Psych wk5
A psychiatric nurse's colleague has expressed a reluctance to assess a client's risk for suicide, stating, "The last thing I want to do is to plant the thought in the client's head and bring on a suicide attempt." What is the nurse's best response?
"Evidence shows that talking about suicide with clients doesn't cause suicide attempts."
A 17-year-old client comes to the community crisis clinic with multiple superficial cuts on the wrist. The client is crying uncontrollably and states that the client's romantic partner has left and the client doesn't want to live without the partner. What would be the most therapeutic initial nursing response?
"I can see that you are feeling anxious. I will stay with you until you feel better."
A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse?
"I get upset once in a while, too."
During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is most appropriate?
"I must stay with you until we are sure you will not hurt yourself."
A 43-year-old female client is observed walking and dancing around the unit dressed in red high heels and a provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which is the most therapeutic nursing intervention?
"I need for you to get off his lap, this behavior is not appropriate."
The nurse is interviewing a client with a diagnosis of depression and the client states, "Honestly, I know my family would be a lot better off if I wasn't around to be a burden on them. That's just between you and me, though, okay?" What is the nurse's best response?
"I'm obliged to share what we talk about with the other people on your care team."
While caring for a client in the hospital, the nurse becomes concerned that the client may be having thoughts of suicide. Which statement would be most therapeutic?
"I've noticed something is bothering you. Please share you thoughts with me."
A client with major depression is admitted to the health facility and expresses feelings of worthlessness and abandonment by significant others. Which replies by the nurse would convey empathy?
"It sounds like this is a really difficult time for you."
A client with borderline personality disorder has been admitted to the inpatient unit because the client has been engaging in wrist cutting. The client's sibling is visiting, and the sibling asks the nurse to explain why the client sometimes does this. Which response by the nurse would be most appropriate?
"Sometimes the self-injurious behavior is undertaken to relieve stress."
A psychiatric-mental health nurse is conducting an in-service education program about suicide for a group of nurses working at a community mental health center. The nurse determines that the teaching was successful based on which statement by the group?
"Suicide has profound effects on those connected to the individual."
A nursing instructor is teaching about the importance of bonding and how an easy temperament can serve as a protective factor against psychopathology. Which statement made by a student demonstrates a need for further instruction?
"Temperament is not changeable."
A client with a diagnosis of depression tells the nurse that the client's mood was especially bad this morning but that the client pushed through it to attend a support group. How can the nurse best validate the client?
"That shows an admirable level of perseverance on your part. Well done!"
The nurse is assessing a client with depression and a colleague suggests that the client be encouraged to sign a no-suicide contract. What is the nurse's best response to the colleague?
"There's no demonstrated benefit of no-suicide contracts, though they're not believed to be harmful."
Which statement by a client with borderline personality disorder (BPD) is an example of catastrophizing?
"This is the most awful thing that has ever happened to me."
When a woman in the last weeks of her pregnancy expresses concern over experiencing postpartum depression (PPD) after the birth of her baby, which response by the nurse indicates the use of therapeutic communication?
"What makes you feel that you'll get depressed after your baby's birth?"
A client has just been diagnosed with bipolar disorder and is upset with the diagnosis. The client tells the nurse, "It is probably my mother's fault, she has bipolar too." Which is the best response by the nurse?
"While bipolar disorders are genetic, there are other causes as well."
A 38-year-old client has been diagnosed with major depressive disorder. The client is being placed on an antidepressant and the nurse is providing medication teaching. Which would be appropriate information to provide to the client?
"You may not notice an improvement in your symptoms for 2 to 6 weeks."
A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate?
"You'll need to continue the medication for about 6 to 12 months to see how things go."
A nurse is developing a plan of care for a client with bipolar disorder. When preparing to administer medications, which agent would the nurse anticipate as being prescribed as the mainstay of pharmacotherapy? Select all that apply.
-Lithium carbonate -Divalproex -Carbamazepine -Lamotrigine
A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the client will have to demonstrate specific symptoms. What are some of these symptoms? Select all that apply.
-disruption in sleep. -disruption in appetite. -disruption in concentration. -excessive guilt.
Personality disorders occur in approximately what percentage of the general population?
10%
A nurse is preparing a presentation for a group of staff nurses on personality disorders. When describing antisocial personality disorders (ASPD), the nurse would explain that for a person to be diagnosed with the disorder, the person must be at least which age?
18 years
For a person to be diagnosed with antisocial personality disorder, the individual must be a minimum of what age?
18 years
The mental health nurse appropriately provides education on light therapy to which client?
20-year-old college student who reports being "too tired, sad, and unfocused" to enroll for classes in the winter term
Because of the lag period before monoamine oxidase inhibitors (MAOIs) are effective, adequate washout periods of which time frame are recommended between the time that the MAOI is discontinued and another class of antidepressants is started?
5 to 6 weeks
When completing discharge medication education for the client, the client asks how long it will take before the selective serotonin reuptake inhibitor (SSRI) medication will help the client's mood improve. Which is the correct response by the nurse?
7 to 10 days
Which sleep pattern is suggestive of a manic episode?
A client stays awake for several days and nights before "crashing" and sleeping for a long period.
Treatment approaches for clients with personality disorders generally rely on which modality?
A combination of approaches
Which is considered the etiology of personality disorders?
A combination of psychosocial and biologic variables
A client was abandoned by the parents at age 3, resulting in the client's perception of the world as a hostile place and the subsequent development of rage against men. This statement is an example of what?
A psychodynamic interpretation of the client's major depressive disorder.
The community mental health nurse is providing care for a large number of clients. What client should the nurse monitor most closely for the warning signs of suicide?
A young male with schizophrenia who is in danger of becoming homeless
A nurse is reviewing the medical record of a female client diagnosed with borderline personality disorder (BPD). Which would the nurse identify as one of the strongest risk factors for this disorder?
Abuse as a child
After being diagnosed with a chronic disease, a client has been feeling depressed. Which diagnosis has the strongest association with an increased suicide risk?
Acquired immunodeficiency syndrome
After teaching a group of nurses about borderline personality disorder, the leader determines that the education was successful when the group identifies that symptoms typically begin in which age group?
Adolescence
A client comes to the clinic for a follow-up visit. Despite being warm and friendly with the nurse on a previous visit, today the client presents with anger and sarcastic undertones with the same nurse. The client is presenting which behavior commonly seen in borderline personality disorder?
Affective instability
The nurse is seeing a 26-year-old client and the client's family. The client's family describes the client as being "very, very different." The family describes a history of periods of unpredictable behavior and disregard for consequences occurring a few times each year. The client has recently been diagnosed with bipolar I disorder, a condition that is characterized by what?
An elevated mood that lasts for at least 1 week
The nurse is seeing a 43-year-old client whose spouse just died by suicide. Which is a common emotional response that the nurse should anticipate from this client?
Anger toward the loved one who committed suicide
A loss of pleasure or interest in a client diagnosed with depression would be documented as what?
Anhedonia
During assessment of a client with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like I used to." The nurse documents this finding as indicative of what?
Anhedonia
A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?
Anticonvulsants
Which diagnosis is associated with a pervasive disregard for and violation of the rights of others?
Antisocial personality
The nurse is interviewing a client with a history of violence. The client boasts that the client "put a kid in a wheelchair" once when the client was younger and has maimed others. The client states, "Who cares? Life's tough." Violence and insensitivity are associated with which personality disorder?
Antisocial personality disorder
A client has a diagnosis of borderline personality disorder and lives at home with the client's parents. The client has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which would be most therapeutic when the client's parents come in to discuss discharge plans?
Ask the parents to keep a written schedule of activities for each day for the client
A client's depression is being treated in the community with phenelzine. The client has presented to the clinic stating, "I had a few beers and I'm feeling absolutely miserable." What is the nurse's best action?
Assess the client's blood pressure
A nurse is providing care to a client with borderline personality disorder. When providing for the client's biopsychosocial needs, the nurse would address which in the biologic domain?
Assisting with sleep measures
A nurse is describing histrionic personality disorder to a group of new nurses. Which term would the nurse most likely use?
Attention seeking
Which is a food that might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder?
Bananas
Which personality disorder would be placed in Cluster B?
Borderline
Which personality disorder is most commonly found in clinical settings?
Borderline personality
A client is admitted to the mental health unit after the client's spouse brings the client to the emergency department. Upon arrival, the spouse explained that the client had been crying all weekend and stating that the client wanted to die. Upon further assessment, the spouse reports that the client always has difficulty controlling anger and frequently worries that the spouse will leave the client. Recently, the client has been getting drunk every night, which the client never used to do. What diagnosis should the nurse suspect applies to this client?
Borderline personality disorder
Impulsivity and difficulty controlling anger are characteristic of which mental health diagnosis?
Borderline personality disorder
The nurse is in the process of planning the care of a psychiatric-mental health client and has specified the following outcome: The client will be free from self-inflicted harm. What is this client's most likely diagnosis?
Borderline personality disorder
A client with bipolar disorder has been ordered a medication that is classified as an anticonvulsant. Which drug does the nurse know falls within this class of medications?
Carbamazepine
A personality disorder is defined as a collection of traits that do what?
Cause behavioral dysfunction and inner distress
The major difference between bipolar I and bipolar II disorder is what?
Clients with bipolar II disorder do not have symptoms of mania that interfere enough to cause marked functional disturbances.
Into which personality disorder category are individuals placed whose behavior appears odd or eccentric?
Cluster A
Which cluster of disorders corresponds to symptoms of being dramatic and emotional?
Cluster B
When assessing a client immediately following electroconvulsive therapy (ECT), the nurse expects what in a client?
Confusion
A client with a personality disorder is upset and calls the nurse a "stupid cow." Which is an effective initial response to this client's behavior?
Discuss displacement of anger and set limits.
The nurse in charge of an inpatient psychiatric unit is irritated with a client who has borderline personality disorder. Which step should the nurse take?
Discuss the feelings with a colleague to promote coping.
Which occurs when thinking, feeling, or behaviors occur outside a person's awareness?
Dissociation
A 35-year-old client with bipolar disorder has a history of discontinuing medication when feeling well and then becoming manic again. During the client's last episode of mania, the client lost several thousand dollars in risky investments. Which intervention will be most helpful in achieving medication adherence?
During stabilization, discuss the client's individual signs, symptoms, and consequences of relapse.
A client diagnosed with schizoid personality disorder is described by family members as what?
Eccentric and a loner
A nurse is preparing a teaching plan for a client with antisocial disorder. Which would the nurse most likely employ to promote successful education?
Engaging the client in a discussion to direct the topic to the client.
A client has been successfully treated on the psychiatric mental health unit following a suicide attempt. In preparation for discharge, the nurse should prioritize what action?
Ensuring a plan is in place for the client's community-based care
A client who has experienced the recent loss of an infant child and recent immigration to the United States is admitted to the inpatient psychiatric unit with severe symptoms of depression. The client has expressed thoughts of suicide. Which is the nurse's priority intervention for this client?
Ensuring that the client is not permitted to use anything that would be potentially dangerous.
A client is prescribed a selective serotonin reuptake inhibitor (SSRI) as treatment for depression. Which would the nurse most likely administer?
Escitalopram
Which is considered a part of the social domain of the biopsychosocial interventions for the client diagnosed with borderline personality disorder (BPD)?
Establishing boundaries
A nurse providing community education for parents regarding adolescent suicide should include in the teaching session that the most frequent cause or motive for suicide in this age group is what?
Feelings of alienation or isolation
Following a change in job position, a minister asks a client how the client likes the new job. The client states, "Oh everything is great. I can really see myself going far in this new position." However, the client's voice is monotone and the client's face is nearly absent of affective expression. The minister is worried about this client and describes this facial expression as what?
Flat
Which would be a finding related to perceptual disturbances during the mental status exam in the client with mania?
Hallucinations
Which personality disorder is diagnosed more often in women?
Histrionic
selective serotonin reuptake inhibitor
Impulsive behaviors
Gambling, binge eating, and engaging in unsafe sex are examples of what?
Impulsivity
Which could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension?
Increase hydration
When providing care to a client who consistently attempts to manipulate the staff, the nurse can best maintain the therapeutic milieu by doing what?
Instructing the staff to enforce all unit rules consistently
After reviewing information about different personality disorders, a group of nursing students demonstrates understanding when they identify which as associated with schizoid personality disorder?
Introverted
A nurse is providing care to a client with antisocial personality disorder. As part of the plan of care, the client is to participate in a problem-solving group. The nurse understands that this intervention is effective based on which rationale?
It helps to reinforce self-responsibility.
The nurse is conducting an education group for women at risk for self-mutilation. What is the most important goal for this group?
Learning strategies to refrain from self-harm
A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when members identify which as the probability that a person will successfully complete suicide?
Lethality
A 56-year-old client who suffers from seasonal affective disorder is being assessed by the nurse in an outpatient mental health clinic. The nurse is aware which treatment is the most effective type of treatment for this condition?
Light therapy
A nurse caring for a client with borderline personality disorder (BPD) consistently informs the client of the length of the relationship and routinely prepares the client for termination and the end of hospitalization. Which is the nurse trying to prevent?
Maladaptive expression of emotions
Limit setting is most appropriate in which client population?
Manic
A client has been diagnosed with major depression. The client reports that the client often wakes up during the night and has trouble returning to sleep. The nurse interprets this finding as suggesting what?
Middle insomnia
A client diagnosed with a personality disorder exhibits a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Which personality disorder would the nurse identify as being characterized by this behavior?
Narcissistic
A nurse is preparing an inservice program for a group of mental health nurses on the topic of borderline personality disorder. When discussing the need for hospitalization, which would the nurse include as the most likely reason for inpatient hospitalization?
Nonsuicidal self-injury
Which is a true statement regarding depressive disorders?
Norepinephrine, dopamine, and serotonin have been implicated.
A client attends an outpatient mental health clinic accompanied by the client's spouse for an assessment. The client's spouse reports the client is easily irritated if the home is not maintained in a specific order and when the client is unable to complete a "to do" list on time. The client has a serious and formal demeanor. Which personality disorder best describes this client?
Obsessive-compulsive personality disorder
A depressed older adult client is being treated with a tricyclic antidepressant (TCA). For which clinical manifestations should the nurse monitor the client?
Orthostatic hypotension and urinary retention
A client is a 25-year-old who has a long history of being suspicious of the client's friends and spouse. The client persistently accuses the client's spouse of being unfaithful. The client accuses friends of making statements that are insulting to the client's character. Which is the most accurate description of the client's personality?
Paranoid
A client is diagnosed with a personality disorder manifested by odd, eccentric behavior. Which personality disorder would be associated with this manifestation?
Paranoid
A client is admitted with a diagnosis of schizotypal personality disorder. Which characteristic would this client exhibit during social situations?
Paranoid thoughts
A newly admitted client's history includes multiple suicide attempts. How can the nurse on the psychiatric-mental health unit best protect the client's safety?
Performing vigilant assessment and close observation
A client is admitted to a mental health unit with reports of fatigue, poor appetite, and difficulty making decisions. The client also states feeling unhappy most of the time for "as long as the client can remember." Which diagnosis should the nurse anticipate for this client?
Persistent depressive disorder
How does personality disorder differ from personality traits?
Personality disorder causes impairment in social and occupational functioning, whereas traits do not.
Which is the greatest predictor of a future suicide attempt?
Previous attempt
A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would expect to assess what?
Psychomotor retardation
A client with bipolar disorder is currently experiencing mania. The nurse identifies a nursing diagnosis of sleep deprivation related to the effects of the mania. Which would be most appropriate for the nurse to include in the client's plan of care?
Reducing environmental stimuli
The nurse is caring for a client with major depressive disorder who has been admitted to a psychiatric-mental health facility. After assessing the client, the nurse has developed a nursing diagnosis of "risk for violence toward others related to agitation and low tolerance level." Which would be an appropriate intervention for this client?
Remove all dangerous items from the client's room.
After assessing a client, the nurse identifies that the client is at risk for suicide. Which would be the nurse's priority intervention?
Remove means of suicide from the client's access.
Which would be the priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?
Risk for self-mutilation
A nursing student is caring for an elderly client who is taking sertraline for depression. The instructor quizzes the student about the medication and its actions. To what classification of drugs should the student assign sertraline?
Selective serotonin reuptake inhibitor
A client with major depression is prescribed paroxetine. The nurse develops an education plan for the client based on the understanding that this drug belongs to which class of drugs?
Selective serotonin reuptake inhibitors
The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?
Self-dramatization
The most serious consequence of behaviors seen in borderline personality disorder includes what?
Self-injury
A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which the client has been receiving outpatient treatment. The client tells the nurse that the client recently found out the client's therapist is moving and will no longer be able to work with the client. What is the priority nursing diagnosis for this client?
Self-mutilation
A client on an inpatient psychiatric unit has features of borderline personality disorder. The client is frequently angry, has an unstable sense of self, and is highly impulsive. The client can be verbally abusive to staff, who feel manipulated by the client's behaviors. Which intervention does the nurse determine as priority?
Setting limits
A client taking lithium for bipolar disorder is having mild diarrhea. The nurse informs the client that this is an example of what?
Side effect
The nurse is working with a 50-year-old client admitted for a major depressive episode. The client has remained isolated and withdrawn since admission and is reluctant to speak. Which therapeutic communication skill is most likely to encourage the client to verbalize the client's feelings?
Silence and active listening
Before a client became depressed, the client was an active, involved parent with three children, often attending their school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals that the client feels like an unnecessary burden on the client's family. Which nursing diagnosis is most appropriate?
Situational low self-esteem
Which is a primary risk factor for suicide?
Social isolation
For clients with borderline personality disorder, there is a tendency to see the world as either good or bad. As a result, these clients use the primitive defense of what?
Splitting
Which occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way?
Splitting
A nurse is providing a presentation about suicide for a group of health professionals. Which would the nurse address as a major contributing factor to the rising suicide rate among men?
Substance abuse
A parent of four small children lost a spouse in an automobile accident 3 months ago and is admitted to the hospital with severe depression. Since the spouse's death, the client's mood has been somber; until now, the client has refused treatment. What is this client at high risk for?
Suicide
A client with major depression is scheduled to receive electroconvulsive therapy. The nurse understands that this treatment is typically used in which situation?
The client is experiencing catatonia.
The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt?
The client recently purchased a large bottle of over-the-counter analgesics
A client admitted to the inpatient psychiatric unit changes clothes eight or nine times a day, wears heavy eye makeup, is intrusive with other clients, and makes inappropriate sexual advances toward staff members. Which goal would be most appropriate for this client?
The client will refrain from being intrusive with others and change clothing only twice per day.
A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most approraite for this nursing diagnosis?
The client will reframe negative thoughts in a more positive way.
A client who has just been prescribed lithium for bipolar disorder is being given education from the nurse about this medication. Which is important for the nurse to include in teaching?
The higher the sodium level, the lower the lithium level will be.
A nurse is developing a presentation for families who have members who have been diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include?
The risk for suicide is high with either depression or mania.
Which is a technique used to help the client with borderline personality disorder gain control over self-critical thoughts?
Thought stopping
A nurse working with a client with borderline personality disorder could establish which as outcome criteria?
Tolerate stress without self-mutilation.
Psychodynamic theory attributes the development of mood disorders to what?
Unexpressed and unconscious anger
When caring for a client with mania, which would the nurse most likely assess?
Unusual self-confidence
When conducting a suicide risk assessment, the nurse understands that which method has the least lethality?
Wrist slashing
The genetic theory, when applied to the occurrence of depression, supports that the psychiatric nurse should
assess for depression in the client's family history.
A client who has attempted suicide has an underlying diagnosis of depression. Which would the nurse anticipate being ordered for the client?
selective serotonin reuptake inhibitor
When assessing a client who reports mild symptoms of depression, the nurse expects that the diagnostic tests ordered will include:
thyroid stimulating hormone (TSH).