2nd mental test

A client being treated for depression asks the nurse what causes this illness. Which response by the nurse is the most accurate, evidence-based statement? 1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors." 2) "Depression has been proven to be the result of an imbalance in certain neurotransmitters." 3) "Depression is transmitted by a specific gene for the illness." 4) "Depression has been proven to develop as a result of negative thinking patterns."

1

A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech? 1) Identify with the person speaking 2) Imitate the nurse's movements 3) Alleviate alogia 4) Alleviate avolition

1

A client is scheduled for electroconvulsive therapy (ECT). Prior to the client's ECT, what should the nurse teach the client? 1) "General anesthesia and a muscle relaxant drug will be used during the treatment." 2) "It will take 4 to 5 hours to recover from the procedure." 3) "ECT has been used since the 1930s. There is absolutely no risk involved." 4) "Permanent memory loss is a major side effect."

1

A withdrawn client, newly diagnosed with schizophrenia, is experiencing delusional thinking. Which nursing intervention is most appropriate? 1) Present objective reality. 2) Use self-disclosure. 3) Use physical touch for reassurance. 4) Provide an in-depth explanation of unit rules and regulations.

1

Bill is a 70-year-old man who is diagnosed with major depressive disorder. He is married and has two adult children who are alcoholics. He currently lives in a rural neighborhood and works part-time at a convenience mart. Which of these demographics is a risk factor for suicide? 1) 70-year-old male 2) Parent of alcoholic children 3) Lives in a rural neighborhood 4) Works part-time

1

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

1

Sophie is admitted to an inpatient psychiatric unit in an acute manic episode. She is morbidly obese and believes she is a famous ballerina. She repeatedly runs from one end of the unit to the other and attempts to twirl around while standing on chairs in the patient lounge. She is prescribed temazepam (Restoril) for sleep, and since her admission she has generally slept for five to six hours each night. What should the nurse consider to be the priority nursing diagnosis? 1) Risk for Injury related to excessive hyperactivity. 2) Disturbed Sleep Pattern related to manic hyperactivity. 3) Imbalanced Nutrition, Less than Body Requirements, related to inadequate intake. 4) Situational Low Self-esteem related to embarrassment secondary to high-risk behaviors.

1

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

1

A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client? 1) "Do not alter your dietary sodium intake." 2) "Have serum lithium levels checked every 6 months." 3) "Limit fluid intake to 1,000 mL per day." 4) "Adjust the dose if you feel out of control."

1 Clients taking lithium should consume a diet adequate in sodium and drink 2,500 to 3,000 mL of fluid per day. Lithium is a salt and competes in the body with sodium. If sodium is lost, the body will retain lithium, resulting in toxicity. Conversely, if sodium levels are significantly increased, it will reduce the level of lithium, resulting in decreased efficacy. Maintaining normal sodium and fluid levels is critical to maintaining therapeutic levels of lithium.

A client has a history of major depressive disorder (MDD). Police escort the client to the ED after finding the client nude at an ATM, screaming for money to pay off credit card debt. What would make the ED psychiatrist question the client's prior diagnosis? 1) The client is experiencing symptoms of mania. 2) The client is experiencing symptoms of a severe anxiety disorder. 3) The client is experiencing symptoms of an amnestic disorder. 4) The client is experiencing symptoms of a histrionic personality disorder.

1 The DSM-5 criteria for the diagnosis of MDD rule out this diagnosis if the client has ever experienced a manic episode. The symptoms described in the question indicate that this client is experiencing a manic episode. Therefore, it would be appropriate for the ED psychiatrist to question the diagnosis of MDD.

A client diagnosed with schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response? 1) "I know you believe that to be true, but I find that hard to believe." 2) "What would make you think such a thing?" 3) "I know your roommate. He would do no such thing." 4) "I can see why you feel that way."

1 This client is experiencing a persecutory delusion. This nursing response is an example of voicing doubt, which expresses uncertainty as to the reality of the client's perceptions. This is an appropriate therapeutic communication technique in dealing with clients experiencing delusional thinking.

Jennifer is working with the nurse on her care plan related to post trauma syndrome. Jennifer repeatedly asks the nurse why she is writing down everything and who will be seeing this information. Which of these interpretations by the nurse reflects an understanding of the post trauma patient? 1) Post trauma patients may be suspicious of others in their environment. 2) Post trauma patients need a lot of redirection. 3) Female post trauma patients are often very confused about details. 4) Post trauma patients are always confrontational and challenging with health care professionals.

1 An understanding that post trauma patients may be suspicious of others in the environment will assist the nurse in responding to the patient in a manner that promotes trust between them.

The nurse is assessing a patient who is diagnosed with obsessive-compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion? 1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done."

1 A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior.

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

1 During a panic attack, the client is experiencing extreme levels of anxiety. The symptoms experienced may mimic life-threatening physiological symptoms, such as chest pain and feelings of suffocation and/or impending doom. Clients need reassurance that these symptoms are psychologically, not physiologically, based. It is a priority to be present for the client and offer this support.

Cliff has been attending group counseling for depression and has been expressing more hopelessness in the last few days. When the nurse provides the group with a homework assignment to be completed and returned to the group the next day, Cliff responds "I don't need to bother." Which of these responses by the nurse is most appropriate? 1) "Are you having suicidal thoughts?" 2) "Trust me, it will be beneficial." 3) "Why don't you want to cooperate?" 4) "This assignment will help you combat the hopelessness."

1 Hopelessness is a risk factor for suicide, and the client's statement may be a veiled suicide threat, so it is most important to assess for suicide risk in response.

Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders? 1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms. 3) Use behavioral therapies such as systematic desensitization and implosion. 4) Conduct psychological tests to support proper diagnosis of the anxiety disorder.

1 Self-awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. 3 therapist

After undergoing a complete diagnostic work-up, a client is diagnosed with post-traumatic stress disorder (PTSD). What must the nurse understand about the symptoms of PTSD before planning care? 1) Symptoms are psychological coping mechanisms. 2) Symptoms result in feelings of invulnerability. 3) Symptoms are a means to manipulate others. 4) Symptoms develop from a nonspecific psychic event.

1 Symptoms of PTSD include psychological numbing, flashbacks, nightmares, and explosive anger. These symptoms are coping mechanisms used to deal with anxiety by blocking memories of traumatic events. Resolution of the post-trauma response is largely dependent on the effectiveness of the coping strategies employed.

What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? 1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming

1 Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.

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

1 behavior directs the client away from the underlying anxiety and focuses the client on a repetitive activity, such as packing and unpacking and folding and refolding personal belongings.

An adult male has sought counseling at a community mental health center for PTSD. He reports during assessment that he witnessed the murder of a close friend last year in a random, drive-by shooting in his neighborhood. Since this loss he has had recurrent nightmares, explosive episodes, and frequently incapacitating anxiety. Which of the following nursing diagnoses would be appropriate, based on this assessment data? Select all that apply. 1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares. 2) Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 3) Isolation R/T unresolved anxiety, as evidenced by complaints of incapacitating anxiety. 4) Risk for suicide R/T survivor guilt.

1,2

The nurse is conducting an intake assessment for a patient with PTSD. Which of the following pieces of information support this diagnosis? Select all that apply. 1) The patient reports having nightmares but can't remember what they are about. 2) The patient states that he heard a loud noise when he was walking down the street and thought he was back in the war zone where he had last been deployed. 3) The patient took antidepressants when he was in junior high school and reports they didn't help. 4) The patient denies any history of substance abuse or dependence.

1,2

Barbara asks to speak to the nurse about her husband, who has been diagnosed with bipolar I disorder. She tells the nurse she is thinking of divorcing her husband because his agitation "comes out of nowhere" and is "impossible to manage." She also admits to being "fed up with his extramarital affairs" and says "I just don't know what to say anymore." The nurse recognizes that family psychoeducational treatment is important in improving adjustment and preventing relapses. Which of the following are components of family psychoeducational treatment that will be beneficial to Barbara on the basis of her expressed concerns? Select all that apply. 1) Problem-solving skills training 2) Communication training 3) Education about the illness 4) Codependency education 5) Divorce training

1,2,3

Haley is a 35-year-old woman being assessed for complaints of racing thoughts, impulsive agitation, and distractibility. She denies having ever been diagnosed with a mental disorder. Which of the following items are important for the nurse to include in Haley's initial assessment to assist in identifying the correct diagnosis? Select all that apply. 1) Family history of thyroid disorders 2) Family history of depression or bipolar disorders 3) Medications and other substances currently being taken 4) Birth order 5) Interest in attending group therapy

1,2,3

Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply. 1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins

1,2,3 1: Anxiety is "contagious" and may be transferred between the client and nurse, so it is essential that the nurses who intervene evaluate and manage their own anxiety 3: if the client's anxiety is high, education will likely be ineffective. Learning occurs best when anxiety is at the mild level. 5: Administering antianxiety agents should be considered only when assessment deems them necessary and other interventions are ineffective in reducing anxiety.

The family of a patient who has been prescribed antipsychotic medication tells the nurse they understand there are potentially fatal side effects with these medications. They ask the nurse for information about what they should look for that could signal potentially dangerous or fatal side effects. Which of the following responses by the nurse are accurate with regard to the family's question? Select all that apply. 1) "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." 2) "If the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." 3) "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the medication." 4) "If the male patient begins to show signs of breast enlargement or the female patient experiences amenorrhea, take the patient immediately to the ER." 5) "If the patient's psychotic symptoms appear to be absent, call the doctor immediately."

1,2,3 Feedback 1: These symptoms are indicative of an acute dystonia, which can progress to laryngospasm if not treated. Emergency intervention with an anticholinergic such as Cogentin is needed to reverse this side effect. Feedback 2: These symptoms are indicative of neuroleptic malignant syndrome, which can progress rapidly and be fatal. Immediate discontinuation of antipsychotic medication and emergency intervention are critical needs. Feedback 3: These symptoms may be indicative of agranulocytosis, which can be fatal if not treated. Further bloodwork is needed.

Which of the following medications would be appropriately administered by an anesthesiologist to a client immediately prior to electroconvulsive therapy (ECT)? Select all that apply. 1) Thiopental sodium (Pentothal) 2) Methohexital sodium (Brevital) 3) Succinylcholine chloride (Anectine) 4) Glycopyrrolate (Robinul) 5) Meperidine (Demerol)

1,2,3 Thiopental sodium (Pentothal) and Methohexital sodium (Brevital) is a short-acting anesthetic that would be appropriate for an anesthesiologist to administer to a client immediately prior to ECT. 3: Succinylcholine chloride (Anectine) is a muscle relaxant that would be appropriate for an anesthesiologist to administer to a client immediately prior to ECT. 4: Glycopyrrolate (Robinul) is a preoperative medication given to decrease secretions and prevent aspiration. It is administered by the nurse about 30 minutes prior to the procedure. 5: Meperidine (Demerol) is a narcotic analgesic that would not be given by the anesthesiologist to a client prior to ECT.

A client diagnosed with major depression is being discharged from the hospital with a prescription for fluoxetine (Prozac). The nurse's discharge teaching should include which of the following? Select all that apply. 1) "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed." 2) "Make sure that you follow up with scheduled outpatient psychotherapy." 3) "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year." 4) "You should avoid foods with tyramine, including beer, beans, processed meats, and red wine." 5) "You can discontinue the Prozac when you are feeling better."

1,2,3 The nurse should inform the client that it is important to take Prozac as prescribed and that the therapeutic effect can take up to 4 weeks to be realized. 2: Along with medication compliance, the nurse should also stress the importance of follow-up psychotherapy. 3: The nurse should advise the client to discontinue the medication only under a doctor's supervision. Although the medication may be tapered and stopped after 6 months, there is a risk for further depressive episodes. 4: with maoi

Kelly has come to the mental health clinic for an assessment at the request of her husband. Kelly refuses to talk to the nurse until her personal assistant arrives. She states, "Apparently you don't know that I'm a famous person, and when my fans get here, you'll be glad my personal assistant is here to manage the crowd." The nurse meets with the husband to begin the assessment process. Which of the following observations by the husband are consistent with symptoms of a manic episode? Select all that apply. 1) "She has concocted this story about having a personal assistant and being a famous person; none of it is true." 2) "She has over-extended our credit cards, buying huge quantities of unnecessary items." 3) "Ever since we married, she has had periods where she makes superficial cuts on her wrists and becomes convinced I'm going to divorce her." 4) "I've noticed her behaving in a very provocative manner around other men." 5) "When we go to a party she drinks more alcohol than anyone there and inevitably becomes loud and obnoxious."

1,2,4

To assist the psychiatrist in determining appropriate medication needs, the nurse has been asked to assess whether a patient is in a hypomanic or an acute manic state. Which of the following symptoms are consistent with hypomania? Select all that apply. 1) Cheerful mood, but underlying irritability surfaces rapidly when needs are not fulfilled 2) Fragmented cognition and perception; often psychotic 3) Delusions of grandeur 4) Easily distracted, which sometimes interferes with completing goal-directed activity 5) Extroverted and sociable

1,2,4,5 acute manic state presents as euphoric, more often presents with flighty and rapid flow of ideas; inexhaustible energy, poor impulse control, and marked interference with completing tasks; uninhibited and manipulative

A patient who has recently been diagnosed with PTSD asks the nurse what his options are for treatment of this disorder. Which of the following items should the nurse include in teaching the patient about primary treatments for PTSD? Select all that apply. 1) Prolonged exposure therapy 2) Cognitive therapy 3) ECT 4) Antipsychotic medication 5) EMDR

1,2,5

The nurse is conducting an admission assessment for Mark, who is diagnosed with schizoaffective disorder. When asking the patient about his relationships with family members, the patient begins responding to someone else's voice (although there is no one else present) and begins pacing around the room. Which of these are appropriate interpretations of the patient's behavior? Select all that apply. 1) Mark is hallucinating. 2) Mark is agitated. 3) Mark is a victim of abuse. 4) Mark is delusional. 5) Mark is anxious about discussing family relationships.

1,2,5

A patient admitted to the psychiatric unit and diagnosed with schizophrenia reports to the nurse that there are people playing drums in his chest. Which of these would be appropriate interventions by the nurse? Select all that apply. 1) Check the patient's vital signs. 2) Tell the patient that these are tactile hallucinations and that he need not be concerned. 3) Ask the patient to describe more completely what he is feeling. 4) Give the patient prn Cogentin as ordered. 5) Encourage the patient to discuss this with the music therapist.

1,3 4: The patient's report does not indicate presence of abnormal involuntary movements that would warrant administration of Cogentin.

The parents of a teenage son who was recently diagnosed with bipolar disorder ask the nurse to provide them with information about this illness, since they had previously been told their son had ADHD. Which of the following is evidence-based information that can be shared with the family? Select all that apply. 1) ADHD is the most common comorbid condition in children and adolescents with bipolar disorder. 2) Bipolar disorder in children and adolescents is an acute condition that they usually outgrow. 3) There is evidence to support that psychosocial therapy enhances the effectiveness of pharmacological therapy in treatment of bipolar disorder in children and adolescents. 4) Stimulants used in the treatment of ADHD can exacerbate mania in children and adolescents with bipolar disorder. 5) Medication discontinuation can be considered after the patient has been in remission for two months.

1,3,4

Donald's wife asks the nurse why her husband has been ordered an anticonvulsant when he's never had a seizure and his real problem is bipolar disorder. Which of these teaching points by the nurse are accurate? Select all that apply. 1) The mechanism of action for anticonvulsants in bipolar disorder is unclear. 2) Anticonvulsants are used to prevent seizures that may be an undesired effect of other medications the patient is taking. 3) Anticonvulsants have demonstrated mood stabilizing effects in patients with bipolar disorder. 4) The FDA does require that antiepileptic medications carry a warning label indicating an increased risk for suicidal thoughts and behavior. 5) Anticonvulsants are prescribed to prevent alcohol withdrawal, which is common in patients with bipolar disorder.

1,3,4 The mood-stabilizing effect of anticonvulsants is the primary reason for their use in patients with bipolar disorder Although anticonvulsant medication has positive effects on the mood, it may increase the risk for suicide ideation and attempts, and the FDA does require a warning label to that effect, so this teaching point is accurate.

During a psychiatric nursing assessment, Sally reports to the nurse that she was sexually assaulted 6 months ago and since then has had trouble concentrating at work. Her employer tells her he is sensitive to the amount of stress she is under, since she also recently went through a divorce, but that she needs to seek help for her anxiety and depression to avoid further consequences at work. Which of these data support the diagnosis of PTSD according to DSM-5 criteria? Select all that apply. 1) She directly experienced a traumatic event. 2) She is a single female. 3) She has had difficulty concentrating at work. 4) Her anxiety and depression are interfering with job functioning. 5) Her symptoms have been present for more than 6 months.

1,3,4,5 Symptoms present for more than 1 month warrant a diagnosis of PTSD.

A client has been diagnosed with major depression. The psychiatrist prescribes imipramine (Tofranil). Which of the following medication information should the nurse include in discharge teaching? Select all that apply. 1) "The medication may cause dry mouth." 2) "The medication may cause urinary incontinence." 3) "The medication should not be discontinued abruptly." 4) "The medication may cause photosensitivity." 5) "The medication may cause nausea."

1,3,4,5 TCA May cause sedation Some increase energy, improve appetite, reduce anxiety SE: Dry mouth, blurred vision, decreased lacrimation, constipation, delirium, increase suicide ideation, orthostatic hypotension, dizzy, weight gain, arrhythmia

Harold is admitted to the psychiatric unit with bipolar I disorder: manic episode in a highly agitated state. His speech is rapid and incoherent, he is pacing and in constant motion, and he is loudly proclaiming that his "lawyers are on the way and every one of you is going to be sued for malpractice." Which of the following nursing interventions are appropriate in this situation? Select all that apply. 1) Provide an environment with low levels of stimulation. 2) Set limits on Harold's threats by instructing him that he is not permitted to sue the staff. 3) Convey a calm attitude and voice when communicating with Harold. 4) Put Harold in seclusion with restraints for the protection of himself and others. 5) Offer activities that will provide safe outlets for Harold's agitation and excessive energy.

1,3,5 2: inc agitation

A client who is experiencing command hallucinations is hospitalized after jumping from a bridge. The client's parents insist that their son fell rather than jumped. Which of the following likely explain the parents' response? Select all that apply. 1) The parents are in denial about the reality of their son's mental illness. 2) The parents are grieving over the loss of their expectations for their child. 3) The parents do not understand the extent or seriousness of mental illness. 4) The parents reject the idea of their son having a mental illness. 5) The parents are showing support for their son.

1-4

The nurse is developing a plan of care for a patient diagnosed with PTSD. Which of the following variables will have an impact on the patient's response to interventions? Select all that apply. 1) Patient's self-esteem 2) Socioeconomic status 3) History of psychopathology 4) Amount of control over recurrence 5) Temperament 6) Immediate crisis debriefing

1-5 6: preventative

A client diagnosed with schizophrenia manifests the symptom of mutism. Which nursing intervention would assist the client in communicating with others? 1) Providing assistance with self-care needs 2) Using clear, concrete statements 3) Conveying acceptance of the client's need for false beliefs 4) Attempting to decode incomprehensible communication patterns

2

A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess? 1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span

2

An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four-point restraints will be applied? 1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions."

2

Beth is being treated for an adjustment disorder following a job demotion 2 months ago. Since the demotion, she has frequently called in sick, complains of incapacitating migraines, and has been disciplined for yelling at her boss. Her husband asks the nurse why his wife is still having so much trouble functioning, since he knows people who have lost their jobs entirely and have since resolved their concerns. Which of these statements by the nurse accurately reflects understanding of the dynamics of different kinds of stressors in patient recovery? 1) Women have more difficulty managing work-related stressors than men. 2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. 3) Job demotion is associated with longer-term recovery because it is so uncommon. 4) Carol probably had pre-existing difficulties managing stressors as a child.

2

In planning care to reinforce reality for a client diagnosed with schizophrenia, the nurse should include which intervention? 1) Explore the client's expressions of distorted thinking. 2) Discuss perceptions and thinking that are in touch with reality. 3) Encourage the client to share delusional thinking in group discussions. 4) Ask the client why distorted thinking and bizarre behavior have occurred.

2

The physician orders fluoxetine (Prozac) for a client diagnosed with depression. Which information is true about this medication? 1) Prozac is a tricyclic antidepressant. 2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun. 3) Aged cheese, yogurt, soy sauce, and bananas should not be eaten while the client is taking this drug. 4) Prozac may be administered in combination with monoamine oxidase inhibitors (MAOIs).

2

The wife of a patient being treated with lithium for bipolar disorder states to the nurse, "My husband has been on lithium for 3 days and he's still as manic as ever." Which of the following is important for the nurse to include in patient/family education about lithium? 1) Lithium prevents relapse into depression but has no direct effects on manic episodes. 2) Lithium takes up to 3 weeks to reach peak effectiveness. 3) Lithium is a neurotransmitter that can trigger mania in some individuals. 4) Lithium can be rendered ineffective if the patient restricts sodium intake.

2

Tori has been diagnosed with bipolar I disorder and presents at her clinic appointment with complaints of feeling depressed and hopeless. What is the most important assessment for the nurse to make at this point? 1) If Tori has been taking her medication 2) If Tori is having thoughts of suicide 3) If Tori has had any new stressors in her life 4) If Tori is using alcohol

2

When teaching about the tricyclic group of antidepressant medications, which information should the nurse include? 1) Strong or aged cheese should not be eaten while the client is taking this group of medications. 2) The full therapeutic potential of tricyclics may not be reached for 4 weeks. 3) Tricyclics may cause hypomania or recent memory impairment. 4) Tricyclics should not be given with antianxiety agents.

2 1: for maoi

A client is to undergo electroconvulsive therapy (ECT) in the morning. Which nursing intervention is appropriate? 1) Keep the client NPO 24 hours before the procedure. 2) Verify that informed consent has been granted. 3) Ascertain that client has dentures securely in place. 4) Place side rails down for easy access to the restroom.

2 6-8 hrs

Elizabeth has been taking lithium for 4 weeks and complains that she thinks she might have lithium toxicity. Which of these findings by the nurse are consistent with lithium toxicity? Select all that apply. 1) Elizabeth has had very little urine output in the last 24 hours. 2) Elizabeth has had several bouts of diarrhea in the last 24 hours. 3) Elizabeth's lithium level is 1.2 mEq/L. 4) Elizabeth's temperature is 99.6°F. 5) Elizabeth complains of less energy since she started taking lithium.

2 Excessive output of dilute urine, not inadequate output, is evidence of lithium toxicity.

A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss. Which nutritional intervention would be most therapeutic for this client? 1) Allow the client full kitchen privileges to eat anything as needed (prn). 2) Initiate tube feedings with nutritional supplements. 3) Provide small, frequent feedings of finger foods. 4) Provide a quiet place where the client can sit down to eat meals.

3

A client diagnosed with schizophrenia hears another patient say "You'll be tied up for another hour" and becomes agitated because he interprets that to mean he will literally be tied up. Which cognitive symptom of schizophrenia is this client manifesting? 1) Nihilistic delusions 2) Concrete thinking 3) Circumstantiality 4) Perseveration

2 Concrete thinking is manifested by literal interpretation of abstract or figurative ideas. This symptom may be present in schizophrenia and is believed to represent regression to an earlier level of cognitive development.

Which is a projected outcome of electroconvulsive therapy (ECT)? 1) The client's anxiety disorder should improve. 2) The client's mood will be elevated. 3) The client's visual hallucinations will decrease. 4) The client's personality disorder symptoms will improve.

2 ECT has been shown to be effective for clients diagnosed with severe depression. The projected outcome of the treatment should be elevated mood.

Several types of delusions may occur in an individual with schizophrenia. Which of the following types of delusion place the patient at greatest risk for agitation or aggression? 1) Delusions of grandeur 2) Delusions of persecution 3) Delusions of reference 4) Nihilistic delusions

2 In delusions of persecution an individual falsely believes he or she is being threatened or persecuted in some way. This carries a high risk for increasing the individual's agitation and possibly aggression in protective efforts.

A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented? 1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals.

2 The initial intervention is to rule out organic factors contributing to the paralysis. Once this has been identified, a plan of care can be effectively established. 3: ROM is important, but this physical intervention would not be implemented until the cause of the paralysis is determined.

A nursing home resident who has been taking antipsychotic medications for several months complains to the nurse of a stiff neck and difficulty swallowing. These symptoms are indicative of which condition? 1) Dysphonia 2) Tardive dyskinesia 3) Akathisia 4) Echolalia

2 (could be dystonia) Tardive dyskinesia is a syndrome characterized by abnormal, involuntary movements, including bizarre facial and tongue movements, a stiff neck, and/or difficulty swallowing. This condition may occur as an adverse effect of long-term therapy with antipsychotic medications. Dysphonia is a speech disorder caused by a dysfunction of the vocal cords Akathisia is a condition that causes restlessness Echolalia is the parrot-like repetition of words spoken by anotherEcholalia is the parrot-like repetition of words spoken by another

For the past year, a college student continually and unrealistically worries about academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis? 1) Post-traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive-compulsive disorder (OCD)

2 GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object, as in phobia, or event, as in PTSD.

A client newly diagnosed in a manic episode of bipolar disorder tells the nurse, "Now that I'm only sleeping 4 hours a night, I can get so much more work accomplished." Which ego defense mechanism is this client using? 1) Denial 2) Intellectualization 3) Rationalization 4) Suppression

2 Intellectualization occurs when an individual attempts to avoid expressing actual emotions associated with a stressful situation by using the intellectual processes of logic, reasoning, and analysis. The individual in the question is using reasoning to avoid dealing with feelings about the new diagnosis of bipolar disorder.

A suicidal client with a history of manic behavior is admitted to the ED. The client's diagnosis is documented as "bipolar I disorder: depressed." What is the rationale for this diagnosis versus a diagnosis of major depressive disorder? 1) The physician does not believe the client is suffering from major depression. 2) The client has experienced a manic episode in the past. 3) The client does not exhibit psychotic symptoms. 4) There is no history of major depression in the client's family

2 The client's history of mania and current suicide attempt support the diagnosis of "bipolar I disorder: depressed." According to the DSM-5 criteria, a manic episode rules out the diagnosis of major depressive disorder.

A client diagnosed with bipolar disorder has been hospitalized for 2 weeks. The client asks the nurse, "Do you think that the doctor is ever going to discharge me?" Which is the appropriate nursing response? 1) "Ask your doctor when you can be discharged." 2) "Tell me more about your feelings about being hospitalized." 3) "You are not ready to go yet." 4) "Let the doctor know your feelings."

2 therapeutic response that explores the client's feelings and addresses the client's concerns about the length of hospitalization.

The family of a patient being treated for PTSD asks the nurse to describe EMDR (eye movement desensitization and reprocessing), since it is being recommended for this patient. Which of the following teaching points are accurate descriptions of this intervention? Select all that apply. 1) EMDR has been shown to be effective in the treatment of all mental illnesses, including schizophrenia. 2) The process involves rapid eye movement while processing painful memories. 3) This process is contraindicated for patients with retinal detachment or glaucoma. 4) This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 5) The biological mechanism that makes EMDR effective is that it releases opioid-like chemicals in the brain.

2,3,4

The nurse is conducting an assessment for a patient diagnosed with PTSD. She recognizes that people with PTSD are at high risk for several comorbid conditions. Which of the following will she need to assess carefully because of the high risk in people with PTSD? Select all that apply. 1) Trichotillomania 2) Depression and suicide ideation 3) Substance abuse 4) Verbal or physical aggression 5) Narcissistic Personality Disorder

2,3,4

A client is about to undergo electroconvulsive therapy (ECT). Which statement most accurately reflects the nurse generalist's role during this procedure? 1) With advanced training, to perform the ECT procedure 2) To administer the general anesthetic during the procedure 3) To administer the ordered preoperative medications 4) To determine the number of ECT treatments

3

Janice is diagnosed with major depressive disorder and is beginning to participate in a cognitive therapy group. As the nurse is orienting Janice to the group, which of the following statements about cognitive therapy are accurate? Select all that apply. 1) Cognitive therapy is designed to focus on emotional dysregulation. 2) Cognitive distortions, such as negative expectations about oneself, serve as the basis for depression. 3) Cognitive therapy focuses on altering mood by changing the way one thinks. 4) Cognitive distortions arise out of a defect in cognitive development. 5) Cognitive therapy explores pent-up rage that has been turned against oneself because of identification with the loss of a loved object.

2,3,4 1: In cognitive therapy the focus is on cognitive distortions. Emotional dysregulation is the central focus of dialectical behavior therapy. 2: Beck et al. (1979) postulated that negative and irrational thinking contribute to depression. These are referred to as cognitive distortions. 3: A primary assumption in cognitive therapy is that changing the way one thinks will change one's mood. Specifically, developing patterns of more rational and positive thinking will improve one's mood. 4: In cognitive theory, it is assumed that cognitive distortions arise from a defect in cognitive development, which culminates in an individual thinking that he or she is worthless, inadequate, and rejected by others. These patterns of thinking need to be corrected to promote a positive change in mood. 5: The concept of rage turned inward is based in psychoanalytical theory

Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply. 1) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely.

2,3,4 2:Essential to managing anxiety is the client's awareness of escalating anxiety and developing strategies to reduce anxiety before it reaches panic level. 3: Anxiety can be beneficial in alerting one to dangers in the environment so the goal is not to rid one of anxiety altogether but to teach the client how to maintain anxiety at a manageable level. 4: The primary goal of interventions to treat anxiety is that the client will develop adaptive rather than maladaptive methods for managing anxiety.

Emily has been receiving treatment for major depressive disorder over several weeks. She is taking an antidepressant and attending cognitive behavioral therapy group once a week. When the nurse evaluates her progress in treatment, which of the following are indications that the depression is improving? Select all that apply. 1) Emily is taking the antidepressant medication as ordered. 2) Emily is expressing hope that she can return to her university classes soon and continue her education. 3) Emily demonstrates ability to make decisions concerning her own self-care. 4) Emily reports that suicide ideas have subsided. 5) Emily is engaging in activities that she enjoys.

2,3,4,5

Susan is being seen in the emergency department. Her sister brought her in with concern that Susan is depressed and might be suicidal. Which of the following questions are priorities for the nurse to ask when assessing for suicide risk? Select all that apply. 1) "Why are you feeling depressed and suicidal?" 2) "Are you having thoughts of hurting or killing yourself?" 3) "When you have these thoughts, do you have a plan in mind?" 4) "Do you ever feel like you want to hurt someone else?" 5) "Are you currently using any drugs or alcohol?"

2,3,5

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply. 1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages.

2,4,5

The client asks the nurse what is involved with electroconvulsive therapy (ECT). What is the appropriate client teaching? Select all that apply. 1) "It creates a seizure in the brain that lasts no more than 5 to 10 seconds." 2) "It involves placing electrodes on your head." 3) "You will need only one treatment." 4) "You will get a muscle relaxant before the treatment." 5) "You may need maintenance treatments on an outpatient basis."

2,4,5 15-25 sec, about 6-12 treatments

A female patient, Sally, was admitted to the psychiatric inpatient unit with PTSD following a rape 6 months ago in which she suffered several physical injuries. This evening she was approached from behind by a male patient who touched her on the shoulder, and Sally began screaming "I'm going to kill you for what you did to me!" Which of these immediate interventions by the nurse demonstrates a safe and effective care environment? Select all that apply. 1) Place the patient in seclusion for the safety of others. 2) Offer the patient reassurance that she is in a safe environment. 3) Tell the patient to share the details that she remembers about the traumatic event. 4) Stay with the patient. 5) Acknowledge and validate the patient's feelings as they are expressed.

2,4,5 1: Seclusion should be used only as a last resort and when there is imminent risk of danger to self or others. There is no evidence that this patient presents such a risk. 3: prompting a patient to share details about the traumatic event at this time, when her anxiety is already heightened, could trigger additional anxiety and negative symptoms.

A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply. 1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response.

2,4,5 1: recognize but can't change

61.Hannah is being evaluated for postpartum depression after she reported to her family physician that she just doesn't think she can take care of her baby. She expresses fear that God will take her children from her for being a bad mother. Which of the following is the highest priority for the nurse to assess during the initial interview? 1) The number of children Hannah is currently trying to care for. 2) Availability of support systems in Hannah's family. 3) Risks for suicide and/or infanticide. 4) What time of day the symptoms occur.

3

A patient with PTSD who has been having nightmares is prescribed propranolol to treat PTSD symptoms. He asks the nurse why this medication was ordered since he doesn't have high blood pressure. Which of the following is the most appropriate response by the nurse at this point? 1) Call the doctor and question this order. 2) Discontinue the medication and check the patient's blood pressure. 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 4) Explain that this medication is used to treat hypertension that often accompanies PTSD.

3

Cameron, who has been treated with lithium for several months, was recently placed on sodium-depleting diuretics by his family physician. He now presents in the ER with tremors, psychomotor retardation, confusion, and giddiness. What is the most likely reason for his symptoms? 1) Cameron's lithium level has dropped R/T sodium depletion and he is experiencing a return of manic symptoms. 2) Cameron is experiencing extrapyramidal symptoms R/T a drug:drug interaction. 3) Cameron is experiencing lithium toxicity R/T sodium depletion. 4) Cameron is experiencing psychosis R/T lithium toxicity.

3

Lamont has been scheduled for electroconvulsive therapy (ECT) and asks the nurse, "Is it true what I heard, that ECT causes brain damage?" Which of these would be the most appropriate, evidence-based response by the nurse? 1) "ECT has no effect on brain function at all." 2) "ECT has only been shown to cause brain damage in the elderly population." 3) "There is no evidence that ECT causes permanent changes in brain structure or function." 4) "Current evidence suggests that brain damage after ECT treatments is related to the anesthetic agents, not the treatment itself."

3

In the post-treatment period of electroconvulsive therapy (ECT), which is an appropriate nursing intervention? 1) Monitor vital signs every 30 minutes during the first hour. 2) Place client on back to facilitate comfort. 3) Orient client to time and place. 4) Ambulate immediately to promote adequate circulation.

3 Vital signs should be monitored every 15, not 30, minutes during the first The client should be placed on his or her side, not back, to avoid aspiration. After ECT recovery, the client should be restricted to bed rest, not ambulated, for at least 15 minutes.

A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety? 1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin)

3 Chlorpromazine - typical Clozapine - atypical

A client has been admitted to the inpatient psychiatric unit and is manifesting mutism. His diagnosis is schizophrenia with catatonia. What would the nurse expect to observe? 1) Frenzied and purposeless movements 2) Exaggerated suspiciousness 3) Stuporous withdrawal 4) Sexual preoccupation

3 The client's mutism indicates catatonic stupor. This client would be noted to have extreme psychomotor retardation, and efforts to move the individual may be met with bodily resistance. no response

A patient admitted to the psychiatric unit, who has been experiencing flashbacks and troubling nightmares, reports to the nurse that he just awoke from a nightmare and is still having chest pain. Which of these nursing interventions is a priority? 1) Encourage the patient to return to bed and try to calm down. 2) Administer prn antianxiety medication as ordered. 3) Assess the patient's cardiovascular status. 4) Encourage the patient to reflect on the troubling dream.

3 This intervention is the most important priority since complaints of chest pain should not be assumed to be solely anxiety symptoms. The patient may be having a heart attack.

A client diagnosed with schizophrenia is experiencing disorganized thinking. Which technique should the nurse use to promote communication? 1) Giving broad openings 2) Probing 3) Verbalizing the implied 4) Using open-ended questions

3 When working with clients who have greatly impaired communication ability, the nurse can use the technique of verbalizing the implied. By putting into words what the client may be experiencing, the nurse helps the client to organize his or her thinking.

A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis? 1) Strong ego boundaries and abstract thinking 2) Acute dystonias and tardive dyskinesia 3) Altered mood and thought disturbances 4) Substance abuse and cachexia

3 characteristic symptoms of schizoaffective disorder are a combination of alterations in mood (mania or depression) and thought.

A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order? 1) Paroxetine (Paxil) 2) Carbamazepine (Tegretol) 3) Benztropine (Cogentin) 4) Lorazepam (Ativan)

3 Cogentin is an anticholinergic medication that blocks cholinergic activity in the central nervous system, which is responsible for extrapyramidal symptoms. This is the drug of choice to treat extrapyramidal symptoms associated with antipsychotic medications.

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

3 Anxiolytic medications work quickly to decrease anxiety levels by depressing the central nervous system. Control of the client's physical symptoms of extremity numbness, trembling, and hyperventilation must take priority to maintain physiological and psychosocial integrity.

The nurse is providing care for an emaciated client experiencing an acute phase of catatonic stupor. Which nursing intervention would take priority when meeting this client's needs? 1) Minimize attempts to communicate with the client. 2) Assist the client to ambulate. 3) Provide nutrient-dense foods and beverages. 4) Place the patient is seclusion for safety.

3 Nutrition is an essential consideration for a client with catatonic stupor. The emaciated client in the question is suffering from malnutrition. The nurse must prioritize this basic physical need.

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

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

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

3 Research studies show that propranolol is effective in decreasing anxiety symptoms. It has potent effects on the somatic manifestations of anxiety, such as palpitations and tremors, but has less dramatic effects on the psychic components of anxiety. It is most effective in the treatment of acute situational anxiety, such as performance anxiety and/or test anxiety.

The physician informs the client that succinylcholine chloride (Anectine) will be administered prior to electroconvulsive therapy (ECT). The client asks, "Why must I take this medication?" Which is the appropriate nursing response? 1) "To help settle your stomach before the procedure." 2) "To facilitate prolonged muscular activity during the procedure." 3) "To relax skeletal muscles during ECT." 4) "To control your respirations during ECT."

3 Succinylcholine chloride is the medication of choice used to relax the skeletal muscles and prevent severe muscle contractions and potential skeletal fractures during the seizure induced by ECT

The nurse is caring for four clients. Which client should not be considered a candidate for electroconvulsive therapy (ECT)? 1) A client experiencing mania 2) A client diagnosed with catatonic schizophrenia 3) A client experiencing intracranial pressure 4) A client diagnosed with major depressive disorder

3 The only absolute contraindication for ECT is increased intracranial pressure (from brain tumor, recent cardiovascular accident, or other cerebrovascular lesions)

A client demonstrating manic behavior has become demanding and hyperactive. Which is the most appropriate nursing intervention to address these client behaviors? 1) Help lessen the client's feelings of guilt and rejection. 2) Warn the client that restraints may be necessary if behavior does not improve. 3) Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner. 4) Introduce the client to peers in order to increase interpersonal contacts.

3 focusing on the behavior and not the client

A client is being treated with sertraline (Zoloft) for major depression. The client tells the nurse, "I've been taking this drug for only a week, but I'm sleeping better and my appetite has improved." Which is the most appropriate response by the nurse? 1) "It will take a minimum of 3 to 4 weeks for therapeutic effects to occur." 2) "Sleep disturbances and appetite problems are not affected by Zoloft." 3) "A change in your environment and activity is the reason for this improvement." 4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week."

4

On the morning of a patient's first ECT procedure, the patient states, "I've been thinking about this all night and I've changed my mind; please call my doctor and tell her I don't want ECT treatments." Which of the following is the most appropriate response by the nurse? 1) "Since you have already signed the informed consent document, you will need to go through with the procedure." 2) "Don't worry; ECT treatments are not that bad." 3) "The team has already been assembled; it would be costly to back out now." 4) "I'll contact your doctor and let her know you are reconsidering."

4

Tara experienced the death of a parent 2 years ago. She has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes Tara's problem? 1) Post-trauma syndrome R/T parent's death. 2) Anxiety R/T parent's death. 3) Coping, ineffective, R/T parent's death. 4) Grieving, complicated, R/T parent's death.

4 The excessive reactions that the individual continues to exhibit, such as daily crying, inability to return to work, and inability to look at the parent's belongings after a 2-year period, are indicative of dysfunctional or complicated grieving. This individual's grieving response has arrested in the anger stage of grief and is manifested by exaggerated grieving behaviors.

A client, diagnosed with major depression, is scheduled for electroconvulsive therapy (ECT) in the morning. After awakening, prior to the treatment, the client asks, "Can I please get something to eat?" Which is the appropriate nursing response? 1) "You may have something light, such as crackers." 2) "You'll need to ask the doctor. He'll be in shortly." 3) "Just don't eat anything containing tyramine, such as aged meats and yellow cheeses." 4) "I know you'd like breakfast, but eating before your treatment may lead to complications."

4 Clients are administered general anesthesia during ECT. Clients must be NPO before ECT to prevent nausea, vomiting, and possible aspiration during treatment.

A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication? 1) "If you forget to take your morning dose of Haldol, double the dose at bedtime." 2) "Limit your alcohol intake to no more than 3 ounces per day." 3) "When you go home, sit outside and enjoy the sunshine." 4) "Do not stop taking Haldol abruptly."

4 The client should be taught not to stop taking Haldol abruptly after long-term use. To do so might produce withdrawal symptoms, such as nausea, vomiting, dizziness, gastritis, headache, tachycardia, insomnia, and/or tremulousness.

Which medication does the nurse determine will give the client the most immediate relief from neuroleptic-induced extrapyramidal side effects? 1) Lorazepam (Ativan), 1 mg PO 2) Diazepam (Valium), 5 mg PO 3) Haloperidol (Haldol), 2 mg IM 4) Benztropine (Cogentin), 2 mg PO

4 The symptoms of neuroleptic-induced extrapyramidal side effects include tremors, chorea, dystonia, akinesia, and akathisia. Cogentin, 1 to 4 mg given once or twice daily, is the drug of choice to treat these symptoms.

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

4 4:Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation. 1:Attending three group sessions would be an unrealistic outcome for a client experiencing social isolation.

A nursing instructor is teaching about nursing interventions during electroconvulsive therapy (ECT). Which student statement indicates the need for further instruction? 1) "I have to ensure that the client's airway is patent and provide suctioning if needed." 2) "I have to observe and record the type and amount of seizure activity." 3) "I have to monitor vital signs and cardiac functioning, and time the seizure." 4) "I have to determine the electrode placement as either bilateral or unilateral."

4 Determining the electrode placement as either bilateral or unilateral is the function of the psychiatrist, not the nurse. This student statement indicates the need for further instruction.

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

4 Repetitive mirror-checking and excessive grooming R/T perception of flawed appearance that interferes with social, occupational, or other areas of functioning are symptoms of body dysmorphic disorder.

The activity therapist is planning an individualized program for a client diagnosed with bipolar I disorder: manic episode who is exhibiting hostility and excessive energy. Which activity would be most appropriate? 1) Writing memoirs 2) Team sports 3) Ping-pong 4) Walking

4 Walking is the best activity choice because it is not considered competitive and provides an opportunity for the release of energy.

Shelly is a patient on the inpatient psychiatric unit and was diagnosed with major depressive disorder. She is staying in her room and sleeping most of the day. Which of the following approaches by the nurse would best facilitate getting Shelly involved in the occupational therapy group on the unit? 1) "Would you like to go to occupational therapy? It is starting right now." 2) "Let me know what activities you want to be involved in and I'll give you a schedule." 3) "If you don't go to occupational therapy today, you will have to stay in your room for the entire evening." 4) "Occupational therapy is starting in 30 minutes; I'll help you get ready."

4 active approach (stating the expected behavior rather than encouraging the patient to decide), provides time to prepare, and offers assistance in the process. This approach would most likely facilitate Shelly's participation in the occupational therapy activities.

14.A patient on antipsychotic medication reports to the nurse that her muscles feel very stiff, and she appears diaphoretic. Her temperature is 105 degrees. Her symptoms are indicative of the potentially fatal adverse reaction to antipsychotic medication known as ____________.

Although neuroleptic malignant syndrome is rare, its rapid progression and potential to cause death make it a priority to assess for regularly and to intervene aggressively when symptoms are apparent. Antipsychotic medication should be immediately discontinued.

A 60-year-old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply. 1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status

Anxiety can be a symptom of cardiac conditions and respiratory conditions -of intoxication and/or withdrawal from many substances -of hypoglycemia -of hyperthyroidism or hypothyroidism. Blood tests would be relevant and definitive of whether or not this is a cause for the anxiety symptoms.

Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________.

DSM-5 diagnostic criteria for agoraphobia identify that fear or anxiety must occur in at least two of five situations to diagnose agoraphobia; fear of public transportation and being in crowds are two of those criteria.

Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following? 1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution

Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions. (not schizo)

The psychiatrist has asked the nurse to make an assessment of how well Aaron is responding to the lithium he is being prescribed. Which of the following observations by the nurse suggest that Aaron's manic episode is subsiding? Select all that apply. 1) Aaron is able to finish his meals seated at a table. 2) Aaron is sleeping an average of six hours per night. 3) Aaron demonstrates an ability to listen and respond appropriately to questions. 4) Aaron complains of feeling less energetic and creative.

all correct; manic episode is lack of sleep, sometimes for days at a time

Although death as a result of ECT is rare, the major cause of death with ECT is ____________.

cardiovascular complications such as acute myocardial infarction or cerebrovascular accidents, when they do occur after ECT, are usually in individuals with previously compromised cardiac status. Assessment and management of cardiac disease prior to initiating ECT treatments is vital to reducing morbidity and mortality associated with ECT.

A type of therapy in which a client is directed to imagine or actually participate in real-life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________.

implosion therapy