MH final

planning/implementation

Although this plan of care is directed toward the individual client, it is essential that family members or primary caregivers participate in the ongoing care of the client with mental retardation Clients' families need to receive information regarding The scope of the client's condition Realistic expectations and client potentials Methods for modifying behavior as required Community resources from which they may seek assistance and support

dissociative amnesia

An inability to recall important personal data that is too extensive to be explained by ordinary forgetfulness Not due to the direct effects of substance use or a general medical condition

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? Select one: a. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." b. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." c. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." d. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

Ans: 4 Rationale: The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others

narcissistic personality disorder

Definition Characterized by an exaggerated sense of self-worth Lacks empathy Believes he or she has an inalienable right to receive special consideration Prevalence of the disorder is from 2% to 16% in the clinical population Less than 1% of the general population is narcissistic Disorder more common in men than in women Clinical picture Client overly self-centered Exploits others in an effort to fulfill own desires Mood, which is often grounded in grandiosity, is usually optimistic Client relaxed, cheerful, and carefree Etiological implications As children, these people have had their fears, failures, or dependency needs responded to with criticism, disdain, or neglect Parents were often narcissistic themselves

A physician orders methylphenidate (Ritalin) for a child diagnosed with attention deficit-hyperactivity disorder (ADHD). Which information about this medication should the nurse provide to the parents? Select one: a. If one dose of Ritalin is missed, double the next dose. b. Administer Ritalin to the child after breakfast. c. Administer Ritalin to the child just prior to bedtime. d. A side effect of Ritalin is decreased ability to learn.

ANS: 2 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

In planning care for a child diagnosed with autistic disorder, which would be a realistic client outcome? Select one: a. The client will communicate all needs verbally by discharge. b. The client will participate with peers in a team sport by day 4. c. The client will establish trust with at least one caregiver by day 5. d. The client will perform most self-care tasks independently

ANS: 3 Rationale: The most realistic client outcome for a child diagnosed with autistic spectrum disorder is for the client to establish trust with at least one caregiver. Trust should be evidenced by facial responsiveness and eye contact. This outcome relates to the nursing diagnosis impaired social interaction.

5. 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."

ANS: 4 Rationale: The client reflects insight when referring to feelings toward family dynamics that may have influenced the development of the disease. Families who are overprotective and perfectionistic can contribute to the development of anorexia nervosa.

Which symptom exhibited by a client diagnosed with a conversion disorder would predict the poorest prognosis? A. Seizures B. Blindness C. Aphonia D. Paralysis

ANS: A The nurse should anticipate that a client diagnosed with a conversion disorder who suffers from seizures would have the poorest prognosis. Symptoms of blindness, aphonia, and paralysis are associated with a good prognosis

ODD causes

Biological influences Family influences Parental problems in disciplining, structuring, and limit-setting Identification by the child with an impulse-disordered parent who sets a role model for oppositional and defiant interactions with other people Parental unavailability

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this behavior? Select one: a. Compulsive personality disorder. b. Schizotypal personality disorder. c. Histrionic personality disorder. d. Manic personality disorder

C. Histrionic personality disorder The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

dissociative disorders

Dissociative disorders are defined by a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. Dissociative disorders are thought to be rare. DID and dissociative amnesia are more common in women than in men. Brief episodes of depersonalization symptoms appear to be common in young adults, particularly in times of severe stress.

jumping to conclusions

Without individuals saying so, we know what they are feeling and why they act the way they do. In particular, we are able to determine how people are feeling toward us. For example, a person may conclude that someone is reacting negatively toward them but doesn't actually bother to find out if they are correct. Another example is a person may anticipate that things will turn out badly, and will feel convinced that their prediction is already an established fact.

systematized amnesia

inability to recall events relating to a specific category of information, such as one's family or one particular person or event

fixing CD

1. Identify the Cognitive Distortion. Create a list of troublesome thoughts and examine them later for matches with a list of cognitive distortions. An examination of cognitive distortions allows us to see which distortions we prefer. Additionally, this process will allow us to think about the problem or predicament in more natural and realistic ways 2. Examine the Evidence. A thorough examination of an experience allows us to identify the basis for our distorted thoughts. If we are quite self-critical, then, we should identify a number of experiences and situations where we had success. 3. Thinking in Shades of Gray. Instead of thinking about our problem or predicament in an either-or polarity, evaluate things on a scale of 0-100. When a plan or goal is not fully realized, think about and evaluate the experience as a partial success, again, on a scale of 0-100. 4. Double Standard Method. An alternative to "self-talk" that is harsh and demeaning is to talk to ourselves in the same compassionate and caring way that we would talk with a friend in a similar situation. 5. Survey Method. We need to seek the opinions of others regarding whether our thoughts and attitudes are realistic. If we believe that our anxiety about an upcoming event is unwarranted, check with a few trusted friends or relatives. 6. Definitions. What does it mean to define ourselves as "inferior," "a loser," "a fool," or "abnormal." An examination of these and other global labels likely will reveal that they more closely represent specific behaviors, or an identifiable behavior pattern instead of the total person 7. Re-attribution. Often, we automatically blame ourselves for the problems and predicaments we experience. Identify external factors and other individuals that contributed to the problem. Regardless of the degree of responsibility we assume, our energy is best utilized in the pursuit of resolutions to problems or identifying ways to cope with predicaments. 8. Cost-Benefit Analysis. It is helpful to list the advantages and disadvantages of feelings, thoughts, or behaviors. A cost-benefit analysis will help us to ascertain what we are gaining from feeling bad, distorted thinking, and inappropriate behavior. Note: 1) clinical concept of secondary gain; and 2) refer to cost-benefit analysis

four modules of DBT

1. Mindfulness The essential part of all skills taught in skills group are the core mindfulness skills. Observe, Describe, and Participate are the core mindfulness "what" skills. They answer the question, "What do I do to practice core mindfulness skills?" Non-judgmentally, One-mindfully, and Effectively are the "how" skills and answer the question, "How do I practice core mindfulness skills?" 2. Interpersonal Effectiveness Interpersonal response patterns taught in DBT skills training are very similar to those taught in many assertiveness and interpersonal problem-solving classes. They include effective strategies for asking for what one needs, saying no, and coping with interpersonal conflict. This module focuses on situations where the objective is to change something (e.g., requesting someone to do something) or to resist changes someone else is trying to make (e.g., saying no). The skills taught are intended to maximize the chances that a person's goals in a specific situation will be met, while at the same time not damaging either the relationship or the person's self-respect. Interpersonal Effectiveness and Borderline Borderline individuals frequently possess good interpersonal skills in a general sense. The problems arise in the application of these skills to specific situations. Individual may be able to describe effective behavioral sequences when discussing another person encountering a problematic situation. But, may be completely incapable of generating or carrying out a similar behavioral sequence when analyzing her own situation. 3. Distress Tolerance Distress tolerance skills constitute a natural development from mindfulness skills. They have to do with the ability to accept, in a non-evaluative and nonjudgmental fashion, both oneself and the current situation. Although the stance advocated here is a nonjudgmental one, this does not mean that it is one of approval: acceptance of reality is not approval of reality. Distress tolerance behaviors are concerned with tolerating and surviving crises and with accepting life as it is in the moment. Four sets of crisis survival strategies are taught: distracting, self-soothing, improving the moment, thinking of pros and cons. Acceptance skills include radical acceptance, turning the mind toward acceptance, and willingness versus willfulness. 4. Emotion Regulation Borderline and suicidal individuals are emotionally intense and labile - frequently angry, intensely frustrated, depressed, and anxious. This suggests that borderline clients might benefit from help in learning to regulate their emotions. Dialectical behavior therapy skills for emotion regulation include: Identifying and labeling emotions Identifying obstacles to changing emotions Reducing vulnerability to "emotion mind" Increasing positive emotional events Increasing mindfulness to current emotions Taking opposite action Applying distress tolerance techniques

inductive method

A central aspect of Rational thinking is that it is based on fact. Often, we upset ourselves about things when, in fact, the situation isn't like we think it is. If we knew that, we would not waste our time upsetting ourselves. Inductive method encourages us to look at our thoughts as being hypotheses or guesses that can be questioned and tested. If we find that our hypotheses are incorrect (because we have new information), then we can change our thinking to be in line with how the situation really is.

schizotypal personality disorder

A graver form of the pathologically less severe schizoid personality pattern Affects about 3% of the population Clinical picture Clients aloof and isolated Behave in a bland and apathetic manner Cognitive manifestations include Magical thinking Ideas of reference Illusions Depersonalization Clinical picture Exhibits bizarre speech pattern When under stress, may decompensate and demonstrate psychotic symptoms Demonstrates bland, inappropriate affect Etiological implications Possible hereditary factor Possible physiological influence, such as anatomic deficits or neurochemical dysfunctions within certain areas of the brain Early family dynamics characterized by Indifference Impassivity Formality Pattern of discomfort with personal affection and closeness

conversion disorder

A loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism Paralysis of an arm or leg Loss of voice or inability to speak Sudden blindness or double vision Deafness Poor balance or coordination Seizures Inability to walk Convulsions Loss of sense of touch Loss of sense of pain The most obvious and "classic" conversion symptoms are those that suggest neurological disease and occur following a situation that produces extreme psychological stress for the individual Client often expresses a relative lack of concern that is out of keeping with the severity of the impairment This lack of concern is identified as la belle indifference and may be a clue to the physician that the problem is psychological rather than physical

ADHD assessment

A major portion of the child's problems relates to difficulties in performing age-appropriate tasks Highly distractible Extremely limited attention span Impulsivity Difficulty forming satisfactory interpersonal relationships Demonstrates behaviors that inhibit acceptable social interaction Disruptive and intrusive in group endeavors "Perpetual motion machines" Accident-prone Common comorbid disorders with ADHD Oppositional defiant disorder Conduct disorder Anxiety Depression Substance abuse

A nursing instructor presents a case study in which a 3-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? Select one: a. "This child's behavior must be evaluated according to developmental norms." b. "This child has symptoms of attention deficit hyperactivity disorder." c. "This child has symptoms of the early stages of autistic disorder." d. "This child's behavior indicates possible symptoms of oppositional defiant disorder.

A nursing instructor presents a case study in which a 3-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? Select one: a. "This child's behavior must be evaluated according to developmental norms." b. "This child has symptoms of attention deficit hyperactivity disorder." c. "This child has symptoms of the early stages of autistic disorder." d. "This child's behavior indicates possible symptoms of oppositional defiant disorder

hypochondriasis

A preoccupation with the fear of contracting, or the belief of having, a serious disease The fear becomes disabling and persists despite reassurance that no organic pathology can be detected Even in the presence of disease, the symptoms are excessive in relation to the degree of pathology Anxiety and depression are common, and obsessive-compulsive traits frequently accompany the disorder Learning theory (cont.) Hypochondriasis: past experience with serious or life-threatening physical illness, either personal or that of close relatives, can predispose to hypochondriasis

dissociative fugue

A sudden, unexpected travel away from home or customary workplace The individual is unable to recall personal identity and assumption of a new identity is common

Which interventions should a nurse anticipate when planning care for children diagnosed with attention deficit-hyperactivity disorder (ADHD)? (Select all that apply.) Select one or more: a. Behavior modification b. Antianxiety medications c. Competitive group sports d. Group therapy e. Family therapy

A, D, E The nurse should anticipate that behavior modification, group therapy, and family therapy may be implemented in the management of ADHD in children. These interventions are often used in conjunction with psychopharmacology to reduce impulsive and hyperactive behaviors and to increase attention span.

A child diagnosed with severe autistic disorder has the nursing diagnosis disturbed personal identity. Which outcome would best address this client diagnosis? Select one: a. The client will name own body parts as separate from others by day 5. b. The client will establish a means of communicating personal needs by discharge. c. The client will initiate social interactions with caregivers by day 4. d. The client will not harm self or others by discharge

ANS: 1 Rationale: An appropriate outcome for this client is to name own body parts as separate from others. The nurse should assist the client in the recognition of separateness during self-care activities, such as dressing and feeding. The long-term goal for disturbed personal identity is for the client to develop an ego identity.

2. 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

ANS: 1 Rationale: The most appropriate nursing diagnosis and intervention for the husband is dysfunctional grieving; AD support group. Clients with AD are often at risk for trauma and have significant self-care deficits that require more care than a spouse may be able to provide.

7. 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."

ANS: 1 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.

An older client has met the criteria for a diagnosis of major depressive disorder. The client does not respond to antidepressant medications. Which therapeutic intervention should a nurse anticipate will be ordered for this client? 1. Electroconvulsive therapy (ECT) 2. Neuroleptic therapy 3. An antiparkinsonian agent 4. An anxiolytic agent

ANS: 1 Rationale: The nurse should anticipate that ECT will be ordered to treat this client's symptoms of depression. ECT remains one of the safest and most effective treatments for major depression in older adults. The response to ECT may be slower in older clients, and the effects may be of limited duration.

A nurse assesses an adolescent client diagnosed with conduct disorder who, at the age of 8, was sentenced to juvenile detention. How should the nurse's interpret this assessment data? Select one: a. Childhood-onset conduct disorder is more severe than the adolescent-onset type, and these individuals likely develop antisocial personality disorder in adulthood. b. Childhood-onset conduct disorder is caused by a difficult temperament, and the child is likely to outgrow these behaviors by adulthood. c. Childhood-onset conduct disorder is diagnosed only when behaviors emerge before the age of 5, and therefore improvement is likely. d. Childhood-onset conduct disorder has no treatment or cure, and children diagnosed with this disorder are likely to develop progressive oppositional defiant disorder.

ANS: 1 Rationale: The nurse should determine that childhood-onset conduct disorder is more severe than adolescent-onset type. These individuals are likely to develop antisocial personality disorder in adulthood. Individuals with this subtype are usually boys and frequently display physical aggression and have disturbed peer relationships.

When planning care for a client, which medication classification should a nurse recognize as effective in the treatment of Tourette's syndrome? Select one: a. Neuroleptic medications b. Anti-manic medications c. Tricyclic antidepressant medications d. Monoamine oxidase inhibitor medications

ANS: 1 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 nurse is attempting to differentiate between the symptoms of anorexia nervosa and the symptoms of bulimia. Which statement should the nurse identify as correct? Select one: 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: 1 Rationale: The nurse should understand that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia do not. Anorexia is characterized by a morbid fear of obesity and often results in low caloric and nutritional intake. Bulimia is characterized by episodic, rapid consumption of large quantities of food followed by purging.

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

ANS: 1, 2 Rationale: The nurse should identify that topiramate is the drug of choice when treating binge eating with a diagnosis of obesity or bingeing and purging with a diagnosis of bulimia nervosa. Topiramate is an anticonvulsant that produces a significant decline in binge frequency and reduction in body weight.

21. 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 nurturance 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.

11. A nurse is leading a bereavement group. Which of following members of the group should the nurse identify as being at high risk for complicated grieving? (Select all that apply.) 1. A widower who has recently experienced the death of two good friends 2. A man whose wife died suddenly after a cerebrovascular accident 3. A widow who removed life support after her husband was in a vegetative state for a year 4. A woman who had a competitive relationship with her recently deceased brother 5. A young couple whose child recently died of a genetic disorder

ANS: 1, 2, 4, 5 Rationale: The nurse should identify that individuals are at a high risk for complicated grieving when the bereaved person was strongly dependent on the lost entity, the relationship with the lost entity was highly ambivalent, the individual experienced a number of recent losses, the loss is that of a young person, the individual's physical or psychological health is unstable, and the bereaved person perceived responsibility for the loss. Having a year to process grief while her husband was in a vegetative state would reduce the widow's risk for the problem of complicated grieving.

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.

13. A nurse is charting assessment information about a 70-year-old client. According to the U.S. Census Bureau, what term would the nurse use to describe this client? 1. The nurse should document using the term older. 2. The nurse should document using the term elderly. 3. The nurse should document using the term aged. 4. The nurse should document using the term very old.

ANS: 2 Rationale: The U.S. Census Bureau classifies a 70-year-old individual as elderly. The U.S. Census Bureau has developed a system for classification of older Americans: older: 55-64; elderly: 65-74; aged: 75-84; very old: 85 years and older.

A client has an IQ of 47. Which nursing diagnosis best addresses a client problem associated with this degree of mental retardation? Select one: a. Risk for injury R/T self-mutilation. b. Altered social interaction R/T nonadherence to social convention. c. Altered verbal communication R/T delusional thinking. d. Social isolation R/T severely decreased gross motor skills.

ANS: 2 Rationale: The appropriate nursing diagnosis associated with this degree of IDD is altered social interaction R/T non-adherence to social convention. A client with an IQ of 47 would be diagnosed with moderate intellectual developmental disorder and may also experience some limitations in speech communications.

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior?

ANS: 2 Rationale: The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

7. An older client attending an adult day care program suddenly begins reporting dizziness, weakness, and confusion. What should be the initial nursing intervention? 1. Implement complete bedrest. 2. Advocate for a complete physical exam. 3. Address self-esteem needs. 4. Advocate for individual psychotherapy.

ANS: 2 Rationale: The initial nursing intervention should be to advocate for a complete physical exam. Sudden onset of dizziness, weakness, and confusion could indicate a problem with the client's cardiovascular or respiratory symptoms. Physical symptoms should be thoroughly assessed prior to attributing symptoms to psychological causes

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? Select one: a. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." b. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." c. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." d. "They pay particular attention to details, which can frustrate the development of relationships."

ANS: 2 Rationale: The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs.

7. 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

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."

ANS: 2 Rationale: The most appropriate response by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

10. Which is the most accurate description of the nursing diagnosis of dysfunctional grieving? 1. Inability to form a valid appraisal of a loss and to use available resources 2. The experience of distress, with accompanying sadness, which fails to follow norms 3. A perceived lack of control over a current loss situation 4. Aloneness perceived as imposed by others and as a negative or threatening state

ANS: 2 Rationale: The nurse should define dysfunctional grieving as the experience of distress, with accompanying sadness, which fails to follow norms. Three types of pathological grief reactions are delayed or inhibited grief, distorted (exaggerated) grief response, and chronic or prolonged grieving. One crucial difference between normal and dysfunctional grieving is the loss of self-esteem marked my feelings of guilt or worthlessness that may precipitate depression.

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."

ANS: 2 Rationale: 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 anorexia nervosa.

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? Select one: a. The use of highly lethal methods to commit suicide. b. The use of suicidal gestures to elicit a rescue response from others. c. The use of isolation and starvation as suicidal methods. d. The use of self-mutilation to decrease endorphins in the body

ANS: 2 Rationale: The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? Select one: a. A client diagnosed with antisocial personality disorder. b. A client diagnosed with borderline personality disorder. c. A client diagnosed with schizoid personality disorder. d. A client diagnosed with paranoid personality disorder

ANS: 2 Rationale: The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilating behaviors. Most gestures are designed to elicit a rescue response.

13. 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

ANS: 2 Rationale: The nurse should expect that the client will be diagnosed with vascular NCD, which is caused by significant cerebrovascular disease. Vascular NCD often has an abrupt onset. Progression of this disease often occurs in a fluctuating pattern.

Which finding should a nurse expect when assessing a child diagnosed with separation anxiety disorder? Select one: a. The child has a history of antisocial behaviors. b. The child's mother is diagnosed with an anxiety disorder. c. The child previously had an extroverted temperament. d. The child's mother and father have an inconsistent parenting style.

ANS: 2 Rationale: The nurse should expect to find a mother diagnosed with an anxiety disorder when assessing a child with separation anxiety. 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.

6. Which grieving behaviors should a nurse anticipate when caring for a Navajo client who recently lost a child? 1. Celebrating the life of a deceased person with festivities and revelry 2. Not expressing grief openly and reluctance to touch the dead body 3. Holding a prayerful vigil for a week following the person's death 4. Expressing grief openly and publicly and erecting an altar in the home to honor the dead

ANS: 2 Rationale: The nurse should identify that a Navajo client who recently lost a child would not express grief openly and would be reluctant to touch the dead body. Navajo Indians do not bury the body of a deceased person for four days after death, and they conduct a cleaning ceremony prior to burial. The dead are buried with their shoes on the wrong feet and rings on their index fingers.

A child has been recently diagnosed with mild mental retardation (MR). What information about this diagnosis should the nurse include when teaching the child's mother? Select one: a. Children with mild MR need constant supervision. b. Children with mild MR develop academic skills up to a sixth-grade level. c. Children with mild MR appear different from their peers. d. Children with mild MR have significant sensory-motor impairment

ANS: 2 Rationale: The nurse should inform the child's mother that children with mild IDD develop academic skills up to a sixth-grade level. Individuals with mild IDD are capable of independent living, capable of developing social skills, and have normal psychomotor skills.

13. 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

ANS: 2 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.

A nursing instructor is teaching about specific phobias. Which student statement should indicate to the instructor that learning has occurred? Select one: "These clients recognize that their fear is excessive and seek treatment to promote change." "These clients have a panic level of fear that is overwhelming and unreasonable." "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis

ANS: 2 Rationale: The nursing instructor should evaluate that learning has occurred when the student knows that clients with phobias 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. Even though the disorder is relatively common among the general population, people seldom seek treatment unless the phobia interferes with ability to function.

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? Select one: a. Allow the clients to apply the democratic process when developing unit rules. b. Maintain consistency of care by open communication to avoid staff manipulation. c. Allow the client spokesman to verbalize concerns during a unit staff meeting. d. Maintain unit order by the application of autocratic leadership.

ANS: 2 Rationale: The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

12. 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.

ANS: 2 Rationale: The priority nursing action is to first medicate the client to avoid injury to self or others. It is important to assess environmental triggers and potential unmet needs in order to address these problems in the future, but interventions to ensure safety must take priority. Because of the cognitive decline experienced in clients diagnosed with this disorder, communication skills and orientation may limit assessment and teaching interventions.

Which findings should a nurse identify that would contribute to a client's development of attention deficit-hyperactivity disorder (ADHD)? (Select all that apply.) Select one or more: a. The client's father was a smoker. b. The client was born 7 weeks premature. c. The client is lactose intolerant. d. The client has a sibling diagnosed with ADHD. e. The client has been diagnosed with dyslexia

ANS: 2, 4 Rationale: The nurse should identify that premature birth and having a sibling diagnosed with ADHD would predispose a client to the development of ADHD. Research indicates evidence of genetic influences in the etiology of ADHD. Studies also indicate that environmental influences, such as lead exposure and diet, can be linked with the development of ADHD.

Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder (SPD)? Select one: a. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with SPD need medications to treat the pathology of their disorder. b. Clients diagnosed with SPD experience increased anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. c. Clients diagnosed with social phobia would avoid attending birthday parties, whereas clients diagnosed with SPD would isolate themselves on a continual basis. d. Clients diagnosed with SPD would avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate themselves on a continual basis

ANS: 3 Rationale: A client diagnosed with schizoid personality disorder exhibits a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder prefer being alone to being with others and avoid social situations, social contacts, and activities.

Which adult client should a nurse identify as exhibiting the characteristics of a dependant personality disorder? Select one: a. A physically healthy client who is dependant on meeting social needs by contact with 15 cats. b. A physically healthy client who has a history of depending on intense relationships to meet basic needs. c. A physically healthy client who lives with parents and depends on public transportation. d. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security

ANS: 3 Rationale: A physically healthy adult client who lives with parents and depends on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behaviors.

15. 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.

ANS: 3 Rationale: Obtaining adequate sleep without zolpidem by discharge is a goal that should be included in the client's plan of care. Having no flashbacks and experiencing a full range of emotions by discharge are unrealistic goals. Clients are encouraged, not discouraged, to discuss the traumatic event.

A client in the middle stage of Alzheimer's disease has difficulty communicating because of cognitive deterioration. Which nursing intervention is appropriate to improve communication? 1. Discourage attempts at verbal communication owing to increased client frustration. 2. Increase the volume of the nurse's communication responses. 3. Verbalize the nurse's perception of the implied communication. 4. Encourage the client to communicate by writing.

ANS: 3 Rationale: The most appropriate nursing intervention is to verbalize the nurse's perception of the implied communication. The nurse should also keep explanations simple, use face-to-face interaction, and speak slowly without shouting.

1. A client has recently been placed in a long-term care facility, because of marked confusion and inability to perform most activities of daily living (ADLs). Which nursing intervention is most appropriate to maintain the client's self-esteem? 1. Leave the client alone in the bathroom to test ability to perform self-care. 2. Assign a variety of caregivers to increase potential for socialization. 3. Allow client to choose between two different outfits when dressing for the day. 4. Modify the daily schedule often to maintain variety and decrease boredom.

ANS: 3 Rationale: The most appropriate nursing intervention to maintain this client's self-esteem is to allow the client to choose between two different outfits when dressing for the day. The nurse should also provide appropriate supervision to keep the client safe, maintain consistency of caregivers, and maintain a structured daily routine to minimize confusion.

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.

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? Select one: 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: 3 Rationale: The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against the parents viewed by the child as a means of gaining and remaining in control.

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? "Using your imagination, we will attempt to achieve a state of relaxation." "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." "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.

A mother questions the decreased effectiveness of methylphenidate (Ritalin), prescribed for her child's attention deficit hyperactivity disorder. Which nursing response best addresses the mother's concern? Select one: a. "The physician will probably switch from Ritalin to a central nervous system stimulant." b. "The physician may prescribe an antihistamine with the Ritalin to improve effectiveness." c. "Your child has probably developed a tolerance to Ritalin and may need a higher dosage." d. "Your child has developed sensitivity to Ritalin and may be exhibiting an allergy."

ANS: 3 Rationale: The nurse should explain to the mother that the child has probably developed a tolerance to Ritalin and may need a higher dosage. Methylphenidate is a central nervous system stimulant, and tolerance can develop rapidly. Physical and psychological dependence can also occur.

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? Select one: a. Interpreting the compliment as a secret code used to increase personal power. b. Feeling the compliment was well deserved. c. Being grateful for the compliment but fearing later rejection and humiliation. d. Wondering what deep meaning and purpose is attached to the compliment

ANS: 3 Rationale: The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

16. A client diagnosed with PTSD is receiving paliperidone (Invega). Which symptoms should a nurse identify that would warrant the need for this medication? 1. Flat affect and anhedonia 2. Persistent anorexia and 10 lb weight loss in 3 weeks 3. Flashbacks of killing the enemy 4. Distant and guarded in relationships

ANS: 3 Rationale: The nurse should identify that a client who has flashbacks of killing the enemy may need paliperidone. Paliperidone is an antipsychotic medication that will address the symptoms of psychosis.

9. A nurse assesses a woman whose husband died 13 months ago. She isolates herself, screams at her deceased spouse, and is increasingly restless. According to Bowlby, this widow is in which stage of the grieving process? 1. Stage I: Numbness or protest 2. Stage II: Disequilibrium 3. Stage III: Disorganization and despair 4. Stage IV: Reorganization

ANS: 3 Rationale: The nurse should identify that this client is in the third stage of Bowlby's grief process, called disorganization and despair. This stage is characterized by feelings of despair in response to the realization that the loss has occurred. The individual experiences helplessness, fear, and hopelessness. Perceptions of visualizing or being in the presence of the lost one may occur.

8. A nurse assigns a client the nursing diagnosis of complicated grieving. According to Bowlby, which long-term outcome would be most appropriate for this nursing diagnosis? 1. The client will accomplish the recovery stage of grief by year one. 2. The client will accomplish the acceptance stage of grief by year one. 3. The client will accomplish the reorganization stage of grief by year one. 4. The client will accomplish the emotional relocation stage of grief by year one

ANS: 3 Rationale: The nurse should identify that, according to Bowlby, an appropriate long-term outcome for this client is to accomplish the reorganization stage of grief by year one. Until the client can recognize and accept personal feelings regarding the loss, grief work cannot progress. The reorganization stage of grieving is the final stage in which the individual accepts the loss and new goals and patterns are established.

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? Select one: a. Schizoid personality disorder. b. Obsessive-compulsive personality disorder. c. Histrionic personality disorder. d. Paranoid personality disorder.

ANS: 3 Rationale: The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over gregarious, and seductive.

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? Select one: a. The client experiences unwanted, intrusive, and persistent thoughts. b. The client experiences unwanted, repetitive behavior patterns. c. The client experiences inflexibility and lack of spontaneity when dealing with others. d. The client experiences obsessive thoughts that are externally imposed

ANS: 3 Rationale: The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

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

ANS: 3 Rationale: The priority nursing intervention when caring for a child diagnosed 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.

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? Select one: 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.

ANS: 4 Rationale: An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are not sociable.

4. A nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. Why is this intervention the treatment of choice? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's uncontrollable behaviors. 4. It allows clients to maintain control

ANS: 4 Rationale: Behavior-modification programs are the treatment of choice for clients diagnosed with eating disorders, because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques function to restore healthy weight.

During an interview, which client statement to a nurse should indicate a potential diagnosis of schizotypal personality disorder? Select one: a. "I really don't have a problem. My family is inflexible, and every relative is out to get me." b. "I am so excited about working with you. Have you noticed my new nail polish: 'Ruby Red Roses'?" c. "I spend all my time tending my bees. I know a whole lot of information about bees." d. "I am getting a message from the beyond that we have been involved with each other in a previous life."

ANS: 4 Rationale: The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

10. 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

ANS: 4 Rationale: The nurse should determine that once the client has been medically cleared, the diagnosis of altered family process should take priority. Clients diagnosed with anorexia nervosa have a need to control and feel in charge of their own treatment choices. Behavioral-modification therapy allows the client to maintain control of eating.

. 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

Which developmental characteristic should a nurse identify as typical of a client diagnosed with severe mental retardation? Select one: a. The client can perform some self-care activities independently. b. The client has more advanced speech development. c. Other than possible coordination problems, the client's psychomotor skills are not affected. d. The client communicates wants and needs by "acting out" behaviors.

ANS: 4 Rationale: The nurse should identify that a client diagnosed with severe IDD may communicate wants and needs by "acting out" behaviors. Severe IDD indicates an IQ between 20 and 34. Individuals diagnosed with severe IDD require complete supervision and have minimal verbal skills and poor psychomotor development

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? Select one: a. "You really don't have to go by that schedule. I'd just stay home sick." b. "There has got to be a hidden agenda behind this schedule change." c. "Who do you think you are? I expect to interact with the same nurse every Saturday." d. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

ANS: 4 Rationale: The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

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.

3. 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.

ANS: 4 Rationale: The nurse should question the client's safety at home if the client smokes cigarettes. Vascular NCD is a clinical syndrome of NCD due to significant cerebrovascular disease. The cause of vascular NCD is related to an interruption of blood flow to the brain. Hypertension is a significant factor in the etiology.

What symptoms should a nurse use to differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? Select one: GAD is acute in nature, and panic disorder is chronic. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. Hyperventilation is a common symptom in GAD and rare in panic disorder. Depersonalization is commonly seen in panic disorder and absent in GAD

ANS: 4 Rationale: The nurse should recognize that a client 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 cab driver, stuck in traffic, suddenly is lightheaded, tremulous, diaphoretic, and experiences tachycardia and dyspnea. An extensive 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? Select one: Generalized anxiety disorder and a nursing diagnosis of fear. Altered sensory perception and a nursing diagnosis of panic disorder. Pain disorder and a nursing diagnosis of altered role performance. 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.

A nursing instructor is teaching about the developmental characteristics of clients diagnosed with moderate mental retardation (MR). Which student statement indicates that further instruction is needed? Select one: a. "These clients can work in a sheltered workshop setting." b. "These clients can perform some personal care activities." c. "These clients may have difficulties relating to peers." d. "These clients can successfully complete elementary school.

ANS: 4 Rationale: The nursing student needs further instruction about moderate IDD, because individuals diagnosed with moderate IDD are capable of academic skill up to a second-grade level. Moderate IDD reflects an IQ range of 35 to 49.

11. 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.

ANS: 4 Rationale: The priority nursing intervention for this client is to 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

A nurse is working with a client diagnosed with somatoform pain disorder. What predominant symptoms should a nurse expect to assess? A. The client's predominant symptom focuses on discomfort in one or more anatomical sites. B. The client's predominant symptom affects voluntary motor or sensory functioning. C. The client's predominant symptom is the belief that the body is deformed or defective. D. The client's predominant symptom is the preoccupation and fear of having a serious disease

ANS: A The nurse should assess that a client diagnosed with somatoform pain disorder would experience severe and prolonged pain in one or more anatomical sites that causes significant distress

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which nursing care should be included for this client? A. Deal with physical symptoms in a detached manner. B. Challenge the validity of physical symptoms. C. Meet dependency needs until the physical limitations subside. D. Encourage a discussion of feelings about the lower-extremity problem

ANS: A The nurse should assist the client in dealing with physical symptoms in a detached manner to avoid reinforcing the symptoms by providing secondary gains. This is an example of a conversion disorder in which symptoms affect voluntary motor or sensory functioning. Examples include paralysis, aphonia, seizures, coordination disturbance, difficulty swallowing, urinary retention, akinesia, blindness, deafness, double vision, anosmia, and hallucinations.

A client has a history of excessive fear of water. What is the term that a nurse should use to describe the specific phobia, and what is the subtype of the specific phobia? Select one: Aquaphobia, a natural environment type of phobia. Aquaphobia, a situational type of phobia. Acrophobia, a natural environment type of phobia. Acrophobia, a situational type of phobia

ANS: A The nurse should determine that an excessive fear of water is identified as aquaphobia, which is a natural environment type of phobia. Natural environment-type phobias are fears about objects or situations that occur in the natural environment, such as a fear of heights or storms

A nursing instructor is teaching about the etiology of hypochondriasis from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates that learning has occurred? A. "They express personal worthlessness through physical symptoms because physical problems are more acceptable than psychological problems." B. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." C. "They misinterpret and cognitively distort their physical symptoms." D. "They tend to have a familial predisposition to this disorder

ANS: A The nurse should understand that from a psychoanalytical perspective, hypochondriasis occurs because physical problems are more acceptable than psychological problems. Psychodynamicists view hypochondriasis as a defense mechanism

14. A client is exhibiting symptoms of generalized amnesia. Which of the following questions should the nurse ask to confirm this diagnosis? (Select all that apply.) A. "Have you taken any new medications recently?" B. "Have you recently traveled away from home?" C. "Have you recently experienced any traumatic event?" D. "Have you ever felt detached from your environment?" E. "Have you had any history of memory problems?"

ANS: A, C, E The nurse should assess the client for possible causes of amnesia which may include taking new medications, experiencing a traumatic event, or having a history of memory problems. Amnesia is a pathological loss of memory which may be organic, emotional, dissociative, or of mixed origin

A client is diagnosed with hypochondriasis. Which of the following symptoms is the client most likely to exhibit? (Select all that apply.) A. Obsessive-compulsive traits B. Pseudocyesis C. Anxiety D. Flat affect E. Depression

ANS: A, C, E The nurse should expect that a client diagnosed with hypochondriasis would exhibit obsessive-compulsive traits, anxiety, and depression. Hypochondriasis involves an unrealistic or inaccurate interpretation of physical symptoms or sensations that can lead to preoccupation with and fear of having a serious disease

17. Which statement should a nurse identify as most accurate regarding the differentiation between the diagnoses of dementia disorders and amnesic disorders? A. Dementia disorders involve disorientation that develops suddenly, whereas amnestic disorders develop more slowly. B. Dementia disorders involve impairment of abstract thinking and judgment, whereas amnestic disorders do not. C. Dementia disorders include the symptom of confabulation, whereas amnestic disorders do not. D. Both dementia disorders and profound amnesia typically share the symptom of disorientation to person, place, and self.

ANS: B Dementia disorders involve impairment of abstract thinking and judgment. Amnestic disorders are characterized by an inability to learn new information and to recall previously learned information with no impairment in higher cortical functioning or personality change.

Which nursing intervention related to self-care would be most appropriate for a teenager diagnosed with moderate mental retardation? Select one: a. Meeting all of the client's self-care needs to avoid injury. b. Providing simple directions and praising client's independent self-care efforts. c. Avoid interfering with the client's self-care efforts in order to promote autonomy. d. Encouraging family to meet the client's self-care needs to promote bonding

ANS: B Providing simple directions and praise is an appropriate intervention for a teenager diagnosed with moderate intellectual disability. Individuals with moderate intellectual disability can perform some activities independently and may be capable of academic skill to a second-grade level

Which would be considered an appropriate outcome when planning care for an inpatient client diagnosed with somatization disorder? A. The client will admit to fabricating physical symptoms to gain benefits by day 3. B. The client will list three potential adaptive coping strategies to deal with stress by day 2. C. The client will comply with medical treatments for physical symptoms by day 3. D. The client will openly discuss physical symptoms with staff by day 4

ANS: B The nurse should determine that an appropriate outcome for a client diagnosed with somatization disorder would be for the client to list three potential adaptive coping strategies to deal with stress by day 2. Because the symptoms of somatization disorder are associated with psychosocial distress, increasing coping skills may help the client reduce symptoms

Which should the nurse recognize as an example of systematized amnesia? A. A client cannot relate any lifetime memories, including personal identity. B. A client can relate family memories but has no recollection of a particular brother. C. A client cannot remember events surrounding a fatal car accident. D. A client whose home was destroyed by a tornado only remembers waking up in the hospital

ANS: B The nurse should identify that an example of systematized amnesia is when a client can relate family memories but has no recollection of a particular brother. This type of amnesia occurs when the individual cannot remember events that relate to a specific category of information or to a specific person or event

What symptom differentiates dissociative fugue from dissociative amnesia? A. Clients diagnosed with dissociative fugue experience symptoms that are precipitated by extreme stress, and clients diagnosed with dissociative amnesia do not. B. Clients diagnosed with dissociative fugue are unaware of their memory loss, whereas clients diagnosed with dissociative amnesia are aware of their forgetfulness. C. Clients diagnosed with dissociative amnesia assume a new identity, and clients diagnosed with dissociative fugue do not. D. Clients diagnosed with dissociative amnesia usually recover completely, whereas clients diagnosed with dissociative fugue display residual effects

ANS: B The nurse should identify that clients diagnosed with dissociative fugue are unaware of their memory loss, whereas clients diagnosed with dissociative amnesia are aware of the loss. Recovery from a dissociative fugue is typically rapid, spontaneous, and complete. Recovery from dissociative amnesia may resolve suddenly, but many require administration of amobarbital to assist in memory retrieval.

A preschool child is admitted to a psychiatric unit with the diagnosis autistic disorder. To help the child feel more secure on the unit, which intervention should a nurse include in this client's plan of care? Select one: a. Encourage and reward peer contact. b. Provide consistent caregivers. c. Provide a variety of safe daily activities. d. Maintain close physical contact throughout the day

ANS: B The nurse should provide consistent caregivers as part of the plan of care for a child diagnosed with autism spectrum disorder. Children diagnosed with autism spectrum disorder have an inability to trust. Providing consistent caregivers allows the client to develop trust and a sense of security.

Which nursing intervention should be prioritized when caring for a child diagnosed with mild mental retardation? Select one: a. Encourage the parents to always prioritize the needs of the child. b. Modify the child's environment to promote independence and encourage impulse control. c. Delay extensive diagnostic studies until the child is developmentally mature. d. Provide one-on-one tutorial education in a private setting to decrease overstimulation

ANS: B The nurse should prioritize modifying the child's environment to promote independence and encourage impulse control. This intervention is related to the nursing diagnosis self-care deficit. Positive reinforcement can serve to increase self-esteem and encourage repetition of behaviors

A client diagnosed with somatization disorder is most likely to exhibit which personality disorder characteristic? A. Experiences intense and chaotic relationships with fluctuating attitudes toward others B. Socially irresponsible, exploitative, guiltless, and disregards rights of others C. Self-dramatizing, attention seeking, overly gregarious, and seductive D. Uncomfortable in social situations, perceived as timid, withdrawn, cold, and strange

ANS: C It has been suggested that in somatization disorder there may be some overlapping of personality characteristics and features associated with histrionic personality disorder. These features include self-dramatizing, attention-seeking, and overly gregarious, and seductive behaviors. Somatization is the process by which a person expresses psychological needs in the form of physical symptoms.

A client diagnosed with dissociative identity disorder (DID) switches personalities when confronted with destructive behavior. The nurse recognizes that this dissociation serves which function? A. It is a means to attain secondary gain. B. It is a means to explore feelings of excessive and inappropriate guilt. C. It serves to isolate painful events so that the primary self is protected. D. It serves to establish personality boundaries and limit inappropriate impulses

ANS: C The nurse should anticipate that a client who switches personalities when confronted with destructive behavior is dissociating in order to isolate painful events so that the primary self is protected. The transition between personalities is usually sudden, dramatic, and precipitated by stress.

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

Which are examples of primary and secondary gains that clients diagnosed with somatoform pain disorders may experience? A. Primary: chooses to seek a new doctor; secondary: euphoric feeling from new medications B. Primary: euphoric feeling from new medications; secondary: chooses to seek a new doctor C. Primary: receives get-well messages; secondary: pain prevents attendance at family reunion D. Primary: pain prevents attendance at family reunion; secondary: receives get-well messages

ANS: D The nurse should identify that when the client avoids an unpleasant activity (family reunion) the client experiences a primary gain. When the client receives emotional support or attention (get-well messages), the client is experiencing a secondary gain

Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? Select one: a. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone." b. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, while clients diagnosed with avoidant personality disorder do not." c. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant." d. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, while clients diagnosed with avoidant personality disorder remain based in reality

Ans: 1 Rationale: The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships. Clients diagnosed with schizoid personality disorder may exhibit odd and eccentric behaviors but not to the extent of psychosis.

Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder? Select one: a. Risk for violence: directed toward others R/T paranoid thinking. b. Risk for suicide R/T altered thought. c. Altered sensory perception R/T increased levels of anxiety. d. Social isolation R/T inability to relate to others

Ans: 1 Rationale: The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T paranoid thinking. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that result in a constant threat readiness. They are often tense and irritable, which increases the likelihood of violent behavior.

A pessimistic female client expressing low self-worth has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which statement by an instructor to a student best explains the etiology of this client's personality disorder? Select one: a. Nurturance is provided from many sources, and independent behaviors are encouraged. b. Nurturance is provided exclusively from one source, and independent behaviors are discouraged. c. Nurturance is provided exclusively from one source, and independent behaviors are encouraged. d. Nurturance is provided from many sources, and independent behaviors are discouraged.

Ans: 2 Rationale: The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

From a behavioral perspective, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder? Select one: a. Seclude the client when inappropriate behaviors are exhibited. b. Contract with the client to reinforce positive behaviors with unit privileges. c. Teach the purpose of antianxiety medications to improve medication compliance. d. Encourage the client to journal feelings to improve awareness of abandonment issues.

Ans: 2 Rationale: The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change

autistic disorder

Autistic disorder is characterized by a withdrawal of the child into the self and into a fantasy world of his or her own creation The child with autistic disorder has markedly abnormal or impaired development in social interaction and communication and a markedly restricted repertoire of activity and interests

separation anxiety therapeutic approaches

Behavior therapy Based on classical and/or operant conditioning Positive reinforcement (reward) encourages behavior Aversive reinforcement (consequences) discourage behavior Family therapy Children live in the family community Whole community must be healthy to sustain change Group therapy Appropriate social behavior is learned and reinforced by peers Music, art, and play therapy Psychoeducational groups are good for teens; teaches about their specific disorder and ways of coping Psychopharmacology Medication should not be sole treatment modality Use may improve quality of life and allow the child maximum benefit from therapy

tourettes disorder causes

Biological factors Genetics Biochemical factors Structural factors Environmental factors Complications of pregnancy Carbon monoxide poisoning Post-strep autoimmune phenomenon

separation anxiety causes

Biological influences Genetics Temperament Environmental influences Stressful life events Family influences

ADHD etiological implications

Biological influences: genetics, biochemical theory, anatomical influences, prenatal/ perinatal/postnatal factors Environmental influences: lead exposure and dietary factors Psychosocial influences: chaotic home, family disturbances, poverty, maternal mental disorder, paternal criminality

avoidant personality disorder

Characterized by Extreme sensitivity to rejection Social withdrawal Prevalence is between 0.5% and 1% and is equally common in both men and women Clinical picture Awkward and uncomfortable in social situations Desires close relationships but avoids them because of fear of being rejected Fear of rejection creates significant anxiety Perceived as timid, withdrawn, or cold and strange Often lonely and express feelings of being unwanted View others as critical, betraying, and humiliating

oppositional defiant disorder

Characterized by a pattern of negativistic, defiant, disobedient, and hostile behavior toward authority figures that occurs more frequently than is typically observed in people of comparable age and developmental level

dependent personality disorder

Characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation Relatively common within the population More common among women than men More common in the youngest children of a family than in the older ones Clinical picture Client has a notable lack of self-confidence that is often apparent in Posture Voice Mannerisms Typically passive and acquiescent to desires of others Overly generous and thoughtful while underplaying own attractiveness and achievements Assumes passive and submissive roles in relationships Avoids positions of responsibility and becomes anxious when forced into them Etiological implications Possible hereditary influence Stimulation and nurturance are experienced exclusively from one source A singular attachment is made by the infant to the exclusion of all others

dissociative identity disorder

Characterized by existence of two or more personalities within a single individual Transition from one personality to another usually sudden, often dramatic, and usually precipitated by stress

obsessive compulsive personality disorder

Characterized by inflexibility about the way in which things must be done Devotion to productivity at the exclusion of personal pleasure Relatively common and occurs more often in men than women Within family constellation, appears to be most common in the oldest children Clinical picture Especially concerned with matters of organization and efficiency Tend to be rigid and unbending Social behavior is polite and formal They are rank-conscious (ingratiating with authority figures) Appear to be very calm and controlled Underneath there is a great deal of Ambivalence Conflict Hostility Etiological implications Overcontrol by parents Notable parental lack of positive reinforcement for acceptable behavior Frequent punishment for undesirable behavior

depersonalization disorder

Characterized by persistent feelings of Unreality Detachment from oneself or one's body Observing oneself from outside the body Depersonalization is defined as a disturbance in the perception of oneself Derealization is described as an alteration in the perception of the external environment Symptoms of depersonalization disorder are often accompanied by Anxiety and depression Fear of going insane Obsessive thoughts Somatic complaints Disturbance in the subjective sense of time causes: Genetics: possible hereditary factors are associated with DID Neurobiological: dissociative amnesia and dissociative fugue may be related to neurophysio- logical dysfunction; EEG abnormalities have been observed in some clients with DID Psychodynamic theory: Freud described dissociation as repression of distressing mental contents from conscious awareness; current psychodynamic explanations reflect Freud's concepts that dissociative behaviors are a defense against unresolved painful issues Psychological trauma A growing body of evidence points to the etiology of DID as a set of traumatic experiences that overwhelms the individual's capacity to cope by any means other than dissociation These experiences usually take the form of severe physical, sexual, or psychological abuse by a parent or significant other in the child's life outcomes: The client Can recall events associated with stressful situation Can recall all events of past life Can verbalize anxiety that precipitated the dissociation Can demonstrate coping methods to avert dissociative behaviors Verbalizes existence of multiple personalities Is able to maintain a sense of reality during stressful situations planning/implementation: Nursing care is aimed at restoring normal thought processes Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment treatment: Individual psychotherapy Cognitive-behavioral Therapy Hypnosis Supportive care Integration therapy (DID)

schizoid personality disorder

Characterized primarily by a profound defect in the ability to form personal relationships Failure to respond to others in a meaningful, emotional way Diagnosis occurs more frequently in men than in women Prevalence within the general population has been estimated at 3% to 7.5% Clinical picture: Indifferent to others Aloof and emotionally cold In presence of others, clients appear shy, anxious, or uneasy Inappropriately serious about everything and have difficulty acting in a light-hearted manner Etiological implications Possible hereditary factor Childhood has been characterized as Notably lacking in nurturing Bleak Cold Unempathetic

antisocial personality disorder

Definition A pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others Prevalence estimates in the United States range from 3% in men to about 1% in women Clinical picture Fails to sustain consistent employment Exploits and manipulates others for personal gain Has a general disregard for the law Common behaviors Socially irresponsible Exploitative Guiltless Disregard for the rights of others General disregard for the law Cold, callous, intimidating Inconsistent work or academic performance Failure to conform to societal norms Cruel and malicious Unable to form satisfying interpersonal relationships Etiological implications Possible genetic influence Sociopathic or alcoholic father Aggressive temperament as a child Parental deprivation during the first 5 years of life History of ADHD or conduct disorder during childhood or adolescence Absence of parental discipline Extreme poverty Removal from the home Being "rescued" each time in trouble (never having to suffer the consequences of own behavior) Maternal deprivation Growing up without parental figures of both sexes Erratic and inconsistent methods of discipline

borderline personality disorder

Definition Characterized by a pattern of intense and chaotic relationships with affective instability Fluctuating and extreme attitudes regarding other people Most common form of personality disorder Emotionally unstable Lacks a clear sense of identity Highly impulsive Biological influences Biochemical: possible serotonergic defect Genetic: possible hereditary factor Psychosocial influences Childhood trauma and abuse Developmental factors Fixed in the rapprochement phase of development (16 to 24 months old) The child fails to achieve task of autonomy Risk factors for BPD include: Abandonment in childhood or adolescence Disrupted family life Poor communication in the family Sexual abuse Tends to occur more often in women and among hospitalized psychiatric patients. Symptoms: People with BPD are often uncertain about their identity. As a result, their interests and values may change rapidly. People with BPD also tend to see things in terms of extremes, such as either all good or all bad. Their views of other people may change quickly. A person who is looked up to one day may be looked down on the next day. These suddenly shifting feelings often lead to intense and unstable relationships. Other symptoms of BPD include: Fear of being abandoned Feelings of emptiness and boredom Frequent displays of inappropriate anger Impulsiveness with money, substance abuse, sexual relationships, binge eating, or shoplifting Intolerance of being alone Repeated crises and acts of self-injury, such as cutting or overdosing Always seem to be in a state of crisis Affect is one of extreme intensity Behavior reflects frequent changeability Self-destructive behaviors present Clients are impulsive Clients are most strikingly identified by the intensity and instability of their affect and behavior Common behaviors Depression Inability to be alone Clinging and distancing Splitting Manipulation

paranoid personality disorder

Definition: a pervasive distrust and suspiciousness, such that the motives of others are interpreted as malevolent; condition begins by early adulthood and presents in a variety of contexts Disorder is more common in men than in women Clinical picture Constantly on guard Hypervigilant Ready for any real or imagined threat Trusts no one Constantly tests the honesty of others Oversensitive Tends to misinterpret minute cues Magnifies and distorts cues in the environment Etiological implications Possible hereditary link Subject to early parental antagonism and aggression

autistic disorder NI

Ensuring safety of client Encouraging social interactions with others Establishing a means of communication Assisting child with separation/individuation process

passive aggressive personality disorder

Exhibits a pervasive pattern of negativistic attitudes and passive resistance to demands for adequate performance in social and occupational situations Clinical picture Exhibits passive resistance Exhibits general obstructiveness Commonly switches among the roles of the martyr, the affronted, the aggrieved, the misunderstood, the contrite, the guilt-ridden, the sickly, and the overworked Able to vent anger and resentment subtly while gaining the attention, reassurance, and dependency these individuals crave Etiological implications Contradictory parental attitudes and behavior are implicated in predisposition to passive-aggressive personality disorder

mental retardation

Hereditary factors Causes about 5% of cases Inborn errors of metabolism such as Tay-Sachs & PKU Early alterations in embryonic development Causes about 30% of cases Maternal illness/infection Exposure to drugs/alcohol Complications of pregnancy Pregnancy and perinatal factors Account for 10% Insult during the pregnancy or delivery such as fetal malnutrition, placental issues, birth trauma General medical conditions acquired in infancy or childhood Account for 5% Infectious illness like meningitis/encephalitits Toxic insult- lead exposure, pesticides, medications Physical trauma Environmental influences and other mental disorders Factor in about 15-20% of cases Deprivation of nurturing, social interaction, linguistic stimulation Autistic disorder

control fallacies

If we feel externally controlled, we see ourselves as helpless a victim of fate. For example, "I can't help it if the quality of the work is poor, my boss demanded I work overtime on it." The fallacy of internal control has us assuming responsibility for the pain and happiness of everyone around us. For example, "Why aren't you happy? Is it because of something I did?"

separation anxiety assessment

In most cases, the child has difficulty separating from the mother Anticipation of separation may result in tantrums, crying, screaming, complaints of physical problems, and clinging behaviors Reluctance or refusal to attend school is especially common in adolescence Younger children may "shadow" Worrying is common Specific phobias are not uncommon

polarized thinking or black and white thinking

In polarized thinking, things are either "black-or-white." We have to be perfect or we're a failure — there is no middle ground. You place people or situations in "either/or" categories, with no shades of gray or allowing for the complexity of most people and situations. If your performance falls short of perfect, you see yourself as a total failure.

overgeneralization

In this cognitive distortion, we come to a general conclusion based on a single incident or a single piece of evidence. If something bad happens only once, we expect it to happen over and over again. A person may see a single, unpleasant event as part of a never-ending pattern of defeat.

two components of DBT

Individual weekly psychotherapy sessions: Emphasize problem-solving behavior for the past week's issues and troubles that arose in the person's life. Self-injurious and suicidal behaviors take first priority, followed by behaviors that may interfere with the therapy process. Quality of life issues and working toward improving life in general may also be discussed. Individual sessions in DBT also focus on decreasing and dealing with post-traumatic stress responses (from previous trauma in the person's life) and helping enhance their own self-respect and self-image. During individual therapy sessions, the therapist and client work toward learning and improving many basic social skills. Weekly group therapy sessions, generally 2 1/2 hours a session and led by a trained DBT therapist, where people learn skills from one of four different modules: interpersonal effectiveness, distress tolerance/reality acceptance skills, emotion regulation, mindfulness skills are taught.

localized/selective amnesia

Localized amnesia: inability to recall all incidents associated with the traumatic event for a specific period following the event Selective amnesia: inability to recall only certain incidents associated with a traumatic event for a specific period following the event

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

NS: 1 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.

A nursing instructor is teaching about reminiscence therapy. What student statement indicates that learning has occurred? 1. "Reminiscence therapy is a group in which participants create collages representing significant aspects of their lives." 2. "Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution." 3. "Reminiscence therapy is a social group where members chat about past events and future plans." 4. "Reminiscence therapy encourages members to share positive memories of significant life transitions."

NS: 2 Rationale: Reminiscence therapy encourages members to share both positive and negative significant life memories to promote resolution. Stimulation of life memories serve to help older clients work through their losses and maintain self-esteem. Reminiscence therapy can take place in one-on-one or group settings.

4. 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)

NS: 3 Rationale: The nurse should identify that an appropriate treatment for clients diagnosed with GAD is 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.

autistic disorder etiological implications

Neurological implications Involved areas of abnormality include the cerebellum, cerebral cortex, limbic system, corpus callosum, basal ganglia, and brain stem Neurotransmitters may play a role Genetics Familial tendency Chromosomes linked 2,7,11 15,16,17 and brain-development gene neurexin 1 Perinatal influences Asthma and allergy problems during pregnancy increases risk of child with autism Environmental risk factors Physiological Implications Associated conditions are tuberous sclerosis, fragile X, maternal rubella syndrome, PKU, Down syndrome, Angelman's syndrome, neurofibromatosis

histrionic personality disorder

Personality is Excitable Emotional Colorful Dramatic Extroverted in behavior Prevalence thought to be about 2% to 3% More common in women than men Clinical picture Affected clients are Self-dramatizing Attention-seeking Overly gregarious Seductive Manipulative Exhibitionistic Affected clients Are highly distractible Have difficulty paying attention to detail Are easily influenced by others Have difficulty forming close relationships Etiological implications Possible link to the noradrenergic and serotonergic systems Possible hereditary factor Learned behavior patterns

personalization

Personalization is a distortion where a person believes that everything others do or say is some kind of direct, personal reaction to the person. We also compare ourselves to others trying to determine who is smarter, better looking, etc. A person engaging in personalization may also see themselves as the cause of some unhealthy external event that they were not responsible for. For example, "We were late to the dinner party and caused the hostess to overcook the meal. If I had only pushed my husband to leave on time, this wouldn't have happened."

pain disorder

Predominant disturbance in pain disorder is severe and prolonged pain that causes clinically significant distress or impairment in social, occupational, or other areas of functioning Even when organic pathology is detected, the pain complaint may be evidenced by the correlation of a stressful situation with the onset of symptoms Pain disorder may be maintained by Primary gains: symptom enables the client to avoid some unpleasant activity Secondary gains: symptom promotes emotional support or attention for the client Tertiary gains: in dysfunctional families, the physical symptom may take such a position that the real issue is disregarded and remains unresolved even though some of the conflict is relieved Symptoms of depression and substance abuse are common

somatoform disorders

Somatoform disorders are characterized by physical symptoms suggesting medical disease but without demonstrable organic pathology or a known pathophysiological mechanism to account for them. more found in Women than in men The poorly educated Lower socioeconomic classes Genetic: hereditary factors are possibly associated with somatization disorder, conversion disorder, and hypochondriasis Biochemical: decreased levels of serotonin and endorphins may play a role in the etiology of pain disorder Psychodynamic theory: this theory suggests that hypochondriasis may be an ego defense mechanism; physical complaints become the expression of low self-esteem, because it is easier to feel something is wrong with the body than to feel something is wrong with the self Conversion disorder may represent emotions associated with a traumatic event that are too unacceptable to express and so are acceptably "converted" into physical symptoms Family dynamics: in dysfunctional families, when a child becomes ill, focus shifts from the open conflict to the child's illness and leaves unresolved underlying issues the family is unable to confront in an open manner Somatization brings some stability to the family and positive reinforcement to the child Learning theory: Somatic complaints are often reinforced when the sick person learns that he or she may avoid stressful obligations or be excused from unwanted duties (primary gain) Becomes prominent focus of attention because of the illness (secondary gain) Relieves conflict within family as concern is shifted to the ill person and away from the real issue (tertiary gain)

characteristics of DBT

Support-oriented: It helps a person identify their strengths and builds on them so that the person can feel better about him/herself and their life. Cognitive-based: DBT helps identify thoughts, beliefs, and assumptions that make life harder: "I have to be perfect at everything." "If I get angry, I'm a terrible person" Helps people to learn different ways of thinking that will make life more bearable: "I don't need to be perfect at things for people to care about me", "Everyone gets angry, it's a normal emotion"

conduct disorders assessment

The child lacks feelings of guilt or remorse Use of tobacco, alcohol, or nonprescription drugs as well as participation in sexual activities occurs earlier than the peer group's expected age norm

somatoform disorder outcomes, planning/implementation

The client Copes effectively without resorting to physical symptoms Verbalizes relief from pain Has decreased frequency of physical complaints and interprets bodily sensations rationally Is free of physical disability Verbalizes realistic perception of appearance and expresses positive body image Nursing care of the individual with a somatoform disorder is aimed at relief of discomfort from the physical symptoms Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms

outcomes for autistic disorder

The client Exhibits no evidence of self-harm Interacts appropriately with at least one staff member Demonstrates trust in at least one staff member Is able to communicate so that he or she can be understood by at least one staff member Demonstrates behaviors that indicate he or she has begun the separation/individuation process

separation anxiety disorder

The essential feature is excessive anxiety concerning separation from the home or from those to whom the person is attached The anxiety exceeds that expected for the person's developmental level and it interferes with social, academic, occupational, or other areas of functioning

tourettes disorder

The essential feature is the presence of multiple motor tics and one or more vocal tics Tics may appear simultaneously or at different periods during the illness Presence of tics causes marked distress

ADHD

The essential feature of ADHD is a persistent pattern of inattention and/or hyperactivity-impulsivity that is more frequent and severe than is typically observed in people at a comparable level of development

mental retardation symptom assessment

The extent of severity of mental retardation is identified by the client's IQ level Four levels have been delineated: Mild- IQ 50-70 Moderate- IQ 35-49 Severe- IQ 20-34 Profound- IQ <20 assessment to include: Nurses should assess and focus on each client's strengths and individual abilities Knowledge regarding level of independence in the performance of self-care activities is essential to the development of an adequate plan for the provision of nursing care

invalidating environment (DBT)

The term Invalidating Environment refers essentially to a situation in which the personal experiences and responses of the growing child are disqualified or "invalidated" by the significant others in her life. The child's personal communications are not accepted as an accurate indication of her true feelings and it is implied that, if they were accurate, then such feelings would not be a valid response to circumstances. characterized by a tendency to place a high value on self-control and self-reliance. Possible difficulties in these areas are not acknowledged and it is implied that problem solving should be easy given proper motivation. Any failure on the part of the child to perform to the expected standard is therefore ascribed to lack of motivation or some other negative characteristic of her character. Linehan suggests that an emotionally vulnerable child can be expected to experience particular problems in such an environment. She will neither have the opportunity accurately to label and understand her feelings nor will she learn to trust her own responses to events. Neither is she helped to cope with situations that she may find difficult or stressful, since such problems are not acknowledged. It may be expected then that she will look to other people for indications of how she should be feeling and to solve her problems for her. The child's behavior may then oscillate between opposite poles of emotional inhibition in an attempt to gain acceptance and extreme displays of emotion in order to have her feelings acknowledged. Erratic response to this pattern of behavior by those in the environment may then create a situation of intermittent reinforcement resulting in the behavior pattern becoming persistent.

body dysmorphic disorder

This disorder is characterized by an exaggerated belief that the body is deformed or defective in some specific way Symptoms of depression and characteristics associated with obsessive-compulsive personality are common

tourettes disorder assessment

Tics may involve the head, torso, and upper and lower limbs Signs may begin with a single motor tic, most commonly eye blinking, or with multiple symptoms Palilalia Echolalia

always being right (CD)

We are continually on trial to prove that our opinions and actions are correct. Being wrong is unthinkable and we will go to any length to demonstrate our rightness. For example, "I don't care how badly arguing with me makes you feel, I'm going to win this argument no matter what because I'm right." Being right often is more important than the feelings of others around a person who engages in this cognitive distortion, even loved ones.

emotional reasoning

We believe that what we feel must be true automatically. If we feel stupid and boring, then we must be stupid and boring. You assume that your unhealthy emotions reflect he way things really are — "I feel it, therefore it must be true."

catastrophizing

We expect disaster to strike, no matter what. This is also referred to as "magnifying or minimizing." We hear about a problem and use what if questions (e.g., "What if tragedy strikes?" "What if it happens to me?"). For example, a person might exaggerate the importance of insignificant events (such as their mistake, or someone else's achievement). Or they may inappropriately shrink the magnitude of significant events until they appear tiny (for example, a person's own desirable qualities or someone else's imperfections).

heaven's reward fallacy

We expect our sacrifice and self-denial to pay off, as if someone is keeping score. We feel bitter when the reward doesn't come.

fallacy of change

We expect that other people will change to suit us if we just pressure or cajole them enough. We need to change people because our hopes for happiness seem to depend entirely on them.

fallacy of fairness

We feel resentful because we think we know what is fair, but other people won't agree with us. As our parents tell us, "Life is always fair," and people who go through life applying a measuring ruler against every situation judging its "fairness" will often feel badly and negative because of it.

global labeling

We generalize one or two qualities into a negative global judgment. These are extreme forms of generalizing, and are also referred to as "labeling" and "mislabeling." Instead of describing an error in context of a specific situation, a person will attach an unhealthy label to themselves. For example, they may say, "I'm a loser" in a situation where they failed at a specific task. When someone else's behavior rubs a person the wrong way, they may attach an unhealthy label to him, such as "He's a real jerk." Mislabeling involves describing an event with language that is highly colored and emotionally loaded. For example, instead of saying someone drops her children off at daycare every day, a person who is mislabeling might say that "she abandons her children to strangers."

shoulds (cognitive distortions)

We have a list of ironclad rules about how others and we should behave. People who break the rules make us angry, and we feel guilty when we violate these rules. A person may often believe they are trying to motivate themselves with shoulds and shouldn'ts, as if they have to be punished before they can do anything. For example, "I really should exercise. I shouldn't be so lazy." Musts and oughts are also offenders. The emotional consequence is guilt. When a person directs should statements toward others, they often feel anger, frustration and resentment.

filtering (cognitive distortions)

We take the negative details and magnify them while filtering out all positive aspects of a situation. For instance, a person may pick out a single, unpleasant detail and dwell on it exclusively so that their vision of reality becomes darkened or distorted.

conduct disorders

With this disorder, there is a repetitive and persistent pattern of behavior in which the basic rights of others or major age-appropriate societal norms or rules are violated Two subtypes Childhood-onset type- before age 10 Adolescent-onset type- no criteria present prior to age 10 Biological influences Genetics Temperament Biochemical factors Psychosocial influences Poor peer relationships Family influences Parental rejection Inconsistent management with harsh discipline Early institutional living Frequent shifting of parental figures Large family size Absent father Marital conflict and divorce Inadequate communication patterns Parental permissiveness Parents with antisocial personality disorder, alcohol dependence, or both Classic characteristic of conduct disorder is the use of physical aggression in the violation of the rights of others Stealing, lying, and truancy are common problems Association with a delinquent subgroup

dialectic behavior therapy

an innovative method of treatment that has been developed specifically to treat this difficult group of patients in a way which is optimistic and which preserves the morale of the therapist. a cognitive-behavioral approach that emphasizes the psychosocial aspects of treatment. The theory behind the approach is that some people are prone to react in a more intense and out-of-the-ordinary manner toward certain emotional situations, primarily those found in romantic, family and friend relationships. suggests that some people's arousal levels in such situations can increase far more quickly than the average person's, attain a higher level of emotional stimulation, and take a significant amount of time to return to baseline arousal levels. based on a bio-social theory of borderline personality disorder. Linehan hypothesizes that the disorder is a consequence of an emotionally vulnerable individual growing up within a particular set of environmental circumstances which she refers to as the Invalidating Environment. An emotionally vulnerable person is someone whose autonomic nervous system reacts excessively to relatively low levels of stress and takes longer than normal to return to baseline once the stress is removed. It is proposed that this is the consequence of a biological diathesis.

CBT

based on a model or theory that it's not events themselves that upset us, but the meanings we give them. If our thoughts are too negative, it can block us seeing things or doing things that don't fit - that disconfirm - what we believe is true. In other words, we continue to hold on to the same old thoughts and fail to learn anything new. Beck suggested that these thinking patterns are set up in childhood, and become automatic and relatively fixed. So, a child who didn't get much open affection from their parents but was praised for school work, might come to think, "I have to do well all the time. If I don't, people will reject me." Such a rule for living (known as a dysfunctional assumption) may do well for the person a lot of the time and help them to work hard.

cluster C

behaviors that are described as anxious or fearful Avoidant personality disorder Dependent personality disorder Obsessive-compulsive personality disorder

cluster b

behaviors that are described as dramatic, emotional, or erratic Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder

Cluster A

behaviors that are described as odd or eccentric Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder

ODD assessment

characterized by passive aggressive behaviors Stubbornness Procrastination Disobedience Carelessness Negativism Testing of limits Resistance to directions Ignoring others' communication Unwilling to compromise

somatization disorder

chronic syndrome of multiple somatic symptoms that cannot be explained medically and are associated with psychosocial distress and long-term seeking of assistance from health-care professionals The disorder is chronic Anxiety, depression, and suicidal ideations are frequently manifested Drug abuse and dependence are not uncommon Personality characteristics Heightened emotionality Strong dependency needs A preoccupation with symptoms and oneself

generalized amnesia

inability to recall anything that has happened during the individual's entire lifetime, including personal identity

continuous amnesia

inability to recall events occurring after a specific time up to and including the present