Mental Health Evolve ch 10-15
A nurse has worked on a mental health unit for an extended period of time. Which statement is best associated with behaviors demonstrated as a result of compassion fatique? A. "I'm really looking forward to the day I can retire and travel." B. "The clients often behave in a manner that makes them unlikable." C. "These clients are like living with my mother and aunt." D. "I'm so tired; having a 4-day stretch off will be so wonderful."
"C. These clients are like living with my mother and aunt." Nurses should be alert to secondary traumatic stress/compassion fatigue. The secondary traumatic stress/compassion fatigue symptoms include having difficulty separating work from personal life. The statement about the nurse's family members suggests a problem with countertransference. Recognizing the difficulty of interacting with certain clients is not a concrete indication of being ineffective when working with them. The remaining options are expressions that are typical and not associated with burnout.
Which statement reflects successful achievement of a therapeutic long-term goal for a client diagnosed with somatic symptom disorder? A. "I haven't missed a day of work in the last 6 months." B. "My symptoms may not be signs of a serious cancer." C. "I may have found a doctor who can really help me." D. "My husband is starting to believe I'm really in pain."
A. "I haven't missed a day of work in the last 6 months." The overall long-term goal in treating individuals with somatic symptom disorders is that people with these disorders will eventually be able to live as normal a life as possible. This includes symptom or pain reduction, improved level of independence, and a better overall quality of life. Not missing work is an indication of desired independence and overall quality of life. The remaining client statements indicate a continued belief that a health problem will be found and that the reports of pain are accepted by family.
The nurse will encourage the client to engage in regular involvement with which formalized groups as an intervention directed toward the treatment of a primary risk factor associated with depression? (Select all that apply.) Select all that apply. A. Alcoholics Anonymous (AA) B. Senior citizens travel group C. Sexual assault survivors group D. New moms support group E. Church-associated men's group
A. Alcoholics Anonymous (AA) C. Sexual assault survivors group D. New moms support group Primary risk factors for depression include experiencing a negative, stressful event (sexual assault), postpartum period (support group), and alcohol or substance abuse (AA). The remaining options do not focus on identified risk factors and so are social in their nature.
The nurse is managing a group of clients diagnosed with somatic symptom disorders. Which client behavior best demonstrates the nurse's ability to manage manipulative behaviors therapeutically? A. Clients direct all requests to a designated nurse. B. Clients are involved in their personal discharge planning. C. All clients attend assertiveness training daily. D. Each client is aware of the role stress plays in his or her behaviors.
A. Clients direct all requests to a designated nurse. While all the options demonstrate behaviors that are appropriate, the implementation of the designated nurse reduces manipulation by the clients. The client is unable to make similar requests to multiple staff members thus increasing the chances of confusion and inconsistent care.
Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? (Select all that apply.) Select all that apply. A. "Tell me what you are trying to accomplish by being so rude to the staff and other clients." B. "Remember that all clients must follow the rules regarding the use of the telephone." C. "Missing group today means that you will not be able to attend the pizza party later." D. "Tell me what triggered your angry response to what I said." E. "The staff is responsible for determining unit rules that are fair to all clients."
B. "Remember that all clients must follow the rules regarding the use of the telephone." D. "Tell me what triggered your angry response to what I said." E. "The staff is responsible for determining unit rules that are fair to all clients." Manipulation is the using or controlling of others or of situations for only one's personal benefit. Setting limits/rules, reinforcing the limits/rules, and enforcing consequences for disregarding the limits/rules demonstrates therapeutic management of manipulative behaviors. The remaining options are associated with the management of impulsivity.
Which nursing assessment question is focused on determining the client's motivation for binge eating? A. "Does binging help you get the attention you need?" B. "Would you say that you are less depressed after binging?" C. "Are you less likely to hear voices while you are binging?" D. "Do you sleep better at least temporarily after binging?
B. "Would you say that you are less depressed after binging?" Overeating is frequently noted as a symptom of a depression. Binge eaters report that binge eating is soothing and helps to regulate their moods. The dysfunctional eating pattern is not associated with a need for attention, auditory hallucinations, or a sleep disorder.
Which nursing intervention will best address the intense need to control demonstrated by a client receiving treatment of bulimia nervosa? A. Monitoring the client for the presence of suicidal thoughts and behaviors B. Clearly stating expectations and admitting that they differ from those of the client C. Helping the client reframe irrational thinking that leads to dysfunctional eating D. Having the client keep a journal that identifies triggers that cause dysfunctional eating
B. Clearly stating expectations and admitting that they differ from those of the client A straightforward statement that the nurse's perceptions are different will help avoid a power struggle. Arguments and power struggles intensify the patient's need to control. Suicide assessment relates to client safety. While reframing and journaling are appropriate, those interventions are not associated with the need for the client to control his or her life.
A client recently diagnosed as obese is experiencing stress related to the need to lose weight. How can the nurse best help the client focus on the eustress nature of this stressor? A. Encourage the client to discuss his or her feelings about being obese. B. Discuss weight loss strategies with the client. C. Re-enforce for the client that obesity is a health problem that is manageable. D. Provide the client with a list of realistic, time-focused weight loss goals.
B. Discuss weight loss strategies with the client. Eustress is beneficial stress; it motivates people to develop the skills they need to solve problems and meet personal goals. Providing support with identifying and selecting weight loss strategies will help the client to be motivated and empowered to reach weight loss goals. The remaining options are not inappropriate but they lack the element that best promotes the client's personal motivation.
Which behavior is most characteristic of a client diagnosed with antisocial personality disorder? A. Insisting that it is necessary to eat only green foods on Thursdays. B. Justifying taking another client's dessert by stating, "I deserve two desserts." C. Repeatedly accusing the staff of favoring another client. D. Throwing a book when asked to turn down the volume on the television.
B. Justifying taking another client's dessert by stating, "I deserve two desserts." Entitlement is a characteristic demonstrated by clients diagnosed with antisocial personality disorder. Poor impulse control is a hallmark of borderline personality disorder. Schizotypal personality disorder is associated with eccentric behavior while intense jealousy is characteristic of paranoid personality disorder.
The nurse is managing care for a client who is reporting increased stress related to a new work-related position. What intervention suggested by the nurse is associated with an increase of energy and fewer muscle aches? A. Adding Vitamin C to the daily diet B. Limiting or eliminating caffeine from diet C. Being screened for depression D. Monitoring heart and respiratory rates daily
B. Limiting or eliminating caffeine from diet Lowering or eliminating caffeine from one's diet can lead to more energy, fewer muscle aches, and greater relaxation. Ensuring proper hydration is most associated with this side effect of stress. The remaining options are appropriately related to the possible effects of stress but are not associated with the hypothalamus-pituitary-adrenal cortex.
A client diagnosed with depression has been prescribed various first-line antidepressant agents but has demonstrated only minimal improvement. In preparation for the prescription of a second-line agent, the nurse will educate the client on which classification of antidepressant? A. Atypical B. Monoamine oxidase inhibitors C. Tricyclic D. Dual action
B. Monoamine oxidase inhibitors First-line agents include cyclic antidepressants (e.g., TCAs), dual action antidepressants (SSRIs, SNRIs, and NDRIs), and atypical antidepressants while monoamine oxidase inhibitors (MAOIs) are considered second-line agents.
Which patient behaviors noted by the nurse supports the diagnosis of severe level panic? A. Pacing nervously. B. Too preoccupied to respond when unit fire alarm is tested. C. Repeatedly demands that the staff, "make the voices stop saying those bad things." D. Reports being, "too nervous to eat."
B. Too preoccupied to respond when unit fire alarm is tested. Severe level anxiety is associated with the inability to attend to events occurring in the environment such as reacting to a fire alarm. Pacing and a disinterest in things like eating are associated with moderate anxiety. Hallucinations are characteristic of the psychotic behavior triggered by panic level anxiety.
When assessing for the subjective symptoms of posttraumatic stress disorder (PTSD), which question will the nurse ask a client hospitalized for severe anxiety related to a sexual assault by a family member as a teenager? A. "On a regular basis, do you get enough restful sleep?" B. "Am I correct to say that you try to avoid certain family members?" C. "Are you experiencing a flashback of the rape right now?" D. "Can we discuss what triggered your angry outburst a few minutes ago?"
C. "Are you experiencing a flashback of the rape right now?" There are considered to be four cardinal symptoms of PTSD. Intrusive re-experiencing of the traumatic event (flashback) is a subjective symptom of this disorder. The other options assess objective or behavioral symptoms of PTSD.
Which statement demonstrates a characteristic of depression-associated behaviors that is especially associated with children and adolescents? A. "I can't go on being so depressed." B. "Life is no fun since I lost my sister." C. "I don't care that friends say I'm grumpy." D. "I'm so very sad since my sister died."
C. "I don't care that friends say I'm grumpy." Depressed mood most of the day, nearly every day, is an indication of depression (e.g., sad, empty, hopeless). In children and adolescents, this can be demonstrated by an irritable mood.
Which statement demonstrates a defense mechanism often implemented by clients diagnosed with a borderline personality disorder? A. "I'm so ashamed when I lose my temper." B. "I can't go to group unless you go with me." C. "There is nothing good I can say about my mother." D. "I've attempted suicide on three different occasions."
C. "There is nothing good I can say about my mother." Splitting is a primitive defense mechanism used by individuals demonstrating borderline personality characteristics. Shame, clinging, and suicidal attempts are behaviors not associated with defense mechanisms used by these individuals.
A nurse managing the care of a client diagnosed with an eating disorder has begun to experience frustration when the client consistently pushes back against the planned interventions. What action on the part of the nurse is indicated to help strengthen the nurse-client relationship? A. Regularly sharing with peers the feelings and asking for their suggestions on minimizing the frustration B. Demonstrating a very matter-of-fact attitude when addressing issues related to interventions C. Acknowledging to the client that working toward these treatment goals must be very frightening D. Asking that a more experienced nurse be allowed to act as monitor in order to identify any existing countertransference
C. Acknowledging to the client that working toward these treatment goals must be very frightening In the effort to motivate the patient and take advantage of the decision to seek help and be healthier, the nurse must take care not to cross the line toward authoritarianism and assumption of a parental role in the relationship. Frequent acknowledgment of the situation for the client and of the constant struggle that so characterizes the treatment will help during times of extreme resistance. Being supervised by a competent, supportive, more experienced clinician and sharing with peers help minimize feelings of frustration and can contribute to therapeutic growth in the nurse.
When considering comorbid conditions, which nursing intervention is most appropriate for a client diagnosed with a somatic symptom disorder? A. Preparing for diagnostic testing to evaluate client's report that, "my heart skips beats" B. Administering medication to manage constipation as prescribed C. Assessing client for suicidal ideations D. Inspecting skin for signs of damage resulting from repetitive hand washing
C. Assessing client for suicidal ideations A suicide assessment should be performed with any psychiatric patient. Patients with somatic symptom may be especially prone to self-harm behaviors. While clients may experience constipation, cardiac arrhythmia, and compulsive behaviors, these conditions are not typically associated with dissociative disorders.
What is the foundational principle to consider when assessing clients from varying ethnic cultures for behaviors associated with anxiety disorders? A. There are basic anxiety-driven behaviors demonstrated by all cultures. B. Asian Americans are least reluctant to seek psychiatric help. C. Effective diagnosis of anxiety is dependent on an awareness of cultural norms. D. Anxiety triggers somatic symptoms more prevalently than cognitive ones.
C. Effective diagnosis of anxiety is dependent on an awareness of cultural norms. The incidence and demonstration of anxiety disorders seems to vary among culture and countries. Anxiety disorders also vary among immigrants from generation to generation. One must be aware of the cultural norm before making a diagnosis. The remaining options are neither true nor the foundation of anxiety diagnosis and treatment.
Which life event related to a client demonstrating depressive symptoms supports a diagnosis of persistent depressive disorder (PDD)? A. Lost employment as a result of frequent absences B. Two unsuccessful suicide attempts over the last year C. Recognized symptoms of depression over 2 years ago D. Abruptly ended a long-term romantic relationship
C. Recognized symptoms of depression over 2 years ago In persistent depressive disorder (PDD), the symptoms last for at least 2 years and are usually considered mild to moderate. Usually, a person's social or occupational functioning is not as greatly impaired as they are in major depressive disorder (MDD), although they may cause significant distress or some impairment in these areas. The symptoms in a chronic/dysthymic depression (PDD) are often congruent with the person's usual pattern of functioning. The remaining options support a diagnosis of MDD.
The nurse concludes that the treatment plan for a client diagnosed with a somatic disorder best demonstrates success when which observation is made? A. The client agrees to adhere to interventions identified in the treatment plan. B. Client engages in productive discussions related to managing aggression. C. Reports of physical pain have lessened substantially. D. Client regularly attends aversion training group.
C. Reports of physical pain have lessened substantially. Treatment is considered successful when outcomes are met. When somatization is present, the patient's ability to perform self-care activities may be impaired. In general, nursing interventions involve the use of a straightforward approach to support the highest level of functioning. While agreement to adhere to the treatment plan is a positive indicator, it doesn't necessarily demonstrate achievement of a foundational goal. Neither of the remaining options are associated with a diagnosis of somatic disorder; but rather anger management disorder or phobias.
Which intervention will the nurse include in the plan of care to address a common co-morbid condition demonstrated by many clients diagnosed with body dysmorphic disorder (BDD)? A. Set and enforce reasonable limits regarding boundaries B. Frequent re-orientation to time and place C. Suicide precautions D. Anger management group
C. Suicide precautions Individuals with BDD have higher rates of suicidal ideations, suicide attempts, and completed suicides than individuals who do not meet the criteria for BDD. The remaining options are focused on anger, memory loss, or poor social boundaries.
Which nursing assessment question is focused on evaluating for the most prevalent comorbid mental ill issue among the clients diagnosed with anxiety disorder?" A. "Do you ever engage in binge eating?" B. "Are you hearing voices that no one else can hear?" C. "Can you tell me the names and ages of your grandchildren?" D. "Are you currently experiencing any suicidal ideations?"
D. "Are you currently experiencing any suicidal ideations?" Major depressive disorder (MDD) co-occurs in up to half of people with anxiety disorders and produces greater impairment and poorer response to treatment. Assessing for suicidal ideation would be appropriate for such a co-occurring condition. The remaining options are associated with either a cognitive dysfunction, psychosis, or an eating disorder.
Which response is characteristic of the implementation of an immature defense mechanism? A. Giving an expense gift to someone who you took advantage of. B. Drinking alcohol to get the courage to ask for a salary increase. C. "I'm not a bully; it's just that people are envious of how rich I am." D. "I only steal from stores that overcharge for the products in the first place."
D. "I only steal from stores that overcharge for the products in the first place." Projection, example of an immature defense mechanism, is characterized by attributing the blame for unacceptable behavior someone or something else. Such behavior generally abandoned by adulthood is maladaptive when demonstrated by adults. The remaining options are examples of intermediate defenses that include rationalization, undoing, and compensation.
Recognizing that somatic symptom disorders focus on physical symptoms, which client statement best demonstrates the unique characteristic of this type of disorder? A. "I wonder if my fear of cancer is real or imagined." B. "For a while medication helped but now my stomach problems are back again." C. "The pain I feel is nearly constant and very specific." D. "I've been to so many doctors but none can find out what's wrong with me."
D. "I've been to so many doctors but none can find out what's wrong with me." The emphasis in the DSM-5 is not only on the presence of physical symptoms but also on the way an individual presents and interprets the symptoms in a persistent and excessive manner. Often, people with somatic symptom disorders are associated with increased health care use, and dissatisfaction with and changing providers. The client never considers that the physical issues could be imagined. The symptoms tend to be vague and constant rather than specific and intermittent.
Which statement by a client scheduled for a series of electroconvulsive therapy (ECT) treatments indicates to the nurse that the client has an understanding of the goals of this treatment? A. "My prognosis is so much better since I didn't have any delusional symptoms." B. "If this works, I will likely be able to stop taking lithium." C. "I'm prepared to deal with the certain loss of my short-term memory." D. "It is expected that my chance for remission is very good."
D. "It is expected that my chance for remission is very good." ECT is safe and effective, and can achieve a 70% to 90% remission rate in depressed patients within 1 to 2 weeks. ECT is useful in treating patients with major depressive disorder especially when psychotic symptoms are present (e.g., delusions of guilt, somatic delusions, or delusions of infidelity). On awakening from ECT, the patient may be confused and disoriented. Many patients state that they have memory deficits for the first few weeks after treatment. Memory usually, although not always, recovers. ECT is not a permanent cure for depression, and maintenance treatment with TCAs or lithium decreases the relapse rate.
Which assessment data confirms that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome? A. Acknowledges that symptoms of depression exist. B. Client has eaten 60% of three meals per day for 3 consecutive weeks. C. Demonstrates an understanding of what constitutes healthy eating habits. D. Client has maintained weight at 87% of ideal body weight for 2 months.
D. Client has maintained weight at 87% of ideal body weight for 2 months. Some common outcome criteria for patients with anorexia nervosa include normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks and achieving 85% to 90% of ideal body weight; demonstrating two new, healthy eating habits and improved self-acceptance; and participating in treatment of associated psychiatric symptoms (defects in mood, self-esteem), not just acknowledging the presence of symptoms.
How can the nurse manager on a mental health unit devoted to the care of clients diagnosed with personality disorders address the needs of the nursing staff? A. Design schedules to provide staff with 3 consecutive days off each period. B. Schedule monthly in-services on the management of this client population. C. Require that nursing staff rotate to another nursing unit for 6 months every 24 months. D. Hold a daily meeting to focus on communication between nursing and supervisory staff.
D. Hold a daily meeting to focus on communication between nursing and supervisory staff. Frequent communication among staff and continuous availability of supervision and support are vital in times when the behaviors of these patients start to affect the confidence, feelings, behaviors, and effectiveness of staff members. The remaining options fail to provide the opportunity for communication and support.
Which stress management behavior is most reflective of those associated with personality disorders? A. Demonstrating ritualistic behaviors B. Binge drinking every weekend C. Having difficulty making a decision concerning which movie to view D. Holding spouse responsible for the client's poor work performance
D. Holding spouse responsible for the client's poor work performance In people with personality disorders (PDs), personality traits tend to be inflexible and unpredictable, and coping strategies tend to be more primitive and immature. They often blame others for their difficulties or even deny having a problem. None of the other options are specifically associated with characteristics/behaviors associated with personality disorders.
What classic characteristic is noted in clients diagnosed with bulimia nervosa? A. Involved in sports B. Obesity C. Male D. Onset in late adolescence
D. Onset in late adolescence The most common age of onset for eating disorders is during adolescence, although eating disorders can occur in patients of any age, gender, race, or ethnicity. The risk is highest for young men and women between 13 and 17 years of age. The onset of binge-eating disorders is most common in the mid-20s. The DSM-5 states that approximately one-third of binge eaters are obese. Being athletic is not considered a characteristic. Eating disorders of all kinds are more prevalent in females than males.
A nurse is planning interventions for a veteran who has recently been discharged from the military and is reporting difficulty sleeping. When considering the client's past medical history, which data is most relevant to the development of posttraumatic stress disorder (PTSD)? A. Family history of depression B. Regularly smoked marijuana as a teenager C. Quit smoking tobacco 2 months ago D. Sustained a concussion a month before discharge
D. Sustained a concussion a month before discharge A concussion can result in traumatic brain injury (TBI). Recent TBI is the strongest predictor of PTSD. A family history of depression is a risk factor for possible depression that can be diagnosed in some cases of PTSD, but it is not a strong predictor of the disorder. The remaining options are not relevant to the diagnosis of PTSD.