessment

10. During an inpatient educational group, a client shouts out, "This information is worthless. Nothing you have said can help me." These statements indicate to the nurse leader that the client is assuming which group role? A. The group role of aggressor B. The group role of initiator C. The group role of gatekeeper D. The group role of blocker

ANS: A The nurse should identify that the client is assuming the group role of the aggressor. The aggressor expresses negativism and hostility toward others in the group or to the group leader and may use sarcasm in an effort to degrade the status of others. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

11. A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

ANS: A The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

A client diagnosed with depression and substance abuse has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. B. Sedative-hypnotics are expensive and have numerous side effects. C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

ANS: A The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another and are capable of producing physiological and psychological dependence.

4. During a community meeting, a nurse encourages clients to present unit problems and discuss possible solutions. Which type of leadership style is the nurse demonstrating? A. Democratic B. Autocratic C. Laissez-faire D. Bureaucratic

ANS: A The nurse who encourages clients to present problems and discuss solutions is demonstrating a democratic leadership style. Democratic leaders share information with group members and promote decision making by the members of the group. The leader provides guidance and expertise as needed. PTS: 1 REF: 194 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."

ANS: A The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food followed by purging.

21. A client is struggling to explore and solve a problem. Which nursing statement would verbalize the implication of the client's actions? A. "You seem to be motivated to change your behavior." B. "How will these changes affect your family relationships?" C. "Why don't you make a list of the behaviors you need to change." D. "The team recommends that you make only one behavioral change at a time."

ANS: A This is an example of the therapeutic communication technique of verbalizing the implied. Verbalizing the implied puts into words what the client has only implied or said indirectly

27. During a nurse-client interaction, which nursing statement may belittle the client's feelings and concerns? A. "Don't worry. Everything will be alright." B. "You appear uptight." C. "I notice you have bitten your nails to the quick." D. "You are jumping to conclusions."

ANS: A This nursing statement is an example of the nontherapeutic communication block of belittling feelings. Belittling feelings occur when the nurse misjudges the degree of the client's discomfort, thus a lack of empathy and understanding may be conveyed. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. Which nursing response is an example of the nontherapeutic communication block of requesting an explanation? A. "Can you tell me why you said that?" B. "Keep your chin up. I'll explain the procedure to you." C. "There is always an explanation for both good and bad behaviors." D. "Are you not understanding the explanation I provided?"

ANS: A This nursing statement is an example of the nontherapeutic communication block of requesting an explanation. Requesting an explanation is when the client is asked to provide the reason for thoughts, feelings, behaviors, and events. Asking "why" a client did something or feels a certain way can be very intimidating and implies that the client must defend his or her behavior or feelings. PTS: 1 REF: 157 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa

ANS: A, B The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa.

34. Which of the following individuals are communicating a message? (Select all that apply.) A. A mother spanking her son for playing with matches B. A teenage boy isolating himself and playing loud music C. A biker sporting an eagle tattoo on his biceps D. A teenage girl writing, "No one understands me" E. A father checking for new e-mail on a regular basis

ANS: A, B, C, D The nurse should determine that spanking, isolating, getting tattoos, and writing are all ways in which people communicate messages to others. It is estimated that about 70% to 90% of communication is nonverbal. PTS: 1 REF: 151 KEY: Cognitive Level: Application | Integrated Process: Assessment

30. A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? Select all that apply. A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I'll be sure not to stop this medication abruptly."

ANS: A, B, C, E The nurse should evaluate that teaching has been successful when the client states that phenelzine (Nardil) should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is a monoamine oxidase inhibitor (MAOI) that can have negative interactions with other medications. The client needs to tell other physicians about taking MAOIs because of the risk of drug interactions.

Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with substance-abuse disorders? (Select all that apply.) A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." C. "I need to review the side effects of the medications used in the withdrawal process." D. "I'll need to set boundaries to maintain a therapeutic relationship." E. "I need to take charge when dealing with clients diagnosed with substance disorders."

ANS: A, B, D The nurse should examine personal bias and preconceived negative attitudes prior to caring for clients diagnosed with substance-abuse disorders. A deficit in this area may affect the nurse's ability to establish therapeutic relationships with these clients.

21. Which of the following observed client behaviors would lead a nurse to evaluate a member as assuming a maintenance group role? (Select all that apply.) A. A client decreases conflict within the group by encouraging compromise. B. A client offers recognition and acceptance of others. C. A client outlines the task at hand and proposes solutions. D. A client listens attentively to group interaction. E. A client uses the group to gain sympathy from others.

ANS: A, B, D The nurse should identify clients who decrease conflict within the group, offer recognition and acceptance of others, and listen attentively to group interaction as assuming a maintenance group role. There are member roles within each group. Maintenance roles include the compromiser, the encourager, the follower, the gatekeeper, and the harmonizer. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Assessment

A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: A, C The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

29. A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? Select all that apply. A. Encourage the client to recognize the signs of escalating anxiety. B. Encourage the client to avoid any situation that causes stress. C. Encourage the client to employ newly learned relaxation techniques. D. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. E. Encourage the client to avoid caffeinated products

ANS: A, C, D, E

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence? A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

ANS: B May require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client's response to another drug.

14. An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "We'll go to the day room when you are ready for group." B. "I'll walk with you to the day room. Group is about to start." C. "It must be difficult for you to attend group when you feel so bad." D. "Let me tell you about the benefits of attending this group."

ANS: B A client diagnosed with major depressive disorder exhibits little to no motivation and must be actively directed by staff to participate in therapy. It is difficult for a severely depressed client to make decisions, and this function must be temporarily assumed by the staff.

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

ANS: B A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."

ANS: B A positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.

12. A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. "I cannot drink any alcohol with this medication." B. "It is going to take 2 to 3 weeks in order for me to begin to feel better." C. "This drug causes physical dependence, and I need to strictly follow doctor's orders." D. "I can't take this medication with food. It needs to be taken on an empty stomach."

ANS: B BuSpar takes at least 2 to 3 weeks to be effective in controlling symptoms of anxiety. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

ANS: B By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

15. A client who is diagnosed with major depressive disorder asks the nurse what causes depression. Which of these is the most accurate response? A. Depression is caused by a deficiency in neurotransmitters, including serotonin and norepinephrine. B. The exact cause of depressive disorders is unknown. A number of things, including genetic, biochemical, and environmental influences, likely play a role. C. Depression is a learned state of helplessness cause by ineffective parenting. D. Depression is caused by intrapersonal conflict between the id and the ego.

ANS: B Depression is likely an illness that has varied and multiple causative factors, but at present the exact cause of depressive disorders is not entirely understood.

23. A student nurse tells the instructor, "I'm concerned that when a client asks me for advice I won't have a good solution." Which should be the nursing instructor's best response? A. "It's scary to feel put on the spot by a client. Nurses don't always have the answer." B. "Remember, clients, not nurses, are responsible for their own choices and decisions." C. "Just keep the client's best interests in mind and do the best that you can." D. "Set a goal to continue to work on this aspect of your practice."

ANS: B Giving advice tells the client what to do or how to behave. It implies that the nurse knows what is best and that the client is incapable of any self-direction. It discourages independent thinking.

In assessing a client diagnosed with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)

ANS: B If large doses of central nervous system (CNS) depressants (like Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.

6. What is the priority reason for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression is a symptom of several medical conditions. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: B Medical conditions such as hormone disturbances, electrolyte disturbances, and nutritional deficiencies may produce symptoms of depression. These are a priority to identify and treat, since they may be the cause of the depressive symptoms and represent physiological needs.

18. A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better, so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I have been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."

ANS: B Often suicidal clients resist personal monitoring, which impedes the implementation of a suicide plan. A nurse should continually observe a client when risk for suicide is suspected.

15. A mother rescues two of her four children from a house fire. In the emergency department, she cries, "I should have gone back in to get them. I should have died, not them." What is the nurse's best response? A. "The smoke was too thick. You couldn't have gone back in." B. "You're feeling guilty because you weren't able to save your children." C. "Focus on the fact that you could have lost all four of your children." D. "It's best if you try not to think about what happened. Try to move on."

ANS: B The best response by the nurse is, "You're experiencing feelings of guilt because you weren't able to save your children." This response utilizes the therapeutic communication technique of reflection which identifies a client's emotional response and reflects these feelings back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

19. A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effect of suicide on family dynamics. B. Carefully and unobtrusively observe on the basis of assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self-esteem.

ANS: B The most effective way to interrupt a suicide attempt is to carefully, unobtrusively observe on the basis of assessed data at varied intervals around the clock. If a nurse observes behavior that indicates self-harm, the nurse can intervene to stop the behavior and keep the client safe.

12. During a group session, which client statement demonstrates that the group has progressed to the middle, or working, phase of group development? A. "It's hard for me to tell my story when I'm not sure about the reactions of others." B. "I think Joe's Antabuse suggestion is a good one and might work for me." C. "My situation is very complex, and I need professional, not peer, advice." D. "I am really upset that you expect me to solve my own problems."

ANS: B The nurse should determine that group members have progressed to the working phase of group development when members begin to look to each other instead of to the leader for guidance. Group members in the working phase begin to accept criticism from each other and then use it constructively to foster change. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Evaluation

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

ANS: B The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder.

1. During a therapeutic group, a client talks about personal accomplishments in an effort to gain attention. Which group role, assumed by this client, should the nurse identify? A. The task role of gatekeeper B. The individual role of recognition seeker C. The maintenance role of dominator D. The task role of elaborator

ANS: B The nurse should evaluate that the client is assuming the individual role of the recognition seeker. Other individual roles include the aggressor, the blocker, the dominator, the help seeker, the monopolizer, and the seducer. PTS: 1 REF: 195 KEY: Cognitive Level: Application | Integrated Process: Evaluation

A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

ANS: B The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

10. A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results with the combination of these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."

ANS: B The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

5. Which situation should a nurse identify as an example of an autocratic leadership style? A. The president of Sigma Theta Tau assigns members to committees to research problems. B. Without faculty input, the dean mandates that all course content be delivered via the Internet. C. During a community meeting, a nurse listens as clients generate solutions. D. The student nurses' association advertises for candidates for president.

ANS: B The nurse should identify that mandating decisions without consulting the group is considered an autocratic leadership style. Autocratic leadership increases productivity but often reduces morale and motivation due to lack of member input and creativity. PTS: 1 REF: 193-194 KEY: Cognitive Level: Application | Integrated Process: Assessment

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediate report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

ANS: B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

31. Which therapeutic communication technique should the nurse use when communicating with a client who is experiencing auditory hallucinations? A. "My sister has the same diagnosis as you and she also hears voices." B. "I understand that the voices seem real to you, but I do not hear any voices." C. "Why not turn up the radio so that the voices are muted." D. "I wouldn't worry about these voices. The medication will make them disappear."

ANS: B This is an example of the therapeutic communication technique of presenting reality. Presenting reality is when the client has a misperception of the environment. The nurse defines reality or indicates his or her perception of the situation for the client. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

33. A client slammed a door on the unit several times. The nurse responds, "You seem angry." The client states, "I'm not angry." What therapeutic communication technique has the nurse employed and what defense mechanism is the client unconsciously demonstrating? A. Making observations and the defense mechanism of suppression B. Verbalizing the implied and the defense mechanism of denial C. Reflection and the defense mechanism of projection D. Encouraging descriptions of perceptions and the defense mechanism of displacement

ANS: B This is an example of the therapeutic communication technique of verbalizing the implied. The nurse is putting into words what the client has only implied by words or actions. Denial is the refusal of the client to acknowledge the existence of a real situation, the feelings associated with it, or both. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

7. A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, "I relapsed three times, but now have been sober for 15 years." Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Catharsis D. Universality

ANS: B This scenario is an example of the curative group factor of instillation of hope. This occurs when members observe the progress of others in the group with similar problems and begin to believe that personal problems can also be resolved. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Assessment

22. Which of the following behavioral skills should a nurse implement when leading a group that is functioning in the orientation phase of group development? (Select all that apply.) A. Encouraging members to provide feedback to each other about individual progress B. Ensuring that group rules do not interfere with goal fulfillment C. Working with group members to establish rules that will govern the group D. Emphasizing the need for and importance of confidentiality within the group E. Helping the members to resolve conflicts and foster cohesiveness within the group

ANS: B, C, D During the orientation phase of group development, the nurse leader should work together with members to establish rules that will effectively govern the group. The leader should ensure that group rules do not interfere with goal fulfillment and establish the need for and importance of confidentiality within the group. Members need to establish trust and cohesion to move into the working phase of group development. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Implementation

29. An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? Select all that apply. A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressors

ANS: B, C, D The nurse should identify drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November).

19. An experienced psychiatric registered nurse has taken a new position leading groups in a day treatment program. Without further education, which group is this nurse most qualified to lead? A. A psychodrama group B. A psychotherapy group C. A parenting group D. A family therapy group

ANS: C A psychiatric registered nurse is qualified to lead a parenting group. A parenting group can be classified as either a teaching group or therapeutic group. Psychodrama, psychotherapy, and family therapy are forms of group therapy that must be facilitated by qualified leaders who generally have advanced degrees in psychology, social work, nursing, or medicine. PTS: 1 REF: 190 KEY: Cognitive Level: Application | Integrated Process: Implementation

22. A 75-year-old client with a long history of depression is currently on doxepin (Sinequan), 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell count

ANS: C A side effect of Sinequan is orthostatic hypotension. Dehydration due to fluid loss from a combination of diuretic medication and flu symptoms can also contribute to this problem, putting this client at risk for injury R/T orthostatic hypotension.

20. The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to help the clients alter their mood by learning how to change the way they think. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

ANS: C Cognitive theory suggests that depression is a product of negative thinking. Helping the individual change the way they think is believed to have a positive impact on mood and self-esteem.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

ANS: C Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client's fainting to the loss of alkaline stool due to laxative abuse which would lead to a relative metabolic acidotic condition.

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

ANS: C Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

During her aunt's wake, a four-year-old child runs up to the casket before a mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? A. Complicated grieving B. Altered family processes C. Ineffective coping D. Body image disturbance

ANS: C Rationale: Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hair-pulling disorder, or trichotillomania, may be assigned

The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

ANS: C The CAGE questionnaire is a screening tool used to determine the diagnosis of alcoholism. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? A. "Why do you assume responsibility for his behaviors?" B. "Codependency is a typical behavior of spouses of alcoholics." C. "Your husband needs to deal with the consequences of his drinking." D. "Do you understand what the term 'enabler' means?"

ANS: C The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Partners of clients with substance abuse must come to realize that the only behavior they can control is their own.

3. During a therapeutic group, which nursing action demonstrates a laissez-faire leadership style? A. The nurse mandates that all group members reveal an embarrassing personal situation. B. The nurse asks for a show of hands to determine group topic preference. C. The nurse sits silently as the group members stray from the assigned topic. D. The nurse shuffles through papers to determine the facility policy on length of group.

ANS: C The nurse leader who sits silently and allows group members to stray from the assigned topic is demonstrating a laissez-faire leadership style. This style allows group members to do as they please with no direction from the leader. Group members often become frustrated and confused in reaction to a laissez-faire leadership style. PTS: 1 REF: 194-195 KEY: Cognitive Level: Application | Integrated Process: Implementation

11. A nurse believes that the members of a parenting group are in the initial, or orientation, phase of group development. Which group behaviors would support this assumption? A. The group members manage conflict within the group. B. The group members use denial as part of the grief response. C. The group members compliment the leader and compete for the role of recorder. D. The group members initially trust one another and the leader.

ANS: C The nurse should anticipate that members in the initial, or orientation, phase of group development often compliment the leader and compete for the role of recorder. Members in this phase have not yet established trust and have a fear of not being accepted. Power struggles may occur as members compete for their position in the group. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Evaluation

Upon admission for symptoms of alcohol withdrawal a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping

ANS: C The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

16. When planning group therapy, a nurse should identify which configuration as most optimal for a therapeutic group? A. Open-ended membership; circle of chairs; group size of 5 to 10 members B. Open-ended membership; chairs around a table; group size of 10 to 15 members C. Closed membership; circle of chairs; group size of 5 to 10 members D. Closed membership; chairs around a table; group size of 10 to 15 members

ANS: C The nurse should identify that the most optimal conditions for a therapeutic group are when the membership is closed and the group size is between 5 and 10 members who are arranged in a circle of chairs. The focus of therapeutic groups is on relationships within the group and the interactions among group members. PTS: 1 REF: 191-192 KEY: Cognitive Level: Application | Integrated Process: Planning

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

ANS: C The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing which is followed by inappropriate compensatory behaviors.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

ANS: C The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these behaviors.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

ANS: C The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.

16. What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular bloodwork B. The client's mood and affect score, according to the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment

ANS: C There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.

22. The nurse asks a newly admitted client, "What can we do to help you?" What is the purpose of this therapeutic communication technique? A. To reframe the client's thoughts about mental health treatment B. To put the client at ease C. To explore a subject, idea, experience, or relationship D. To communicate that the nurse is listening to the conversation

ANS: C This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication.

28. A client on an inpatient psychiatric unit tells the nurse, "I should have died because I am totally worthless." In order to encourage the client to continue talking about feelings, which should be the nurse's initial response? A. "How would your family feel if you died?" B. "You feel worthless now, but that can change with time." C. "You've been feeling sad and alone for some time now?" D. "It is great that you have come in for help."

ANS: C This nursing statement is an example of the therapeutic communication technique of reflection. When reflection is used, questions and feelings are referred back to the client so that they may be recognized and accepted. PTS: 1 REF: 154 KEY: Cognitive Level: Application | Integrated Process: Implementation

A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports getting to sleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium

ANS: C Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.

Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

ANS: D A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.

7. A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

ANS: D Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

21. Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "Nothing will help me feel better."

ANS: D Hopelessness and helplessness are typical symptoms of clients diagnosed with major depressive disorder.

25. A nurse is caring for four clients taking various medications, including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate

ANS: D Hypertensive crisis occurs in clients receiving a monoamine oxidase inhibitor (MAOI) who consume foods or drugs with a high tyramine content.

13. Which group leader activity should a nurse identify as being most effective in the final, or termination, phase of group development? A. The group leader establishes the rules that will govern the group after discharge. B. The group leader encourages members to rely on each other for problem solving. C. The group leader presents and discusses the concept of group termination. D. The group leader helps the members to process feelings of loss.

ANS: D The most effective intervention in the final, or termination, phase of group development would be for the group leader to help the members to process feelings of loss. The leader should encourage the members to review the goals and discuss outcomes, reminisce about what has occurred, and encourage members to provide feedback to each other about progress. PTS: 1 REF: 193 KEY: Cognitive Level: Application | Integrated Process: Implementation

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

ANS: D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.

17. A client diagnosed with major depressive disorder states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's affective symptoms? A. "Have you been diagnosed with any physical disorder within the last 3 months?" B. "Have you ever felt this way before? C. "People who have mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"

ANS: D The nurse is using a clarifying statement in order to gather more details related to this client's mood.

Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

ANS: D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.

9. A confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect, and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different serotonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

ANS: D The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

17. During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader? A. To referee the debate B. To adamantly oppose physical discipline measures C. To redirect the group to a less controversial topic D. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem solving. Members are encouraged to cooperatively solve issues that relate to the group. PTS: 1 REF: 194 KEY: Cognitive Level: Application | Integrated Process: Implementation

During the sixth week of a 10-week parenting skills group, a nurse observes as several members get into a heated dispute about spanking. As a group, they decide to create a pros-and-cons poster on the use of physical discipline. At this time, what is the role of the group leader?A. To referee the debateB. To adamantly oppose physical discipline measuresC. To redirect the group to a less controversial topicD. To encourage the group to solve the problem collectively

ANS: D The role of the group leader is to encourage the group to solve the problem collectively. A democratic leadership style supports members in their participation and problem-solving. Members are encouraged to cooperatively solve issues that relate to the group.

6. A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. A mother of three admits to having felt that way herself. Which of Yalom's curative group factors does this illustrate? A. Imparting of information B. Instillation of hope C. Altruism D. Universality

ANS: D The scenario is an example of the curative group factor of universality. Universality occurs when individuals realize that they are not alone in the problems, thoughts, and feelings they are experiencing. This realization reduces anxiety by the support and understanding of others. PTS: 1 REF: 192 KEY: Cognitive Level: Application | Integrated Process: Assessment

14. A nursing instructor is teaching students about self-help groups like Alcoholics Anonymous (AA). Which student statement indicates that learning has occurred? A. "There is little research to support AA's effectiveness." B. "Self-help groups used to be the treatment of choice, but their popularity is waning." C. "These groups have no external regulation, so clients need to be cautious." D. "Members themselves run the group, with leadership usually rotating among the members."

ANS: D The student indicates an understanding of self-help groups when stating, "Members themselves run the group, with leadership usually rotating among the members." Nurses may or may not be involved in self-help groups. These groups allow members to talk about feelings and reduce feelings of isolation while receiving support from others undergoing similar experiences. PTS: 1 REF: 191 KEY: Cognitive Level: Application | Integrated Process: Evaluation

30. A client states, "You won't believe what my husband said to me during visiting hours. He has no right treating me that way." Which nursing response would best assess the situation that occurred? A. "Does your husband treat you like this very often?" B. "What do you think is your role in this relationship?" C. "Why do you think he behaved like that?" D. "Describe what happened during your time with your husband."

ANS: D This is an example of the therapeutic communication technique of exploring. The purpose of using exploring is to delve further into the subject, idea, experience, or relationship. This technique is especially helpful with clients who tend to remain on a superficial level of communication. PTS: 1 REF: 155 KEY: Cognitive Level: Application | Integrated Process: Implementation

25. Which nursing statement is a good example of the therapeutic communication technique of focusing? A. "Describe one of the best things that happened to you this week." B. "I'm having a difficult time understanding what you mean." C. "Your counseling session is in 30 minutes. I'll stay with you until then." D. "You mentioned your relationship with your father. Let's discuss that further."

ANS: D This is an example of the therapeutic communication technique of focusing. Focusing takes notice of a single idea or even a single word and works especially well with a client who is moving rapidly from one thought to another

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

ANS: D When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

Order the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe. ________ Delusional disorder ________ Schizotypal personality disorder ________ Schizophrenia ________ Brief psychotic disorder ________ Psychotic disorder associated with another medical condition ________ Catatonic disorder associated with another medical condition ________ Schizoaffective disorder ________ Schizophreniform disorder ________ Substance-induced psychotic disorder

ANS: The correct order is 2, 1, 9, 3, 5, 6, 8, 7, 4 1. Schizotypal personality disorder 2. Delusional disorder 3. Brief psychotic disorder 4. Substance-induced psychotic disorder 5. Psychotic disorder associated with another medical condition 6. Catatonic disorder associated with another medical condition 7. Schizophreniform disorder 8. Schizoaffective disorder 9. Schizophrenia

Ordered Response 17. Number the following nursing interventions as they would proceed through the steps of the nursing process. ________ Determine if an antianxiety medication is decreasing a clients stress. ________ Measure a clients vital signs and review past history. ________ Encourage deep breathing and teach relaxation techniques. ________ Aim, with client collaboration, for a seven-hour nights sleep. ________ Recognize and document the clients problem.

ANS: The correct order is 5, 1, 4, 3, 2 Rationale: 1. Measuring a clients vital signs and reviewing past history is a nursing intervention that occurs in the assessment step of the nursing process. 2. Recognizing and documenting the clients problem occurs in the nursing diagnosis step. 3. Setting a goal with client collaboration, for a seven-hour nights sleep occurs in the planning step. 4. Encouraging deep breathing and teaching relaxation techniques occur in the implementation step. 5. Determining if an antianxiety medication is decreasing a clients stress occurs in the evaluation step.

A polysubstance user makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? A) The client abuses amphetamines and anxiolytics B) The client abuses alcohol and cocaine C) The client is psychotic D) The client abuses narcotics and marijuana

ANSWER: A A) The client abuses amphetamines and anxiolytics

Which of the following medications is the physician most likely to order for the client experiencing alcohol withdrawal syndrome? A) Haloperidol (Haldol) B) Chlordiazepoxide (Librium) C) Methadone (Dolophine) D) Phenytoin (Dilantin)

B) Chlordiazepoxide (Librium) Treats anxiety, symptoms of alcohol withdrawal, and tremor. benzodiazepine. SE=Depressed mood/severe confusion, unsteadiness, drowsiness/weakness, Slow heartbeat, Sudden mood changes, SOB, Blurred vision, H/A, Diarrhea/ S/A constipation, Dry mouth, Feeling "hungover" the next morning after bedtime use, Trouble concentrating

Dan, who has been admitted to the alcohol rehab unit after being fired for "drinking on the job", states "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my co-workers." The nurses best response is: A) "Maybe you boss is mistaken, Dan." B) "You are here because your drinking was interfering with your work, Dan" C) "Get real, Dan! You're a boozer and you know it" D) "Why do you think your boss sent you here, Dan'?

B)" You are here because your drinking was interfering with your work, Dan"

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.) A "Have you confronted him with this?" B "He may be demonstrating flattening of affect and anhedonia." C "He may have sedation or masked facial expressions from his medications." D "Maybe he's depressed about having a chronic illness." E "It's sad when a loved one does not have any feelings."

B, C, D

Which family member statements demonstrate recognition of the effects of social pressures associated with schizophrenia? (Select all that apply.) A "If my family member would just move in with me, it would be a lot easier for me to maintain my household and care for my children." B "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.'" C "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." D "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." E "I used to protect my family member from a lot of the interpersonal conflicts in the family, but we need to express our emotions more openly."

B, C, D

14. Which of the following are characteristics of a Program of Assertive Community Treatment (PACT), as described by the National Alliance on Mental Illness (NAMI)? (Select all that apply.)A. PACT offers nationally based treatment to people with serious and persistent mental illnesses. B. PACT is a type of case-management program. C. The PACT team provides services 24 hours a day, 7 days a wk, 365 dys a year. D. The PACT team provides highly individualized services directly to consumers. E. PACT is a multidisciplinary team approach.

B, C, D, E

11. A family member is seeking advice about an elderly parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing reply? A. "My mother also worries unnecessarily. I think it is part of the aging process." B. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." C. "From what you have told me, you should get her to a psychiatrist as soon as possible." D. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

B. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her 3 small children. She tells the nurse her husband inflicted these wounds on her. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is: A. "How often does he drink too much?" B. "It is not your fault. You did the right thing by coming here." C. "How many times has he done this to you?" D. "He is not a good husband. You have to leave before he kills you."

B. "It is not your fault. You did the right thing by coming here."

19. A nursing student questions an instructor regarding the order for fluvoxamine (Luvox), 300 mg daily, for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor reply is most accurate? A. "High doses of tricyclic medications will be required for effective treatment of OCD." B. "Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD." C. "The dose of Luvox is low due to the side effect of daytime drowsiness and nighttime insomnia." D. "The dosage of Luvox is outside the therapeutic range and needs to be questioned."

B. "Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD."

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

B. "The client is expressing a neologism." The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly.

1. A nursing instructor is teaching about specific phobias. Which student statement should indicate that learning has occurred? A. "These clients do not recognize that their fear is excessive, and they rarely seek treatment." B. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus." C. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." D. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

B. "These clients have overwhelming symptoms of panic when exposed to the phobic stimulus."

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. What is the most appropriate nursing intervention for this symptom? A. Ask the client to describe his physical symptoms. B. Ask the client to describe what he is hearing. C. Administer a dose of benztropine. D. Call the physician for additional orders.

B. Ask the client to describe what he is hearing.

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

B. Focus on feelings suggested by the delusion The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

Jan, age 5, is sent to the school nurses's office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jan has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jan's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that: A. Jan is experiencing physical and sexual abuse B. Jan is experiencing physical abuse and neglect C. Jan is experiencing emotional neglect D. Jan is experiencing sexual and emotional abuse

B. Jan is experiencing physical abuse and neglect

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

B. Risk for other-directed violence R/T yelling accusations The nursing diagnosis that must be prioritized in this situation should be risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.

2. A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

B. Social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive disorder. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming.

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

B. Structure the ct's schedule so that she has plenty of time for washing her hands.

15. A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? A. The client will refrain from ritualistic behaviors during daylight hours. B. The client will wake early enough to complete rituals prior to breakfast. C. The client will participate in three unit activities by day 3. D. The client will substitute a productive activity for rituals by day 1.

B. The client will wake early enough to complete rituals prior to breakfast.

Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect: A. panic disorder. B. adult separation anxiety disorder. C. agoraphobia. D. social anxiety disorder.

B. adult separation anxiety disorder. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. Cognitive Level: Analyze (Analysis) Nursing Process: Diagnosis NCLEX: Psychosocial Integrity

To best assure the safety of a 3-year-old child whose parent admits to finding it difficult to control their anger, the most appropriate short-term goal would be for the parent to A. understand the impact of violence on the child within 2 days. B. begin attending anger management training sessions within 2 weeks. C. state a willingness to attend a support group for physical abusers within 1 week. D. show remorse for their anger management issues within 2 days.

B. begin attending anger management training sessions within 2 weeks. Perpetrators of violence need help learning how to manage anger. A structured group is an excellent way to provide this teaching.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports A. that his symptoms started right after he was robbed at gunpoint. B. being so worried he hasn't been able to work for the last 12 months. C. that eating in public makes him extremely uncomfortable. D. repeatedly verbalizing his prayers helps him feel relaxed.

B. being so worried he hasn't been able to work for the last 12 months. GAD is characterized by symptomatology that lasts 6 months or longer.

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of A. altruism. B. denial. C. undoing. D. suppression.

B. denial. Denial involves escaping unpleasant reality by ignoring its existence.

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

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

An abuse victim tearfully tells the nurse in the emergency department, "Don't tell my husband that you know he beats me because if he thinks anyone knows, he will beat me again." Based on this information, the most appropriate nursing diagnosis is A. chronic pain. B. fear. C. post-trauma syndrome. D. risk for self-directed violence.

B. fear. The client is expressing fear based on a known threat.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of A. acute dystonia. B. tardive dyskinesia. C. cholestatic jaundice. D. pseudoparkinsonism.

B. tardive dyskinesia. An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

A nursing intervention designed to help a schizophrenic client manage relapse is to A. schedule the client to attend group therapy that includes those who have relapsed. B. teach the client and family about behaviors associated with relapse. C. remind the client of the need to return for periodic blood draws to minimize the risk for relapse. D. help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

B. teach the client and family about behaviors associated with relapse. Correct By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

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

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

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? Select one: a. The client is using denial by avoiding responsibility. b. The client is using displacement by blaming his wife. c. The client is using rationalization to excuse his alcohol dependence. d. The client is using reaction formation by appealing to the group for sympathy.

C The nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? Select one: a. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. b. Educate the client about the biopsychosocial consequences of alcohol abuse. c. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. d. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of withdrawal from substances.

A nurse is designing a relapse-prevention inpatient group for clients with schizophrenia. Which statement addresses a main category of nursing activities? A "We're going to discuss current events." B "Let's go around the room and have each person say something positive about our group." C "If you can increase your self-assessment skills, you'll be able to tell when you're getting more stressed." D "We will go around the room and each person will state a personal goal for today."

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

The client with schizophrenia is preparing for discharge. To minimize relapse, what is the most important feature of planning the client's aftercare? A Identification of two new ways to bolster self-esteem B Ensuring that the client lists three potential sources of social support C An accurate description of the medication regimen with a specific plan for obtaining refills D Identification of three new methods of spending leisure time

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

Dan, who has been admitted to the alcohol rehab unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? A) Search his room for evidence. B) Ask, " Have you been drinking alcohol, Dan?" C) Send a urine specimen from Dan to the lab for a drug screening. D) Tell Dan, "These guys cannot come to the unit to visit you again".

C) Send a urine specimen from Dan to the lab for a drug screening.

20. Which nursing statement is a good example of the therapeutic communication technique of giving recognition? A. "You did not attend group today. Can we talk about that?" B. "I'll sit with you until it is time for your family session." C. "I notice you are wearing a new dress and you have washed your hair." D. "I'm happy that you are now taking your medications. They will really help."

C. "I notice you are wearing a new dress and you have washed your hair." This is an example of the therapeutic communication technique of giving recognition. Giving recognition acknowledges and indicates awareness. This technique is more appropriate than complimenting the client which reflects the nurse's judgment.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be A. "You are safe here in the hospital; nothing bad will happen to you." B. "The voices are wrong about the hospital food. It is not contaminated." C. "I understand that the voices are very real to you, but I do not hear them." D. "Other people are eating the food, and nothing is happening to them."

C. "I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.

13. A client diagnosed with dependant personality disorder states, "Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? A. "It would be best to do that in order to increase independence." B. "Why would you want to leave a secure home?" C. "Let's discuss and explore all of your options." D. "I'm afraid you would feel very guilty leaving your parents."

C. "Let's discuss and explore all of your options." In this example, the nurse is encouraging the client to formulate ideas and decide independently the appropriate course of action.

9. An instructor is correcting a nursing student's clinical worksheet. Which instructor statement is the best example of effective feedback? A. "Why did you use the client's name on your clinical worksheet?" B. "You were very careless to refer to your client by name on your clinical worksheet." C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." D. "It is disappointing that after being told, you're still using client names on your worksheet."

C. "Surely you didn't do this deliberately, but you breeched confidentiality by using the client's name." An example of effective feedback. Feedback is a method of communication to help others consider a modification of behavior. Feedback should be descriptive, specific, and directed toward a behavior that the person has the capacity to modify and should impart information rather than offer advice or criticize the individual.

14. A client living on the beachfront seeks help with an extreme fear of crossing bridges, which interferes with daily life. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this therapy should the nurse convey to the client? A. "Using your imagination, we will attempt to achieve a state of relaxation that you can replicate when faced with crossing a bridge." B. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." D. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety."

Which nursing statement best describes the current nature of mental health care in the community? A. "All homeless people have a history of institutionalization and are frequently admitted to acute care settings." B. "The deinstitutionalization movement in the United States was successful in transitioning clients into the community." C. "Today, the majority of clients admitted to psychiatric hospitals are in a crisis stage, and the treatment goal is stabilization."

C. "Today, the majority of clients admitted to psychiatric hospitals are in a crisis stage, and the treatment goal is stabilization."

Which child is at lowest risk for abuse? A. A 3-month-old who has colic and teenaged parents. B. A 4-year-old who has cerebral palsy and retarded parents. C. A 2-year-old who has leukemia and two working parents. D. A 5-year-old who has ADHD and a father who was abused as a child.

C. A 2-year-old who has leukemia and two working parents. Although the child in option C has a serious physical disorder, she is at lower risk than the child in option A, whose inconsolable crying can be frustrating; the child in option B, who will not be as independent as other children his age and who has parents who may not understand his needs; or the child in option D, whose hyperactivity can be annoying, especially to a parent who himself has been abused.

Which symptom would NOT be assessed as a positive symptom of schizophrenia? A. Delusion of persecution B. Auditory hallucinations C. Affective flattening D. Idea of reference

C. Affective flattening Correct Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

13. A college student is unable to take a final examination because of severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Noncompliance R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

C. Altered coping R/T anxiety

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing which of the following? A. Somatic delusions B. Catatonic stupor C. Auditory hallucinations D. Pseudoparkinsonism

C. Auditory hallucinations

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

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

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? A. Provide large motor activities to relieve the client's pent-up tension. B. Administer a dose of prn chlorpromazine to keep the client calm. C. Call for sufficient help to control the situation safely. D. Convey to the client that his behavior is unacceptable and will not be permitted.

C. Call for sufficient help to control the situation safely.

3. How would a nurse differentiate a client diagnosed with a social phobia from a client diagnosed with a schizoid personality disorder (SPD)? A. Clients diagnosed with social phobia can manage anxiety without medications, whereas clients diagnosed with SPD can manage anxiety only with medications. B. Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social phobia are not. C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

C. Clients diagnosed with social phobia avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life.

24. How should a nurse best describe the major maladaptive client response to panic disorder? A. Clients overuse medical care because of physical symptoms. B. Clients use illegal drugs to ease symptoms. C. Clients perceive having no control over life situations. D. Clients develop compulsions to deal with anxiety.

C. Clients perceive having no control over life situations.

3. Which therapeutic communication technique is being used in this nurse-client interaction? Client: "When I am anxious, the only thing that calms me down is alcohol." Nurse: "Other than drinking, what alternatives have you explored to decrease anxiety?" A. Reflecting B. Making observations C. Formulating a plan of action D. Giving recognition

C. Formulating a plan of action helps the client explore alternatives to drinking alcohol. The use of this technique, rather than direct confrontation regarding the client's poor coping choice, may serve to prevent anger or anxiety from escalating.

Which intervention should the nurse consider as primary prevention for an individual who is on the verge of being homeless because of a job layoff? A. Referral to primary care provider to improve general health status B. Encouraging client to recognize reasons for job layoff C. Job training to increase employment options D. Encouraging the use of prn medications to control symptoms

C. Job training to increase employment options

5. Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? A. Long-term treatment with diazepam (Valium) B. Acute symptom control with citalopram (Celexa) C. Long-term treatment with buspirone (BuSpar) D. Acute symptom control with ziprasidone (Geodon)

C. Long-term treatment with buspirone (BuSpar)

19. A client's younger daughter is ignoring curfew. The client states, "I'm afraid she will get pregnant." The nurse responds, "Hang in there. Don't you think she has a lot to learn about life?" This is an example of which communication block? A. Requesting an explanation B. Belittling the client C. Making stereotyped comments D. Probing

C. Making stereotyped comments . Clichés and trite expressions are meaningless in a therapeutic nurse-client relationship.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? A. Having the client repeatedly touch "dirty" objects B. Not allowing the client to seek reassurance from staff C. Not allowing the client to wash hands after touching a "dirty" object D. Telling the client that he or she must relax whenever tension mounts

C. Not allowing the client to wash hands after touching a "dirty" object Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval.

Which of the following is true regarding schizophrenia treatment and outcomes? A. If treated quickly following diagnosis, schizophrenia can be cured. B. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. D. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her 3 small children. She tells the nurse her husband inflicted these wounds on her. In the interview, she tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge of the cycle of battering, what does this situation represent? A. Phase 1; Sharon was desperately trying to stay out of his way and keep everything calm B. Phase I; a minor battering incident for which Sharon assumes all the blame C. Phase II; the acute battering incident that Sharon provoked with her threat to leave D. Phase III; the honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again."

C. Phase II; the acute battering incident that Sharon provoked with her threat to leave

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

C. Risperidone (Risperdal) to address the positive symptom The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan's mother's question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone? A. All antipsychotic medications have an equal chance of producing EPSs. B. Newer antipsychotic medications have a higher risk for EPSs. C. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. D. Advise Declan's mother to ask the provider to change the medication to clozapine instead of risperidone.

C. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

14. When interviewing a client, which nonverbal behavior should a nurse employ? A. Maintaining indirect eye contact with the client B. Providing space by leaning back away from the client C. Sitting squarely, facing the client D. Maintaining open posture with arms and legs crossed

C. Sitting squarely, facing the client Facilitative skills for active listening can be identified by the acronym SOLER. SOLER includes sitting squarely facing the client (S), open posture when interacting with a client (O), leaning forward toward the client (L), establishing eye contact (E), and relaxing (R).

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

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

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

C. The client will perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

C. This therapy will provide the client with control over behavioral choices.

8. A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out neurocognitive disorder D. To rule out a personality disorder

C. To rule out neurocognitive disorder . The elderly are often misdiagnosed with neurocognitive disorder such as Alzheimer's disease, when depression is their actual diagnosis. Memory loss, confused thinking, and apathy are common symptoms of depression in the elderly.

Which statement reflects a fact about family violence? A. Ninety-five percent of abuse victims are women. B. The victim's behavior is often the cause of the violence. C. Violence occurs in families of all backgrounds. D. Alcohol and stress are the major causes of abuse.

C. Violence occurs in families of all backgrounds. Option C is a true statement. The others are false.

A rape victim in the emergency department keeps repeating, "I don't know why he did it." Although the nurse does not necessarily give the answer at this juncture, the nurse correctly identifies the motivation for most perpetrators of rape as A. anxiety relief. B. an overwhelming sexual desire. C. a desire to dominate and humiliate. D. a wish to be apprehended and punished.

C. a desire to dominate and humiliate. Power and domination, as well as humiliation of the victim, are the motivations for rape. In this scenario the nurse understands that rape is not a sexual act. Rape is a violent expression of aggression, anger, and the need for power.

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

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

A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should: A. suggest that the client take something for her fever and get extra rest. B. advise the physician that the client should be admitted to the hospital. C. arrange for the client to have blood drawn for a white blood cell count. D. consider recommending a change of antipsychotic medication.

C. arrange for the client to have blood drawn for a white blood cell count. Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to: A. reassure Lana that she is experiencing normal anxiety and do deep breathing exercises with her. B. use the call light to inquire whether Lana has any prn anxiety medication. C. call for help and assess Lana's vital signs. D. tell Lana you will stay with her until the anxiety subsides.

C. call for help and assess Lana's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nurse A. interacting with a neutral attitude. B. using concrete language. C. giving multistep directions. D. providing nutritional supplements

C. giving multistep directions. The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to A. make jokes to relieve tension. B. miss appointments. C. justify illogical ideas and feelings D. behave in ways that are the opposite of his/hr=er feeling

C. justify illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.qq

A client diagnosed with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by A. chronic uncooperativeness. B. personality conflict. C. neural dysfunction. D. dependency needs.

C. neural dysfunction. . Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing A. denial. B. compensation. C. normal anxiety. D. selective inatention

C. normal anxiety. Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating A. projection. B. rationalization. C. reaction formation. D. undoing.

C. reaction formation. Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion

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

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

A nurse is interviewing a client in an outpatient substance-abuse clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? Select one: a. The client will identify one person to turn to for support. b. The client will give up all old drinking buddies. c. The client will be able to verbalize the effects of alcohol on the body. d. The client will correlate life problems with alcohol use.

D The nurse should expect that the client would initially correlate life problems with alcohol abuse. Acceptance of the problem is the first part of the recovery process.

You have presented your client with written aftercare medication directions: "Take one capsule three times per day." Your client informs you that she has reviewed the material. Which response specifically addresses your concerns about adherence? A "If you forget one dose, you can double the next one." B "Do you understand everything?" C "This medication really works best if you take one capsule three times per day." D "What might get in the way of your taking your medications?"

D "What might get in the way of your taking your medications?"

While you are employed as a charge nurse on an inpatient psychiatric unit, you recognize that you are choosing to spend less time interacting with the clients with schizophrenia. Your first action is: A Discussing your observation with your clinical supervisor. B Requesting a transfer to another unit. C Forcing yourself to interact with the clients with schizophrenia. D Reflecting on your behavior.

D Reflecting on your behavior.

Working to help the client view an occurrence in a more positive light is called A. flooding. B. desensitization. C. response prevention. D. cognitive restructuring.

D cognitive restructuring. The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive.

12. A client who frequently exhibits angry outbursts is diagnosed with antisocial personality disorder. Which appropriate feedback should a nurse provide when this client experiences an angry outburst? A. "Why do you continue to alienate your peers by your angry outbursts?" B. "You accomplish nothing when you lose your temper like that." C. "Showing your anger in that manner is very childish and insensitive." D. "During group, you raised your voice, yelled at a peer, left, and slammed the door."

D. "During group, you raised your voice, yelled at a peer, left, and slammed the door." Giving appropriate feedback involves helping the client consider a modification of behavior. Feedback should give information to the client about how he or she is perceived by others. Feedback should not be evaluative in nature or be used to give advice.

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."

D. "I am angry at my mother. I can only get her approval when I win competitions." Families who are overprotective and perfectionism can contribute to a family member's development of anorexia nervosa.

Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Which of the following is the most appropriate response by the nurse? A. "That's ridiculous, Clint. No one is going to hurt you." B. "The CIA isn't interested in people like you, Clint." C. "Why do you think the CIA wants to kill you?" D. "I know you believe that, Clint, but it's really hard for me to believe."

D. "I know you believe that, Clint, but it's really hard for me to believe."

Declan is a 26-year-old patient with schizophrenia. He states to you, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be: A. "You are having problems with your speech. You need to try harder to be clear." B. "You are confused. I will take you to your room to rest a while." C. "I will get you a prn medication for agitation." D. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

D. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" Telling the patient he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes.

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

D. "It helps prevent relapse by reducing drug cravings." Naltrexone is used for withdrawal and also to prevent relapse by reducing the craving for the drug. The other options do not accurately describe the action of naltrexone.

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to Dexecute me," an appropriate response for the nurse would be D. "You are safe here. This is a locked unit, and no one can get in." B. "I do not believe I understand the word volmers. Tell me more about them." C. "Why do you think someone or something is going to harm you?" D. "It must be frightening to think something is going to harm you."

D. "It must be frightening to think something is going to harm you." This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience.

16. A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. "Everyone diagnosed with OCD needs to control their ritualistic behaviors." B. "It is important for you to discontinue these ritualistic behaviors." C. "Why are you asking for help if you won't participate in unit therapy?" D. "Let's figure out a way for you to attend unit activities and still wash your hands."

D. "Let's figure out a way for you to attend unit activities and still wash your hands." This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing the client's anxiety.

18. A client tells the nurse, "I feel bad because my mother does not want me to return home after I leave the hospital." Which nursing response is therapeutic? A. "It's quite common for clients to feel that way after a lengthy hospitalization." B. "Why don't you talk to your mother? You may find out she doesn't feel that way." C. "Your mother seems like an understanding person. I'll help you approach her." D. "You feel that your mother does not want you to come back home?"

D. "You feel that your mother does not want you to come back home?" Restatement is the repeating of the main idea that the client has verbalized. This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or clarify if necessary.

Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.

D. Decreased seratonin, increased norepinephrine, and decreased GABA. pg. 530

4. How would a nurse differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? A. GAD is acute in nature, and panic disorder is chronic. B. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. C. Hyperventilation is a common symptom in GAD and rare in panic disorder. D. Depersonalization is commonly seen in panic disorder and absent in GAD.

D. Depersonalization is commonly seen in panic disorder and absent in GAD.

18. A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? A. Distract the client with other activities whenever ritual behaviors begin. B. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. C. Lock the room to discourage ritualistic behavior. D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

D. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

1. A client is diagnosed with persistent depressive (dysthymia) disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

D. Gloomy and pessimistic outlook on life The nurse should classify a gloomy and pessimistic outlook on life as an affective symptom of dysthymia.

A woman who has long hx of being battered by her husband is staying at the woman's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is: A. "I just can't believe you have decided to go back to that horrible man." B. I'm just afraid that he will kill you or the children when you get back. C. What makes you think things have changed with him? D. I hope you have made the right decision. Call this number if you need help.

D. I hope you have made the right decision. Call this number if you need help.

What distinction can be made between abuse and neglect? A. Neglect occurs in the psychological domain; abuse occurs in the physical domain. B. Neglect is always physical; abuse can be verbal, physical, sexual, or emotional. C. Neglect is perpetrated against children; abuse victims can be children or adults. D. Neglect is a failure to provide; abuse is a failure to control aggression.

D. Neglect is a failure to provide; abuse is a failure to control aggression. Neglect is failure to provide necessary care, and abuse is physical maltreatment

Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder? A. Express mild amusement over symptoms. B. Arrange for client to spend time away from others. C. Advise client to minimize exercise to conserve endorphins. D. Reinforce use of positive self-talk to change negative assumptions.

D. Reinforce use of positive self-talk to change negative assumptions. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try."

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

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

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

D. Tardive dyskinesia and treat by discontinuing antipsychotic medications The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications

3. A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

D. The client has maxed-out charge cards and exhibits promiscuous behaviors. manic symptoms, these symptoms would rule out the diagnosis of major depressive disorder.

The type of altered perception most commonly experienced by clients with schizophrenia is A. delusions. B. illusions. C. tactile hallucinations. D. auditory hallucinations.

D. auditory hallucinations. Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to: A. reinforce the preoperative teaching by restating it slowly. B. have Lana read the teaching materials instead of verbal instruction. C. have a family member read the preoperative materials to Lana. D. not attempt any teaching at this time.

D. not attempt any teaching at this time. Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

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

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

A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as A. mild. B. moderate. C. severe. D. panic.

D. panic. Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be A. safety and crisis intervention. B. acute symptom stabilization. C. stress and vulnerability assessment. D. social, vocational, and self-care skills.

D. social, vocational, and self-care skills. planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.

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

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

Which side effect of antipsychotic medication is generally nonreversible? A. Anticholinergic effects B. Pseudoparkinsonism C. Dystonic reaction D. Tardive dyskinesia

D.Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in A, B, and C often appear early in therapy and can be minimized with treatment.

A symptom commonly associated with panic attacks is A. obsessions. B. apathy. C. fever. D. fear of impending doom.

D.fear of impending doom. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.

A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply) a. The client has a long history of focusing thoughts and behaviors on other people. b. The client, as a child, experienced overindulgent and overprotective parents. c. The client is a people pleaser and does almost anything to gain approval. d. The client exhibits helpless behaviors but actually feels very competent. e. The client can achieve a sense of control only through fulfilling the needs of others.

a,c,e The nurse should recognize the symptoms of codependency: they focus on other people and can only achieve a sense of control through fulfilling the needs of others, they are "people pleasers."

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? a. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." b. "My mother worries unnecessarily. I think it is part of the aging process." c. "From what you have told me, you should get her to a psychiatrist as soon as possible." d. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

a. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning."

A nursing instructor is teaching about case management. What student statement indicates that learning has occurred? a. "Case management provides coordination of services required to meet client needs." b. "Case management exists mainly to facilitate client admission to needed inpatient services." c. "Case management is a method to facilitate physician reimbursement." d. "Case management is a method used to achieve independent client care."

a. "Case management provides coordination of services required to meet client needs."

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? a. "I will need to schedule blood work in order to monitor for toxic levels of this drug." b. "I won't stop taking this medicine abruptly because there could be serious complications." c. "I will not drink alcohol while taking this medication." d. "I won't take extra doses of this drug because I can become addicted."

a. "I will need to schedule blood work in order to monitor for toxic levels of this drug."

A client with depression and substance abuse has an interrupted sleep pattern. She demands that her psychiatrist prescribe her a sedative. What teaching would the nurse provide about the rationale for the use of non-pharmacological interventions instead? a. "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them." b. "Sedative-hypnotics work best in combination with other techniques." c. "Sedative-hypnotics are not permitted for use in patients with substance abuse disorders." d. "Sedative-hypnotics are not as effective as the antidepressant medications for treating sleep disturbances."

a. "Sedative-hypnotics are potentially addictive and gradually lose their effectiveness as one builds up tolerance to them."

A client diagnosed with Alzheimer's Disease (AD) is prescribed donepezil (Aricept). The client's spouse inquires, "How does this work? Will this cure him?" Which is the appropriate nursing response? a. "This medication delays the destruction of acetycholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." b. "This medication encourages production of acetylcholine, a chemical in the brain necessary for memory processes. It delays the progression of the disease." c. "This medication delays the destruction of dopamine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease." d. "This medication encourages production of dopamine, a chemical in the brain necessary for memory processes. It delays the progression of the disease."

a. "This medication delays the destruction of acetycholine, a chemical in the brain necessary for memory processes. Although most effective in the early stages, it serves to delay, but not stop, the progression of the disease."

A client with Schizophrenia has recently begun a new medication, Clozapine (clozaril). Which potentially fatal side effect will the nurse teach the client about? a. Agranulocytosis b. Akathisia c. Dystonia d. Akinesia

a. Agranulocytosis

A client with schizophrenia has recently begun a new medication, Clozapine (Clozaril). Which potentially fatal side effect will the nurse teach the client about? a. Agranulocytosis b. Akathisia c. Dystonia d. Akinesia

a. Agranulocytosis

The following outcome was developed for a client: "Client will list 5 personal strengths by the end of day one." Which correctly written diagnostic statement most likely generated the development of this outcome? a. Altered self esteem R/T years of emotional abuse AEB self-deprecating statements b. Self-care deficit R/T altered thought process c. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 d. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

a. Altered self esteem R/T years of emotional abuse AEB self-deprecating statements

The client with schizophrenia is preparing for discharge. To minimize relapse, what is the most important feature of planning the client's aftercare? a. An accurate description of the medication regimen with a specific plan for obtaining refills b. Identification of three new methods of spending leisure time c. Ensuring that the client lists three potential sources of social support d. Identification of two new ways to bolster self-esteem

a. An accurate description of the medication regimen with a specific plan for obtaining refills The nurse should recognize that the most common reason patient's relapse or decompensate into their illness is because they have stopped taking their medication, so teaching should emphasize compliance with medication.

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder (BPD)? a. Being firm, consistent, and empathetic, while addressing specific client behaviors b. Promoting client self-expression by implementing laissez-faire leadership c. Using authoritative leadership to help clients learn to conform to society norms d. Overlooking inappropriate behaviors to avoid providing secondary gains

a. Being firm, consistent, and empathetic, while addressing specific client behaviors

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? a. Phase III: The honeymoon phase b. Phase IV: The resolution and reorganization phase c. Phase II: The acute battering incident phase d. Phase I: Tension-building

a. Phase III: The honeymoon phase

A 25 year old woman has been admitted to your unit with Borderline Personality Disorder. She self mutilates and is bulimic. What are the nurse's priorities when planning care for the client? a. Provide safety and close observation b. Close observation and medicate c. Set firm limits and medicate d. Provide safety and set firm limits

a. Provide safety and close observation

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? a. Risk for injury R/T central nervous system stimulation. b. Disturbed thought processes R/T tactile hallucinations. c. Ineffective coping R/T powerlessness over alcohol use. d. Ineffective denial R/T continued alcohol use despite negative consequences

a. Risk for injury R/T central nervous system stimulation.

A newly admitted client asks, quote why do we need a unit schedule? I'm not going to these groups. I'm here to get some rest. which is the most appropriate nursing response? a. The purpose of group therapy is to learn and practice new coping skills b. group theory therapy is mandatory. All clients must attend. c. Group therapy is completely optional. You can go if you find the topic helpful an interesting. d. Group therapy is an economical way of providing therapy too many clients concurrently.

a. The purpose of group therapy is to learn and practice new coping skills

The best treatment for a client with a disabling phobia would be? a. facing the fear through gradual exposure b. administer 10 mg of Valium as needed c. hypnosis d. facing the fear through implosion therapy

a. facing the fear through gradual exposure

A potential problem for a client diagnosed with severe obsessive-compulsive disorder is A. sleep disturbance. B. excessive socialization. C. command hallucinations. D. altered state of consciousness.

a. sleep disturbance. Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep.

The nurse is assigning staff to care for a number of clients with emotional disorders. Which facet of care is suitable to the skills of the nursing assistant? Obtaining the vital signs of a client admitted for alcohol withdrawal Helping a client with depression with bathing and grooming Monitoring a client who is receiving electroconvulsive therapy Sitting with a client with mania who is in seclusion

b Helping a client with depression with bathing and grooming

A client is brought to the emergency department and diagnosed with a panic level of anxiety. What biological system domination would be responsible for this diagnosis? a) Parasympathetic division of the autonomic nervous system b) Sympathetic division of the autonomic nervous system c) The cerebral cortex d) The cerebellum

b) Sympathetic division of the autonomic nervous system The sympathetic division of the autonomic nervous system is dominant in stressful situations and prepares the body for "fight or flight." In the situation presented the client is experiencing panic anxiety and therefore the sympathetic system dominates.

A nursing supervisor is about to meet with a staff nurse suspected of diverting client medications. Which of the following assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply) a. The staff nurse is frequently absent from work. b. The staff nurse experiences mood swings. c. The staff nurse makes elaborate excuses for behavior. d. The staff nurse frequently uses the restroom. e. The staff nurse has a flushed face.

b,c,d,e The nurse should recognize the symptoms of substance use by a coworker: Mood swings, elaborate excuses for behavior, frequently using the restroom and a flushed face are all signs of an impaired nurse.

The nurse is planning a teaching session for a client who has recently been prescribed disulfiram (Antabuse) as deterrent therapy for alcohol use disorder. What statement indicates that the client has accurate knowledge of this subject matter? a. "Over-the-counter cough and cold medication should not affect me while I am taking the disulfiram." b. "I'll have to stop using my alcohol-based aftershave while I am taking the disulfiram ." c. "Disulfiram should decrease my cravings for alcohol and make my recovery process easier." d. "Disulfiram is used as a substitute for alcohol to help me avoid alcohol withdrawal symptoms."

b. "I'll have to stop using my alcohol-based aftershave while I am taking the disulfiram ." Alcohol can be absorbed through the skin. Alcohol-based aftershaves should be avoided when taking disulfiram. This client's statement indicates that the client has accurate knowledge related to this important information.

Which of the following client statements would demonstrate a major symptom of schizophrenia spectrum disorder? a. "I've been depressed ever since our house was destroyed by fire." b. "You can read my mind. This light of mine will shine, fine; blinding world will end at nine." c. "I had too much to drink last night, started feeling all-powerful, and stupidly drove my truck into a tree." d. ''A stitch in time saves nine' means that prevention is easier than fixing a real problem."

b. "You can read my mind. This light of mine will shine, fine; blinding world will end at nine." The nurse should recognize this statement is a rhyming statement and is called a clang association and is a positive symptom of schizophrenia spectrum disorder.

According to Maslow's hierarchy of needs, which situation on an inpatient psychiatric unit would require priority intervention by a nurse? a. A client rudely complaining about limited visiting hours b. A client exhibiting aggressive behavior toward another client c. A client stating that no one cares d. A client verbalizing feelings of failure

b. A client exhibiting aggressive toward another client

what is an example of an intentional tort? a. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome b. A nurse places and irritating client in four-point restraints c. a nurse makes a medication error and does not report the incident d. a nurse gives patient information to an authorized person

b. A nurse places and irritating client in four-point restraints

A child diagnosed with oppositional defiant disorder (ODD) begins yelling at staff members when asked to leave group therapy because of inappropriate language. Which nursing intervention would be appropriate? a. Administer prn medication to decrease acting-out behaviors. b. Accompany the child to a quiet area to decrease external stimuli. c. Institute seclusion following agency protocol. d. Allow the child to stay in group therapy to monitor the situation further.

b. Accompany the child to a quiet area to decrease external stimuli.

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? a. Establishing personal contact with family members. b. Being reliable, honest, and consistent during interactions. c. Sharing limited personal information. d. Sitting close to the client to establish rapport.

b. Being reliable, honest, and consistent during interactions. The nurse should convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had no alcohol to drink in the last 48 hours. When the nurse reports to the ED physician, which client symptom should be the nurse's first priority? a. Hearing and visual impairment b. Blood pressure of 180/100mm Hg c. Mood rating of 2/10 on a numeric scale d. Dehydration

b. Blood pressure of 180/100mm Hg

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence? Select one: a. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. b. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. c. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction, because these clients have a higher pain tolerance. d. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

b. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug.

Nurse Rosetta, who is the adult child of an alcoholic, is working with John, a client who abuses alcohol. John has experience a successful detoxification process and is beginning a rehabilitation program. He says to Rosetta, "I'm not going to go to those stupid AA meetings. They don't help anything." Rosetta, who's father died of complications from alcoholism, responds with anger: "Don't you even care what happens to your children?" Rosetta's response is an example of which of the following? a. Transference b. Countertransference c. Self-disclosure d. A breach of professional boundaries

b. Countertransference

Which of the following tasks are associated with the orientation phase of relationship development? (Select all that apply.) a. Promoting the client's insight and perception of reality b. Creating an environment for the establishment of trust and rapport c. Using the problem-solving model toward goal fulfillment d. Obtaining available information about the client from various sources e. Formulating nursing diagnoses and setting goals

b. Creating an environment for the establishment of trust and rapport e. Formulating nursing diagnoses and setting goals

When admitting a child diagnosed with conduct disorder, which symptom would the nurse expect to assess? a. Excessive distress about separation from home and family. b. History of cruelty toward people and animals c. Confabulation when confronted with wrongdoing. d. Repeated complaints of physical symptoms such as headaches and stomachaches.

b. History of cruelty toward people and animals

A client who has been newly diagnosed with depression is beginning tricyclic antidepressant therapy. The nurse has just completed teaching with this client. Which statement by the client indicates the need for further education? a. I will continue to take this medication even if the symptoms have not subsided. b. I do not need to quit smoking. c. I may experience drowsiness or dizziness while taking this medication. d. I will stop drinking alcohol now that I am taking this medication.

b. I do not need to quit smoking.

Which nursing statement regarding the concept of psychosis is most accurate? a. Individuals experiencing psychoses are aware that their behaviors are maladaptive. b. Individuals experiencing psychoses experience little distress. c. Individuals experiencing psychoses are aware of experiencing psychological problems. d. Individuals experiencing psychoses are based in reality.

b. Individuals experiencing psychoses experience little distress.

Which statement regarding the concept of psychosis is most accurate? a. Individuals experiencing psychoses are aware that their behaviors are maladaptive. b. Individuals experiencing psychoses experience little distress. c. Individuals experiencing psychoses are aware of experiencing psychological problems. d. Individuals experiencing psychoses are based in reality.

b. Individuals experiencing psychoses experience little distress.

A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this the intervention the treatment of choice? a. It manages the client's uncontrollable behaviors. b. It allows clients to maintain control. c. It addresses the underlying client anger. d. It helps the client correct a distorted body image.

b. It allows clients to maintain control.

Ann is a psychiatric home health nurse. She has just received an order to begin regular visits to Mrs. W a 78 year old widow who lives alone. Mrs. W.'s PCP has diagnosed her as depressed. Which criteria would qualify Mrs. W for home health visits? a. Mrs W never learned to drive and hast o depend on others for her transportation b. Mrs. W is physically too weak to travel without risk of injury c. Mrs. W refuses to seek assistance as suggested by her physician "because I don't have a psychiatric problem"

b. Mrs. W is physically too weak to travel without risk of injury

A school nurse provides education on drug abuse to a high school class. This nursing action is an example of which level of prevention? a. Primary intervention b. Primary prevention c. Secondary prevention d. Tertiary prevention

b. Primary prevention

A mother abuses her children and tells the case-worker that it's her husband who abuses the children, even though it has been proven that he's a dutiful father. Which defense mechanism is the mother using? a. Compensation b. Projection c. Displacement d. Denial

b. Projection

What would be the best nursing strategy to use when a client is attempting to split staff on the 3 shifts against one another? a. Assign one staff member to her each shift. b. Rotate staff assigned to her each shift. c. Have each shift develop a plan. d. Schedule a meeting with the client to discuss the problem.

b. Rotate staff assigned to her each shift.

A client experiencing a panic attack would display which physical symptom? a. Fear of dying b. Sweating and palpitations c. Depersonalization d. Restlessness and pacing

b. Sweating and palpitations

A physician prescribes an additional medication for a client taking an anti-psychotic agent. The medication is to be administered "prn for EPS." When will the nurse plan to give this medication? a. When the client's white blood cell count falls below 3,000/mm b. When the client exhibits tremors and a shuffling gait c. When the client complains of a dry mouth d. When the client experiences a seizure

b. When the client exhibits tremors and a shuffling gait

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the clients positive and negative symptoms of schizophrenia? a. paranoid delusions, anhedonia, an anergia or positive symptoms of schizophrenia b. paranoid delusions, neologisms, echolalia are positive symptoms of schizophrenia c. paranoid delusions, anergia, and echolalia or negative symptoms of schizophrenia d. paranoid delusions, flat effect, and anhedonia negative symptoms of schizophrenia

b. paranoid delusions, neologisms, echolalia are positive symptoms of schizophrenia

Which of the following represents a nursing intervention at the secondary level of prevention? a. teaching a class about menopause to middle-aged women b. providing support in the emergency room to a rape victim c. leading a support group for women in transition d. making monthly visits to the home of a client with schizophrenia to ensure medication compliance

b. providing support in the emergency room to a rape victim

A client diagnosed with schizophrenia functions well and his bright, spontaneous, an interactive during hospitalization but then decompensates after discharge. What does the milieu provide that may be missing in the home environment? a. Peer pressure b. structured programming c. visitor restrictions

b. structured programming

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? Select all that apply a. benzodiazepine therapy b. systematic desensitisation c. imploding flooding d. assertiveness training e. aversion therapy

b. systematic desensitisation c. imploding flooding

Which statement about the tray cyclic group of anti depressant medications is accurate? a. strong or aged cheeses should not be eaten while taking them b. their full therapeutic potential may not be reached until 4 weeks c. they may cause hypomania or recent memory impairment d. they should not be given with anti-anxiety agents

b. their full therapeutic potential may not be reached until 4 weeks

A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should a nurse interpret this assessment data? a. Childhood-onset conduct disorder is caused by a difficult temperment, and the child is likely to outgrow these behaviors by adulthood. b. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and, therefore, improvement is likely. c. Childhood-onset conduct disorder is more severe than the adolescent-onset type, & these individuals likely develop antisocial personality disorder in adulthood. d. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

c. Childhood-onset conduct disorder is more severe than the adolescent-onset type, & these individuals likely develop antisocial personality disorder in adulthood.

Three of the following are positive outcome criteria for an Antisocial Personality client. Which one is NOT? a. Client recognizes when anger is escalating. b. Client experiences a true desire to change. c. Client manipulates others to his advantage. d. Client follows established rules.

c. Client manipulates others to his advantage.

A preschool child diagnosed with autistic spectrum disorder has been engaging in constant head-banging behavior. Which nursing intervention is appropriate? a. Place client in restraints until the aggression subsides. b. Distract the client with a variety of games and puzzles. c. Hold client's head steady and apply a helmet. d. Sedate the client with neuroleptic medications.

c. Hold client's head steady and apply a helmet.

A client diagnosed with schizophrenia states, can you hear him? It's the devil. He's telling me I'm going to hell. Which is the most appropriate nursing response? a. Did you take your medicine this morning? b. You are not going to hell, you are a good person c. I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness. d. The devil only talks to people who are receptive to his influence.

c. I'm sure the voices sound scary, but the devil is not talking to you. This is part of your illness.

Upon admission to an inpatient treatment facility for symptoms of alcohol withdrawal, a client states, "I haven't eaten in 3 days." A nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97°F (36°C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? Select one: a. Knowledge deficit b. Fluid volume excess c. Imbalanced nutrition: less than body requirements d. Ineffective individual coping

c. Imbalanced nutrition: less than body requirements The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

Which statement regarding nursing interventions should a nurse identify as accurate? a. Nursing interventions are independent from the treatment team's goals. b. Nursing interventions are solely directed by written physician orders. c. Nursing interventions occur independently but in concert with overall treatment team goals. d. Nursing interventions are standardized by policies and procedures.

c. Nursing interventions occur independently but in concert with overall treatment team goals.

An angry client on an inpatient unit approaches a nurse stating, "Someone took my lunch! People need to respect others, and you need to do something about this now!" The nurse's response should be guided by which basic assumption of milieu therapy? a. Conflict should be avoided at all costs on inpatient psychiatric units. b. Conflict should be resolved by the nursing staff. c. On inpatient units, every interaction is an opportunity for therapeutic intervention. d. Conflict resolution should only be addressed during group therapy.

c. On inpatient units, every interaction is an opportunity for therapeutic intervention.

An instructor is teaching nursing students about the differences between partial and inpatient hospitalization. In what way does partial hospitalization differ from traditional inpatient hospitalization? a. Partial hospitalization does not use an interdisciplinary team. b. Partial hospitalization does not offer a comprehensive treatment plan. c. Partial hospitalization does not provide supervision 24 hours a day. d. Partial hospitalization does not provide medication administration and monitoring.

c. Partial hospitalization does not provide supervision 24 hours a day.

A nurse discovers a client's suicide note that details the time place and means to commit suicide. What should be the priority nursing intervention and the rationale for this action? A,, Administering the Raza Pam add a van PRN, because the client is angry about the discovery of the note. b. Establishing room restrictions, because the clients threat is an attempt to manipulate the staff. c. Placing this client on one to one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide. d. Calling an emergency treatment team meeting, because the clients threat must be addressed.

c. Placing this client on one to one suicide precautions, because the more specific the plan, the more likely the client will attempt suicide.

A nursing instructor is developing a lesson plan to teach about domestic violence. Which information should be included? a. Emotional injury and learned helplessness are central to the dynamic of domestic violence. b. Poor communication and social isolation are central to the dynamic of domestic violence. c. Power and control are central to the dynamic of domestic violence. d. Erratic relationships and vulnerability are central to the dynamic of domestic violence.

c. Power and control are central to the dynamic of domestic violence.

A client is brought to he emerge department after being violently raped. Which nursing action is appropriate? a. Probe for further, detailed description of the rape event. b. Discourage the client from discussing the rape, because this may lead to further emotional trauma. c. Remain nonjudgmental while actively listening to the client's description of the violent rape event. d. Meet the client's self-care needs by assisting with showering and perineal care.

c. Remain nonjudgmental while actively listening to the client's description of the violent rape event.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? a. Tactile hallucinations b. Flat affect c. Restlessness and muscle rigidity d. Reports of hearing disturbing voices

c. Restlessness and muscle rigidity

The nurse is assessing a client who has a diagnosis of schizophrenia and takes an anti-psychotic agent daily. Which finding requires further nursing assessment? a. Respirations of 22 beats/minute b. Weight gain of 8 lbs. in 2 months c. Temperature of 101 degree F d. Excess salivation

c. Temperature of 101 degree F

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize? a. Respirations of 22 beats/minute b. Weight gain of 8 pounds in 2 months c. Temperature of 106 degrees F d. Excessive salivation

c. Temperature of 106 degrees F high temperature could be an indicator of neuroleptic malignant syndrome (NMS), a serious and potentially fatal side effect of anti-psychotic medication, notify HCP immed.

Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and a box of chocolates to his room. He presents these gifts to Nurse Mary, saying, "Thank you for taking care of me." What is a correct response by the nurse? a. "I don't accept gifts from patients." b. "Thank you so much! It is so nice to be appreciated." c. Thank you. I will share these with the rest of the staff." d. "Hospital policy forbids me to accept gifts from patients."

c. Thank you. I will share these with the rest of the staff."

During group therapy, a client diagnosed with chronic alcohol dependence states,"I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should the nurse interpret this statement? a. The client is using denial by avoiding responsibility. b. The client is using displacement by blaming his wife. c. The client is using rationalization to excuse his alcohol dependence. d. The client is using reaction formation by appealing to the group for sympathy.

c. The client is using rationalization to excuse his alcohol dependence. The nurse should recognize the use of rationalization by this patient as a way to justify his drinking.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (Buspar). Which client statement indicates teaching has been effective? a. The client verbalizes that the clonazepam is to be used for long-term therapy in conjunction with buspirone. b. The client verbalizes that buspirone can cause sedation and should be taken at night. c. The client verbalizes that clonazepam is to be used short-term until the buspirone takes full effect. d. The client verbalizes that tolerance could result with the long-term use of buspirone.

c. The client verbalizes that clonazepam is to be used short-term until the buspirone takes full effect.

What should be the nurse's primary goal during the preinteraction phase of the nurse-client relationship? a. To evaluate goal attainment and ensure therapeutic closure. b. To establish trust and formulate a contract for intervention. c. To explore self-perceptions. d. To promote client change.

c. To explore self-perceptions.

When planning group therapy a nurse should identify which configuration as most optimal for a therapeutic group? a. Open ended membership, circle of chairs, group size of 5 to 10 members b. open ended membership, cheers around a table, group size of 10 to 15 members c. closed membership, circle of chairs, group size of 5 to 10 members d. closed membership, chairs around a table, group size of 10 to 15 members

c. closed membership, circle of chairs, group size of 5 to 10 members

John, a homeless person, has just come to live in the shelter. The shelter nurse is assigned to his care. Which of the following is a priority intervention on the part of the nurse? a. referring John to a social worker b. Developing a plan of care for John c. conducting a behavioral and needs assessment on John d. helping John apply for social security benefits

c. conducting a behavioral and needs assessment on John

Your client has been diagnosed with OCD-"handwashing". You initiate a treatment program that includes: a. titrating antianxiety medication with frequency of handwashing. b. setting limits on # of times handwashing can be done every 24 hours. c. permitting handwashing around clients scheduled activites. d. stopping all handwashing except before and after meals and toileting.

c. permitting handwashing around clients scheduled activites.

A client diagnosed with schizophrenia is hospitalized due to an exacerbation of psychosis related to nonadherence with antipsychotic medications. Which level of care does the clients hospitalization reflect? a. tertiary prevention level of care b. case management level of care c. secondary prevention level of care d. primary prevention level of care

c. secondary prevention level of care

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred? a. Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives." b. "Reminiscence therapy encourages members to share positive memories of significant life transitions." c. "Reminiscence therapy is a social group where members chat about past events and future plans." d. "Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution."

d. "Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution."

Which client statement demonstrates positive progress toward recovery from substance use disorder? a. "I have completed detox and therefore an in control of my drug use." b. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my cravings." c. "As a church deacon, my focus will now be on spiritual renewal." d. "Taking those pills got out of control. It cost me my job, marriage, and children."

d. "Taking those pills got out of control. It cost me my job, marriage, and children."

A client diagnosed with Major Depressive Disorder asks, "What part of my brain makes me depressed?" Which nursing response is appropriate? a. 'The occipital lobe governs perceptions, judging them as positive or negative.' b. 'The parietal lobe has been linked to depression.' c. 'The medulla regulates key biological and psychological activities.' d. 'The limbic system is largely responsible for one's emotional state.'

d. 'The limbic system is largely responsible for one's emotional state.'

A nurse is planning care for a client diagnosed with bipolar disorder: manic episode. In which order should the nurse prioritize the client outcomes? The following are the outcomes: 1. Maintains nutritional status 2. interacts appropriately with peers 3. remains free from injury 4. sleep 6-8 hours at night. a. 2, 1, 3, 4 b. 1, 4, 2, 3 c. 4, 1, 2, 3 d. 3, 1, 4, 2

d. 3, 1, 4, 2

In which situation would the nurse suspect a diagnosis of social anxiety disorder? a. A client abuses marijuana daily and avoids social situations because of fear of humiliation. b. An 8 year-old child isolates from adults because of fear of embarrassment but has good peer relationships in school. c. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. d. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

d. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

As part of discharge teaching, which guideline regarding lithium therapy will the nurse plan to include? a. Avoid excess use of beverages containing caffeine. b. Maintain a consistent sodium intake. c. Consume at least 2,500 to 3,000 ml of fluid per day. d. All of the above

d. All of the above

How can the nurse assist a newly admitted schizophrenic client to become comfortable initially, on the psychiatric unit? a. Assign him a unit responsibility. b. Allow him to stay in his room the first few days. c. Put him group therapy and introduce him to others. d. Allow him to move at his own pace.

d. Allow him to move at his own pace. new environment could promote fear and discomfort to this client, allowing him to move at their own pace and not to force them into any situation that may be uncomfortable for them, will help in developing a trusting nurse-client relationship.

The autistic child has difficulty with trust. Which of the following nursing actions would be most appropriate? a. Avoid eye contact, as it is extremely uncomfortable for the child, and may even discourage trust. b. Assign a different staff member each day so the child will learn that everyone can be trusted. c. Encourage all staff to hold the child as often as possible, conveying trust through touch. d. Assign the same staff person as often as possible to promote feelings of security and trust.

d. Assign the same staff person as often as possible to promote feelings of security and trust.

A child has been recently diagnosed with mild intellectual developmental disorder (IDD). What information about this diagnosis should the nurse include when teaching the child's mother? a. Children with mild IDD have significant sensory-motor impairment. b. Children with mild IDD need constant supervision. c. Children with mild IDD appear different from their peers. d. Children with mild IDD develop academic skills up to a sixth-grade level.

d. Children with mild IDD develop academic skills up to a sixth-grade level.

Which expected client outcome should a nurse identify as being correctly formulated? a. Client will feel happier by discharge. b. Client will demonstrate two relaxation techniques. c. Client will verbalize triggers to anger by end of session. d. Client will initiate interaction with one peer during free time within 2 days.

d. Client will initiate interaction with one peer during free time within 2 days.

Which of the following is NOT a characteristic of a crisis? a. A crisis situation contains the potential for psychological growth and development. b. Crisis occurs in all individuals at one time or another is not necessarily equated with psychopathology. c. Crises are personal by nature and what may be considered a crisis to one person may not be so for another. d. Crises are chronic and may last for an extended period of time.

d. Crises are chronic and may last for an extended period of time.

A person experiencing heroin withdrawal would likely experience which of the following symptoms: a. Increased heartrate and blood pressure b. Tremors, insomnia and seizures c. Incoordination and unsteady gait d. Nausea and vomiting, diarrhea, and diaphoresis

d. Nausea and vomiting, diarrhea, and diaphoresis

Nurse Jones is working with Kim, a client in the anger-management program. Which of the following identifies actions associated with the working phase of the therapeutic relationship? a. Kim tells Nurse Jones she wants to learn more adaptive ways to handle her anger. Together they set some goals. b. The goals of therapy have been met, but Kim cries and says she has to keep coming to therapy in order to be able to handle her anger appropriately. c. Nurse Jones reads Kim's previous medical records. She explores her feelings about working with a woman who has abused her child. d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

d. Nurse Jones helps Kim practice various techniques to control her angry outbursts. She gives Kim positive feedback for attempting to improve maladaptive behaviors.

John has a history of paranoid schizophrenia and non compliance with medications, which of the following might be the best choice of neuroleptic for John? a. Haldol b. Navane c. Lithium Carbonate d. Prolixin decanoate

d. Prolixin decanoate

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? a. Altered thought processes R/T increased stress b. Risk for suicide R/T loneliness c. Risk for violence: directed toward others R/T paranoid thinking d. Social isolation R/T inability to relate to others

d. Social isolation R/T inability to relate to others

A client is experiencing a panic attack. The client states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority? a. Encourage the client to express feelings. b. Teach the etiology and management of panic disorders. c. Distract the client by redirecting to physical activities. d. Stay with the client and offer support.

d. Stay with the client and offer support.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during the substance induced disorder of alcohol withdrawal? a. Antagonist therapy b. Deterrent therapy c. Codependency therapy d. Substitution therapy

d. Substitution therapy Various medications have been used to decrease intensity of sympt in an indiv withdrawing from, or who is experienc the effects of excessive use of, alcohol and other drugs. This is called substitution therapy and may be required to reduce the life-threatening effects of alcohol withdrawal.

A client diagnosed with bipolar disorder has been taking lithium carbonate (Lithobid) for 1 year. The client presents in the emergency department with a temperature of 101 F (38 C), severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? a. Symptoms indicate consumption of foods high in tyramine. b. Symptoms indicate lithium carbonate discontinuation syndrome. c. Symptoms indicate the development of lithium carbonate tolerance. d. Symptoms indicate lithium carbonate toxicity.

d. Symptoms indicate lithium carbonate toxicity.

A nurse is implementing care within the parameters of tertiary prevention. Which nursing action is an example of this type of care? a. Teaching a client the reportable side effects of a newly prescribed neuroleptic medication b. Teaching a client about his or her new diagnosis of bipolar disorder c. Teaching an adolescent about pregnancy prevention d. Teaching a client to cook meals, make a grocery list, and establish a budget

d. Teaching a client to cook meals, make a grocery list, and establish a budget

Which assessment data should a school nurse recognize as a sign of physical neglect? a. The child is very insecure and has poor self-esteem. b. The child has sophisticated knowledge of sexual behaviors. c. The child has multiple bruises on various body parts. d. The child is often absent from school and seems apathetic and tired.

d. The child is often absent from school and seems apathetic and tired.

A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety? a. His wife works from home in telecommunication. b. The client has worked the night-shift his entire career. c. His wife has minimal family support. d. The client smokes one pack of cigarettes per day.

d. The client smokes one pack of cigarettes per day.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which statement regarding a client's home environment should a nurse associate with the development of anorexia nervosa? a. The home environment maintains loose personal boundaries. b. The home environment condones corporal punishment. c. The home environment places an overemphasis on food. d. The home environment is overprotective and demands perfection.

d. The home environment is overprotective and demands perfection.

A nurse states to a client, "Things will look better tomorrow after a good night's sleep." This is an example of which communication technique? a. The therapeutic technique of 'giving advice. b. The therapeutic technique of 'defending.' c. The non-therapeutic technique of 'presenting reality.' d. The non-therapeutic technique of 'giving false reassurance.'

d. The non-therapeutic technique of 'giving false reassurance.'

After an adolescent diagnosed with attention deficit-hyperactivity disorder (ADHD) begins methylphenidate (Ritalin) therapy, a nurse notes that the adolescent loses 10 pounds in a 2-month period. What is the best explanation for this weight loss? a. Hyperactivity seen in ADHD causes increased caloric expenditure. b. Increased ability to concentrate allows the client to focus on activities rather than food. c. Side effects of methylphenidate (Ritalin) cause nausea, and, therefore, caloric intake is decreased. d. The pharmacological action of methylphenidate (Ritalin) causes a decrease in appetite.

d. The pharmacological action of methylphenidate (Ritalin) causes a decrease in appetite.

Most rapists are in what age category?

25-44

Which finding is a negative symptom of schizophrenia?

Flat affect and social inatentiveness

A client diagnosed with AD has been assigned the nursing diagnosis of anxiety R/T divorce. Which correctly written outcome addresses this client's problem? 1. Rates anxiety as 4 out of 10 by discharge 2. States anxiety level has decreased by day one 3. Accomplishes activities of daily living independently 4. Demonstrates ability for adequate social functioning by day three

1.Rates anxiety as 4 out of 10 by discharge

A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety? 1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin)

3) Diazepam (Valium) Diazepam is an antianxiety agent. Chlorpromazine is an antipsychotic medication. Clozapine is an antipsychotic medication. Methylphenidate is a central nervous system stimulant used to treat attention deficit-hyperactivity disorder.

A home health nurse has several elderly clients in her case load. Which of the following clients is most likely to be a victim of elder abuse? A 76-year-old female with Alzheimer's dementia A 70-year-old male with diabetes mellitus A 64-year-old female with a hip replacement A 72-year-old male with Parkinson's disease

A 76-year-old female with Alzheimer's dementia

A family member asks you, "As both of my siblings have schizophrenia, why are my brother's symptoms so different from my sister's? He withdraws when there's a change in his environment or routine. She starts cursing and yelling about the Mafia and the CIA when I do something that's less than perfect." Based on your knowledge, your response should address: A The many differences in the presentation of schizophrenia. B The significance of paranoid content in the differential diagnosis of paranoid schizophrenia. C The typical progression of symptoms within an individual over time. D The effect of gender on clinical presentation in schizophrenia.

A The many differences in the presentation of schizophrenia.

An obsession is defined as A. thinking of an action and immediately taking the action. B. a recurrent, persistent thought or impulse. C. an intense irrational fear of an object or situation. D. a recurrent behavior performed in the same manner.

A a recurrent, persistent thought or impulse. Correct Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.

3. Hypothalamus.

A client is exhibiting signs and symptoms of anorexia nervosa. Identify the anatomical structure of the brain in which alteration in biological function may contribute to these symptoms. 1. Thalamus. 2. Amygdala. 3. Hypothalamus. 4. Hippocampus.

An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects is called _________________.

Trauma

Neurocognitive disorder (NCD)

A clinically significant deficit in cognition or memory that represents a significant change from a previous level of functioning. This category includes disorders of delirium and mild and major NCDs

What is the definition of battering?

A pattern of coercive control founded on and supported by physical and/or sexual violence or threat of violence of an intimate partern

Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? A) "They claim they will help me stay sober" B) "I'll dry out, in AA, then I can have a social drink now and then." C) "AA is only for people who have reached the bottom." D) "If I loose my job, AA will help me find another one"

A) "They claim they will help me stay sober"

Which statement made by a parent of a child diagnosed with Tourette's syndrome would be assessed as a risk factor for family violence? A. "My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." B. "Our son is really a good little boy, but he needs to be disciplined both at home and in school." C. "We shouldn't be, but we are ashamed of our son's disorder and his inability to control the tics in public." D. "We have become active in the support group but still find the suggestions extremely difficult to put into practice."

A."My husband lost his job, and it seems all our savings are going to pay for our son's expensive medication and all the other things he needs." Job loss, financial problems, and a child who is "different" and has special needs should alert the nurse to the risk for family violence, because all these factors contribute to a crisis situation.

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

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

20. A client, who is taking transdermal selegiline (Emsam) for depressive symptoms, states, "My physician told me there was no need to worry about dietary restrictions." Which would be the most appropriate nursing response? 1. "Because your dose of Emsam is 6 mg in 24 hours, dietary restrictions are not recommended." 2. "You must have misunderstood. An MAOI like Emsam always has dietary restrictions." 3. "Only oral MAOIs require dietary restrictions." 4. "All transdermal MAOIs do not require dietary modifications."

ANS: 1 Rationale: Selegiline is a Monoamine Oxidase Inhibitor (MAOI). Hypertensive crisis, caused by the ingestion of foods high in tyramine, has not shown to be a problem with selegiline transdermal system at the 6 mg/24 hr dosage, and dietary restrictions at this dose are not recommended. Dietary modifications are recommended, however, at the 9 mg/24 hr and 12 mg/24 hr dosages. Cognitive Level: Application Integrated Process: Implementation

17. ________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking.

ANS: Mania Page: 419 Feedback: Mania is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, and accelerated thinking and speaking. Mania can occur as a biological (organic) or psychological disorder, or as a response to substance use or a general medical condition.

10. A client is diagnosed with bipolar disorder: manic episode. Which nursing intervention would be implemented to achieve the outcome of "Client will gain 2 lbs. by the end of the week?" 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

ANS: 1 Page: 427-430 Feedback 1 The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lbs. by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals. 2 Accompanying the client to the cafeteria is not realistic. 3 Initiating total parenteral nutrition is not realistic. 4 Education is important, but is unrealistic to help the client gain weight by the end of the week.

4. Immediately after electroconvulsive therapy (ECT), in which position should a nurse place the client? 1. On his or her side, to prevent aspiration 2. In high Fowler's position, to prevent increased intracranial pressure 3. In Trendelenburg's position, to promote blood flow to vital organs 4. In prone position, to prevent airway blockage

ANS: 1 Rationale: The nurse should place a client who has received ECT on his or her side, to prevent aspiration. Cognitive Level: Application Integrated Process: Implementation

. ___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).

ANS: Schizoaffective Rationale: Schizoaffective disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania). The decisive factor in the diagnosis of schizoaffective disorder is the presence of hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major mood episode.

Antianxiety drugs are also called ______________________ and minor tranquilizers.

ANS: anxiolytics Rationale: Antianxiety drugs are also called anxiolytics and minor tranquilizers.

A _________________ __________________ provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

ANS: nursing diagnosis Rationale: Nursing diagnoses are clinical judgments about individual, family, or community experiences/responses to actual or potential health problems/life processes. A nursing diagnosis provides the basis for selection of nursing interventions to achieve outcomes for which the nurse has accountability.

What is a compounded rape reaction?

Additional symptoms occur like depression, suicide, substance abuse, psychotic behaviors

Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________.

Agoraphobia fear or anxiety must occur in at least two of five situations to diagnose agoraphobia; fear of public transportation and being in crowds are two of those criteria.

The following outcome was developed for a client: "Client will list 5 personal strengths by the end of day one." Which correctly written diagnostic statement most likely generated the development of this outcome? Altered self esteem R/T years of emotional abuse AEB self-deprecating statements Self-care deficit R/T altered thought process Disturbed body image R/T major depressive disorder AEB mood rating of 2/10 Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

Altered self esteem R/T years of emotional abuse AEB self-deprecating statements

The client is having electroconvulsive therapy for treatment of severe depression. Prior to the ECT, the nurse should: Apply a tourniquet to the client's arm Administer an anticonvulsant medication Ask the client if he is allergic to shellfish Apply a blood pressure cuff to the arm

Apply a blood pressure cuff to the arm applied to the client's arm prior to the initiation of ECT

What do you give if an anti-psychotic med give a client EPS?

Benztropine (cogentin) think Parkinsons

Bill has relapsed three times in his alcohol recovery over the past 3 years. This is his fourth admission and he has monopolized his group therapy offering advice on recovery. The nurse recognized that: a. Bill is an expert on recovery. b. Bill is in denial. c. Bill needs more medication. d. Bill needs to go somewhere else for treatment.

Bill is in denial.

In the biological theory of predisposition to abuse, what factors are thought to be involved?

Brain: temporal lobe, limbic system, amygdaloid nucleus, brain tumors (esp. in limbic system and temporal lobes), trauma to the brain, encephalitis, epilepsy Aggressive impulse facilitation/inhibition: Norepinephrine, dopamine, serotonin

What is a biochemical abnormality associated with panic disorder?

Blood elevations of lactate. Pg 533

What antidepressant medication has been used with some success in treating ADHD?

Bupropion (Wellbutrin)

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as A. mild. B. moderate. C. severe. D. panic

C. severe. Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should A. question the physician's order because the dose is excessive. B. explain the long-term nature of benzodiazepine therapy. C. teach the client to limit caffeine intake. D. tell the client to expect mild insomnia. Caffeine is an antagonist of antianxiety medication.

C. teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication.

The victim of abuse can expect the abuse to worsen when A. the perpetrator feels he is in complete control. B. the perpetrator is feeling remorseful for being abusive. C. the victim moves toward independence from the abuser. D. the victim submits to the domination of the perpetrator.

C. the victim moves toward independence from the abuser. When the abuser thinks he is losing control over the victim, the violence escalates.

What is the most essential task for a nurse to accomplish prior to forming a therapeutic relationship with a client?1. clarify personal attitudes, values, and beliefs2. Obtain thorough assessment data3. Determine the client's length of stay4. Establish personal goals for the interaction.

Clarify personal attitudes, values, and beliefs..

A child is taking guanfacine for ADHD. Which of the following would be part of the client education associated with administration of this medication? a)Do not take with foods that contain tyramine. b)Always use sunblock when spending time outdoors. c)Report for blood tests once a month. d)Do not discontinue the medication abruptly.

Correct answer: D •Clients taking an alpha agonist should not discont therapy abruptly. May result in sympt of nervousness, agitation, headache, and tremor, and a rapid rise in blood pressure. Should be tapered under supervis ofphysician. • Answer A pertains to MAOIs. • Answer B is more specific to tricyclic antidepressants. • Answer C pertains to lithium.

Which client statement demonstrates positive progress toward recovery from substance abuse? Select one: a. "I have completed detox and therefore am in control of my drug use." b. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." c. "As a church deacon, my focus will now be on spiritual renewal." d. "Taking those pills got out of control. It cost me my job, marriage, and children."

D A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery from substance abuse. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? Select one: a. To assess for emotional strength. b. To assess for Wernicke-Korsakoff syndrome. c. To assess for tachycardia. d. To assess for fine tremors.

D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors.

What is agranulocytosis? S/S?

Decreased WBC count; a common side effect of taking antipsychotic medications long term.S/S: sore throat, fever, malaise.

What physiological signs may be associated with the excessive vomiting of the purging syndrome?

Dehydration, electrolyte imbalance, erosion of tooth enamel, (rarely) tears in the gastric or esophageal mucosa

Schizophrenia neurotransmitters

Dopamine elevated

Antipsychotic meds cause?

Extra pyramidal side effects "EPS" Shuffling gait, tremors, dystonia

s/s of emotional abuse

Extremes in behavior-overly compliant, extremely passive, or aggressive; inappropriately adult; inappropriately infantile; physically/emotionally delayed; attempted suicide; reports lack of attachment to parent

What is the difference between fear and anxiety?

Fear involves cognition-the intellectual appraisal of a threatening stimulus while anxiety is the emotional response to that stimulus.

When a nurse conveys open, honest communication and there is congruence between what the nurse feels and what the nurse says, then the nurse is manifesting a quality of ____________.

Genuineness Trust is an essential component of therapeutic relationships, and when the nurse does not bring genuineness to the nurse-patient relationship, a reality base for trust cannot be established.

21. ___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.

Hallucinations

A type of therapy in which a client is directed to imagine or actually participate in real-life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________.

Implosion therapy, or flooding

The neurotransmitter most strongly associated with panic disorder is:

Increased levels of Norepinephrine. It's known to mediate arousal, and it causes hyperarousal and anxiety. Seratonin and GABA are believed to be decreased in panic disorder as well.

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of BDD.

Narcissistic

What are Walker's 3 phases in the cycle of battering?

Phase 1: Tension Building; tolerance for frustration is declining, angry with little provocation, quick to apologize for lashing out. Woman may be nurturing, compliant. Accepts abuse as legitimately directed toward her. Denies her anger. May last a few weeks to years Phase 2: Acute battering incident. Lasts up to 24 hrs. Phase 3: Calm, loving, respite "Honeymoon". Batterer is charming, begs forgiveness. Woman wants to believe

Orientation

Rapport; contract for intervention

What are the 7 stages of Alzheimer's Disease (AD), the cause of 50-60% of NCDs?

STAGE1. asymptomatic STAGE2. Forgetfulness: STAGE3. Mild cognitive decline: work performance, getting lost, names/words STAGE4. Mild to moderate cognitive decline:forget child's/own b-day, confabulation, depression STAGE5. Moderate cognitive decline: Loss some ADLs.Forgets address/phone number, names of close relatives. Frustration,w/d,self-absorption common STAGE6. Moderate to severe cognitive decline: Disorientation to surroundings, can't ADl, incontinence Sleeping, worse evening, commun more difficult STAGE 7 . Severe cognitive decline: End stage.

The phase of the therapeutic relationship in which a plan for continuing aftercare is mutually established by the nurse and patient is called ____________.

Termination When progress has been made toward attaining established treatment goals and the focus changes to planning for the period following treatment, the nurse and patient are in the termination phase of the relationship.

A client diagnosed with vascular neurocognitive disorder (NCD) is discharged to home under the care of his wife. Which information should cause the nurse to question the client's safety? His wife works from home in telecommunication. The client has worked the night-shift his entire career. His wife has minimal family support. The client smokes one pack of cigarettes per day.

The client smokes one pack of cigarettes per day.

3. Individuals with anorexia nervosa have a "distorted body image." What does this mean?

The individual's perception is that he or she is "fat" even when obviously underweight or even emaciated.

What is a nurse's purpose in providing appropriate feedback? To give the client good advice. To advise the client on appropriate behaviors. To evaluate the client's behavior. To give the client critical information.

To give the client critical information.

Carl develops a fondness for the nurse who is providing diabetic education, because she reminds him of his wife, who is also a teacher. This is an example of what phenomenon that often arises in a therapeutic relationship?____________

Transference Transference occurs when a patient unconsciously displaces onto the nurse feelings formed toward another person in his or her past.

The disorder that is characterized by the presence of multiple motor tics and one or more vocal tics is called ____________.

Tourette's disorder characterized by motor tics and vocal tics not attributable to a substance or other medical condition. Pharmacotherapy is not recommended except in very severe cases. Psychosocial therapies such as behavior therapy, individual counseling, and family therapy have been identified as beneficial.

What is the psychodynamic theory about predisposition to abuse?

Unmet needs for satisfaction and security cause an underdeveloped ego and weak superego. The frustrated abuser gets power and prestige from aggression and violence.

Which mental illness should a nurse identify as being associated with a decrease in prolactin hormone level? a. Major depressive episode b. Schizophrenia c. Anorexia nervosa d. Alzheimer's disease

b. Schizophrenia

What is learned helplessness?

When an individual comes to learn that no matter what their behavior is, the outcome is unpredictable and usually undesirable

Crisis

When an individual experiences a stressor & perceives coping strategies to be ineffective A crisis is precipitated by an event that is specific and identifiable.

What demographic has the highest percentage of intimate violence?

Women 25-34

While interviewing a client who abuses alcohol, the nurse learns that the client has experienced "blackouts." The wife asks what this means. What is the nurse's best response at this time? "Your husband has experienced short-term memory amnesia." "Your husband has experienced loss of remote memory." "Your husband has experienced a loss of consciousness." Your husband has experienced a fainting spell."

a "Your husband has experienced short-term memory amnesia."

A client with psychotic depression is receiving Haldol (haloperidol). Which one of the following adverse effects is associated with the use of haloperidol? Akathisia Cataracts Diaphoresis Polyuria

a Akathisa

Swallows a bottle of pills after therapist leaves on vacation.

a Borderline personality disorder

A client on the psychiatric unit is threatening other clients and staff, and interventions to distract him have not been successful. What action should the nurse take? Call security for assistance and administer PRN medication to calm the client Tell the client to calm down and ask him again if he would like to play cards Tell the client that if he continues this behavior he will lose recreational privileges Ignore the client since it is unlikely he will actually harm anyone

a Call security for assistance and administer PRN medication to calm the client

An appropriate nursing intervention for the client with borderline personality disorder is: Observing the client for signs of depression or suicidal thinking Allowing the client to lead unit group sessions Restricting the client's activity to the assigned unit of care throughout hospitalization Allowing the client to select a primary caregiver

a Observing the client for signs of depression or suicidal thinking

A client is diagnosed with post-traumatic stress disorder following a rape by an unknown assailant. The nurse should give priority to: Providing a supportive environment Controlling the client's feelings of anger Discussing the details of the attack Administering a hypnotic for sleep

a Providing a supportive environment

A client with a history of schizophrenia is seen in the local health clinic for medication follow-up. To maintain a therapeutic level of medication, the nurse should tell the client to avoid: Taking over-the-counter allergy medication Eating cheese and pickled foods Eating salty foods Taking over-the-counter pain relievers

a Taking over-the-counter allergy medication

Which of the following conditions increases the risk of adverse events associate with ECT? (Select all that apply). a. Increased intracranial pressure b. Recent myocardial infarction c. Severe underlying hypertension d. Congestive heart failure e. Breast Cancer

a, b, c, d a. Increased intracranial pressureb. Recent myocardial infarctionc. Severe underlying hypertensiond. Congestive heart failure

A nursing counselor is about to meet with a client suffering from codependency. Which of the following data would further support the assessment of this dysfunctional behavior? (Select all that apply) a. The client has a long history of focusing thoughts and behaviors on other people. b. The client, as a child, experienced overindulgent and overprotective parents. c. The client is a people pleaser and does almost anything to gain approval. d. The client exhibits helpless behaviors but actually feels very competent. e, The client can achieve a sense of control only through fulfilling the needs of others.

a, c, d

A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? (Select all that apply) a. This client has personality traits that are deeply ingrained and difficult to modify. b. This client needs medication to treat the underlying physiological pathology. c. This client uses manipulation, making the implementation of treatment problematic. d. This client has poor impulse control that hinders compliance with a plan of care. e. This client is likely to have secondary diagnoses of substance abuse and depression.

a, c, d, e

After disturbing the peace, an aggressive, disoriented, unkept, homeless individual is escorted to the emergency Department. The client threatens suicide. Which of the following criteria would enabling physician to consider involuntary hospitalization? (select all that apply) a. Being dangerous to others b. being homeless c. being disruptive to the community d. being gravely disabled and unable to meet basic needs e. being suicidal

a,d,e

Symptoms of amenorrhea are related to which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

a. Anorexia

Symptoms of preoccupation of food are related to which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

a. Anorexia

Symptoms may be related to issues of control in which eating disorder? (select all that apply) a. Anorexia b. Bulimia c. Obesity

a. Anorexia b. Bulimia

Which of the following behaviors are associated with the phenomenon of transference? (Select all that apply.) a. The client attributes toward the nurse feelings associated with a person from the client's past. b. The nurse attributes toward the client feelings associated with a person for the nurse's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

a. The client attributes toward the nurse feelings associated with a person from the client's past. c. The client forms an overwhelming affection for the nurse. d. The client becomes excessively dependent of the nurse and forms unrealistic expectations of him or her.

Which of the following behaviors suggest a possible breach of professional boundaries? (Select all that apply.) a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment. d. The nurse shares how she dealt with a similar difficult situation.

a. The nurse repeatedly requests to be assigned to a specific client. b. The nurse shared the details of her divorce with the client. c. The nurse makes arrangements to meet the client outside of the therapeutic environment.

Client threatens to jump off bridge, brought to ER, nurse priority to ask? ch.10

are you thinking of harming yourself

Which of the following conditions promote a therapeutic community? (Select all that apply) a. The unit schedule includes unlimited free time for personal reflection. b. Unit responsibilities are assigned according to client capabilities. c. A flexible schedule is determined by client needs. d. The individual is the sole focus of therapy. e. A democratic form of government exists.

b & e b. Unit responsibilities are assigned according to client capabilities. e. A democratic form of government exists.

The physician has ordered Eskalith (lithium carbonate) 500mg three times a day and Risperdal (risperidone) 2mg twice daily for a client admitted with bipolar disorder, acute manic episodes. The best explanation for the client's medication regimen is: The client's symptoms of acute mania are typical of undiagnosed schizophrenia. Antipsychotic medication is used to manage behavioral excitement until mood stabilization occurs. The client will be more compliant with a medication that allows some feelings of hypomania.

b Antipsychotic medication is used to manage behavioral excitement until mood stabilization occurs.

Within the nurse's scope of practice, which function is exclusive to the advanced practice psychiatric nurse? a. Teaching about the side effects of neuroleptic medications b. Using psychotherapy to improve mental health status c. Using milieu therapy to structure a therapeutic environment d. Providing case management to coordinate continuity of health services

b. Using psychotherapy to improve mental health status

At what point should the nurse determine that a client is at risk for developing a mental disorder? a. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria b. When maladaptive responses to stress are coupled with interference in daily functioning c. When the client communicates significant distress d. When the client uses defense mechanisms as ego protection

b. When maladaptive responses to stress are coupled with interference in daily functioning

The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ________________________.

bingeing

A client with schizophrenia spends much of his time pacing the floor, rocking back and forth, and moving from one foot to another. The client's behaviors are an example of: Dystonia Tardive dyskinesia Akathisia Oculogyric crisis

c Akathisia an extrapyramidal side effect of antipsychotic medication, results in an inability to sit still or stand still.

A client with a history of cocaine abuse is experiencing tactile hallucinations. This symptom is known as: Dyskinesia Confabulation Formication Dystonia

c Formication symptom is known as formication

An elderly client has been noted to have increasing confusion late in the afternoon and before bedtime. The nurse is aware that the client is experiencing: Proprioception Agnosia Sundowning Confabulation

c Sundowning

A client with schizophrenia has been taking Thorazine (chlorpromazine) 200 mg four times a day. Which finding should be reported to the doctor immediately? The client complains of thirst. The client has gained four pounds in the past two months. The client complains of a sore throat and fever. The client naps throughout the day.

c The client complains of a sore throat and fever.

A client exhibiting dependent behavior says," Do you think I should move from my parent's house and get a job?" Which nursing response is most appropriate? a. "It would be best to do that in order to increase independence." b. "Why would you want to leave a secure home." c. "Let's discuss and explore all of your options." d. "I'm afraid you would feel very guilty leaving your parents."

c. "Let's discuss and explore all of your options."

A student nurse asks an instructor how best to develop nursing outcomes for clients. Which response by the instructor most accurately answers the student's question? a. "You can use NIC, a standardized reference for nursing outcomes," b. "Look at your client's problems and set a realistic, achievable goal." c. "With client collaboration, outcomes should be based on client problems." d. "Copy your standard outcomes from a nursing care plan textbook."

c. "With client collaboration, outcomes should be based on client problems."

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? a. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. b. Educate the client about the biopsychosocial consequences of alcohol abuse. c. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. d. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

c. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol.

Which of the following would be an appropriate medication for a child with ADHD? a. Carbamazapine (Tegretol) b. Halolperidal (Haldol) c. Atomoxetine (Strattera) d. Chlordiazepoxide (Librium)

c. Atomoxetine (Strattera)

When planning care for clients diagnosed with personality disorders, what should be the goal of treatment? a. To stabilize the client's pathology with the correct combination of psychotropic medications. b. To change the characteristics of the dysfunctional personality. c. To reduce inflexibility of personality traits that interferes with functioning and relationships. d. To decrease the prevalence of neurotransmitters at receptor sites

c. To reduce inflexibility of personality traits that interferes with functioning and relationships.

A homeless client comes to the emergency department reporting cough, night sweats, weight loss, and blood-tinged sputum. Which disease, which has recently become more prevalent among the homeless community, should a nurse suspect? a. Mononucleosis b. Meningitis c. Tuberculosis d. Encephalopathy

c. Tuberculosis

A client is admitted to the chemical dependency unit for poly-drug abuse. The client states, "I don't know why you are all so worried; I am in control. I don't have a problem." Which defense mechanism is being utilized? Rationalization Projection Dissociation Denial

d Denial

An elderly client who experiences nighttime confusion wanders from his room into the room of another client. The nurse can best help with decreasing the client's confusion by: Assigning a nursing assistant to sit with him until he falls asleep Allowing the client to room with another elderly client Administering a bedtime sedative Leaving a nightlight on during the evening and night shifts

d Leaving a nightlight on during the evening and night shifts

A client with alcoholism has been instructed to increase his intake of thiamine. The nurse knows the client understands the instructions when he selects which food? Roast beef Broiled fish Baked chicken Sliced pork

d Sliced pork

In the role of milieu manager, which activity should the nurse prioritize? a. Setting the schedule for the daily unit activities. b. Evaluating clients for medication effectiveness. c. Conducting therapeutic group sessions. d. Searching the newly admitted clients for hazardous objects.

d. Searching the newly admitted clients for hazardous objects.

A nurse administers 100% oxygen to a client during and after electroconvulsant therapy (ECT). What is the rationale for this procedure? a. To prevent increased intracranial pressure resulting from an anoxia. b. to prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation c. to prevent blocked airway, resulting from seizure activity d. to prevent an anoxia resulting from medication induced paralysis of respiratory muscles

d. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles

All of the following are examples of elder abuse except? a. restraining b. yelling c. lack of eyeglasses, hearing aides, & false teeth d. annual physician visits

d. annual physician visits

Immerses assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, do you receive special messages from certain sources, such as the television or radio? For which potential symptom of this disorder is the nurse assessing? a. thought insertion b. paranoid delusions c. magical thinking d. delusions of reference

d. delusions of reference

Shows no remorse for exploitation and manipulation of others.

e Antisocial personality disorder

To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ______________________ behaviors, which include self-induced vomiting, or the misuse of laxatives, diuretics, or enemas

purging