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A nurse is developing a nurse-client relationship with a client diagnosed with borderline personality disorder (BPD). Which statement by the nurse demonstrates that the nurse understands the client's fears of abandonment and intimacy?

"I will be seeing you during the daytime this week." A key to helping clients with BPD is recognizing their fears of both abandonment and intimacy as they relate to the nurse-client relationship. Informing the client of the length of this relationship allows the client to engage in, and prepare for, termination with minimal pain of abandonment. Therefore the statement about seeing the client during the daytime for a week demonstrates understanding of this concept. The other statements are open ended and do not address the length of the relationship.

A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction?

"Temperament is not changeable." Temperament has a major influence on the chances that a child may experience psychological problems. Temperament is not unchangeable--environmental influences can change or modify a child's emotional style. Temperamental differences can be observed early in life. The patterns of temperament seen in infancy often extend into childhood and later in life.

A client with a diagnosis of depression tells the nurse that the client's mood was especially bad this morning but that the client pushed through it to attend a support group. How can the nurse best validate the client?

"That shows an admirable level of perseverance on your part. Well done!" Acknowledging the effort and perseverance that it took for the client to attend the support group is a good example of validation. Because the client has depression, the client likely had to battle hopelessness more than fear or anxiety. A statement about the benefits of support groups is irrelevant and does not validate the client. It is presumptuous to claim that the client has nearly recovered.

When conducting a suicide risk assessment with a client, the nurse should identify the client as a high imminent risk if which statement is made?

"There are no solutions to my problems." Hopelessness is the pervasive belief that undesirable events are likely to occur coupled with the belief that one's situation is unlikely to improve. A significant evidence base has been established linking hopelessness, loneliness, and other cognitive symptoms to suicide ideation. Depressed persons who are hopeless are more likely to consider suicide than those who are depressed but hopeful about the future. Furthermore, it appears that lack of positive thoughts about the future is more likely to predict suicidal behavior than negative thoughts even though both contribute to hopelessness. The statement, "There are no solutions to my problems" is consistent with the risk that the client has lost hope; therefore, the risk of suicide is high and possibly imminent. The nurse should ensure the suicide risk assessment and associated interventions are a high priority. Having a child can be a protective factor against suicide. Stating one is not going to engage in the act of suicide because of a family member lowers the risk of an imminent attempt. The client who states he or she thinks about starving sometimes has made a vague statement with a plan that is not highly lethal. The risk is likely low with this client but support should be provided, nonetheless. The client who reaches out by asking for someone to talk to is calling for help and being proactive before getting to the point of making the decision to commit suicide.

A client has entered treatment for alcohol dependency at the client's spouse's insistence. The client's spouse has threatened to leave the marriage unless the client seeks treatment. The client admits that the client drinks every day, but that the drinking is well in control. The nurse recognizes the client's comments as denial. What is the best response by the nurse?

"What negative consequences have resulted from your drinking?" To confront denial, the nurse points to the evidence of severe dysfunction that inevitably appears in the substance abuser's life. Job losses, financial problems, possible estrangement from family and friends, and legal problems are common, and the nurse can respectfully but firmly remind the client that many of these problems are a result of alcohol or drug abuse.

The nurse is caring for a client with antisocial personality disorder. Which statement is mostappropriate for the nurse to make when explaining unit rules and expectations to the client?

"You'll be expected to attend group therapy each day." Rules and explanations must be brief, clear, and leave little room for misinterpretation. A client with antisocial personality disorder tends to disregard rules and authority and be socially irresponsible. The words "You'll be expected to attend..." are concise and concrete and convey precisely what behavior is expected. The other options leave open the interpretation that attendance is suggested but not mandatory.

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate?

"You'll need to continue the medication for about 6 to 12 months to see how things go." Even after the first episode of major depression, medication should be continued for at least 6 months to 1 year after the client achieves complete remission of symptoms. If the client experiences a recurrence after tapering the first course of treatment, the regimen should be reinstituted for at least another year, and if the illness reoccurs, medication should be continued indefinitely.

the nurse is providing support to a client's child regarding the parent's alcohol use disorder. When integrating the disease concept treatment approach about this type of disorder, which statement by the nurse would be most effective?

"Your parent's alcohol use problem is a chronic disease but can be treated." According to the Disease Concept, alcoholism is considered a chronic disease with modalities in place to help manage it. Thus, the most assuring response by the nurse is, "Your parent's alcohol use disorder is a chronic disease that can be treated." The other statements do not address this concept.

For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age?

18 years Antisocial personality disorder diagnosis is given to individuals 18 years of age or older who fail to follow society's rules—that is they do not believe that society's rules are made for them and are consistently irresponsible.

The nurse is caring for a client with conversion disorder. The nurse asks the client about the client's relationships with family and friends. What is the nurse trying to determine with this question? Choose the best answer.

The nurse wants to learn if the client has any conflicts with family or friends. Conversion disorders are usually related to interpersonal conflict arising among family or friends. The nurse asks the client about family and friends in order to find out whether any conflicts have caused the disorder in the client. Conversion disorder is not inherited, thus the nurse is not trying to find out if similar symptoms are evident in the family. Asking about family and friends would divert the client's attention from the disability, but this is not the nurse's chief intention here. Asking about family and friends would be useful to decrease the chances of secondary gain, but this again is not the nurse's chief intention in this scenario.

A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?

The nurse wants to prevent increasing the client's confusion. The nurse understands that too many visitors or more than one person speaking at once may increase the client's confusion. The nurse should also explain to the visitors that they should speak quietly with the client, one at a time. This may help prevent the client from becoming overstimulated. Talking with many friends at a time doesn't pose a physical danger to the client. While it is ideal for the client to demonstrate proper orientation, it is not the reason the nurse monitors the client's response to visitors. Talking to one person at a time does not help the client maintain an adequate balance of activity and rest.

A nurse is working with a client diagnosed with antisocial personality disorder. The nurse needs to keep in mind which about the therapeutic relationship?

The relationship initially is superficial because of a lack of client commitment. Therapeutic relationships are difficult to establish because these individuals do not attach to others and are often unable to use the relationship to change behavior. The goal of the therapeutic relationship is to identify dysfunctional thinking patterns and develop new problem-solving behaviors. After the first few meetings with these clients, the nurse may believe that the relationship has a good start, but in reality, a superficial alliance is usually formed. Additional sessions reveal the lack of client commitment to the relationship. These clients begin to revisit topics discussed in previous sessions or lose interest in trying to work on problems.

A client is in treatment for depression and alcohol abuse. The client is unwilling to confront substance abuse issues, stating the client uses alcohol to ease feelings of depression. The client's spouse reports that the spouse often has to care for the client when the client is hung over, calling in sick for the client and doing what the spouse can to help the client catch up with household or job responsibilities. The nurse diagnoses the client's family with dysfunctional family processes. The nurse and clients develop a plan of care. Which goal indicates an understanding of the family situation and the linkages between the diagnosis and the outcomes?

The spouse will refrain from the enabling the client's drinking behaviors. Codependency needs attention from staff and counselors to learn to adjust to the sober spouse and to develop a less vigilant, more interdependent relationship. The nurse recommends that family members begin their own recovery by attending support groups such as Al-Anon or Alateen.

The nurse is planning care for a client with a somatic symptom illness. What should the nurse's goals be while formulating the plan to treat the client? Select all that apply.

To help the client express emotions freely To help the client cope with interpersonal conflicts To help the client identify the cause of the physical illness Clients with somatic symptom illness may have difficulty expressing emotions and feelings. It may be extremely difficult for them to deal with their interpersonal conflicts. These clients may be unable to perceive the real cause of their illness. In order to resolve these issues, the nurse should help such clients express their emotions freely, cope with interpersonal conflicts, and identify the cause of their physical illness. Clients with somatic symptom illness do not pose any danger to other clients or medical personnel. The nurse should not administer narcotic analgesics to these clients because of the risk for dependence or abuse. Nonsteroidal antiinflammatory agents may be prescribed and administered for pain.

An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?

Verbalize feeling safe and comfortable. The client should verbalize feeling safe and comfortable. The other answer choices are goals for longer-term treatment—i.e., after the detoxification process has been successfully completed.

High doses of alcohol produce which effect?

Vomiting An overdose, or excessive alcohol intake in a short period, can result in vomiting, unconsciousness, and respiratory depression.

A client who is prescribed a tricyclic antidepressant is brought to the emergency department with a suspected overdose. Which would the nurse assess to support this suspicion? Select all that apply.

blurred vision urinary retention In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention. Central nervous system suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Headache is a side effect of monoamine oxidase inhibitors.

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia?

provides interaction with those with similar concerns Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. While the other options suggest accurate results, none are the greatest benefit such a support group experience can provide.

The nurse should consider the intervention referred to as "going along with" when managing the care of which client?

the older widower who is worried about his wife not being able to visit because of the snow Going along means providing emotional reassurance to clients without correcting their misperception or delusion. It is important to remember that different interventions are indicated for dealing with psychotic symptoms, depending on the cause. People with dementia cannot regain their cognitive functions, so techniques like redirection or "going along with" the person are indicated. However, when psychotic symptoms are due to a treatable illness, such as schizophrenia, the nurse should not say or do anything to reinforce the notion that the delusions or hallucinations are real in any way. This would only interfere with or impede the client's progress.The child's behavior is not acceptable and limits must be maintained.

A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?

A psychodynamic interpretation of the client's major depressive disorder. Psychodynamic theories postulate that clients with depression have unexpressed and unconscious anger about feeling helpless or dependent on others. Such anger begins in childhood when basic developmental needs are not met. Clients cannot express this anger toward the person or people on whom they feel dependent, so their anger turns inward.

A client has been diagnosed with major depressive disorder. The clinical symptom that would be included when the clinician makes this diagnosis is what?

A significant decrease in appetite Among the nine clinical symptoms of a major depressive episode is a significant increase or decrease in appetite. Failures may precipitate or exacerbate decisions and others may confirm the client's depression, but these are not diagnostic criteria. Unwise decision making is not a hallmark of depression, but indecisiveness is a diagnostic criterion.

After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?

Adolescence Many children and adolescents show symptoms similar to those of BPD, such as moodiness, self-destruction, impulsiveness, lack of temper control, and rejection sensitivity. Because symptoms of BPD begin in adolescence, it makes sense that some of the children and adolescents would meet the criteria for BPD even though it is not diagnosed before young adulthood.

While shopping in a grocery store, a client with borderline personality disorder (BPD) greets the sibling of a neighbor with a great big hug. Then about 5 minutes later, the client walks past the sibling and ignores the sibling. The client is demonstrating what?

Affective instability Affective instability (rapid and extreme shift in mood) is a core characteristic of BPD and is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. For example, a person may greet a casual acquaintance with intense affection, yet later be aloof with the same acquaintance. Dichotomous thinking involves evaluating experiences, people, and objects in terms of mutually exclusive categories (e.g., good or bad, success or failure, trustworthy or deceitful), which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects. Dissociation refers to times when thinking, feelings, or behaviors occur outside a person's awareness. Identity diffusion occurs when a person lacks aspects of personal identity or when personal identity is poorly developed.

A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?

Affective instability Affective instability is a rapid and extreme shift in mood and a core characteristic of borderline personality disorder. It is evidenced by erratic emotional responses to situations and intense sensitivity to criticism, perceived slights, or both.

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what?

Agnosia Deficits typically assessed in clients with Alzheimer's disease include: aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior).

The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?

An elevated mood that lasts for at least 1 week During manic episodes that characterize bipolar disorder, the individual exhibits an abnormal, persistently elevated, or irritable mood that lasts for at least 1 week. Failure to respond to treatment, the presence of signs of depression without anhedonia, and the client's admission of a mood disorder are neither diagnostic nor typical of bipolar disorder.

The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client?

Anger toward the loved one who committed suicide Some of the emotional responses suicide survivors may experience include feelings of unreality, shock, disbelief, and emotional numbness; grief, sadness, and despair; confusion over not knowing why the loved one chose suicide; anger toward the mental health practitioner, another family member, or a friend for failing to prevent the suicide; self-anger and guilt for failing to prevent the suicide; feelings of anger toward and betrayal by the loved one who committed suicide; and social stigmatization and isolation.

Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?

Antisocial personality Antisocial personality disorder is characterized by a disregard for and violation of the rights of others. Antisocial personality disorder is a common diagnosis for those in prison and jails.

The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?

Asians Asians have a genetic intolerance to alcohol even when consumed in small amounts. Such an intolerance has not been identified in those of African, Italian, or German descent.

A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans?

Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder.

A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?

Assess the client's blood pressure Combining phenelzine with beer can precipitate a hypertensive crisis. There is no immediate indication that an emergency code is needed. The client's jugular venous pressure is less likely to be affected and is not a priority for assessment. Performing the MMSE is not a short-term priority.

A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use?

Attention seeking A person with a histrionic personality disorder is often described as "attention seeking," "excitable," and "emotional." Psychopath and sociopath are terms used to describe the behavior of a person with antisocial personality disorder. Lacking empathy describes a person with a narcissistic personality disorder.

Which personality disorder would be placed in Cluster B?

Borderline Borderline personality disorder is placed in Cluster B. Avoidant personality is in Cluster C. Paranoid and schizoid personalities are in Cluster A.

Which personality disorder is most commonly found in clinical settings?

Borderline personality Borderline personality disorder is the most common personality disorder found in clinical settings. It is three times more common in women than in men.

While conducting an admission interview with a client, the nurse suspects the client may be in alcohol withdrawal. Which screening tool can help the nurse identify the severity of withdrawal symptoms?

CIWA-Ar Once alcohol withdrawal is suspected, a screening tool such as the CIWA-Ar can assist nurses to identify the severity of symptoms.

A psychiatric-mental health nurse is conducting a refresher class for a group of psychiatric-mental health nurses returning to the field. After teaching about depressive disorders, the nurse determines a need for additional teaching when the class identifies which physical symptom as being associated with depression?

Catatonia Catatonia is a state of motor or physical activity associated with manic states in bipolar illness. Catatonia is also seen in clients with schizophrenia who have periods of immobility interrupted by episodes of extreme agitation. Fatigue is a lack of energy common during a severely depressed state. Severely depressed clients frequently have difficulty falling asleep or wake early in the morning and are unable to go back to sleep as with insomnia. Feelings of worthlessness or excessive/inappropriate guilt are commonly associated with depression.

A client who has been prescribed fluoxetine for depression and has just had the dosage increased comes the emergency department. The nurse suspects serotonin syndrome based on which assessment?

Change in mental status Ataxia Diaphoresis Fever The symptoms of serotonin syndrome include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses?

Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented. Clients focus on physical symptoms as the primary problem. When physicians are unable to diagnose the cause, clients are often referred to other physicians for further physical assessment.

The major difference between bipolar I and bipolar II disorder is what?

Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances. Bipolar II disorder is characterized by a major depressive episode (either current or past) and at least one hypomanic episode. Bipolar II disorder differs from bipolar I in that the client has never had a manic or mixed episode but may have had an episode in which he/she experienced a persistently elevated, expansive, or irritable mood. The hypomanic symptoms are not severe enough to cause marked social or occupational dysfunction.

Which cluster of personality disorders is represented by individuals who appear anxious or fearful?

Cluster C Cluster C includes clients who appear anxious or fearful, such as avoidant, dependent, and obsessive-compulsive. Cluster A includes individuals whose behavior appears odd or eccentric. Cluster B includes individuals who appear dramatic, emotional, or erratic. There is currently no Cluster D in the DSM-5.

The nurse is studying the medical record of a client who reports blindness. The record indicates there is no ocular abnormality. The client doesn't seem upset by the blindness. What is the client's most likely diagnosis?

Conversion disorder The client has no ocular abnormality and isn't distressed by the situation. These findings indicate that the client may have conversion disorder. This involves unexplained, usually sudden deficits in sensory or motor function, such as blindness. Hypochondriasis is condition in which a client is preoccupied with possibly having a disorder or contracting a serious illness. Because all tests for blindness were negative, the client does not have any somatic dysfunction, such as optic nerve dysfunction. Somatic symptom disorder is a condition characterized by one or more physical symptoms that have no organic basis.

A client enters the emergency room exhibiting tremors, agitation, and restlessness. Upon assessment, the client's blood pressure is 160/90, pulse is 110, and respirations are 22. It has been 36 hours since the client's last drink of alcohol. The nurse would suspect which conditions to be occurring?

Delirium tremens Delirium tremens may occur 24 to 72 hours after the client's last drink. Elevation of vital signs accompanies restlessness, tremulousness, agitation, and hyperalertness. Tolerance is a need for markedly increased amounts of alcohol to achieve the desired effect. Korsakoff's psychosis is a form of amnesia characterized by a loss of short-term memory and the inability to learn new skills. Wernicke's encephalopathy is an inflammatory hemorrhagic, degenerative condition of the brain caused by a thiamine deficiency.

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition?

Depression Somatic symptom disorder frequently coexists with other psychiatric disorders, most commonly depression and anxiety. Others include panic disorder, mania, social phobia, obsessive-compulsive disorder, psychotic disorders, and personality disorders. Older adults are particularly high risk for comorbid depression.

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship Although administering prescribed pharmacotherapy, counseling, and assisting in developing a daily routine are important, the most crucial part of the plan of care is developing a sound, positive nurse-client relationship. Without the relationship, the nurse is just one more provider who fails to meet the client's expectations.

Which disease process is influenced by stress and emotions?

Diabetes Diabetes can be influenced by stress and emotions, as can other conditions such as hypertension and colitis. Deep vein thrombosis, biopoal disorder, and hypotension are not psychosomatic conditions.

A nurse is conducting a review class on borderline personality disorder. When describing the characteristics associated with this disorder, which would the nurse most likely include? Select all that apply.

Difficulty regulating moods Problems with interpersonal relationships Impulsive behavior People with BPD have problems regulating their moods, developing a self-identity, maintaining interpersonal relationships, maintaining reality-based thinking, and avoiding impulsive or destructive behavior.

Which occurs when thinking, feeling, or behaviors occur outside a person's awareness?

Dissociation A cognitive dysfunction seen in BPD is dissociation, or times when thinking, feeling, or behaviors occur outside a person's awareness. Affective instability is evidenced by erratic emotional responses to situations and intense sensitivity to criticism or perceived slights. Impulsivity occurs when there is difficulty delaying gratification or thinking through the consequences before acting on feelings, leading to unpredictable actions. Cognitively, people with BPD have dichotomous thinking. They evaluate experiences, people, and objects in terms of mutually exclusive categories, which informs extreme interpretations of events that would normally be viewed as including both positive and negative aspects.

The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?

Dopamine The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience.

Clinical manifestations of borderline personality disorder (BPD) begin in which period?

Early adulthood BPD is a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity that begins in early adulthood. Borderline personality disorder cannot be diagnosed in the adolescent population because many of the expected behaviors for this developmental stage are the maladaptive behaviors that are seen in BPD.

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest?

Empathize about physical discomfort but encourage independence. The results of a family assessment often reveal that families of these individuals need education about the disorder, helpful strategies for dealing with the multiple complaints of the client, and usually help in developing more effective communication patterns. Empathizing with clients about physical discomfort is important while simultaneously encouraging family members to assist the client in becoming more independent.

A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education?

Engaging the client in a discussion to direct the topic to the client. Client education efforts have to be creative and thought provoking. In teaching a person with antisocial disorder, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue and then direct the topic to the major educational points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked.

After several visits to the primary care provider, a client has been diagnosed with depression. Within the context of the behavioral theorists' beliefs about this disorder, which factors may underlie the client's diagnosis?

Exaggerated response to stressful life event The behaviorists hold that depression occurs primarily as the result of a severe reduction in rewarding activities or an increase in unpleasant events in one's life. The cognitive approach maintains that irrational beliefs and negative distortions of thought about the self, the environment, and the future engender and perpetuate depressive effects. Family theorists ascribe maladaptive patterns of family interaction as contributing to the onset of depression. Psychodynamic theorists ascribes the etiology to an early lack of love, care, warmth, and protection.

When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what?

Extensive use of over-the-counter medications When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified is the extensive use of over-the-counter medications. Many clients with hypochondriasis overuse medication and can become dependent as a result. For example, the nurse should identify if a client has developed laxative dependence as a result of anxiety regarding bowel patterns.

A client is admitted to a mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what?

Factitious disorder imposed on another A rare but dramatic disorder, factitious disorder imposed on another (previously called factitious disorder by proxy or Münchausen's by proxy), involves a person who inflicts injury on another person. It is commonly a mother who inflicts injuries on a child to gain the attention of a health care provider through her child's injuries. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what?

Flat Several terms are used to describe affect. Flat refers to an absent or nearly absent affective expression. Inappropriate describes a discordant affective expression accompanying the content of speech or ideation. Blunted refers to a significantly reduced intensity of emotional expression. Restricted or constricted indicates that there is a mild reduction in the range and intensity of emotional expression.

The nurse is conducting an admission assessment with a 45-year-old client who has been demonstrating signs of bipolar disorder. While conducting the assessment, the client starts speaking in illogical rhymes and using word associations. What is the name for this thought pattern?

Flight of ideas Rapid "flights of ideas" lead to excessive and illogical rhyming, punning, and word associations, along with pressured speech.

A group of nurses is reviewing information about delirium and dementia. The nurses demonstrate a need for additional review when they identify which as a characteristic of dementia?

Fluctuating changes within a 24-hour period With dementia, a client's cognition is stable throughout a 24-hour period, but with delirium, a client's cognition fluctuates. Hallucinations are possible with dementia. Psychomotor activity is normal, and cognition is globally impaired with dementia.

A nurse is reviewing the biologic theories associated with borderlline personalilty disorder. The nurse demonstrates understanding of the information by identifying which areas as being associated with brain dysfunction tied to borderline personality disorder? Select all that apply.

Frontal lobe Limbic system Associated brain dysfunction occurs in the limbic system and frontal lobe and increases the behaviors of impulsiveness, parasuicide, and mood disorders.

A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?

Gastrointestinal (GI) symptoms All four of the commonly prescribed cholinesterase inhibitors have the possibility of producing GI symptoms.

A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?

Hallucinogen PCP is classified as a hallucinogen. Heroin and morphine are considered opioids. Examples of inhalants are aerosols and adhesives. Cannabis is also known as marijuana.

The client is an 84-year-old suffering from delirium. The client has been in a nursing home for the past 2 years but recently is becoming combative and has become a threat to staff. Which medication would the client most likely receive for these symptoms?

Haloperidol Staff members must seriously consider this option when a client's behavior threatens the safety of self, family, or staff. Haloperidol, a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium.

Suspicion that a nursing professional is impaired by a substance abuse problem is mostsupported by which situation?

Having several clients complain that their pain medication is not working Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by having several clients complain that their pain medication is not working.

Which behavior is the priority concern as the nurse begins a care plan for a client in the manic phase of bipolar disorder?

Hyperactivity, dismissing meals, and sleep disturbance Safety needs are always the first priority in care planning. A client who has not eaten or slept for several days and has been extremely hyperactive may be at risk for exhaustion and malnutrition and the implications of those states. Although thought disorder, expansive mood, and dress are important assessment information, priority interventions must center on the basic needs of hyperactivity, dismissing meals, and sleep disturbance.

A nurse is caring for a client with delirium. The client sees a thermometer on the nurse's table and shouts, "Don't stab me!" and cowers. Which feature of delirium is this client exhibiting?

Illusion Clients with delirium may experience illusions. In this case, the client is having an illusion that the thermometer is a knife. Euphoria refers to an extremely elated mood; however, the client does not appear to be highly elated. Hallucinations are typically things that clients "see" with no stimulus in reality. Misinterpretations are a misunderstanding of an actual event or stimulus. In many cases, the client cannot be convinced that their misinterpretation is incorrect.

When documenting observations of the behaviors exhibited by a client diagnosed with borderline personality disorder, the nurse can correctly use which terms?

Impulsive, self-destructive, unstable Borderline personality behavior is characteristically impulsive, self-destructive, and unstable. It is antisocial, not borderline personality, behavior that is characteristically impulsive, aggressive, and manipulative. Obsessive-compulsive, not borderline personality, behavior is characteristically perfectionistic, rigid, and controlling, whereas histrionic personality, not borderline behavior, is characteristically emotional, dramatic, and theatrical.

A nurse is preparing a client for discharge. As part of the discharge process, the nurse provides education to the client regarding safety from self-harm. Which intervention should the nurse employ?

Include family members to provide a better understanding of symptoms of the illness In addition to trying to reduce the stigma that the client and family may associate with suicide, the nurse must educate them about depression, suicidal behavior, and treatments. When possible, the nurse should schedule educational sessions to include significant others so that they will better understand the client's illness and also learn what is necessary in providing outpatient care.

A client was admitted to an inpatient unit with a diagnosis of dementia. A nursing assessment and interview of the client would include what?

Intellectual ability, health history, and self-care ability A comprehensive nursing assessment should include obtaining the premorbid intellectual ability, health history, and self-care abilities of the client. The medical assessments, which are important, are not as critical to nursing assessment as the actions in the correct answer. Exploring early parent-child conflict and relational patterns would not be helpful with the dementive process.

A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?

It helps to reinforce self-responsibility. Problem-solving groups that focus on identifying a problem and developing a variety of alternative solutions are especially helpful for a client with antisocial personality disorder. This is because client self-responsibility is reinforced when clients remind each other of better alternatives. In addition, clients are likely to confront each other with dysfunctional schemas or thinking patterns. Groups that focus on developing empathy would foster attachment. Although groups typically have specific rules and boundaries, this is not the primary focus of problem-solving groups.

A nurse is conducting an inservice presentation for a group of newly hired mental health nurses. Which would the nurse most likely include when describing conversion disorder (functional neurologic symptom disorder)?

Laboratory and diagnostic test results are usually negative. Functional neurologic symptom disorder (or conversion disorder) is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms (APA, 2013). Clients with conversion disorder have neurologic symptoms that include impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing, a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations. In some instances, they may have seizures (Nielsen, Stone, & Edwards, 2013). However, laboratory, electroencephalographic, and neurologic test results are typically negative. The symptoms, different than those with an organic basis, do not follow a neurologic course but rather follow the person's own perceived conceptualization of

A nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex. The nurse knows that the client should have which test completed before initiation of drug therapy?

Liver function Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC count, and cardiac enzymes do not have to be performed routinely before starting this medication.

An older adult client with liver disease is experiencing alcohol withdrawal. Based on the nurse's understanding of drug therapy, which of the following would the nurse expect to be prescribed?

Lorazepam Antianxiety and sedating drugs, such as benzodiazepines, are titrated downwardly over several days as a substitution for the alcohol. Chlordiazepoxide (Librium) and diazepam (Valium) have longer half-lives and smoother tapers. Lorazepam (Ativan) is better for the older adult and people with liver impairment. Fluoxetine is not used.

Cognitive psychotherapy is most likely to be appropriate in the care of a client who has been diagnosed with what?

Moderate depression Cognitive psychotherapy is as effective as antidepressant medication in the treatment of mild to moderate depression. It is less likely to address depression that has a demonstrated medical etiology. The primary treatment for postpartum psychosis is medication. Therapy is not relevant in cases of anaclitic depression since the problem occurs in infants.

A client with a medical diagnosis of dementia of Alzheimer's type has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of "risk for injury related to agitation and confusion" and an outcome of "the client will remain free from injury." What intervention should the nurse use in order to facilitate this outcome?

Monitor amount of environmental stimulation and adjust as needed. Overstimulation from the environment is a likely trigger for agitation. The nurse must monitor the environment and the client's response to it on an ongoing basis. Seclusion would be unsafe. Teaching and setting limits are unlikely to be effective interventions with a client who has a cognitive disorder due to limitations of cognitive processing and impaired short-term memory.

A newly admitted client's history includes multiple suicide attempts. How can the nurse on the psychiatric-mental health unit best protect the client's safety?

Performing vigilant assessment and close observation Assessment and observation are among the core nursing actions to prevent suicide. Medication is a cornerstone of treatment but does not prevent suicide in and of itself. No-suicide contracts have not been shown to be effective. Therapy is not always indicated for all clients and does not supersede assessment and observation as a safety measure.

A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse has this reluctance?

Physical restraints may increase the client's agitation. The use of physical restraints are usually a last resort for clients with dementia, as restraint use may increase any fears or thoughts of being threatened. The nurse may need to use physical restraints if the client is pulling at intravenous lines or catheters. Physical restraints do not commonly cause injury to the client or lead to fatality.

A older adult client develops delirium secondary to an infection. Which would be the most likely cause?

Pneumonia Delirium in the older adult is associated with medications, infections, fluid and electrolyte imbalance, metabolic disturbances, or hypoxia or ischemia. Infections of the respiratory tract such as pneumonia or urinary tract are the most common. Appendicitis and cellulitis are not commonly associated with the development of delirium. Although low platelet count would render the older adult vulnerable to bleeding and easy bruising, it does not increase the risk of delirium.

A client was admitted to the psychiatric unit after being picked up by police officers who found the client frantically running back and forth across the freeway. The client's spouse reports that the client stayed up all night, ate very little, and talked incessantly. Additional assessment findings that indicate a manic episode include what?

Pressured speech, combative behavior, and impaired judgment A manic episode would be characterized by pressured speech, potentially combative behavior, and impaired judgment. Neither psychomotor retardation is present nor are recurrent illusions. Self-destructive behavior is not a classic symptom of mania; more often, clients may have accidents caused by their lack of judgment and psychomotor agitation.

A client with borderline personality disorder has been admitted to the inpatient unit after being found in the client's parents' bedroom, burning the client's arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which is the nursing care priority for this client during the first 24 hours of admission?

Protection from self-mutilation Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves.

A nurse is preparing to interview a client diagnosed with somatic symptom disorder. The nurse anticipates that the client will most likely exhibit what?

Rapidly changing moods during the interview The individual's mood is usually labile, often shifting from extremely excited or anxious to being depressed and hopeless. Response to physical symptoms is usually magnified. The client's mental status is usually normal, and cognition is not impaired but may be distorted.

The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client?

Remove all dangerous items from the client's room. Establishing geographic boundaries, such as room restriction or half-hall restriction, is part of ongoing monitoring. Also, clients likely will have "as-needed" medications ordered; nurses use them if aggressive or agitated behavior escalates. Other environmental approaches include reducing stimuli and opportunities for interaction with other clients in the milieu. Nurses remove all dangerous items from the client's room and monitor closely for use of any dangerous items. Nurses help clients learn to recognize what triggers violent thoughts and behaviors. They teach clients not to act on these thoughts but to leave the situation and find a staff member to talk to about them.

When assessing a client with borderline personality disorder (BPD), which behaviors would the nurse expect to find? Select all that apply.

Repeated, frequent crisis episodes Self-directed anger Learned helplessness Deceptive competence Behavior patterns associated with BPD include: emotional vulnerability (high sensitivity to negative emotional stimuli), self-invalidation (self-directed anger and no personal awareness), active passivity (learned helplessness), unrelenting crises (repeated, stressful, negative environmental events/roadblocks), inhibited grieving, and apparent competence (appearing more competent than person actually is).

A 52-year-old client has a history of alcohol dependence and is admitted to a detoxification unit. The client has tremors, is anxious, has a pulse that has risen from 98 to 110 beats/min, has blood pressure that has risen from 140/88 to 152/100 mm Hg, and has a temperature 0.6º above normal. The client is slightly diaphoretic. Which nursing diagnosis would be the priority?

Risk for injury The client is experiencing alcohol withdrawal, and protecting the client from injury is the priority at this time. Although the client may be coping ineffectively or denying the alcoholism, the client's physical safety is a top priority. There is no indication to suggest that the client's thought processes are disturbed.

A client with which psychiatric disorder is at high risk for suicide?

Schizophrenia Suicide is a high risk for people diagnosed with schizophrenia.

The personal benefit derived from blocking psychological conflict from conscious awareness is called what?

Secondary gain Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members and comfort measures.

A client is brought to the emergency department after having overdosed on cocaine. When assessing the client, which would the nurse expect to find? Select all that apply.

Seizures Cardiac arrhythmia Manifestations of cocaine overdose include cardiac dysrhythmias or arrest, increased or lowered blood pressure, respiratory depression, chest pain, vomiting, seizures, psychosis, confusion, dyskinesia, dystonia, and coma. Euphoria, paranoia, and dilated pupils are effects of cocaine.

As part of a client's treatment plan for borderline personality disorder, the client is engaged in dialectical behavior therapy. As part of the therapy, the client is learning how to control and change behavior in response to events. The nurse identifies the client as learning which type of skills?

Self-management skills Self-management skills focus on helping clients learn how to control, manage, or change their behavior, thoughts, or emotional responses to events. Emotion regulation skills are taught to manage intense, labile moods and involve helping the client label and analyze the context of the emotion, as well as developing strategies to reduce emotional vulnerability. Teaching individuals to observe and describe emotions without judging or blocking them helps clients experience emotions without stimulating secondary feelings that may cause more distress. Mindfulness skills are the psychological and behavioral versions of meditation skills usually taught in Eastern spiritual practice; they are used to help the person improve observation, description, and participation skills by learning to focus the mind and awareness on the current moment's activity. Distress tolerance skills involve helping the individual tolerate and accept distress as a part of normal life.

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this?

Set limits with the client about the complaints. If a client with the diagnosis of hypochondriasis has been told that the client has no life-threatening or severe illnesses, but the client continues to verbalize clinical symptoms, limit-setting is used. A "false" assessment is unethical, and repeating diagnostic testing reinforces the client's behavior. Having diagnostic results presented by another member of the care team is unlikely to eliminate the client's concerns.

Family education concerning the safe care of a client with a history of suicide attempts includes what? Select all that apply.

Signs and symptoms that indicate a mood change that could indicate the client is suicidal Information regarding the stressors that trigger the client's suicidal ideations Techniques to help the client cope with known triggers List of emergency service telephone numbers Family education should include information regarding recognizing changes in mood or behavior that could indicate a plan for self-injury (e.g., irritability, anger, agitation, withdrawal, or self-deprecating comments) and notify the client's health care provider. It should also include how to anticipate future stressors that trigger the client, along with information regarding how to assist the client with coping skills. Also important to family education is information regarding a 24-hour emergency hotline phone number—and the need to keep the information readily available.

Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate?

Situational low self-esteem The client does not express anxiety, issues with marital disagreements, or problems with activity planning. Instead, the client has experienced a change from being an involved, interested parent to feeling as though the client is a burden, which would be reflective of a disturbance of self-esteem. The self-esteem changes the client is experiencing are related to feelings of worthlessness brought on by the depressive episode.

The psychiatric nurse managing the care of a client experiencing alcohol withdrawal instructs unit staff to anticipate that the client may experience which neurological response?

Tactile hallucinations Alcohol withdrawal can be the origin of tactile hallucinations. Alcohol withdrawal is not usually the origin of gustatory hallucinations or delusions of any type.

Which factor would contraindicate the use of disulfiram in the treatment of a client who has an alcohol use disorder?

The client had six drinks a few hours ago. Disulfiram may not be administered to a client who is acutely intoxicated. A family history of alcoholism, marijuana use, and binge drinking do not preclude the use of the drug.

The nurse is assessing a client for warning signs of suicide. Which would be a concern?

The client has engaged in risky behaviors and tends to be impulsive. According to the "Is Path Warm" mnemonic, a risk factor for suicide is risk-taking behavior without thinking.

A client with conversion disorder talks at length about a loss of vision. The nurse talks to the client about good hygiene practices and encourages the client to talk about any topic of interest. What is the nurse's intention for this intervention? Choose the best answer.

The client should pay less attention to the physical problem. By discussing good hygiene practices and encouraging the client to speak on any topic of interest, the nurse is trying to avoid discussing the client's physical symptom. The client with conversion disorder may have good hygiene habits; the nurse is not trying to teach the client about good hygiene habits. The nurse's intervention is not aimed at making the client feel comfortable with the nurse or to make the client express the physical problems. The purpose of the nurse's intervention is to help minimize secondary gain and decrease the client's focus on the symptom.

After teaching a group of nursing students about somatic symptom disorder, the instructor determines that additional education is needed when the students identify which as true?

The client usually thinks anxiety is behind the symptoms. Individuals with somatic symptom disorder perceive themselves as being "sicker than the sick" and report all aspects of their health as poor. Many eventually become disabled and cannot work. They typically visit health care providers multiple times per month and quickly become frustrated because their primary health care providers do not appreciate their level of suffering and are unable to validate that a particular problem accounts for their extreme discomfort. Clients do not have insight to identify anxiety as a problem.

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way. An appropriate outcome for hopelessness would be for the client to reframe and redefine an event positively rather than negatively, which can help the client view the situation in an alternative way, thereby fostering hope. Discussing the cause of fatigue is unrelated to hopelessness. Identifying factors contributing to depression would reflect a knowledge deficit. The ability to differentiate reality from fantasy would be inappropriate for this client. There is nothing to support that the client is not focused in the here and now.

When describing the course of illness associated with somatic symptom disorder, which would the nurse include?

The client will report going to many different providers without satisfaction. Clients living with a somatic symptom disorder usually present exaggerated, inconsistent, yet complicated medical histories. They often seek treatment from multiple health care providers when their physical complaints are not addressed to their satisfaction.

A parent brings a teenaged child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer.

The client's symptoms disappeared after getting the medical note. A malingerer is a person who intentionally produces false or grossly exaggerated physical or psychological symptoms. This behavior is motivated by external motives, and once the motives have been met, the client's symptoms will disappear. If the client had studied all night for an exam, the client may have been suffering from a tension headache and the symptoms would have remained after the client received the medical note. If a client doesn't have any underlying cause of headache on assessment, it could be concluded that the client either is a malingerer or has a somatic symptom illness. However, clients do not have voluntary control over somatic symptoms. If the client reports having signs related to raised intracranial pressure, such as nausea, which are not consistent with the assessment findings, then the client may have Munchausen's syndrome. In this condition the client inflicts illness or injury on oneself in order to gain attention.

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

The drug helps to satisfy the craving for the opioid. Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin.

A nursing instructor is describing somatic symptom disorder to a group of nursing students. The instructor determines that the education was successful when the students state what?

The first symptom usually appears during adolescence. Complex somatic symptom disorder typically has an onset before age 30 years, with the first symptom often appearing during adolescence. The disorder is diagnosed more often in women and occurs most often with depression and anxiety. Epidemiologic studies reveal that the disorder occurs primarily in nonwhite, less educated women, particularly those with lower socioeconomic status and high emotional stress.

Which nursing action would be a protective factor in the prevention of suicide for a client who has been identified at risk?

The nurse facilitates a referral to a drug and alcohol recovery program. Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as extensively as risk factors, but identifying and understanding them are very important. Protective factors include effective clinical care for mental, physical, and substance abuse disorders. The nurse facilitating a referral for a client to a drug and alcohol recovery program can serve to mitigate or prevent the risk for suicide in a client who also has risk factors. Although medical interventions for depression are important, effective depression treatment is multitudinal and should incorporate psycho-social and spiritual care as well. Clients should not be told to avoid conflict rather the nurse should assist the client in building personal capacity to manage conflict in adaptive ways. Clients who are at risk for suicide would find social support to be a protective factor in mitigating or preventing self harm. Client's should be encouraged to be connected to family and community support whenever possible.