H360 Exam 3

A client diagnosed with a mild social phobia would like to try a treatment method that does not require pills or weekly appointments. Which statement by the nurse is appropriate when educating this​ client? "Certain lifestyle​ choices, such as decreasing caffeine​ intake, may be helpful for you." "You will have to get used to taking pills. It will be a part of your life now." "I can teach you how to treat yourself at home. You don​'t need to see a healthcare provider for this." "You should try implosion therapy. I will provide you with information."

"Certain lifestyle​ choices, such as decreasing caffeine​ intake, may be helpful for you."

A client is prescribed paroxetine​ (Paxil) to treat symptoms of stress after the unexpected death of her spouse. What should the nurse instruct the client about this​ medication? Select all that apply. "This medication should not be stopped abruptly." "This medication should not be taken with St. John​'s wort." "This medication may cause difficulties in achieving an orgasm." "This medication takes 4 to 6 weeks to achieve the full effect." "This medication can cause bradycardia."

"This medication should not be stopped abruptly." "This medication should not be taken with St. John​'s wort." "This medication may cause difficulties in achieving an orgasm." "This medication takes 4 to 6 weeks to achieve the full effect."

A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements by the nurse are appropriate? (SATA) A. "When did you start hearing the voices?" B. "The voices are not real, or else we would both hear them." C. "It must be scary to hear voices." D. "Are the voices telling you to hurt yourself?" E. "Why are the voices talking to only you?" ATI RN Mental Health Nursing Modules Ch. 14 Notes

*A, C, D*: ATI RN Mental Health Nursing Modules Ch. 14 Notes

2. A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A. Lithium carbonate B. Paroxetine C. Risperidone D. Haloperidol E. Lorazepam

2. A. Mood stabilizers, such as lithium carbonate, are prescribed for bipolar disorder and are not indicated in a short-term crisis situation. B. CORRECT: SSRI antidepressants, such as paroxetine, may be prescribed to decrease the anxiety and depression of a client who is experiencing a crisis. C. Antipsychotic medications, such as risperidone, may be prescribed for disturbed thought processes, usually when accompanied by other psychotic symptoms (hallucinations, delusions, blunt affect). Antipsychotics are not indicated in a short-term crisis situation. D. Antipsychotic medications, such as haloperidol, may be prescribed for disturbed thought processes, usually when accompanied by other psychotic symptoms (hallucinations, delusions, blunt affect). Antipsychotics are not indicated in a short-term crisis situation. E. CORRECT: Benzodiazepines, such as lorazepam, may be prescribed to decrease the anxiety of a client who is experiencing a crisis.

The brain waves of a client on life support are absent. In response to the family​'s question about the client being​ dead, for how long should the nurse explain that the brain waves must be absent before death can be ​declared? One week or longer 24 hours or longer 1 hour or longer 12 hours or longer

24 hours or longer

4. A nurse is providing discharge teaching to a client who is to begin taking fluoxetine for post-traumatic stress disorder. Which of the following statements is appropriate for the nurse to include in the teaching a. You may have a decreased desire for intimacy while taking this medication. b. You should take this medication at bedtime to help promote sleep. c. You will have fewer urinary adverse effects if you urinate just before taking this medication. d. You'll need to wear sunglasses when outdoors due to light sensitivity caused by this medication.

ANSWER: A Rationale: a. Decreased libido is a potential side effect of fluoxetine and other SSRIs. b. Clients should take fluoxetine in the morning due to CNS stimulation c. Clients taking a TCA, rather than fluoxetine, should void prior to taking the medication due to the potential for urinary hesitancy or retention. d. Clients taking TCA, rather than fluoxetine, should wear sunglasses when outdoors due to the potential for photophobia.

The nurse is caring for a terminally ill client. Which assessment findings indicate to the nurse that the client has passed​ away? Select all that apply. Absence of reflexes No movement Anorexia Absence of respiration Dyspnea

Absence of reflexes No movement Absence of respiration

The nurse is providing care for a client diagnosed with posttraumatic stress disorder​ (PTSD). The client​'s family has asked about nonpharmacologic therapies that may be appropriate. Which therapies will the nurse mention when responding to this​ family? Select all that apply. Acupuncture therapy ​Cognitive-behavioral therapy Selective​ serotonin/norepinephrine reuptake inhibitor therapy Eye movement desensitization and reprocessing therapy Atypical antipsychotic therapy

Acupuncture therapy ​Cognitive-behavioral therapy Eye movement desensitization and reprocessing therapy

A nurse is caring for a client who is taking phenelzine (Nardil). For which of the following adverse effects should the nurse observe? (Select all that apply.) A. Elevated blood glucose level B. Orthostatic hypotension C. Priapism D. Headache E. Bruxism

B, D

A nurse is teaching a client about stress reduction techniques. Which of the following client statements indicates understanding of the teaching? Cognitive reframing will help me change my irrational thoughts to something positive Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate Biofeedback causes my body to releases endorphins so i feel less stress and anxiety Mindfulness allows me to prioritize the stressors that I have in my life so that i have less anxiety

Cognitive reframing will help me change my irrational thoughts to something positive Mindfullness is encouraging the client to be mindful of their surroundings using all of his senses; the client learns to restructure negative thoughts and interpretations into positive ones. Progressive muscle relaxation (PMR)- a trained person help a client attain complete relaxation within a few minutes Biofeedback- uses a mechanical device to help gain control over pulse rate Cognitive reframing is helping the client change irrational thoughts to more positive ones

The nurse is completing the physical examination of a client experiencing symptoms of an anxiety disorder. Which information should the nurse​ collect? General assessment Current stressors Use of alcohol Medication regimen

General assessment Rationale During the physical examination of a client with symptoms of an anxiety​ disorder, the nurse needs to complete a general assessment. Medication​ regimen, current​ stressors, and use of alcohol are part of the client​'s psychosocial​ history, which is obtained when completing the health history.

a nurse observes a client who is pacing and wringing his hands. The client states I dont know why, but Ive worried for over a year that my son will die a horrible death. This finding is consistent with which of the following disorders? Generalized anxiety disorder Panic disorder PTSD acute stress disorder

Generalized anxiety disorder is when the client experience excessive worrying for more than 3 months and have no apparent stimulus or cause. The client may experience muscle tension, restlessness, avoidance of stressful events, increased time and effort required to prepare for stressful activities/events, procrastination in decision making, and seeks repeated reassurance.

The mental health nurse is working with a​ long-term client who has struggled through many​ issues, including homelessness. The client reports finding subsidized housing. The nurse​ responds, "You persisted until you found an apartment.​ Congratulations!" What kind of independent intervention is the nurse​ implementing? Select all that apply. Validating​ client's feelings Identifying successes in life Identifying strategies to meet​ client's goals Implementing Cognitive behavioral therapy​ (CBT) interventions Reinforcing positive coping efforts

Identifying successes in life Reinforcing positive coping efforts

A client asks the nurse how​ cognitive-behavioral therapy will help her to manage her​ obsessive-compulsive disorder. Which response by the nurse is the most​ appropriate? It will help you change your belief system. It teaches techniques that will help you lower stress. It will teach you ways to increase your​ self-esteem. It will make you feel shameful and therefore the behaviors will stop.

It teaches techniques that will help you lower stress.

The nurse is providing care to a client diagnosed with posttraumatic stress disorder​ (PTSD). Which items in the client​'s health history place the client at risk for this​ disorder? Select all that apply. Preexisting mental illness Witnessing the death of a friend Experiencing difficulty sleeping Losing a job after a traumatic event. Being diagnosed with diabetes mellitus

Preexisting mental illness Witnessing the death of a friend Losing a job after a traumatic event.

The nurse is preparing an educational​ in-service for staff nurses regarding phobias. Which statement is appropriate for the nurse to include in the​ presentation? There is no familial link to developing a phobia. Phobias are most likely to be diagnosed during late adulthood. Phobias are caused by a decrease in norepinephrine. Women are more likely to develop a phobia than men.

Women are more likely to develop a phobia than men.

What is the term for the physical cost of adapting to a​ stressor? Biogenic stressor Distress Allostatic load Homeostasis

allostatic load

The nurse is educating a client diagnosed with​ obsessive-compulsive disorder​ (OCD) on the different therapies that are available for the disorder. Which therapies are appropriate for the nurse to include in the teaching​ session? Select all that apply. Antipsychotic medication Antihypertensive agents ​Cognitive-behavioral therapy Hypoglycemic agents Herbal​ supplements, such as St. John​'s wort

antipsychotic medication cognitive behavioral therapy

The nurse is assessing a client who just lost her spouse as the result of cancer. Which question allows the nurse to determine whether socioeconomic factors may cause an alteration in the grieving process? a) "Do you have any family close by that I can call?" b) "Do you have children?" c) "Do you have any financial concerns?" d) "Are there any special requests you have regarding after-death care?"

c) "Do you have any financial concerns?"

After a lecture by a health department nurse, some members of the audience came up to congratulate the nurse on an effective presentation. Which statements by the audience members would the nurse want to correct? (Select all that apply.) a) "Violence challenges coping efforts." b) "Eighty percent of domestic violence victims are women." c) "Elder abuse happens to people over 55 years old." d) "Domestic violence rates are increasing." e) "Violence is not preventable."

c) "Elder abuse happens to people over 55 years old" d) "Domestic violence rates are increasing" e) "Violence is not preventable"

The brain waves of a client on life support are absent. In response to the family's question about the client being dead, for how long should the nurse explain that the brain waves must be absent before death can be declared? a) 1 hour or longer b) 12 hours or longer c) 24 hours or longer d) One week or longer

c) 24 hour or longer

Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid. b. Group therapy with other agoraphobics. c. Facing her fear in a gradual step progression. d. Hypnosis.

c. Facing her fear in a gradual step progression.

Which of the following is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention deficit/hyperactivity disorder

d

Intervention with Andrew (from question 12) would include: a. Encouraging expression of feelings b. Antianxiety medications c. Participation in a support group d. a and c e. All of the above

e. All of the above

Which client should the nurse assess for depression as a result of the grieving​ process? ​School-age client Adolescent client Older adult client Adult client

older adult client

A nurse is assessing a 4-year-old child for indications of autism spectrum disorder. For which of the following indications should the nurse assess? A. Impulsive behavior B. Repetitive counting C. Destructiveness D. Somatic problems

B

A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following is an appropriate response by the nurse? A. "Why do you think you feel the need to give money away?" B. "I am here to provide care and cannot accept this from you." C. "I can request that your case manager discuss appropriate charity options with you." D. "You should know that giving away your money is inappropriate."

B

A nurse is providing teaching for a male client who has schizophrenia and is taking risperidone. Which of the following instructions should the nurse include in the teaching? A. "Add extra snacks to your diet to prevent weight loss." B. "Notify the provider if you develop breast enlargement" C. "You may begin to have mild seizures while taking this medication" D. "This medication is likely to increase your libido"

B

A nurse is providing teaching to a client who has a new prescription for amitriptyline (Elavil). Which of the following client statements indicates understanding of the teaching? A. "While taking this medication, I'll need to stay out of the sun to avoid a skin rash." B. "I may feel drowsy for a few weeks after starting this medication." C. "I cannot eat my favorite pizza with pepperoni while taking this medication." D. "This medication will help me lose the weight that I have gained over the last year."

B

What is the most common mental health problem in the United​ States? Anxiety disorder Phobia Depression Posttraumatic stress disorder​ (PTSD)

anxiety disorder

The nurse is providing care to a client recently diagnosed with generalized anxiety disorder​ (GAD). The client​'s family asks the nurse how this could have occurred. Based on the client​'s ​history, which response is the most​ appropriate? "A lupus diagnosis has been specifically linked to generalized anxiety disorder." "A maternal history of depression can be a risk factor for developing a generalized anxiety disorder." "The recent loss of job is the cause of the diagnosis of generalized anxiety disorder." "Belonging to the upper socioeconomic class is a known factor for developing a generalized anxiety disorder."

"A lupus diagnosis has been specifically linked to generalized anxiety disorder." Rationale The most appropriate response by the nurse regarding the client​'s risk factors for developing GAD is the history of lupus. A maternal history of​ depression, belonging to the upper socioeconomic​ class, and the recent job loss are not known risk factors for developing GAD.

The nurse is providing education to a client diagnosed with generalized anxiety disorder. The client is prescribed alprazolam​ (Xanax) and scheduled to receive​ cognitive-behavioral therapy​ (CBT). The client asks the nurse why medication and therapy are both needed. Which response by the nurse is the most​ appropriate? "Medication without accompanying therapy may lead to substance abuse." "Cognitivedash-behavioral therapy in combination with medication is most effective when dealing with an anxiety disorder." "Medication is not effective without accompanying therapy." "​Cognitive-behavioral therapy uses complementary methods in additional to​ traditional, prescribed medication."

"Cognitivedash-behavioral therapy in combination with medication is most effective when dealing with an anxiety disorder." Rationale The most appropriate statement from the nurse is to educate the client that therapy used in combination to medication is the most effective treatment method for anxiety disorders. Medication can be effective without therapy and is not known to lead to substance abuse if not accompanied with therapy. CBT does not use complementary treatment methods.​ Therefore, this statement is not appropriate.

The nurse is providing education to a client diagnosed with a phobia. Which suggestion by the nurse is appropriate regarding the use of physical exercise as a treatment​ option? "Exercise releases​ endorphins, which will improve your mood and decrease anxiety." "Daily physical activity will help you sleep better at night." "Thought blocking is a wonderful physical activity for you to try." "Walking outside will help you to alleviate your fear."

"Exercise releases​ endorphins, which will improve your mood and decrease anxiety."

The nurse is caring for a client diagnosed with arachnophobia who is prescribed systematic desensitization therapy. After providing education on this type of​ therapy, which statement by the client indicates the need for further​ education? "I am not looking forward to looking at pictures of​ spiders, but I know that it is part of the process." "I am going to be placed in a room with spiders during my first session." "I will be able to discover why I have a fear of spiders because of this therapy." "I should be able to talk about spiders without feeling anxious once I finish a few sessions."

"I am going to be placed in a room with spiders during my first session."

The nurse teaches a client about medications used in the treatment of​ obsessive-compulsive disorder​ (OCD). Which client statement indicates appropriate understanding of the teaching​ session? "There are no side effects associated with this medication." "Medications are not effective in the treatment of OCD." "I will have to take medication for the rest of my life." "I may only have to take medication for​ 1-2 years and gradually be weaned off."

"I may only have to take medication for​ 1-2 years and gradually be weaned off."

While reviewing the goals in a​ client's plan of​ care, the client reports to the nurse that she wants to be taken off her antianxiety medication. Which findings indicate that the client is successfully meeting the identified goals and expected​ outcomes? Select all that apply. ​"I have missed a lot of work​ recently." ​"I sleep well at night​ now." ​"I am taking a yoga class and a cooking​ class." ​"I use what I learned in therapy to calm myself down when I start feeling​ anxious." ​"I feel​ good, not worried or​ anxious, most​ days."

"I sleep well at night​ now." ​"I am taking a yoga class and a cooking​ class." ​"I use what I learned in therapy to calm myself down when I start feeling​ anxious." ​"I feel​ good, not worried or​ anxious, most​ days." Rationale Expected outcomes for clients who succeed in resolving anxiety disorders include​ self-moderation of the anxiety​ response, demonstrating new or improved coping​ measures, and reporting diminished anxiety. Missing work may indicate occupational​ impairment, which could be the result of the​ client's anxiety disorder.

The nursing instructor has just finished educating a group of nursing students on the risk factors associated with the development of phobias. Which statement made by a student nurse would indicate the need for further​ education? "Social anxiety disorder typically develops between the ages of 11 and 15." "Social anxiety disorder almost never develops after the age of 25." "Girls and women are twice as likely to develop phobias as men." "Individuals are at lower risk of developing a phobia if their mom has the phobia."

"Individuals are at lower risk of developing a phobia if their mom has the phobia."

The nurse is providing care to a client who lost a child in a car crash 7 months ago. The client states that she has been feeling better over the last​ month, but that all of a sudden for the past week she has felt like the death just occurred. Which question allows the nurse to assess the reason for this resurgence of​ grief? "Did you recently sell your ​home?" "How many hours of sleep are you getting each ​night?" "Is this time of year significant for any ​reason?" "Have you been experiencing ​anger?"

"Is this time of year significant for any ​reason?"

The nurse is teaching a​ 25-year-old female client about taking a selective serotonin reuptake inhibitor​ (SSRI) for anxiety. Which information should the nurse include in the​ teaching? "The medication prevents blushing and hyperventilation." "The medication has more side effects than older antidepressants. "The medication also is used to treat heart conditions." "The medication takes a few weeks before achieving the full effects."

"The medication takes a few weeks before achieving the full effects." The full effects of SSRIs occur a few weeks after starting​ treatment, not right away. SSRIs have fewer side effects than older antidepressants.​ Beta-blockers are used to prevent physical symptoms of​ anxiety, such as blushing and​ hyperventilation, and to treat heart conditions.

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (SATA) A. Auditory hallucinations B. Lack of motivation C. Use of clang associations D. Delusion of persecution E. Constantly waving arms F. Flat affect ATI RN Mental Health Nursing Modules Ch. 14 Notes

*A, C, D, E*: Positive symptoms: Hallucinations Alterations in speech Delusions Bizarre motor movements ATI RN Mental Health Nursing Modules Ch. 14 Notes

A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are telling her to "kill your doctor." Which of the following is the priority action for the nurse to take? A. Use therapeutic communication to discuss the hallucination with the client. B. Initiate one-to-one observation of the client. C. Focus the client on reality. D. Notify the provider of the client's statement. ATI RN Mental Health Nursing Modules Ch. 14 Notes

*B*: A client who is experiencing a command hallucination is at risk for injury to self or others. Therefore, safety is the priority, and initiating one-to-one observation is the priority action. ATI RN Mental Health Nursing Modules Ch. 14 Notes

A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A. "I am a superhero and am immortal." B. "I am no one, and everyone is me." C. "I feel monsters pinching me all over." D. "I know that you are stealing my thoughts." ATI RN Mental Health Nursing Modules Ch. 14 Notes

*B*: Loss of identity ATI RN Mental Health Nursing Modules Ch. 14 Notes

A nurse is speaking with a client who has schizophrenia when he suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to himself. Which of the following actions should the nurse take? A. Stop the interview at this point, and resume later when the client is better able to concentrate. B. Ask the client, "Are you seeing something on the ceiling?" C. Tell the client, "You seem to be looking at something on the ceiling. I see something there, too." D. Continue the interview without comment on the client's behavior. ATI RN Mental Health Nursing Modules Ch. 14 Notes

*B*: The nurse should ask the client directly about the hallucination to identify client needs and assess for a potential risk for injury. ATI RN Mental Health Nursing Modules Ch. 14 Notes

1. A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should anticipate a prescription of which of the following medications? A. Chlorpromazine (Thorazine) B. Thiothixene (Navane) C. Risperidone (Risperdal) D. Haloperidol (Haldol)

1. A. INCORRECT: Conventional antipsychotics, such as chlorpromazine, are used mainly to control positive, rather than negative, symptoms of schizophrenia. B. INCORRECT: Conventional antipsychotics, such as thiothixene, are used mainly to control positive, rather than negative, symptoms of schizophrenia. C. CORRECT: Atypical antipsychotics, such as risperidone, are effective in treating negative symptoms of schizophrenia, such as lack of grooming and flat affect. D. INCORRECT: Conventional antipsychotics, such as haloperidol, are used mainly to control positive, rather than negative, symptoms of schizophrenia.

1. A nurse is teaching a client who has schizophrenia strategies to cope with anticholinergic effects of fluphenazine. Which of the following should the nurse suggest to the client to minimize anticholinergic effects? A. Take the medication in the morning to prevent insomnia. B. Chew sugarless gum to moisten the mouth. C. Use cooling measures to decrease fever. D. Take an antacid to relieve nausea.

1. A. INCORRECT: Insomnia is not an anticholinergic effect. B. CORRECT: Chewing sugarless gum can help the client cope with dry mouth, a potential anticholinergic effect of fluphenazine. C. INCORRECT: Fever is not an anticholinergic effect. D. INCORRECT: Nausea is not an anticholinergic effect.

1. A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job loss

1. A. Rape is an example of an adventitious crisis. It is not a part of everyday life. B. CORRECT: Marriage is an example of a maturational crisis, which is a naturally occurring event during the life span. C. Severe physical illness is an example of a situational crisis. D. Loss of a job is an example of a situational crisis.

2. A nurse is caring for a client who takes ziprasidone (Geodon). The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A. Olanzapine (Zyprexa) B. Quetiapine (Seroquel) C. Aripiprazole (Abilify) D. Clozapine (Clozaril) E. Asenapine (Saphris)

2. A. INCORRECT: Olanzapine is available only in tablet or injectable form and will therefore not address the current concerns with medication administration. B. INCORRECT: Quetiapine is available only in tablets or extended-release tablets and will therefore not address the current concerns with medication administration. C. CORRECT: Aripiprazole is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. D. CORRECT: Clozapine is available in an orally disintegrating tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection. E. CORRECT: Asenapine is available in a sublingual tablet, which is appropriate for clients who have difficulty swallowing oral tablets. This route also decreases the risk for agitation associated with an injection.

2. A nurse is assessing a male client who recently began taking haloperidol (Haldol). Which of the following findings is the highest priority to report to the provider? A. Shuffling gait B. Neck spasms C. Drowsiness D. Impotence

2. A. INCORRECT: Shuffling gait is an indication of parkinsonism and should be reported to the provider. However, this is not the greatest risk to the client and is therefore not the priority finding. B. CORRECT: Neck spasms are an indication of acute dystonia which is a crisis situation requiring rapid treatment. This is the greatest risk to the client and is therefore the priority finding. C. INCORRECT: Drowsiness is an adverse effect of haloperidol and should be reported to the provider. However, this is not the greatest risk to the client and is therefore not the priority finding. D. INCORRECT: Sexual dysfunction is an adverse effect of haloperidol and should be reported to the provider. However, this is not the greatest risk to the client and is therefore not the priority finding.

3. A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following should the charge nurse identify as being effectively treated by conventional antipsychotics? (Select all that apply.) A. Auditory hallucinations B. Withdrawal from social situations C. Delusions of grandeur D. Severe agitation E. Anhedonia

3. A. CORRECT: Positive symptoms of schizophrenia, such as auditory hallucinations, are effectively treated with conventional antipsychotics. B. INCORRECT: Conventional antipsychotics have minimal effectiveness with negative symptoms of schizophrenia, such as social withdrawal. C. CORRECT: Positive symptoms of schizophrenia, such as delusions of grandeur, are effectively treated with conventional antipsychotics. D. CORRECT: Positive symptoms of schizophrenia, such as severe agitation, are effectively treated with conventional antipsychotics. E. INCORRECT: Conventional antipsychotics have minimal effectiveness with negative symptoms of schizophrenia, such as anhedonia.

3. A nurse is providing discharge teaching for a client who has a new prescription for clozapine (Clozaril). Which of the following statements is appropriate for the nurse to include in the teaching? A. "You should have a high-carbohydrate snack between meals and at bedtime." B. "You are likely to develop hand tremors if you take this medication for a long period of time." C. "You may experience temporary numbness of your mouth after each dose." D. "You should have your white blood cell count monitored every week."

3. A. INCORRECT: Clozapine increases the client's risk of developing diabetes mellitus and weight gain. It is not appropriate to increase carbohydrate intake. B. INCORRECT: Clozapine has a low risk of EPS such as hand tremors. C. INCORRECT: Asenapine, rather than clozapine, causes temporary numbing of the mouth. D. CORRECT: Due to the risk for fatal agranulocytosis weekly monitoring of the client's WBC count is recommended while taking clozapine.

4. A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) A. Decreased level of consciousness B. Drooling C. Involuntary arm movements D. Urinary retention E. Continual pacing

4. A. INCORRECT: Decreased level of consciousness is an indication of neuroleptic malignant syndrome rather than an EPS. B. CORRECT: Drooling is an indication of parkinsonism, which is an EPS. C. CORRECT: Involuntary arm movements are an indication of tardive dyskinesia, which is an EPS. D. INCORRECT: Urinary retention is an anticholinergic effect rather than an EPS. E. CORRECT: Continual pacing is an indication of akathisia, which is an EPS.

4. A nurse performs an Abnormal Involuntary Movement Scale (AIMS) assessment on a client who began taking loxapine 2 years ago for the treatment of schizophrenia. Findings include lip smacking, tongue protrusion, and facial grimacing. The nurse should suspect which of the following? A. Parkinsonism B. Tardive dyskinesia C. Anticholinergic effects D. Akathisia

4. A. INCORRECT: These findings do not indicate parkinsonism, which is most common during the first month of therapy. B. CORRECT: These findings indicate tardive dyskinesia, which can occur months to years after the initiation of therapy. C. INCORRECT: These findings do not indicate an anticholinergic effect. D. INCORRECT: These findings do not indicate akathisia, which is most common during the first 2 months of therapy.

5. A nurse is preparing to perform a follow-up assessment on a client who takes chlorpromazine (Thorazine) for the treatment of schizophrenia. The nurse should expect to find the greatest improvement in which of the following manifestations? (Select all that apply.) A. Disorganized speech B. Bizarre behavior C. Impaired social interactions D. Hallucinations E. Decreased motivation

5. A. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as disorganized speech. B. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as bizarre behavior. C. INCORRECT: Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as impaired social interactions. D. CORRECT: A client who takes a conventional antipsychotic medication, such as chlorpromazine, should have the greatest improvement in positive symptoms such as hallucinations. E. INCORRECT: Conventional antipsychotic medications, such as chlorpromazine, have less effect on negative symptoms such as decreased motivation.

5. A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone (Fanapt). Which of the following client statements indicates understanding of the teaching? A. "I will be able to stop taking this medication as soon as I feel better." B. "If I feel drowsy during the day, I will stop taking this medication and call my provider." C. "I will be careful not to gain too much weight while taking this medication." D. "This medication is highly addictive and must be withdrawn slowly."

5. A. INCORRECT: Antipsychotic medications are considered a long-term treatment for schizophrenia. Discontinuing the medication can result in an exacerbation of manifestations. B. INCORRECT: Drowsiness is a common adverse effect of antipsychotic medications. However, it is not appropriate to discontinue the medication. C. CORRECT: Antipsychotic medications, such as iloperidone, have a high risk for significant weight gain. D. INCORRECT: Antipsychotic medications are not considered addictive, and it is not necessary to titrate iloperidone when discontinuing treatment.

A charge nurse is discussing mirtazapine (Remeron) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A. "This medication increases the release of serotonin and norepinephrine." B. "I will need to monitor the client for hyponatremia while taking this medication." C. "This medication is contraindicated for clients who have an eating disorder." D. "Sexual dysfunction is a common adverse effect of this medication."

A

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching? A. "Care during the continuation phase focuses on treating continued manifestations of MDD." B. "The goal of treatment during the maintenance phase is prevention of future episodes of MDD." C. "The client is at greatest risk for suicide during the first weeks of an MDD episode." D. "Medication and psychotherapy are used to prevent a relapse of MDD."

A

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take? A. Administer the next dose of lithium carbonate as scheduled B. Prepare for administration of aminophyline C. Notify the provider for possible increase in the dosage of lithium carbonate D. Request a stat repeat of the client's lithium blood level

A

A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following is the highest priority action by the nurse? A. Placing the client on one-to-one observation B. Assisting the client to perform ADLs C. Encouraging the client to participate in counseling D. Teaching the client about medication adverse effects

A

A psychiatric nurse is performing an assessment on a client diagnosed with a mood disorder. Which is not an example of effective assessment techniques for this client? A) Ask frequent, direct questions in order to obtain as much information as needed. B) Establish a therapeutic relationship based on mutual trust. C) Remain nonjudgmental D) Validate the client's feelings.

A Rationale: Effective assessment techniques include establishing a therapeutic relationship based on mutual trust, asking open-ended questions and allowing time for the client to talk, remaining nonjudgmental, and validating he client's feelings.

A nurse is conducting research on the relationship between the neurological system and mood disorders. The nurse learns that the neurotransmission hypothesis explains this relationship and also: A) provides an explanation for the higher incidence of depression in women and older adults. B) hypothesizes that an increase in all neurotransmitters lead to mood disorders. C) describes an increase in neurotransmission during depression. D) during the depressive state, receptors may be sub sensitive, resulting in a decrease in the transmission of impulses.

A The neurotransmission hypothesis is specifically concerned with the levels of serotonin, dopamine, norepinephrine, and acetylcholine in the central nervous system (CNS). It is believed that there is a functional deficiency of these neurotransmitters during a depressive episode and a functional excess during a manic episode. The theory provides an explanation for the higher incidence of depression in women and older adults.

A client with major depression tells the nurse, "Life isn't worth living. I can't stand the pain any longer." The nurse should recognize this statement as indicative of: A. the need for a suicide assessment B. the need for a pain assessment C. the need to administer an antidepressant D. the need to provide diversional stimuli

A Because this client has verbalized passive suicidal ideation, the nurse should begin a suicide assessment with a direct question about suicide.

Recently, an adolescent has become increasingly withdrawn, has grown irritable with family members, and has been getting lower grades on schoolwork. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. Which problem is the adolescent at risk for? A. Suicide B. Anorexia C. School phobia D. Psychotic episode

A Changes in academic performance, familial communication, social withdrawal, and the giving away of treasured possessions are behaviors that suggest this adolescent is contemplating suicide.

Which nursing intervention takes priority when working with a newly admitted client experiencing suicidal ideations? A. Monitor the client at close, but irregular, intervals B. Encourage the client to participate in group therapy C. Enlist friends and family to assist the client in remaining safe after discharge D. Remind the client that it takes 6 to 8 weeks for antidepressants to be fully effective

A Clients who experience suicidal ideations must be monitored closely to prevent suicide attempts. By monitoring at irregular intervals, the nurse would prevent the client from recognizing patterns of observation. If a client recognizes a pattern of observation, the client can use the time in which he or she is not observed to plan and implement a suicide attempt.

A 35-year-old - who's a divorced patent of three - was admitted 5 days ago with major depression after a suicide attempt. He was prescribed a daily dosage of fluoxetine (Prozac). Since starting the medication, his appetite and participation in group therapy have improved. Which nursing diagnosis should receive the highest priority? A. Risk for self-directed violence related to suicide attempt B. Deficient knowledge related to antidepressant therapy C. Chronic low self-esteem related to recurrent depression D. Anxiety related to disruption in role performance

A Despite the improvement in appetite and group participation, the client's risk for self-inflicted harm remains a priority. When depression is resolving, the client can focus more on carrying out a suicide plan.

A suicidal Jewish-American client is admitted to an in-patient psychiatric unit 2 days after the death of a parent. Which intervention must the nurse include in the care of this client? A. Allow the client time to mourn the loss during his time of shiva B. Distract the client from the loss and encourage participation in unit group C. Teach the client alternative coping skills to deal with grief D. Discuss positive aspects the client has in his or her life to build on strengths

A In the Jewish faith, the 7-day period beginning with the burial is called shiva. During this time, mourners do not work, and no activity is permitted that diverts attention from thinking about the deceased. Because this client's parent died 2 days ago, the client needs time to participate in this religious ritual.

A​ client, who usually demonstrates an appropriate​ affect, becomes irritated and angry after learning that a community health clinic is closing and care will need to be obtained 20 miles away. What should the nurse suspect as being the reason for this client​'s change in​ affect? A) Location of the clinic 20 miles away B) Length of time receiving care at the community clinic C) Relationship with the person sharing the news about the clinic closing D) Underlying health problem

A Rationale Environmental influences strongly impact the ability to regulate one​'s mood intensity and shift. After learning that a community clinic is closing and the next closest one is 20 miles​ away, the client becomes irritated and angry. There is no information to support that the client​'s irritation and anger is because of an underlying health​ problem, length of time the community clinic was the location to receive​ care, or the relationship with the person sharing the news about the clinic closing.

During morning​ report, the nurse learns that a client​'s affect is flat. What should the nurse expect when interacting with this​ client? A) Complete lack of emotional response B) Switches between sadness and joy C) Loudly states the joy of being hospitalized D) Engages in meaningful conversation

A Rationale With a flat​ affect, there are no visible cues to the person​'s emotions. Affect that suddenly changes in a way that cannot be understood in the context of the situation is labile. Engaging in meaningful conversation would be consistent with an appropriate affect. Affect that is appropriate but out of proportion to the immediate​ situation, such as loudly stating the joy of being​ hospitalized, is​ over-reactive.

A nurse has obtained a new position in a psychiatric facility and is reviewing the facilities policies and procedures regarding preventing client suicide. Which policy will not be included? A) Establish a predictable pattern of observation during the day and night. B) Let suicidal clients know that the environment is safe for them. C) Examine items brought by visitors and monitor for safety. D) Family members cannot substitute for staff in performing one-to-one observation.

A Rationale: The nurse's first priority in all situations is client safety. All policies and procedures regarding preventing client suicide should focus on the client's safety. In a client at risk for suicide, the nurse will let suicidal clients know that the environment is safe for them. The nurse will also examine items brought by visitors and monitor for safety. Family members cannot substitute for staff in performing one-to-one observation of a suicidal client. Also, the nurse will establish an unpredictable pattern of observation in order to let suicidal clients know that the environment is safe.

A client has a nursing diagnosis of risk for suicide R/T a past suicide attempt. Which outcome, based on this diagnosis, would the nurse prioritize? A. The client will remain free from injury throughout hospitalization B. The client will set one realistic goal related to relationships by day 3 C. The client will verbalize one positive attribute about self by day 4 D. The client will be easily redirected when discussion about suicide occurs by day 5

A Remaining free from injury throughout hospitalization is a priority outcome for the nursing diagnosis of risk for suicide R/T a past suicide attempt. Because this outcome addresses client safety, it is prioritized.

A client, admitted after experiencing suicidal ideations, is prescribed citalopram (Celexa). Four days later, the client has pressured speech and is noted wearing heavy makeup. What may be a potential reason for this client's behavior? A. The client is in a manic episode caused by the citalopram (Celexa) B. The client is showing improvement and is close to discharge C. The client is masking depression in an attempt to get out of the hospital D. The client has "cheeked" medications and taken them all in an attempt to overdose

A When an SSRI is prescribed for clients diagnosed with bipolar affective disorder, it can cause alterations in neurotransmitters and trigger a hypomanic or manic episode.

A nurse is working on an acute mental health unit, caring for a client who has PTSD. Which of the following are expected findings? SATA hallucinations obsessive need to talk about the traumatic event exaggerated displays of emotion recurring nightmares diminished reflexes

A client w PTSD will experience hallucinations, recurring dreams, inability to show feelings, detachment, avoidance of stimuli/traumatic event and increased arousal and irritability.

A nurse is caring for a client who has depression and a new prescription for venlafaxine. For which of the following adverse effects should the nurse monitor this client? (Select all the apply) A. Cough B. Dizziness C. Decreased libido D. Alopecia E. Hypotension

A, B, C

A nurse is obtaining a health history from the parents of a 12-year-old client who has conduct disorder. Which of the following are expected findings? (Select all that apply.) A. Bullying of others B. Threats of suicide C. Law-breaking activities D. Narcissistic behavior E. Flat affect

A, B, C

A nurse working in an acute mental health facility is caring for a 35-year-old female client who has clinical findings of depression. The client lives at home with her husband and two young children. She currently smokes and has a history of chronic asthma. The nurse should identify which of the following as risk factors for depression for this client? (Select all that apply.) A. Age of 35 years old B. Female gender C. History of chronic asthma D. Currently smokes E. Being married

A, B, C, D

A nurse is teaching a client who has a new prescription for imipramine (Tofranil) how to minimize anticholinergic effects. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Void just before taking the medication. B. Increase the dietary intake of potassium. C. Wear sunglasses when outside. D. Change positions slowly when getting up. E. Chew sugarless gum.

A, C, E

While reviewing previous​ documentation, the nurse notes that a client is described as demonstrating passive behavior. What should the nurse expect when communicating with this​ client? Select all that apply. A) Avoiding conflict or confrontation B) Intimidating others C) Unexpected explosions of anger D) Lack of consideration for others​' feelings E) Expressive feelings but not at the expense of others

A,C Rationale Characteristics of passive behavior include unexpected explosions of anger and avoiding conflict or confrontation. Intimidating others and lacking consideration for others​' feelings are characteristics of aggressive behavior. Expressing feelings but not at the expense of others is a characteristic of assertive behavior.

The nurse in the emergency department is assessing a client suspected of being suicidal. Number the following assessment questions, beginning with the most critical and ending with the least critical. A. "Are you currently thinking about suicide?" B. "Do you have a gun in your possession?" C. "Do you have a plan to commit suicide?" D. "Do you live alone? Do you have local friends or family?"

A,C,B,D -Assessment of suicidal ideations must occur before any other assessment data are gathered. If the client is not considering suicide, continuing with the suicide assessment is unnecessary. -Assessment of a suicide plan is next. A client's risk for suicide increases if the client has developed a specific plan. -Assessment of the access to the means to commit suicide is next. The ability for the client to access the means to carry out the suicide plan is an important assessment in order for the nurse to intervene appropriately. If a client has a loaded gun available to him or her at home, the nurse would be responsible to assess this information and initiate actions to decrease the client's access. -Assessment of the client's potential for rescue is next. If a client has an involved support system, even if a suicide attempt occurs, there is a potential for rescue. Without an involved support system, the client is at higher risk.

At the conclusion of a health​ history, the nurse is concerned that a​ middle-aged client is experiencing physical manifestations of depression. What did the nurse assess to come to this​ conclusion? Select all that apply. A) Inability to recall the last time ingested food B) Reports sleeping 1 to 2 hours each night C) States a considerable loss of energy D) Clothing​ rumpled; hair not washed or combed E) Became tearful during the interview

A,C,D Rationale Physical manifestations of depression include a loss of​ energy, lack of​ appetite, and appearing unkempt with poor hygiene. Sleeping 1 to 2 hours each night is a physical manifestation of mania. Tearfulness is an affective characteristic of depression.

A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (Select all that apply) A. Conducting a suicide risk screening on all new clients B. Creating a support group for family members of clients who completed suicide C. Educating high school teens about suicide prevention D. Initiating one-on-one observation for a client who has current suicidal ideation E. Teaching middle-school educators about warning indicators of suicide

A,C,E -Primary interventions include suicide prevention through the use of screenings to identify individuals at risk. Conducting a suicide risk screening on all new clients is an example of a primary intervention. -Primary interventions include suicide prevention through the use community education. Educating high school teens about suicide prevention is an example of a primary intervention. -Primary interventions include suicide prevention through the use community education. Educating middle-school teachers to recognize the warning indicators of suicide is an example of a primary intervention.

A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply) A. "My family will be better off if I'm dead." B. "The stress in my life is too much to handle." C. "I wish my life was over." D. "I don't feel like I can ever be happy again." E. "If I kill myself then my problems will go away."

A,C,E These statements are overt comments about suicide in which the client directly talks about his perception of an outcome of his death. The nurse should assess the client further for a suicide plan.

Nurse is discussing routine follow‑up needs with a client who has a new prescription for valproate. the nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT & LDH B. Creatinine & BUN C. WBC & Granulocyte counts D. Serum sodium & potassium

A- Routine monitoring of liver function tests is necessary due to the risk for hepatotoxicity

A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? A. Death of a child 2 months ago B. Recent weight loss of 30 lbs C. Retirement 1 year ago D. History of migraine headaches

A.

2. A nurse is preparing to assess an infant who has shaken baby syndrome. Which of the following is an expected finding? (Select all that apply.) A. Sunken fontanels B. Respiratory distress C. Retinal hemorrhage D. altered level of consciousness E. increase in head circumference

A. Bulging, rather than sunken, fontanels are an expected finding of shaken baby syndrome. B. CORRECT: Respiratory distress is an expected finding of shaken baby syndrome. C. CORRECT: Retinal hemorrhage is an expected finding of shaken baby syndrome. D. CORRECT: an altered level of consciousness is an expected finding of shaken baby syndrome due to intracranial trauma or hemorrhage. E. CORRECT: an increase in head circumference is an expected finding of shaken baby syndrome.

1. A nurse is discussing silent rape reaction with a newly licensed nurse. The nurse should identify which of the following characteristics as expected for this type of reaction? (Select all that apply.) A. Sudden development of phobias B. Development of substance use disorder C. Increased level of anxiety during interview D. Reactivation of a prior physical disorder E. unwillingness to discuss the sexual assault

A. CORRECT: Sudden onset of phobic reactions is a characteristic of a silent rape reaction. B. Development of substance use disorder is a characteristic of a compound rape reaction. C. CORRECT: Increased anxiety during interview is a characteristic of a silent rape reaction. D. Reactivation of a prior physical disorder is a characteristic of a compound rape reaction. E. CORRECT: No verbalization of the sexual assault is a characteristic of a silent rape reaction.

4. A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding? (Select all that apply.) A. "I may experience feelings of resentment." B. "I will probably withdraw from others." C. "I can expect to experience changes in sleep." D. "It is possible that I will experience suicidal thoughts." E. "It is expected that I will have a loss of self‑esteem."

A. CORRECT: resentment is an emotion that can be associated with normal grief. B. CORRECT: Withdrawal is an emotion that can be seen with normal grief. C. CORRECT: somatic manifestations such as changes in sleep patterns can be associated with normal grief. D. Suicidal ideations are associated with maladaptive grieving. The client who is experiencing a distorted or exaggerated grief response can direct anger towards himself. The nurse should assess and monitor the client for thoughts of suicide or self‑injury. E. A client who is experiencing a maladaptive grief response commonly experiences a loss of self‑esteem and a sense of worthlessness. these findings are not associated with normal grief

3. A nurse is working with a client who has recently lost his mother. The nurse recognizes that which of the following factors influence a client's grief and coping ability? (Select all that apply.) A. interpersonal relationships B. Culture C. Birth order D. religious beliefs E. Prior experience with loss

A. CORRECT: the client's interpersonal relationships are factors which influence the client's reaction to grief and ability to cope. B. CORRECT: the client's culture is a factor that influences the client's reaction to grief and ability to cope. C. Birth order is not a factor that influences grief and ability to cope. D. CORRECT: the client's religious beliefs are factors that influence the client's reaction to grief and ability to cope. E. CORRECT: the client's prior experience with loss is a factor that influences the client's reaction to grief and ability to cope.

5. A nurse is caring for an adult client who has injuries resulting from intimate partner abuse. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A. Advise the client about the location of women's shelters. B. Encourage the client to participate in a support group for survivors of abuse. C. Implement case management to coordinate community and social services. D. Educate the client about the use of stress management techniques.

A. CORRECT: the greatest risk to this client is injury from intimate partner abuse; therefore, the priority action the nurse should take is to assist the client with the development of a safety plan that includes the identification of safe places to live. B. The nurse should encourage participation in a support group. However, this does not address the greatest risk to the client and is therefore not the priority nursing action. C. The nurse should implement case management. However, this does not address the greatest risk to the client and is therefore not the priority nursing action. D. The nurse should educate the client about the use of stress management techniques. However, this does not address the greatest risk to the client and is therefore not the priority nursing action.

3. A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of teaching? A. "I will administer prophylactic treatment for sexually transmitted infections, like chlamydia." B. "I am not required to obtain informed consent before the sexual assault nurse examiner collects forensic evidence." C. "I can expect manifestations of rape‑trauma syndrome to be similar to bipolar disorder." D. "I should use narrative documentation when documenting subjective data."

A. CORRECT: the nurse should administer prophylactic treatment for infections such as chlamydia according to the Centers for Disease Control and Prevention. B. The nurse must obtain informed consent to collect data that can be used as legal evidence. C. Manifestations of rape‑trauma syndrome are similar to posttraumatic stress disorder. D. The nurse should document subjective data, using the client's verbatim statements.

5. A nurse is caring for a client who lost his mother to cancer last month. The client states, "I'd still have my mother if the doctor would have diagnosed her sooner." Which of the following responses should the nurse make? A. "You sound angry. Anger is a normal feeling associated with loss." B. "I think you would feel better if you talked about your feelings with a support group." C. "I understand just how you feel. I felt the same when my mother died." D. "Do other members of your family also feel this way?"

A. CORRECT: this is a therapeutic response for the nurse to make. This response acknowledges the client's emotion and provides education on the normal grief response. B. This response offers advice, which is a nontherapeutic communication technique. C. This response minimizes the client's feelings and takes the focus away from the client, which are nontherapeutic communication techniques. D. This response takes the focus away from the client, which is a nontherapeutic communication technique.

5. A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? A. "Stop screaming, and walk with me outside." B. "Why are you so angry and screaming at everyone?" C. "You will not get your way by screaming." D. "What was going through your mind when you started screaming?

A. CORRECT: this is an appropriate therapeutic response. Setting limits and the use of physical activity, such as walking, to deescalate anger is an appropriate intervention. B. "Why" questions imply criticism and will often cause the client to become defensive. C. This is a closed‑ended, nontherapeutic statement. D. The client is not ready to discuss this issue.

1. A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching? A. "Children older than 3 are at greater risk for abuse" B. "Substance use disorder does not increase the risk for violence." C. "Entering an intimate relationship increases the risk for violence." D. "Pregnancy increases the risk for violence toward the intimate partner."

A. Children younger than 3 years of age are at an increased risk for abuse. B. Substance use disorder increases the risk for violence. C. Vulnerable persons are an increased risk for violence when they try to leave the relationship. D. CORRECT: Pregnancy tends to increase the likelihood of violence toward the intimate partner.

2. A charge nurse is reviewing Kübler‑ross: five stages of grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? (Select all that apply.) A. Disequilibrium B. Denial C. Bargaining D. Anger E. Depression

A. Disequilibrium is the second stage of Bowlby's four stages of grief. B. CORRECT: the denial stage is when the client has difficulty believing a terminal diagnosis or loss. This is one of Kübler‑ross five stages of grief. C. CORRECT: The bargaining stage is when the client negotiates for more time or a cure. This is one of Kübler‑ross five stages of grief. D. CORRECT: the anger stage is when the client directs anger toward self, others, or objects. This is one of Kübler‑ross five stages of grief. E. CORRECT: the depression stage is when the client mourns and directly confronts feelings related to the loss. This is one of Kübler‑ross five stages of grief.

4. A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A. Encourage the client to express her feelings. B. Maintain eye contact with the client. C. Move the client away from others. D. Tell the client that the behavior is not acceptable.

A. Encouraging the client to express her feelings is appropriate. However, it is not the priority action. B. Maintaining eye contact with the client is appropriate. However, it is not the priority action. C. CORRECT: the client's behavior indicates that he is at greatest risk for harming others. The priority action for the nurse is to move the client away from others. D. It is appropriate to tell the client that the behavior is not acceptable. However, it is not the priority action.

2. A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape‑trauma syndrome? (Select all that apply.) A. Genitourinary soreness B. Difficulties with low self‑esteem C. Sleep disturbances D. emotional outbursts E. Difficulty making decisions

A. Genitourinary soreness indicates a somatic reaction. B. Difficulties with low self‑esteem are an indication of a sustained and maladaptive emotional response beyond the initial reaction. C. Sleep disturbances indicates a somatic reaction. D. CORRECT: emotional outbursts indicate an expressed initial reaction of rape‑trauma syndrome. E. CORRECT: Difficulty making decisions indicates a controlled initial reaction of rape‑trauma syndrome.

3. A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply.) A. Lethargy B. Defensive responses to questions C. Disorientation D. Facial grimacing E. Agitation

A. Lethargy is more likely to be observed in a client who has depression. B. CORRECT: Defensive responses to questions are an assessment finding that can indicate that a client is in the preassaultive stage of violence. C. Disorientation is more likely to be assessed in a client who has a cognitive disorder. D. CORRECT: Facial grimacing is an assessment finding that can indicate that a client is in the preassaultive stage of violence. E. CORRECT: Agitation is an assessment finding that can indicate that a client is in the preassaultive stage of violence.

3. A nurse working in an emergency department is assessing a preschool‑age child who reports abdominal pain. When conducting a head‑to‑toe assessment, which of the following findings should alert the nurse to possible abuse? (Select all that apply.) A. abrasions on knees B. Round burn marks on forearms C. mismatched clothing D. abdominal rebound tenderness E. areas of ecchymosis on torso

A. Minor injuries, such as abrasions, on the arms and legs are common in this age group. B. CORRECT: Round burn marks anywhere on the child's body can indicate cigarette burns and should alert the nurse to possible abuse. C. Mismatched clothing is consistent with the child's developmental age. D. Abdominal rebound tenderness is a possible indication of appendicitis rather than abuse. E. CORRECT: areas of ecchymosis on the torso, back, or buttocks should alert the nurse to possible abuse.

5. A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? A. "Rape is a crime of passion." B. "Acquaintance rape often involves alcohol." C. Young adults are the typical victims of sexual assault." D. "The majority of rapists are unknown to the victims."

A. Rape is a crime of violence, aggression, anger, and power. B. CORRECT: alcohol and other substances are often associated with date or acquaintance rape. C. Individuals of all ages are affected by sexual assault and can be male or female. D. The majority of perpetrators are known to the vulnerable persons.

4. A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? A. Refusing to pay bills for a dependent, even when funds are available, is neglect. B. Intentionally causing an older adult to fall is an example of physical violence. C. Striking an intimate partner is an example of sexual violence. D. Failure to provide a stimulating environment for normal development is emotional abuse.

A. Refusing to pay bills for a dependent is economic maltreatment, rather than neglect. B. CORRECT: Physical violence occurs when physical pain or harm is directed toward another individual. C. Striking an intimate partner or other individual is an example of physical, rather than sexual, violence. Sexual violence occurs when sexual contact takes place without consent. D. Failure to provide a stimulating environment for normal development is neglect, rather than emotional abuse.

4. A nurse is caring for a client who was recently raped. The client states, "I never should have been out on the street alone at night." Which of the following responses should the nurse make? A. "Your actions had nothing to do with what happened." B. "You should focus on recovery rather than blaming yourself for what happened." C. "You believe this wouldn't have happened if you hadn't been out alone?" D. "Why do feel that you should not have been alone on the street at night?"

A. This response offers the nurse's opinion, which is a nontherapeutic communication technique. B. This responses indicates disapproval, which is a nontherapeutic communication technique. C. CORRECT: this response uses the therapeutic communication technique of restating, which promotes reflection and verbalization of feelings. D. This responses asks a "why" question, which is a nontherapeutic communication technique.

1. A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A. "I wish you would not make me angry." B. "I feel angry when you leave me." C. "It makes me angry when you interrupt me." D. "You'd better listen to me."

A. This statement does not imply a threat, nor does it indicate a lack of respect for another individual. B. This statement does not imply a threat, nor does it indicate a lack of respect for another individual. C. This statement does not imply a threat, nor does it indicate a lack of respect for another individual. D. CORRECT: this statement implies a threat and a lack of respect for another individual.

A nurse assessing a client who has illness anxiety disorder. Which of the following findings should the nurse expect? (select all that apply) A. Obsessive thoughts about disease B. History of childhood abuse C. Avoidance of health care providers D. Depressive Disorder E. Narcissistic personality

ABCD

5. A nurse is caring for a patient who has been taking sertraline for the past 2 days. Which of the following assessment findings should alert the nurse to the possibility that the client is developing serotonin syndrome? a. Bruising b. Fever c. Abdominal pain d. Rash

ANSWER: B Rationale: a. Bleeding can result if an SSRI is administered with warfarin. However, this is not an indication of serotonin syndrome. b. Fever is a manifestation of serotonin syndrome, which can result from taking an SSRI such as sertraline. c. Abdominal pain is not an indication of serotonin syndrome. d. A localized rash is associated with transdermal preparation. However, it is not an indication of serotonin syndrome.

3. A nurse is providing follow-up dietary teaching to a client who was recently prescribed phenelzine. When reviewing the client's dietary log, which of the following foods requires a need for further teaching a. Cottage cheese b. Banana bread c. Apple pie d. Grilled steak

ANSWER: B -- banana bread Rationale: a. The client should avoid aged cheese rather than cottage cheese, which contains little or no tyramine and is therefore considered a safe food choice b. Clients taking phenelzine, an MAOI, should avoid foods containing tyramine. Banana and yeast products contain tyramine. Therefore, the selection of banana bread requires the need for further teaching. c. Apple pie contains little or no tyramine and is therefore considered a safe food choice. d. The client should avoid aged meats rather than grilled steak, which contains little to no tyramine and is considered a safe food choice.

2. A nurse is providing teaching to a client who has a new prescription for amitriptyline for treatment of depression. Which of the following should the nurse include in the teaching? (Select all that apply) a. Expect therapeutic effects in 24-48 hours. b. Discontinue the medication after a week of improved mood. c. Change positions slowly to minimize dizziness. d. Decrease dietary fiber intake to control diarrhea e. Chew sugarless gum to prevent dry mouth.

ANSWERS: C, E Rationale: a. Therapeutic effects are expected after several weeks of taking amitriptyline. b. Stopping amitriptyline abruptly can result in relapse. c. Changing positions slowly helps prevent orthostatic hypotension, which is an adverse effect of amitriptyline d. Clients should increase dietary fiber to prevent constipation, which is an adverse effect of amitriptyline. e. Chewing sugarless gum can minimize dry mouth, which is an adverse effect of amitriptyline.

The student nurse has completed a care plan for a client diagnosed with posttraumatic stress disorder. Which intervention is not appropriate for the student to include in the plan of care for this​ client? Help the client to express fears that interfere with daily life Teach the client the use of positive imagery Identify safe physical outlets for negative feelings Administer propranolol as ordered

Administer propranolol as ordered -beta blocker that is not a pharmacologic therapy for PTSD

The nurse is caring for a client who is experiencing severe anxiety. Which intervention should the nurse include on the plan of​ care? Isolating the client Having the client walk a mile on a treadmill Encouraging the client to participate in group activities Administering medications to the client as ordered

Administering medications to the client as ordered Rationale When a client is experiencing severe​ anxiety, the nurse needs to administer medications as prescribed. Isolating the client will prevent disturbance or threat to others. The nurse needs to provide a​ safe, quiet​ environment, but should not leave the client unattended. Walking a mile on a treadmill is not appropriate for this client at this time.

The nurse is caring for an older adult who is in the process of grieving the loss of a sibling. Which response noted in the client is not typically seen at this developmental​ stage? Aggression Anger Sadness Denial

Aggression

Where is the​ brain's "worry​ center"? Brain stem Hypothalamus Amygdala Frontal lobe

Amygdala The amygdala is the​ brain's worry center. The frontal lobe regulates​ decision-making. The brain stem controls basic survival functions. The hypothalamus controls the autonomic nervous system.

The local​ woman's club has invited a public health nurse to give a seminar about mental health issues. The nurse begins by talking about the disorders that are more common among women than among men. Which disorders will the nurse​ list? Select all that apply. Phobia Anxiety disorder Insomnia Posttraumatic stress disorder​ (PTSD) ​Obsessive-compulsive disorder

Anxiety disorder PTSD Rationale: Anxiety disorder and posttraumatic stress disorder​ (PTSD) are more common among women than among men.​ Obsessive-compulsive disorder is equally common among men and women. Phobia strikes men twice as often as women. Insomnia is a​ symptom, not a disorder.

A client diagnosed with depression expresses feelings of hopelessness to the client's nurse. What is the best response by the nurse? A) "I understand. Your condition can cause these feelings." B) "Are you having thoughts of suicide?" C) "Why do feel like this?" D) "Don't worry. Once you have been treated for depression, these feelings will subside."

B Rationale: A client with depression has an increased risk for suicide. If a client expresses feelings of hopelessness, the nurse must first assess for thoughts of suicide. The other responses are incorrect and inappropriate.

A psychiatric nurse is caring for a client who is undergoing electroconvulsive therapy (ECT). What does the nurse suspect this client has been diagnosed with? A) Bipolar disorder B) Major depressive disorder C) Adjustment disorder with depressed mood D) Postpartum depression

B Rationale: Electroconvulsive therapy (ECT) is used to treat major depressive disorder.

A nursing instructor is presenting statistics regarding suicide. Which student statement indicates that learning has occurred? A. "Approximately 10,000 individuals in the United States will commit suicide each year." B. "Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder." C. "Suicide is the eighth leading cause of death among young Americans 15 to 24 years old." D. "Depressive disorders account for 1/3 of all individuals who commit or attempt suicide."

B Almost 95% of all individuals who commit or attempt suicide have a diagnosed mental disorder. Most suicides are associated with mood disorders.

A client denying suicidal ideations comes into the emergency department complaining about insomnia, irritability, anorexia, and depressed mood. Which intervention would the nurse implement first ? A. Request a psychiatric consultation B. Complete a thorough physical assessment including lab tests C. Remove all hazardous materials from the environment D. Place the client on a one-to-one observation

B Numerous physical conditions can contribute to symptoms of insomnia, including irritability, anorexia, and depressed mood. It is important for the nurse to rule out these physical problems before assuming that the symptoms are psychological in nature. The nurse can do this by completing a thorough physical assessment including review of lab tests.

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? A. Client's educational and economic background B. Lethality of the method and availability of means C. Quality of the client's social support D. Client's insight into the reasons for the decision

B The greatest risk to the client is self-harm as a result of carrying out a suicide plan. The priority assessment is to determine how lethal the method is, how available the method is, and how detailed the plan is.

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following is appropriate for the nurse to include in the plan of care? (Select all that apply.) A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard client complaints E. Use a firm approach with communication

B, C, E

Nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. the nurse should include which of the following manifestations in the teaching? (select all that apply.) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus

B, D

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following should the nurse include in the teaching? (Select all that apply.) A. Use caffeine in moderation to prevent relapse. B. Difficulty sleeping can indicate a relapse. C. Begin taking your medications as soon as a relapse begins. D. Participating in psychotherapy can help prevent a relapse. E. Anhedonia is a clinical manifestation of a depressive relapse.

B, D, E

A nurse is performing an admission assessment on an adolescent client who has depression. Which of the following is an expected finding? (Select all that apply.) A. Fear of being alone B. Substance use C. Weight gain D. Irritability E. Aggressiveness

B, D, E

A client has taken a bottle of acetaminophen (Tylenol) in an attempt to commit suicide. In response to the client's situation, the nurse follows proper protocol. List in chronological order the priority of the nursing actions that should be taken. Use all options. A. Speak directly about the suicide attempt B. Don't leave the client alone C. Focus on the current crisis D. Evaluate teh need for medication

B,A,C,D When executing the protocol for a client who has attempted suicide, the nurse should institute one-on-one observation so that the client is never left alone. After observation is established, the nurse should speak openly and directly about the suicide attempt. The nurse should accept the client's thoughts and feelings, especially negative feelings. Discussion should focus on the client's current crisis situation. After performing these actions, the client should be evaluated for the need for antidepressant therapy, if warranted.

The nurse is conducting a​ follow-up interview with a client using alternative therapy to aid in the treatment of depression. Which observations indicate that yoga therapy has been helpful for this​ client? Select all that apply. A) Asked when feelings of fatigue would subside B) Expressed satisfaction with treatment C) Requested information to treat chronic headaches D) Attentive during the interview E) Motivated to return to work

B,D,E Rationale Yoga has been found to improve life​ satisfaction, attentiveness, motivation and energy in clients with depression. Experiencing chronic headaches and fatigue indicates that yoga has not been effective in the treatment of depression in the client.

Nurse is caring for a client who is prescribed lithium therapy. the client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A. "That is a good choice. ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."

B- Aspirin is recommended as a mild analgesic rather than ibuprofen due to the risk for lithium toxicity

A nurse is discussing the risk factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? (select all that apply) A. Age older than 65 B. Anxiety disorder C. Female gender D. Coronary artery disease E. Obesity

BC

A client experiences a sudden onset of​ diaphoresis, mydriasis,​ palpitations, and immobility. A physical illness has been ruled out. Which type of medication should the nurse anticipate being prescribed for this​ client? Selective serotonin reuptake inhibitor​ (SSRI) Benzodiazepine . Azopirone ​Beta-blocker

Benzodiazepine Rationale This client has symptoms of​ panic, so the nurse should expect an antianxiety​ medication, such as a​ benzodiazepine, to be prescribed. Benzodiazepines have few side​ effects, are felt within​ hours, and are the most commonly prescribed for clients experiencing panic.​ Beta-blockers prevent physical symptoms. SSRIs and azapirones may take several weeks to become effective.

The nurse is planning care for a client who has been prescribed cognitivedash-behavioral therapy​ (CBT) and medication for an anxiety disorder. What complementary and alternative therapy could the nurse suggest for this ​client? Select all that apply. Biofeedback . Norepinephrine Guided imagery Meditation Massage

Biofeedback Guided imagery Meditation Massage Rationale Complementary and alternative medicine​ (CAM) has demonstrated effectiveness in easing symptoms of anxiety. CAM therapies include guided​ imagery, massage,​ biofeedback, and meditation. Norepinephrine is a​ neurotransmitter, not a therapy for anxiety disorders.

A client tells the nurse that since he lost his​ job, he cannot sleep at night and has no energy to get out of bed. Which type of grief response should the nurse educate this client about based on the symptoms​ exhibited? Psychological Behavioral Biophysical Biological

Biological Biological responses are physical manifestations a client may develop in response to grief and​ loss; they may include sleep​ problems, decreased​ energy, lack of​ appetite, or weight loss.

A nurse is counseling a client who has factitious disorder imposed on another. Which of the following client statements should the nurse expect? A. I had to pretend I was injured in order to get disability benefits. B. I know that my abdominal pain is caused by a malignant tumor. C. I needed to make my son sick so that someone else would take care of him for awhile. D. I became deaf when I heard that my husband was having an affair with my best friend.

C

A nurse is interviewing a 25-year-old client who has a new diagnosis of dysthymia. Which of the following findings should the nurse expect? A. There are wide fluctuations in mood. B. The report of a minimum of five clinical findings of depression. C. The presence of manifestations for at least 2 years. D. There is an inflated sense of self-esteem.

C

A nurse is reviewing the medical record of a client who has a new prescription for bupropion (Wellbutrin) for depression. Which of the following findings is the highest priority for the nurse to report to the provider? A. The client has a family history of seasonal pattern depression. B. The client currently smokes 1.5 packs of cigarettes per day. C. The client had a motor vehicle crash last year and sustained a head injury. D. The client has a BMI of 25 and has gained 10 lb over the last year.

C

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. "ECT is the recommended initial treatment for bipolar disorder." B. "ECT is contraindicated for clients who have suicidal ideation." C. "ECT is effective for clients who are experiencing severe mania." D. "ECT is prescribed to prevent relapse of bipolar disorder."

C

A nurse working in an outpatient clinic is providing teaching to a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A. "I can expect my problems with PMDD to be worst when I'm menstruating." B. "I will use light therapy 30 min a day to prevent further recurrences of PMDD." C. "I am aware that my PMDD causes me to have rapid mood swings." D. "I should increase my caloric intake with a nutritional supplement when my PMDD is active."

C

At the conclusion of an appointment with a behavioral​ therapist, a client with anger management issues asks the nurse why the therapist believes the client needs to start taking serotonin. Which response should the nurse make to the​ client? A) "It will facilitate the use of other neurotransmitters in your metabolism." B) "It will reduce your excitability." C) "It is associated with aggressive behavior." D) "It will address sleep problems that you might be having."

C Rationale A serotonin deficiency is associated with​ anxiety, aggression, and​ self-destructive behavior. Serotonin does not affect excitability. An acetylcholine deficiency is associated with sleep disorders. The protein P11 manages how brain cells respond to serotonin.

The mother of an adolescent diagnosed with depression was hoping that the child would not have the problem even though both she and her spouse struggle with depression every day. Which is the best response by the nurse to the​ mother? A) "Depression in adolescence is a minor disorder and the child will outgrow the symptoms." B) "It​'s not really depression in adolescence because the symptoms are not very severe." C) "The genetic risk for children to be diagnosed with depression is greatest if both parents have the disorder." D) "It​'s best to not focus on the depression because there isn​'t a treatment designed for this age group."

C Rationale Children of depressed parents have twice the risk of experiencing depression over a lifetime. If both parents have​ depression, the risk rises to​ 75%. Depression in adolescence is not a minor disorder since​ 11.2% of adolescents between the ages of 13 and 18 have been diagnosed. There is no evidence to suggest that an adolescent will outgrow the symptoms of depression. There is no evidence to support that there aren​'t treatments designed for adolescents with depression.

A nurse working on an inpatient unit is assigned to care for two clients diagnosed with severe depression and attempted suicide. After reviewing the client care assignment, the nurse should institute which nursing action? A. Consult with the admitting physician about the clients' condition B. Ask the supervisor to move both clients to the same room C. Request that the client care assignment be changed D. Document on the client's chart the lack of staffing resources

C The request for an assignment change would help ensure client safety and is a reasonable nursing action. Suicidal clients require frequent assessments, and the nurse can't safely monitor both clients.

A nurse is assisting the parents of a school-age child who has oppositional defiant disorder in identifying strategies to promote positive behavior. Which of the following is an appropriate strategy for the nurse to recommend? (Select all that apply.) A. Allow the child to choose consequences for negative behavior. B. Use role playing to act out unacceptable behavior. C. Develop a reward system for acceptable behavior. D. Encourage the child to participate in school sports. E. Be consistent when addressing unacceptable behavior.

C, D, E

A client who is extremely distraught after losing her spouse of 45 years is sobbing with her head in her hands. The client​ says, open double quote"I don​'t want to go sit with a bunch of other old​ widows; I want to sit with Harold.close double quote" Based on this client​'s assessment​ findings, which collaborative therapy should the nurse​ recommend? Placement in a​ long-term care facility ​Cognitive-behavioral therapy A group hobby session Church attendance on Wednesdays and Sundays

CBT

A nurse is working in a mental health clinic is caring for a client who has obsessive-compulsive disorder and recently started a new prescription for buspirone (BuSpar). The client tells the nurse that the medication has not helped him sleep and that he is still having obsessive compulsions. Which of the following statements is an appropriate response by the nurse? A. "It may take several weeks before you feel like the medication is helping." B. "Take the medication just before bedtime to promote sleep." C. "You should take the medication on an as-needed basis when you experience obsessive urges." D. "Your provider may need to increase your prescription due to developing tolerance."

CORRECT: A. "It may take several weeks before you feel like the medication is helping." - Buspirone may take 3 to 6 weeks before the client reaches full therapeutic benefit INCORRECT: B. Buspirone does not have any sedative effects and will therefore no promote sleep C. Buspirone should be taken on a regular basis rather than an as-needed basis D. Buspirone does not cause tolerance

A nurse is caring for a client who takes paroxetine (Paxil) to treat PTSD. The client states that he grinds his teeth during the night, which causes jaw pain. The nurse should identify which of the following as possible measures to manage the client's bruxism? (select all that apply) A. concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antianxiety medication E. Increasing the dose of paroxetine

CORRECT: A. concurrent administration of buspirone - concurrent administration of a low dose of buspirone is an effective measure to manage the adverse effects of paroxetine C. Use of a mouth guard - using a mouth guard during sleep can decrease the risk for oral damage resulting from bruxism D. Changing to a different class of antianxiety medication - changing to different class of antianxiety medication that does not have the adverse effect of bruxism is an effective measure INCORRECT: B. other SSRIs also will have bruxism as an adverse effect. Therefore, this is not an effective measure E. increasing the dose of paroxetine can cause the adverse effect of bruxism to worsen. Therefore, this is not an effective measure.

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following is the priority nursing action? A. administer Flumazenil (Romazicon) B. identify the client's level of orientation C. infuse IV fluids D. prepare the client for gastric lavage

CORRECT: B. identify the client's level of orientation - when taking the nursing process approach to client care, the initial step is assessment. Therefore, identifying the client's level of orientation is the priority action. INCORRECT. A. administering flumazenil is an appropriate action. However it is not the priority when taking the nurse process approach to client care. C. infusing IV fluids is an appropriate action. However it is not the priority when taking the nurse process approach to client care. D. Gastric lavage is an appropriate action. However it is not the priority when taking the nurse process approach to client care.

A nurse is caring for a client who is to begin taking escitalopram (Lexapro) for treatment of generalized anxiety disorder. Which of the following statements by the client indicates understanding of the use of this medication? A. "I will take the medication at bedtime" B. "I will need to follow a low sodium diet while taking this medication" C. "I need to discontinue this medication slowly." D. "I probably won't desire intimacy during the first days of treatment"

CORRECT: C. "I need to discontinue this medication slowly." - when discontinuing escitalopram, the client should taper the medication slowly according to a prescribed tapered dosing schedule to reduce the risk of withdrawal syndrome. INCORRECT: A. the client should take escitalopram in the morning to minimize sleep disturbances. B. the client is at risk for hyponatremia when taking escitalopram D. sexual dysfunction, including decreased libido, is a late adverse effect that is possible after 5 to 6 weeks of treatment with escitalopram

A nurse is providing teaching to a client who has a new prescription to start buspirone (BuSpar) in place of diazepam (Valium). The client has a history of panic disorder and cirrhosis of the liver. The client asks why his provider is making the medication change. Which of the following statements is an appropriate response by the nurse? A. "Diazepam can cause seizures as an adverse effect." B. "Diazepam is not indicated for the treatment of panic disorder." C. "Buspirone is a safe medication for clients who have liver dysfunction." D. Buspirone has less risk for dependency than other treatment options."

CORRECT: D. Buspirone has less risk for dependency than other treatment options." - Buspirone is preferable to diazepam for long term use due to the decreased risk for dependency INCORRECT: A. diazepam is indicated for the treatment of seizure activity and does not cause seizures as an adverse effect. B. both buspirone and diazepam are indicated for the treatment of panic disorder C. Buspirone must be used cautiously in clients who have liver dysfunction

Which are clinical manifestations of imminent​ death? Select all that apply. ​Cheyne-Stokes breathing Edema and increased respiratory secretions Decrease in volume of Korotkoff sounds Increased heart rate Mottling

Cheyne-Stokes breathing Decrease in volume of Korotkoff sounds Mottling

The nurse educator is teaching a group of students about​ obsessive-compulsive disorder​ (OCD). Which statement will the educator include in the teaching session regarding​ OCD? Diagnosis of OCD is easy. Brain imaging in clients with OCD is normal. Signs and symptoms of OCD occur in older adults. Children who have had a streptococcal infection may be at risk of developing the disorder.

Children who have had a streptococcal infection may be at risk of developing the disorder.

The nurse believes that a client with severe PTSD will benefit from​ cognitive-behavioral therapy​ (CBT). What can the nurse describe as the characteristics of​ CBT? Select all that apply. Client can change unhealthy thoughts. Client can safely confront fears. Client can discontinue medications. Client can remove stressors. Client can do CBT exercises.

Client can change unhealthy thoughts. Client can safely confront fears. Client can do CBT exercises.

After an upsetting divorce, a client had been threatening to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis has the highest priority for this client? A. Hopelessness related to recent divorce B. Ineffective coping related to inadequate stress management C. Spiritual distress related to conflicting thoughts about suicide and sin D. Risk for self-directed violence related to planning to commit suicide by handgun

D Although all of these nursing diagnoses may apply to this client, the nurse's first priority in caring for any suicidal client is safety. The presence of a plan increases the level of suicidal risk.

A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A. Assign the client to a private room B. Document the client's behavior every hour C. Allow the client to keep perfume in her room D. Ensure that the client swallows medication

D Ensure that the client swallows medication to prevent hoarding of medication for an attempted overdose.

A client experiencing suicidal ideations with a plan to overdose on medications is admitted to an in-patient psychiatric unit. Vilazodone (Viibryd) is prescribed. Which nursing intervention takes priority? A. Remind the client that medication effectiveness may take 2 to 3 weeks B. Teach the client to take the medication with food to avoid nausea C. Check the client's blood pressure every shift to monitor for hypertension D. Monitor closely for signs that the client might be "cheeking" medication.

D If a client comes into the in-patient psychiatric unit with a plan to overdose, it is critical that the nurse monitor for cheeking and hoarding of medications. Clients may cheek and hoard medications to take, as an overdose, at another time.

The nurse is reviewing orders written for a client demonstrating signs of depression. Which diagnostic test should the nurse expect to be prescribed for this​ client? A) White blood cell count B) Hemoglobin and hematocrit C) Serum electrolytes D) Thyroid function

D Rationale Thyroid function tests may be prescribed for a client demonstrating manifestations of depression because thyroid disorders can mimic depression. Serum electrolytes would be prescribed for the client demonstrating signs of substance abuse. White blood cell count and hemoglobin and hematocrit levels are not prescribed to determine a physical cause for depression.

A nurse is caring for a client who is suicidal. When accompanying the client to the bathroom, the nurse should: A. give him privacy B. allow him to shave C. open the window and allow him to get some fresh air D. observe him

D The nurse has a responsibility to continuously observe an acutely suicidal client. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent the client from attempting to hang himself or otherwise injure himself. The nurse should check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse should also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.

A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? A. A client's verbal threat of suicide is attention-seeking behavior B. Interventions are ineffective for clients who really want to commit suicide C. Using the term suicide increases the client's risk for a suicide attempt D. A no-suicide contract decreases the client's risk for suicide

D The use of a no-suicide contract decreases the client's risk for suicide by promoting and maintaining trust between the nurse and the client. However, it should not replace other suicide prevention strategies.

A nurse in an acute mental health facility is caring for a client who is experiencing a mixed episode of bipolar disorder. Which of the following is the priority nursing action? A. Set consistent limits for expected client behavior. B. Administer prescribed medications as scheduled. C. Provide the client with step-by-step instructions during hygiene activities. D. Monitor the client for escalating behavior.

D

A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? A. Encourage client to spend time alone in room. B. Monitor client for self-harm 1 time a day C. Allow client unlimited time to discuss physical manifestations D. Discuss alternative coping strategies with the client

D

A nurse working in a pediatric clinic is caring for a preschool-age child who has a new diagnosis of ADHD. When teaching the parent about this disorder, which of the following statements should the nurse include in the teaching? A. "Behaviors associated with ADHD must be present prior to age 3." B. "This disorder is characterized by argumentativeness." C. "Below-average intellectual functioning is associated with ADHD." D. "Because of this disorder, your child is at an increased risk for injury."

D

Nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the priority to report to the provider? A. "My mother has diabetes that is controlled by her diet." B. "My mother recently completed a course of prednisone for acute bronchitis." C. "My mother received her flu vaccine last month." D. "My mother is currently on furosemide for her congestive heart failure."

D

A psychiatric nurse is advising a client on how to utilize the Center for Epidemiological Studies Depression Scale-Revised (CESD-R). Which statement made by the nurse is incorrect? A) "This is a self-rating scale." B) "This scale will ask you how often during the past week you experienced symptoms associated with depression." C) "This scale is useful for a wide age range of populations including older adults." D) "This scale will ask you how often during the past month you experienced symptoms associated with depression."

D Rationale: The Center for Epidemiological Studies Depression Scale-Revised (CESD-R) scale is a 20-item self-rating scale that asks people to rate how often during the past week they experienced symptoms associated with depression. A score of 16 or above indicates depression. This scale is useful for a wide age range of populations including older adults.

A client diagnosed with major depressive disorder and experiencing suicidal ideation is showing signs of anxiety. Aoprazolam (Xanax) is prescribed. Which assessment should be prioritized? A. Monitor for signs and symptoms of physical and psychological withdrawal B. Teach the client about side effects of the medication and how to handle these side effects C. Assess for nausea and give the medication with food if nausea occurs D. Ask the client to rate his or her mood on a mood scale and monitor for suicidal ideations.

D Alprazolam is a central nervous system depressant, and it is important for the nurse in this situation to monitor for worsening depressive symptoms and possible worsening of suicidal ideations.

The nurse is providing care to a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which factors could interfere with the nurse establishing trust during a therapeutic encounter with this​ client? Select all that apply. Depersonalization Hypervigilance Ineffective coping Nightmares ​Irritability, aggressiveness

Depersonalization Hypervigilance Irritability, aggressiveness

A nurse is discussing acute v prolonged stress with a client. Which of the following would the nurse identify as an acute stress response? SATA Chronic pain Depressed immune system Increased B/P Panic attacks Unhappiness

Depressed immune system Panic attacks Unhappiness during an acute stress response the client will feel unhappiness or sorrow, diminished appetite, decreased immune system, decreased peristalsis; increased HR, RR, and B/P in the "fight or flight" response to stress.

Which are manifestations of respiratory failure in the dying​ client? Select all that apply. Diaphoresis Difficulty breathing Anxiety Wheezing Breathlessness

Difficulty breathing Anxiety Wheezing Breathlessness

The nurse is developing a plan of care for a client who is experiencing anxiety related to a phobic disorder. The client states she has extreme difficulty falling asleep at night. Which would be most appropriate for the nurse to include in the plan of care for this​ client? Assisting the client in rethinking the ability to manage the anxiety Assisting the client in gaining insight to her reaction to the fear Educating the client on relaxation techniques Educating the client on healthy ways of living

Educating the client on relaxation techniques

A nurse is preparing to attend an educational seminar on stress. Which of the following should be expected to be included in the discussion? Excessive stressors cause the client to experience stress The body's initial adaptive response to stress is denial The absence of stressors result in homeostasis Negative, rather than positive, stressors produce a biological response

Excessive stressors cause the client to experience stress Stress in moderation is good. Negative and positive stressors produce a biological response. The body's initial adaptive response to stress is fight or flight- increased HR, B/P, RR and decreased immune system. Excessive stressors cause the client to experience stress; the client does not not ever experience stress.

The nurse is assessing a client who reports anxiety associated with a previously diagnosed social anxiety disorder. What signs and symptoms would the nurse expect to​ assess? Select all that apply. Excessive sweating Mumbling speech ​Warm, dry skin Gastrointestinal distress Lethargy

Excessive sweating Mumbling speech Gastrointestinal distress

What are the categories of types of​ stressors? Select all that apply. External environmental stressors Developmental stressors Homeostatic stressors Internal stressors Hormone stressors

External environmental stressors Developmental stressors Internal stressors

Which term best describes an individual who believes that powers outside themselves determine life​ events? Internal locus of control Locus of control External locus of control Control

External locus of control

The health care provider has prescribed an antidepressant for a​ 9-year-old client because therapy and grief counseling have been ineffective. Which selective serotonin reuptake inhibitor​ (SSRI) medication would the nurse anticipate the health care provider to ​prescribe? Escitalopram​ (Lexapro) Paroxetine​ (Paxil) Fluoxetine​ (Prozac) Nortriptyline​ (Pamelor)

Fluoxetine​ (Prozac) Fluoxetine​ (Prozac) is the only recommended SSRI for children under 12 years of age

A client dying from a terminal illness who has been receiving pain medication is now comatose. Which actions should the nurse take to ensure this client​'s ​comfort? Select all that apply. Cover with several blankets to maintain warmth Gently splint joints when repositioning the client Use incontinence pads Suggest tube feedings for nutritional support Provide artificial tears

Gently splint joints when repositioning the client Use incontinence pads Provide artificial tears

The nurse is planning care for a client diagnosed with a severe anxiety disorder. Which problems are appropriate for the nurse to include in the plan of ​care? Select all that apply. Impaired social interaction Disturbed body image Risk for ineffective​ self-health management Acute pain Risk for sleep pattern disturbance

Impaired social interaction Risk for ineffective​ self-health management Risk for sleep pattern disturbance Rationale When planning care for a client with a severe anxiety​ disorder, the nurse should include impaired social​ interaction, risk for sleep pattern​ disturbance, and risk for ineffective​ self-health management. Acute pain and disturbed body image are not appropriate problems to include in the plan of care for this client.

The nurse is providing care to a pediatric client whose mother is terminally ill. Which intervention by the nurse allows the pediatric client to express​ grief? Implementing imaginary games with the client. Allowing the client to talk about the loss. Telling the client that the parent will be in a better place. Administering medication to the client.

Implementing imaginary games with the client.

The nurse is providing care to a client with​ obsessive-compulsive disorder​ (OCD). Which interventions are appropriate for this​ client? Select all that apply. Interrupt the​ ritual, using distraction. Include time in the daily routine to perform the ritual. Assist the client with developing new coping mechanisms. Establish a loud and fun environment for the client. Encourage the client to verbalize his or her feelings.

Include time in the daily routine to perform the ritual. Assist the client with developing new coping mechanisms. Encourage the client to verbalize his or her feelings.

The​ client, a​ psychologist, is interested in the mental health clinic​ nurse's viewpoint about​ Maslow's hierarchy of needs. When it comes to prioritizing a choice to react to a​ stressor, what do both of them know about this​ model? Coping with stressors is a part of safety needs. ​Self-esteem is the most important level of need. Individuals might have their own priorities. Everyone chooses to satisfy basic requirements first.

Individuals might have their own priorities.

A nurse is obtaining informed consent for a client who has just learned she must have a breast biopsy. The client is perspiring and pale, 30/min respiratory rate, and says " I dont quite understand what you are trying to tell me." The nurse should evaluate the clients level of anxiety as mild moderate severe panic

Moderate- decrease problem solving, increased VS somewhat, person is visibly anxious.

During change of​ shift, a unlicensed assistive personnel​ (UAP) finds a client who committed suicide by using a belt on the upper doorjamb in the hospital room. The nursing staff was in report and responded to the cries for​ help, but was not able to save the client. What should the hospital administrator do to assist the nursing​ staff? Select all that apply. ​Nothing, because the nursing staff was not at fault for the client​'s death Notify social services for immediate grief counseling Suggest all staff return to work Analyze the client​'s medical record for signs of pending suicide that were missed Encourage the staff to talk to each other about the experience and offer support

Notify social services for immediate grief counseling Encourage the staff to talk to each other about the experience and offer support

Complicated grief in older adult clients can present with many symptoms. Which symptom would the nurse not expect to see in a grieving older​ adult? Obsession with death Avoidance of people or places that arouse memories Depression Distrust of family and friends

Obsession with death

During a health history​ interview, the nurse is concerned that an​ 8-year-old client is exhibiting signs of developing separation anxiety disorder. Which information from the interview supports this​ diagnosis? Excessive anxiety and worry for 6 months Difficulty sleeping and trouble concentrating Overwhelming fear of being lost that has resulted in missing school Frightened to meet new people

Overwhelming fear of being lost that has resulted in missing school Rationale Symptoms powerful enough to interfere with daily life for at least 4 weeks and an overwhelming fear of being lost or having something bad happen to a loved one are related to development of separation anxiety disorder. A​ school-age child often becomes frightened when meeting new people. Excessive anxiety and worry for 6 months is a diagnostic criterion for generalized anxiety disorder. Difficulty sleeping and trouble concentrating are also manifestations of generalized anxiety disorder.

The nurse is preparing to complete a nursing assessment for a client who is diagnosed with posttraumatic stress disorder​ (PTSD). Which data will the nurse collect during the physical examination portion of the​ assessment? Alcohol use Type of trauma experienced Current job Pain rating

Pain rating

A client presents to the emergency department with bizarre​ behavior, muscular​ incoordination, incoherence, and terror. Which condition should the nurse suspect the client is​ experiencing? Generalized anxiety disorder Moderate anxiety disorder Panic disorder Separation anxiety disorder

Panic disorder Rationale Clinical manifestations of panic disorder include bizarre​ behavior, muscular​ incoordination, incoherence, and terror. Clients with generalized anxiety disorder present with intense tension and​ worry, startle​ easily, and may have​ fatigue, headache, digestive​ issues, and irritability. Clients with separation anxiety disorder have severe anxiety around separation from home and major attachment figures. Clients with moderate anxiety disorder experience reduced​ alertness, feelings of discomfort and irritability with​ others, increased​ restlessness, and perspiration.

The nurse is caring for a client with​ obsessive-compulsive disorder​ (OCD) . Which clinical manifestations would the nurse expect to see in this​ client? Select all that apply. Physical complaints such as irritated skin Happy and overly excited affect Signs of distress and increased anxiety Repetitive actions or motions Intrusive thoughts

Physical complaints such as irritated skin Signs of distress and increased anxiety Repetitive actions or motions Intrusive thoughts

The nurse is providing care to a​ client, diagnosed with posttraumatic stress disorder​ (PTSD), who is experiencing frequent nightmares. Which medication does the nurse anticipate will be prescribed for this​ client? Paroxetine Risperidone Sertraline Prazosin

Prazosin - antidiuretic agent only medication that has shown effectiveness in reducing nightmares associated with PTSD

A​ first-year nursing student goes to the​ university's counseling services. The student hopes that anxiety levels experienced during test taking could be reduced. The nurse counselor asks the student about first thoughts when a test is announced. What kind of appraisal is the counselor having the student​ consider? Primary appraisal Anxiety appraisal Secondary appraisal Cognitive appraisal

Primary appraisal Rationale: Primary appraisal happens immediately upon knowledge of the​ stressor, the upcoming test. Secondary appraisal takes place after​ that, when deciding how to react. Cognitive appraisal is the combination of both primary and secondary appraisal. There is no model called​ "anxiety appraisal."

A client with terminal cancer is experiencing dyspnea. Which actions should the nurse use to help this​ client? Select all that apply. Elevate both legs Provide oxygen as prescribed Raise the head of the bed Place pillows behind head Provide small frequent meals

Provide oxygen as prescribed Raise the head of the bed Place pillows behind head

What are some independent interventions for nurses to use with clients with anxiety​ disorders? Select all that apply. Ordering individualized medical testing Reinforcing positive coping efforts Accessing current mental health resources Validating​ clients' feelings Guaranteeing better coping abilities

Reinforcing positive coping efforts Accessing current mental health resources Validating​ clients' feelings

Which pharmacologic agent is used in the treatment of​ obsessive-compulsive disorder​ (OCD)? Sulfonlyureas Diuretics ACE inhibitors Selective serotonin reuptake inhibitors

Selective serotonin reuptake inhibitors

The school nurse is especially concerned about a specific​ first-grade student. What​ personality-related characteristic would the nurse identify as increasing the risk for development of an anxiety​ disorder? Overweight student Nearsighted student Shy student Short student

Shy student Rationale: Being shy increases the risk of a child developing an anxiety disorder.​ Weight, height, and nearsightedness are not personality characteristics.

A nurse is caring for a client who is experiencing a panic attack. Which of the following is an appropriate nursing intervention? Discuss new relaxation techniques Show the client how to change his behavior Distract the client with a TV show Stay with the client and remain quiet

Stay with the client and remain quiet During a panic attack, the client is unable to concentrate on learning new information such as relaxation techniques. The nurse should maintain a calm, safe, and quiet environment making sure to stay w the client and monitor for safety.

1. A nurse is caring for a client following the loss of her partner due to a terminal illness. Identify the sequence of Engel's five stages of grief that the nurse should expect the client to experience. (Select the stages of grief in order of occurrence. all steps must be used.) A. Developing awareness B. restitution C. shock and disbelief D. recovery E. resolution of the loss

Step 1: C. shock and disbelief is the first stage in Engel's five stages of grief. In this stage the client experiences a sense of numbness and denial over the loss. Step 2: A. Developing awareness is the second stage in Engel's five stages of grief. In this stage the client becomes aware of the reality of the loss resulting in intense feelings of grief. This begins within hours of the loss. Step 3: B. restitution is the third stage in Engel's five stages of grief. In this stage the client carries out cultural/religious rituals, such as a funeral, following the loss. Step 4: E. resolution of the loss is the fourth stage in Engel's five stages of grief. In this stage the client is preoccupied with the loss. This preoccupation gradually decreases over about a 12 month time period. Step 5: D. recovery is the fifth and final stage in Engel's five stages of grief. In this stage the client moves past the preoccupation with the loss and moves forward with life.

The nurse in an endocrinology clinic is seeing a client who has both diabetes and hyperthyroidism. What clinical symptoms could the client have that would be similar to those of a client with​ anxiety? Select all that apply. Tachycardia Feelings of fear Nervousness Ritualized routines Obsessive thoughts

Tachycardia Nervousness Rationale: The clinical symptoms that a client with diabetes and hyperthyroidism has in common with a client with anxiety are tachycardia and nervousness. The client with anxiety could have obsessive​ thoughts, feelings of​ fear, and ritualized routines. Those symptoms would not arise as a result of diabetes or hyperthyroidism.

The nurse manager of an oncology unit is planning a program to assist staff with needs after the death of a client. What should the manager include in this​ staff-training program? Select all that apply. Doubling efforts to prevent another client death Talking to each other about the loss of a client Information to process the loss of a client Keeping personal feelings about death and dying within Importance of using grief counseling as a resource

Talking to each other about the loss of a client Information to process the loss of a client Importance of using grief counseling as a resource

During a home​ visit, the nurse evaluates a client recovering from generalized anxiety disorder​ (GAD). Which observation indicates that additional client teaching is​ required? The client has withdrawn from cognitivedash-behavioral therapy​ (CBT). The client is seeking​ full-time employment. The client takes diazepam​ (Valium) as prescribed. The client walks 3 miles a day.

The client has withdrawn from cognitivedash-behavioral therapy​ (CBT). Rationale The most effective treatment strategy for most people with an anxiety disorder is CBT combined with​ medication, so the client​'s withdrawal from CBT indicates that more teaching is required. Taking medication as prescribed and participating in wellness activities indicates understanding of how to manage anxiety. Seeking​ full-time employment indicates the client is managing anxiety successfully.

A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have a cold that everyone has been getting." Which of the following defense mechanisms is the client using? Reaction formation denial displacement Sublimation

The client is in denial- rejecting the truth/reality

When assessing multiple​ clients, the nurse determines that which clients are at risk for developing generalized anxiety​ disorder? Select all that apply. The client who reports no significant impairment in his social​ life, job or other functioning due to worry and anxiety The client who denies current stressors and drinks alcohol socially The client who reports excessive anxiety and worry about his​ job, relationship and finances for the past 6 months The client who has difficulty​ concentrating, sleep​ disturbance, and muscle tension The client who finds it hard to control the worry and exhibits poor hygiene

The client who reports excessive anxiety and worry about his​ job, relationship and finances for the past 6 months The client who has difficulty​ concentrating, sleep​ disturbance, and muscle tension The client who finds it hard to control the worry and exhibits poor hygiene Rationale The​ DSM-5 diagnostic criteria for generalized anxiety disorder include excessive anxiety and worry occurring more days than not for at least 6​ months; client finds it hard to control the​ worry; the anxiety and worry are associated with difficulty​ concentrating, sleep​ disturbance, and muscle​ tension; the​ anxiety, work, or physical symptoms cause clinically significant distress or impairment in​ social, occupational, or other​ functioning; and the disturbance is not attributable to the physiological effects of a substance. The clients who report no significant impairment and who deny current stressors do not appear to be at risk.

A nurse is conducting a​ follow-up assessment on a client in the clinic. The client​ states, open double quote"I usually cannot leave my house at all but now I can leave at least once a day.close double quote" This statement made by the client indicates the client has achieved which​ goal? The client will report decreased frequency of phobic episodes. The client will participate in therapeutic treatment. The client will verbalize healthy coping skills to use in response to fear. The client will demonstrate relaxation techniques.

The client will report decreased frequency of phobic episodes.

The nurse is caring for a client who is diagnosed with posttraumatic stress disorder. Which goals and outcomes may be appropriate for the nurse to include in the client​'s plan of​ care? Select all that apply. The client will demonstrate avoidance of situations related to the trauma or general social contacts. The client will report fewer or no nightmares. The client will demonstrate comorbidity that may include​ depression, substance​ abuse, or other anxiety disorders. The client will remain free of harm or injury to himself or others. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional.

The client will report fewer or no nightmares. The client will remain free of harm or injury to himself or others. The client will talk about emotions that are associated with traumatic experiences with at least one counseling professional.

The nurse is conducting a nursing assessment for a client diagnosed with​ obsessive-compulsive disorder​ (OCD). Which findings are indicative of the repetitive acts associated with ​OCD? Select all that apply. Poor grooming and stained clothing Underweight and appears older than stated age The need to lock and unlock doors Poor posture and altered motor skills Constant hand washing

The need to lock and unlock doors Constant hand washing

2. A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A. Insist that the client stop yelling. B. Request that other staff members remain close by. C. Move as close to the client as possible. D. Walk away from the client.

The nurse should not make demands of the client by insisting that he stop yelling. B. CORRECT: the nurse should request that other staff members remain close by to assist if necessary. C. Clients who are angry need a large personal space. D. The nurse should never walk away from a client who is angry. It is the nurse's responsibility to intervene as appropriate.

After reviewing multiple medical​ records, the nurse determines that which client is at highest risk for developing an anxiety​ disorder? The older adult female client who is married The young adult female client who witnessed a car crash The​ middle-aged, male client who completed 2 years of college The adolescent male client who attends a private high school

The young adult female client who witnessed a car crash Rationale Being female and witnessing a traumatic event are both risk factors for developing an anxiety​ disorder, so the young adult female client who witnessed a car crash is at highest risk. Although being female is a risk factor for an anxiety​ disorder, being married is not. Children with low socioeconomic status and adults with lower educational levels are also at higher risk.

Which are risk factors for developing a​ phobia? Select all that apply. Peer pressure Traumatic event Age Gender Family history

Traumatic event Age Gender Family history

A client says she is experiencing increased stress because her SO is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that". Which of the following should the nurse recommend to promote a change in the client's situation? Learn to practice mindfulness Use assertiveness training Exercise regularly Rely on support of a close friend

Use assertiveness training All of these techniques work to decreases the clients stress but only assertiveness training will promote a change in the clients life. Assertiveness training is when the client learns to communicate in a more assertive manner in order to decrease psychological stressors; nurse teaches the client to assert her feelings by describing a situation or behavior that causes stress, stating her feelings about the behavior or stress, and then making a change.

The nurse is planning home care for a client with panic disorder. What should the nurse include in this client​'s plan of ​care? Select all that apply. Use of transcendental meditation Participation in cognitivedash-behavioral therapy Isolation at home in a quiet room Use of antianxiety medications as prescribed Participation in massage and yoga

Use of transcendental meditation Participation in cognitivedash-behavioral therapy Use of antianxiety medications as prescribed Participation in massage and yoga Rationale Use of antianxiety medications and participation in cognitivedash-behavioral ​therapy, transcendental​ meditation, massage, and yoga are appropriate to include in the client​'s plan of care. While placing the client in a​ quiet, less stimulating environment may be necessary during an acute episode of​ panic, the nurse should encourage the client to participate in all aspects of treatment with the goal of pursuing normal activities.

A nurse is caring for a client who states, "Im so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing appropriate communication, which of the following statements by the client to his coworker indicates client understanding? You really should complete your own work, I dont think its right to expect me to complete your responsibilities. Why do you expect me to finish your work? You must realize that I have my own responsibilities It is not fair to expect me to complete your work. If you continue, then i will report your behavior to our supervisor When I have to pick up extra work, I feel overwhelmed I need to focus on my own responsibilities

When I have to pick up extra work, I feel overwhelmed I need to focus on my own responsibilities The client should approach his co worker in a non aggressive non threatening manner. By expressing himself in a therapeutic manner the client states his feelings and work to change the behavior. D is the correct answer

Under which conditions can acupuncture be an effective treatment for posttraumatic stress disorder​ (PTSD)? Select all that apply. When used as a​ short-term therapy for a period of no more than a month When used regularly When used as an adjunct to CBT and other traditional therapies When used alone as a primary therapy When used for a period of three months or more

When used regularly When used as an adjunct to CBT and other traditional therapies When used for a period of three months or more

A​ 10-year-old boy has just experienced the death of his father 1 month ago. Which signs and symptoms of grief might the nurse observe in this​ client? Select all that apply. Directing anger at the remaining parent Withdrawing from social activity Believing his poor behavior caused his father​'s death Acting out in school Being curious about death

Withdrawing from social activity Believing his poor behavior caused his father​'s death Acting out in school Being curious about death

A student nurse is attending a clinical rotation in an outpatient childhood psychiatric facility. The nursing student observes that many of the children have decreased socialization. Which possible experiences of these clients might cause this manifestation of childhood traumatic​ grief? Select all that apply. Witnessing a death from cancer Witnessing a loved one die in a motor vehicle accident Witnessing a death caused by an action of violence Witnessing a suicide Witnessing someone die in a fire

Witnessing a loved one die in a motor vehicle accident Witnessing a death caused by an action of violence Witnessing a suicide Witnessing someone die in a fire

1. Lorraine has been diagnosed with somatic symptom disorder. Which of the following symptom profiles would you expect when assessing Lorraine? a. Multiple somatic symptoms in several body systems b. Fear of having a serious disease c. Loss or alteration in sensorimotor functioning d. Belief that her body is deformed or defective in some way

a

8. The ultimate goal of therapy for a client with DID is: a. Integration of the personalities into one b. For the client to have the ability to switch from one personality to another voluntarily c. For the client to select which personality he or she wants to be the dominant self d. For the client to recognize that the various personalities exist

a

A battered women presents tot he ED with multiple cuts and abrasions. Her right eye is swollen shut. She says her husband did this to her. The priority is: a. tending to the immediate care for her wounds b. providing her with info about a safe place to stay c. admin the prn tranquilizer ordered by the physician d. explain how she can bring charges against her hustband

a

A nurse is caring for a client who has acute stress disorder and is experiencing severe anxiety. Which of the following statements actions should the nurse make? a. " Tell me about how you are feeling right now." b. " You should focus on the positive things in your life to decrease your anxiety." c. " Why do you believe you are experiencing this anxiety?" d. " Let's discuss the medications your provider is prescribing to decrease your anxiety."

a

A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? a. Assessing the client's risk for self-harm b. Instilling hope for positive outcomes c. Encouraging the client to participate in group therapy sessions d. Encouraging the client to participate in treatment decisions

a

Clint, a client on the psych unit, have been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clints belief is an example of a : a. delusion of persecution b. delusion of reference c. delusion of control or influence d. delusion of grandeur

a

Leon, a veteran of the war in Iraq, has been diagnosed with PTSD. He is a client of the VA outpatient clinic. He tells the nurse that he experiences panic attacks. Which of the following medications may be prescribed for Leon to treat his panic attack? a. Alprazolam b. Lithium c. Carbamazepine d. Haldol

a

The physician orders lithium carbonate 600 mg tid for a client newly diagnosed with Bipolar I Dis- order. There is a narrow margin between the therapeutic and toxic levels of lithium. What is the therapeutic range for acute mania? a. 1.0 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L

a

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? ( Select all that apply.) a. Excessive worry for 6 months b. Impulsive decision making c. Delayed reflexes d. Restlessness e. Need for reassurance

a d e

A client is prescribed paroxetine (Paxil) to treat symptoms of stress after the unexpected death of her spouse. What should the nurse instruct the client about this medication? (Select all that apply.) a) "This medication should not be taken with St. John's wort." b) "This medication should not be stopped abruptly." c) "This medication may cause difficulties in achieving an orgasm." d) "This medication takes 4 to 6 weeks to achieve the full effect." e) "This medication can cause bradycardia."

a) "This medication should not be taken with St. John's wort" b) "The medication should not be stopped abruptly." c) "This medication may cause difficulties in achieving an orgasm." d) "This medication takes 4 to 6 weeks to achieve the full effect."

The nurse is caring for a terminally ill client. Which assessment findings indicate to the nurse that the client has passed away? (Select all that apply.) a) Absence of respiration b) Dyspnea c) Absence of reflexes d) No movement e) Anorexia

a) Absence of respiration c) Absence of reflexes d) No movement

An older woman who has been physically and financially abused by her son tells the nurse, "I am not pressing charges against my son because I am afraid that he will put me out on the street and I will have no place to go." Which response should the nurse include in her interventions for this client? a) Assess the client's safety and help her develop a safety plan b) Instruct the client not to worry about her son because she is in the hospital, so he will not do it again c) Support the client's wishes to not press charges due to fear d) Encourage the client to move out of her son's home to avoid future encounters with him

a) Assess the client's safety and help her develop a safety plan

The parents of an adolescent client dying from complications related to cystic fibrosis ask the nurse what signs to expect when their child is about to die. What should the nurse explain as signs of cardiovascular failure? (Select all that apply.) a) Clammy, cold skin b) Mottling of the skin c) Reduced blood pressure d) Cheyne-stokes respirations e) Tachycardia

a) Clammy, cold skin b) Mottling of the skin c) Reduced blood pressure

The nurse is evaluating outcomes of care provided to a client dying from a terminal illness. Which observations indicate that care has been effective? (Select all that apply.) a) Client resting comfortably in bed b) Client talking about leaving pain and sadness behind upon death c) Client crying and stating that no one will even mourn for him once he dies d) Client's family sitting and talking with the client e) Client requests pain medication every 4 hours

a) Client resting comfortably in bed b) Client talking about leaving pain and sadness behind upon death d) Client's family sitting and talking with the client e) Client requests pain medication every 4 hours

A nurse is assessing the victim of an automobile accident to check for possible injury to the brain and central nervous system. The client's family is relieved to learn that the client's neurological responses are normal. For which part of the ABCDE priority is the nurse checking? a) D (disability) b) C c) B d) E

a) D

A nurse case manager is working with a family that has been reported to authorities due to evidence of elder abuse. With which possible positive perspectives can the nurse view the crisis situation? (Select all that apply.) a) Families can be more motivated to adopt new behaviors b) The crisis can be a trigger for relocating older adults c) The crisis can lead to the involvement of lawyers and the police d) The crisis can be a window of opportunity for change e) Families can be more open to get help

a) Families can be more motivated to adopt new behaviors b) The crisis can be a trigger for relocating older adults d) The crisis can be a window of opportunity for change e) Families can be more open to get help

The nurse manager of an oncology unit is planning a program to assist staff with needs after the death of a client. What should the manager include in this staff-training program? (Select all that apply.) a) Information to process the loss of a client b) Talking to each other about the loss of a client c) Importance of using grief counseling as a resource d) Doubling efforts to prevent another client death e) Keeping personal feelings about death and dying within

a) Information to process the loss of a client b) Talking to each other about the loss of a client c) Importance of using grief counseling as a resource

The nurse in the emergency department is caring for a woman of Asian descent who was brought in by a neighbor. The right side of the client's face is swollen, bruised, and bleeding. She has multiple bruises on her arms. The client's husband arrives and does not let her speak; he answers questions for her. The nurse should suspect which type of abuse? a) Intimate partner violence b) Financial abuse c) Elder abuse d) Rape

a) Intimate partner violence

A nurse is assessing an older adult client who was being abused and neglected. The nurse should assess the client for which characteristics? (Select all that apply.) a) Malnutrition b) Chronic fatigue c) Trauma to sexual organs d) Withdrawn behavior e) Bruises or burns

a) Malnutrition c) Trauma to sexual organs d) Withdrawn behavior e) Bruises or burns

The nurse is teaching a course on grieving to new staff members at a local hospital. Which manifestation should the nurse include in the presentation as expected alterations or manifestations of grief? (Select all that apply.) a) Moving in with a friend or family member b) Becoming distrustful of others c) Having difficulty concentrating d) Experiencing auditory hallucinations e) Selling the family home

a) Moving in with a friend or family member c) Having difficulty concentrating e) Selling the family home

A recently admitted terminally ill client has not requested pain medication for several hours. Which action should the nurse take? a) Observe for physical clues and assess the client for pain b) Administer pain medication as prescribed c) Assume that the client does not want to take pain medication d) Wait until the client asks for pain medication

a) Observe for physical clues and assess the client for pain

A nurse is preparing a community teaching presentation on prevention of abuse. Which levels of prevention should be included in the nurse's presentation? (Select all that apply.) a) Parental b) Individual c) Historical d) Societal e) Community

a) Parental b) Individual d) Societal e) Community

Which actions are appropriate nonpharmacologic treatments of a neglected or abused child? (Select all that apply.) a) Providing a safe environment for the child b) Reporting the abuse or neglect to the appropriate agency c) Family therapy for the parents d) Play therapy e) Pain medication for the child's injuries

a) Providing a safe environment for a child b) Reporting the abuse or neglect to the appropriate agency c) Family therapy for the parents d) Play therapy

A client with terminal cancer is experiencing dyspnea. Which actions should the nurse use to help this client? (Select all that apply.) a) Raise the head of the bed b) Provide oxygen as prescribed c) Provide small frequent meals d) Elevate both legs e) Place pillows behind head

a) Raise the head of the bed b) Provide oxygen as prescribed e) Place pillows behind head

The nurse who is caring for a client who was a victim of intimate partner violence (IPV) is aware that recovery from this type of relationship can be a long and difficult process. Which should the nurse identify as the victim's main goal in reconstructing her life? a) Regaining a sense of empowerment and safety b) Resolving grief over any losses c) Getting through the shock and confusion of the act d) Getting back into work and home routines

a) Regaining a sense of empowerment and safety

The nurse is providing care to a client who recently lost her child in a car crash. The client presents with difficulty breathing and diaphoresis. Based on these symptoms, which nursing intervention is the priority for this client? a) Staying with the client and treating the symptoms b) Asking the client open-ended questions c) Listening to the client's concerns d) Using body language that encourages the client to talk

a) Staying with the client and treating the symptoms

The nurse manager of an oncology unit observes a staff nurse say to a dying client, "You cannot die now. I don't handle death well." What should the manager do at this time? a) Suggest the nurse talk with a grief counselor to learn how to handle the care of clients facing death b) Explain to the client that the nurse was just kidding c) Remind the nurse that clients cannot control the time of death d) Document the observation for later discussion during the annual performance appraisal

a) Suggest the nurse talk with a grief counselor to learn how to handle the care of clients facing death

A case management nurse is working with a familiar client, a proven victim of repeated and severe domestic abuse. The client has chosen to return for the third time to live with the abuser. What must the nurse remember in this frustrating situation? (Select all that apply.) a) The client feels unable to leave an unsafe situation b) The client's decisions should not be judged by the nurse c) The client's choice should be supported by the nurse d) The client will never make other living arrangements e) The client has the case manager's contact information

a) The client feels unable to leave an unsafe situation b) The client's decisions should not be judged by the nurse c) The client's choice should be supported by the nurse e) The client has the case manager's contact information

During an office visit, a client reports infrequent and difficult bowel movements. Which teaching topic is appropriate for this client? (Select all that apply.) a) The importance of consuming adequate amounts of fluid and fiber b) The use of laxatives or stool softeners c) The importance of staying active d) The avoidance of raw fruit, vegetables, and meat when traveling aboard e) The importance of cooking and storing food correctly

a) The importance of consuming adequate amounts of fluid and fiber b) The use of laxatives or stool softeners c) The importance of staying active

John comes to the mental health clinic with reports of anxiety and depression. According to the transactional model of stress and adaption, which of the following are important to consider when assessing John's complaints? (Select all that apply) a. John's perception of precipitating events b. Past stressors and degree of positive coping abilities c. Existing social supports d. Physical strength e. Pupillary adaption to light

a, b, c

Which of the following is most likely to initiate a grief response in an individual? (Select all that apply) a. Death of the pet dog b. Being told by her doctor that she has begun menopause c. Failing an exam d. Losing a spouse through divorce

a, b, c, d

A client expresses interest in alternate treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? (Select all that apply) a. Light therapy has demonstrated effectiveness that is comparable to antidepressants. b. Light therapy should be used regularly until the season changes. c. Light therapy should be used only when ECT has proven to be ineffective. d. Side effects such as headache, nausea, or agitation, when they occur, are usually mild and transient. e. Light therapy causes sedation, so the best time to use it is before bedtime.

a, b, d

Joan's husband, who was deployed to Afghanistan a year ago, is returning home this week. Which of the following postdeployment situations may be likely to occur during the fist few months of his return? Select all that apply. a. A honeymoon period of physical reconnection b. Resistance from the spouse regarding possible loss of autonomy c. Rejection by the children for perceived abandonment d. A period of adjustment to reconnect emotionally

a, b, d

Sally is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions are identified as those that will promote positive self-esteem in the patient? (Select all that apply). a. Teach assertive communication skills b. Make observations to Sally when she completes a goal or task. c. Instruct Sally that you will not talk with her unless she stops talking negatively about herself. d. Offer to spend time with Sally using a nonjudgmental, accepting approach.

a, b, d

Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply). a. Early intervention at the first episode of psychosis b. Support for employment and/or educational pursuits c. Rapid high-dose loading with anti-psychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused therapy

a, b, e

Trauma-informed care is a philosophical approach that includes which of the following principles? (Select all that apply) a. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization b. Medications need to be given before any other interventions are considered c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client d. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide

a, c

A nurse is caring for a client who takes paroxetine to treat PTSD. The client states that he grinds his teeth during the night which causes pain in his mouth. The nurse should identify which of the following as possible measures to manage the client's bruxism? (Select all that apply.) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antianxiety medication E. Increasing the dose of paroxetine

a, c, d

Mike, a veteran of combat in Afghanistan, has a diagnosis of mild TBI. The psychiatric home health nurse form the VA medical center is assigned to make home visits to Mike and his wife, Nancy, who is his caregiver. Which of the following be an appropriate nursing intervention by the home health nurse? Select all that apply. a. Assess for use of substances by Mike or Nancy b. Encourage Nancy to do everything for Mike to prevent further deterioration in his condition c. Assess Nancy's level of stress and potential for burnout d. Encourage Nancy to allow Mike to be as independent as possible e. Suggest that Nancy ask the physician for a nursing home replacement for Mike

a, c, d

A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply) a. hypothermia b. hallucinations c. muscular flaccidity d. diaphoresis e. agitation

a, d, e

Pam's husband of 1 year left 2 weeks ago for a year-long deployment in Afghanistan. Pam makes an appointment with the psychiatric nurse practitioner at the Community Mental Health Clinic. She tells the nurse that she can't sleep, has no appetite, is chronically fatigued, thinks about her husband constantly and fears for his life. Which of the following might the nurse suggest/prescribe for Pam? Select all that apply. a. A prescription for sertraline, 50 mg/day b. Participation in a support group c. Resume involvement in usual activities d. Perform regular relaxation exercises

a,b,c,d

. Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? Select all that apply. a. Olanzepine (Zyprexa) b. Oxycodone (Oxycontin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) e. Tranylcypromine (Parnate)

a,c,d

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on the medication. What foods should I avoid?" a. Bleu cheese, red wine, raisins b. Black beans, garlic, pears c. Pork, shellfish, egg yolks d. Milk, peanuts, tomatoes

a. Bleu cheese, red wine, raisins

Some biological factors may be associated with the predisposition to suicide. Which of the following biological factors have been implicated? a. Genetics and decreased levels of serotonin b. Heredity and increased levels of norepinephrine c. Temporal lobe atrophy and decreased levels of acetylcholine d. Structural alterations of the brain and increased levels of dopamine

a. Genetics and decreased levels of serotonin

Which of the following is least likely to predispose a child to Tourette's disorder? a. Absence of parental bonding b. Family hx of the disorder c. Abnormalities of brain neurotransmitters d. Structural abnormalities of the brain

a. Absence of parental bonding

A school nurse notices bruises and scars on a child's body. The nurse suspects that the child is being physically abused. How should the nurse proceed with this information? a. As a healthcare worker, report the suspicion to the department of health and human services. b. Check Jana again in a week and see if there are any new bruises. c. Meet with Jana's parents and ask them how Jana I got the bruises. d. Initiate paperwork to have Jana placed in foster care.

a. As a healthcare worker, report the suspicion to the department of health and human services.

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) a. Awareness training. b. Competing response training. c. Social support. d. Hypnotherapy. e. Aversive therapy.

a. Awareness training. b. Competing response training. c. Social support.

4. Anna, who is 72 years old, is of the age when she may have experienced several losses in a short time. What is this called? a. Bereavement overload b. Normal mourning c. Isolation d. Cultural relativity

a. Bereavement overload

The nurse in the emergency department encounters a patient, Niko, who is expressing suicide ideation. The nurse recognizes that which of the following considerations are important to good suicide risk assessment? (Select all that apply.) a. Collaborating with the patient b. Asking specific questions about leisure activities c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

a. Collaborating with the patient c. Establishing trust and open communication with the patient d. Asking the patient specific questions about the strength of his intention to die e. Identifying whether the patient has thought about a plan for trying to kill himself

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called: a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis of anticipated life transitions

a. Crisis resulting from traumatic stress

When Frank's wife of 34 years dies, he is very stoic, handles all the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? a. Delayed grieving b. Distorted grieving c. Prolonged grieving d. Exaggerated grieving

a. Delayed grieving

Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? a. In clinical depression, anhedonia is prevalent b. In normal grieving, the person has generalized feelings of guilt c. The person who is clinically depressed relates feelings of depression to a specific loss d. In normal grieving, there is a persistent state of dysphoria

a. In clinical depression, anhedonia is prevalent

The goal of cognitive therapy with depressed clients is to: a. Identify and change dysfunctional patterns of thinking b. resolve the symptoms and initiate or restore adaptive family functioning c. Alter the neurotransmitters that are creating the depressed mood d. Provide feedback from peers who are having similar experiences

a. Identify and change dysfunctional patterns of thinking

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to: a. Increase energy and elevate mood. b. Stimulate the central nervous system. c. Prevent psychotic symptoms. d. Produce a calming effect.

a. Increase energy and elevate mood.

Which of the following individuals is at highest risk for a suicide attempt? a. John, who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me." b. Kelly, who has been seeing a doctor for chronic, intractable pain and is taking pain medication. c. Jim, an American Indian who just graduated from high school with honors. d. Mike, a physician who reports feeling 'burnt out" and is considering retirement.

a. John, who reports he is in deep emotional pain, feels hopeless, and says "No one is there for me."

The most appropriate nursing intervention with Jenny (from question 5) would be to: a. Make arrangements for her to start attending Alateen meetings b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is c. Teach her about the effects of alcohol on the body and that it can be hereditary d. Refer her to a psychiatrist for private therapy to learn to deal with her home situation

a. Make arrangements for her to start attending Alateen meetings

1. A nurse is caring for a client who has a new prescription for phenelzine for the treatment of depression. Which of the following indicates that the client has developed an adverse effect of this medication? a. Orthostatic hypotension b. Hearing loss c. Gastrointestinal bleeding d. Weight loss

a. Orthostatic hypotension a. Orthostatic hypotension is an adverse effect of MAOIs. b. Phenelzine is more likely to cause blurred vision than hearing loss c. Clients taking phenelzine are at risk for multiple adverse effects. However, these do not include GI bleeding. d. Clients taking phenelzine are at risk for weight gain rather than weight loss.

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy

a. Paroxetine and group therapy

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: a. Relieves her anxiety. b. Reduces the probability of infection. c. Gives her a feeling of control over her life. d. Increases her self-concept.

a. Relieves her anxiety.

Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply) a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment b. Accompany the client to off-unit activities c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precations

a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment b. Accompany the client to off-unit activities c. Obtain a promise from the client that she will not do anything to harm herself for the next 12 hours

Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply.) a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Reassess intensity of suicidal thoughts and urges on a regular basis. d. Put all of the client's possessions in storage and explain to her that she may have them back when she is off suicide precautions.

a. Remove all sharp objects, belts, and other potentially dangerous articles from the client's environment. b. Accompany the client to off-unit activities. c. Reassess intensity of suicidal thoughts and urges on a regular basis.

Which of the following nursing diagnoses would be considered the priority in planning care for the child with autism spectrum disorder (ASD)? a. Risk for self-mutilation evidenced by banging head against wall b. Impaired social interaction evidenced by unresponsiveness to people c. Impaired verbal communication evidenced by absence of verbal expression d. Disturbed personal identity evidenced by inability to differentiate self from others

a. Risk for self-mutilation evidenced by banging head against wall

A client has just been admitted tothe psychiatric unit with a diagnosis of Major Depressive Disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply) a. Slumped posture b. Delusional thinking c. Feelings of despair d. Feels best early in the morning and worse as the day progresses e. Anorexia

a. Slumped posture b. Delusional thinking c. Feelings of despair e. Anorexia

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client? a. Stay with the client and reassure of safety. b. Administer a dose of diazepam. c. Leave the client alone in a quiet room so that she can calm down. d. Encourage the client to talk about what triggered the attack.

a. Stay with the client and reassure of safety.

8. Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? (Select all that apply.) a. Unresolved grief over loss of her husband b. Loss of several relatives and friends over the last few years c. Repressed feelings of guilt over the way Lucky died d. Inability to prepare in advance for the loss

a. Unresolved grief over loss of her husband b. Loss of several relatives and friends over the last few years c. Repressed feelings of guilt over the way Lucky died d. Inability to prepare in advance for the loss

A battered woman presents to the ED with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. The priority nursing intervention is: a. Tending to the immediate care of her wounds b. Providing her with information about a safe place to stay c. Administering the PRN tranquilizer ordered by the physician d. Explaining how she may go about bringing charges against her husband

a. Tending to the immediate care of her wounds

Which of the following is thought to facilitate the grief process? a. The ability to grieve in anticipation of the loss b. The ability to grieve alone without interference from others c. Having recently grieved for another loss d. Taking personal responsibility for the loss

a. The ability to grieve in anticipation of the loss

The nurse identifies the primary nursing diagnosis for Theresa as Risk for Suicide r/t feelings of hopelessness from loss of relationship. Which is the outcome criterion that would most accurately measure achievement of this diagnosis? a. The client has experienced no physical harm to herself b. The client sets realistic goals for herself c. The client expresses some optimism and hope for the future d. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend

a. The client has experienced no physical harm to herself

The nurse identifies the primary nursing diagnosis for Theresa as Risk for suicide related to feelings of hopelessness from loss of relationship. Which is the outcome criterion that would be most appropriate for this diagnosis?" a. The client has experienced no physical harm to herself. b. The client sets realistic goals for herself. c. The client expresses some optimism and hope for the future. d. The client has reached a stage of acceptance in the loss of the relationship with her boyfriend.

a. The client has experienced no physical harm to herself.

The category of adjustment disorder with disturbance of conduct identifies the individual who: a. Violates the rights of others to feel better. b. Expresses symptoms that reveal a high level of anxiety. c. Exhibits severe social isolation and withdrawal. d. Is experiencing a complicated grieving process.

a. Violates the rights of others to feel better.

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic epi- sode. Number the diagnoses in order of the appropriate priority. a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night b. Risk for injury related to manic hyperactivity c. Impaired social interaction evidenced by manipulation of others d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor

a=3,b=1,c=4,d=2

The nurse is teaching a school age child and his parents about a new prescription for lisdexamfetamine. Which of the following information should the nurse include in the teaching? Select all that apply. a. an adverse effect of this medication is CNS stimulation b. administer the medication before bedtime c. Monitor blood pressure while taking this medication d. therapeutic effects of this medication will take 1 to 3 weeks to fully develop e. this medication raises the level of dopamine in the brain

a. an adverse effect of this drug is CNS stimulation such as insomnia and restlessness C. the nurse should instruct the client to monitor his blood pressure due to potential cardiovascular effects of this drug e. this drug is a cns stimulant works by raising the level of norepinephrine and dopamine in the CNS

When an individual's stress response is sustained over a long period, the endocrine system involvement results in which of the following? a. decreased resistance to disease b. increased libido c. decreased blood pressure d. increased inflammatory response

a. decreased resistance to disease

A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? a. perform immediate gastric lavage b. prepare the client for hemodialysis c. administer an additional oral dose of lithium d. request that a stat repeat of the laboratory test

a. perform immediate gastric lavage -gastric lavage is appropriate for a client who has severe toxicity, as evidenced by a plasma lithium level of 2.1 mEq/L. This action will lower the client's lithium level.

A nurse is caring for a client who has a new prescription for valproic acid. The nurse should instruct the client that while taking this medication he will need to have which of the following laboratory tests completed periodically? SELECT ALL THAT APPLY a. thrombocyte count b. hematocrit c. amylase d. liver function tests e. potassium

a. thrombocyte count- treatment with valproic acid can result in thrombocytopenia c. amylase-treatment with valproic acid can result in pancreatitis d. liver function tests-treatment with valproic acid can result in hepatotoxicity

Nurse is teaching in adolescent client who has a new prescription for clomipramine for OCD. Which of the following instructions should the nurse include to minimize an adverse effect of this medication? a. wear sunglasses when outdoors b. check your temperature daily c. take this medication in the morning d. add extra calories to your diet

a. wearing sunglasses when outdoors will decrease photophobia and anti-cholinergic effects associated with TCA use.

2. Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? a. Denial of depression b. Repression of anxiety c. Suppression of grief d. Displacement of anger

b

4. Lorraine, a client diagnosed with somatic symptom disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the basis for Lorraine's statement? a. She thinks her doctor wants to get rid of her as a client. b. She does not understand the correlation of symptoms and stress. c. She thinks psychiatrists are only for "crazy" people. d. She thinks her doctor has made an error in diagnosis.

b

7. In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must: a. Try to relate to Ellen as though she did not have multiple personalities. b. Establish a relationship with each of the personalities separately. c. Ignore behaviors that Ellen attributes to other subpersonalities. d. Explain to Ellen that he or she will work with her only if she maintains the status of the primary personality.

b

9. The ultimate goal of therapy for a client with DID is most likely achieved through: a. Crisis intervention and directed association b. Psychotherapy and hypnosis c. Psychoanalysis and free association d. Insight psychotherapy and dextroamphetamines

b

A nurse is educating a client about his lithium therapy. She is explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia

b

A nurse is teaching the parents of a school-age child about transdermal methylphenidate. Which of the following instructions should the nurse include? a. apply one patch twice per day b. leave the patch on for 9 hr c. apply the patch to the child's waist d. use opened tray within 6 months

b

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity due to an overdose. Which of the following actions is the nurse's priority? a. Administer flumazenil b. Identify the client's level of orientation c. Infuse IV fluids d. Prepare the client for gastric lavage

b

Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of which of the following? a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference d. A delusion of control or influence

b

Margaret, a 68-year-old widow, is brought to the emergency department by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister- in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. Margaret is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just col- lapse!" Margaret is admitted to the psychiatric unit. What is the priority nursing diagnosis for Margaret? a. Imbalanced nutrition: less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression

b

Which of the following groups is most commonly used for drug management of the child with ADHD? a. CNS depressants (e.g., diazepam [Valium]) b. CNS stimulants (e.g. methylphenidate [Ritalin]) c. Anticonvulsants (e.g. phenytoin [Dilantin]) d. Major tranquilizers (e.g. haloperidol [Haldol])

b. CNS stimulants (e.g. methylphenidate [Ritalin])

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in mid sentence, and listens intently. The nurse recognizes these behaviors as a symptom of the clients illness. The most appropriate nursing int. for this symptom would be: a. as the client to describe his physical symptoms b. ask the client to describe what he is hearing c. administer a dose of benztropine d. call the physician for additional orders

b

The primary goal in working with an actively psychotic, suspicious client would be to a. promote interaction with others b. decrease his anxiety and increase trust c. improve his relationship with his parents d. encourage participation in therapy activities

b

Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Tony is to a. give him an injection of Thorazine b. ensure a safe environment for him and others. c. place him in restraints d. order him a nutritious diet

b

Which of the following is the leading cause of TBI in active-duty military personnel in combat? a. military vehicle accident b. blasts from explosive devices c. falls d. blows to the head from falling debris

b

A client with a terminal illness has just died and the nurse is found in the medication room crying. What should the nurse manager do? (Select all that apply.) a) Document that the nurse is hypersensitive and needs additional training b) Ask if there is anyone that the nurse would like to talk to at this time c) Permit the nurse time to grieve d) Provide the nurse with a sedative and send home e) Remind the nurse that postmortem care needs to be completed

b) Ask if there is anyone that the nurse would like to talk to at this time c) Permit the nurse time to grieve

The nurse is talking with a client who just had a beautiful potted flower delivered. Suddenly the client starts to cry and stares out the window. The client has a history of abuse by her husband. Which response should the nurse include in the plan of care for this client? a) Tell the client that the abuse was in the past b) Assess if the client is having a flashback of previous abuse c) Tell the client to enjoy the flowers and that she will feel better in a little while d) Give the client some time and return later

b) Assess if the client is having a flashback of previous abuse

A nurse at a geriatric clinic notices bruises on the arms and legs of a frail older client. If the bruises are caused by abuse, who might be possible perpetrators? (Select all that apply.) a) Meals-on-wheels volunteers b) Children visiting a parent c) Client's spouse d) Prescriber of anticoagulants e) Caregiver living in home

b) Children visiting a parent c) Client's spouse e) Caregiver living in home

A nurse is looking at the professional literature about children with similar risks of environmental exposure to violence. Which outcomes would the nurse read about? (Select all that apply.) a) Lethargy b) Depression c) Nonproblematic behaviors d) Hypertension e) Violence

b) Depression c) Nonproblematic behaviors e) Violence

While assessing a 76-year-old female client who fell off a stepstool in her kitchen, the nurse learns that the client is recently widowed. Which area should the nurse investigate to provide holistic health care for this client? (Select all that apply.) a) Physical therapy resources b) Dietary resources c) Spiritual resources d) Community resources e) Family resources

b) Dietary resources c) Spiritual resources d) Community resources e) Family resources

A 5-year-old girl who has been physically abused is having difficulty putting her feelings into words. Which nursing intervention best enables the child to express her feelings? a) Reporting the abuse to a prosecutor b) Engaging in play therapy c) Role-playing d) Giving the child's drawings to the abuser

b) Engaging in play therapy

The nurse is caring for a client dying of a terminal illness that was diagnosed 3 months ago. Which psychosocial behaviors should the nurse expect the client to exhibit at this time? (Select all that apply.) a) Edema b) Fear c) Anxiety d) Anticipatory grief e) Indifference

b) Fear c) Anxiety d) Anticipatory grief

A client dying from a terminal illness who has been receiving pain medication is now comatose. Which actions should the nurse take to ensure this client's comfort? (Select all that apply.) a) Cover with several blankets to maintain warmth b) Gently splint joints when repositioning the client c) Provide artificial tears d) Use incontinence pads e) Suggest tube feedings for nutritional support

b) Gently splint joints when repositioning the client c) Provide artifical tears d) Use incontinence pads

The nurse on the pediatric unit is caring for a 3-year-old child who has dime-size burns on her legs and bruises in various stages of healing on her abdomen and back. Which is an appropriate nonpharmacologic treatment for this child? a) Give acetaminophen as ordered by the physician b) Refer the child for play therapy c) Treat the burns with silvadene ointment d) Assess the child's back and abdomen for any changes

b) Refer the child for play therapy

The school nurse is assessing a third-grade child for symptoms of sexual abuse. Which behavioral manifestations support the possibility of sexual abuse? a) Enuresis, impulsivity, and decline in school performance b) Thumb-sucking, isolating self from peers on playground, and excessive fear of strangers c) Hyperactivity, stuttering, and isolating self from peers on the playground d) Stuttering, impulsivity, and being the team leader when playing games with peers

b) Thumb-sucking, isolating self from peers on playground, and excessive fear of strangers

A pediatric nurse is conducting a health history on a newly admitted child. The nurse includes the fact that the child's family has been involved in a cycle of violence. What meaning could the nurse be conveying? a) The child has self-abusive behaviors b) Violence has occurred across multiple generations c) The child's parents have never committed violent acts d) Violence occurs unexpectedly and randomly in the child's family

b) Violence has occurred across multiple generations

3. Anna's daughter notices that Anna appears to be listening to another voice when just the two of them are in a room together. When questioned, Anna admits that she hears someone telling her that she was a horrible caretaker for Lucky and did not deserve to ever have a pet. Which of the following best describes what Anna is experiencing? a. Neurosis b. Psychosis c. Depression d. Bereavement

b. Psychosis

The etiologies of interpersonal violence, abuse, and neglect relate to several different theories. Which explanation best describes the social learning theory? a) Some families, cultures, and communities value the subordination of women through power and privilege. b) Violence related to abuse and neglect is a learned behavior. c) The tendency to abuse, neglect, and become violent toward others is a result of genetic considerations and distortion in neurotransmitters. d) The cause of violence lies in the personality of the individual who commits abuse.

b) Violence related to abuse and neglect is a learned behavior

A public health nurse is the guest speaker at a PTA meeting. The nurse describes how parents' activities can decrease the risk of violence in their family. Which actions supported by CDC research will the nurse include? (Select all that apply.) a) Achieving financial success b) Watching the child's sports team play c) Regularly attending worship service together d) Rewarding good report cards e) Showing interest in the child's homework

b) Watching the child's sports team play c) Regularly attending worship services together d) Rewarding god report cards e) Showing interest in the child's homework

A nurse is conducting a nursing assessment interview of an individual with unexplained rib fractures. To check whether the person is a possible victim of domestic abuse, the nurse asks, "Has your partner ever struck you when feeling angry?" Which word in the nurse's phrasing of the question shows consideration? a) Using the word "partner" b) Using the word "ever" c) Using the word "stuck" d) Using the word "angry"

b) using the word "ever"

Leon, a veteran of the war in Iraq, has been diagnosed with PTSD. He has been hospitalized after swallowing a handful of his anti-panic medication. His physical condition has been stabilized in the emergency department, and has been admitted to the psychiatric unit. In developing the initial plan of care, which is the priority nursing diagnosis that the nurse selects for Leon? a. post-trauma syndrome b. risk for suicide c. complicated grieving d. disturbed thought processes

b.

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Xanax is not effective for generalized anxiety disorder." b. "Buspirone must be taken daily in order to be effective." c. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." d. "Your friend really should be taking the Xanax every day."

b. "Buspirone must be taken daily in order to be effective."

Sharon, a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is: a. "How often does he drink too much?" b. "It is not your fault. You did the right thing by coming here." c. "How many times has he done this to you?" d. "He is not a good husband. You have to leave him before he kills you."

b. "It is not your fault. You did the right thing by coming here."

10. Which of the following statements by Anna might suggest that she is achieving resolution of her grief over Lucky's death? a. "I don't cry anymore when I think about Lucky." b. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands." c. "I remember how it happened now. I should have held tighter to his leash!" d. "I won't ever have another dog. It's just too painful to lose them."

b. "It's true. Lucky didn't always mind me. Sometimes he ignored my commands."

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving for the marriage you did not have. It's natural for you to feel bad." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."

b. "You are grieving for the marriage you did not have. It's natural for you to feel bad."

Kate is an 18-year-old freshman at the State University. She was extremely flattered when Dawn, a senior star football player, invited her to a party. On the way home, he parked the car in a secluded area by the lake. He became angry when she refused his sexual advances. He began to beat her and finally raped her. She tried to fight him, but his physical strength overpowered her. He dumped her in the dorm parking lot and left. The dorm supervisor rushed Kate to the emergency department. Kate says to the nurse, "It's all my fault. I shouldn't have allowed him to stop at the lake." The nurses best response is: a. "yes, you're right. You put yourself in a very vulnerable position when you allowed him to stop at the lake." b. "You are not to blame for his behavior. You obviously made some right decisions, because you survived the attack." c. "There's no sense in looking back now. Just look forward, and make sure you don't put yourself in the same situation again." d. "you'll just have to see that he is arrested so he won't do this to anyone else."

b. "You are not to blame for his behavior. You obviously made some right decisions, because you survived the attack."

A nurse is preparing a teaching plan for a female client who has bipolar disorder and a new prescription for carbamazepine. Which of the following instructions should the nurse include in the teaching? a. "this medication can safely be taken during pregnancy." b. "eliminate grapefruit juice from your diet." c. "you will need to have a complete blood count and carbamazepine levels drawn periodically." d. "notify your provider if you develop a rash." e. "avoid driving for the first few days after starting this medication."

b. "eliminate grapefruit juice from your diet." -grapefruit juice affects carbamazepine metabolism and should be avoided c. "you will need to have a complete blood count and carbamazepine levels drawn periodically." -carbamazepine blood levels and the CBC should be monitored during therapy. The client is at risk for bone marrow depression while taking carbamazepine and should notify the provider for a sore throat or other manifestations of an infection d. "notify your provider if you develop a rash." -carbamazepine can cause Stevens-Johnson syndrome, which can be fatal. e. "avoid driving for the first few days after starting this medication." -CNS effects such as drowsiness or dizziness can occur early in treatment with carbamazepine and the client should avoid activities requiring alertness until those effects subside

Theresa, who has been hospitalized following a suicide attempt is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions are most appropriate in this instance? (Select all that apply.) a. Restrict access to any item that might be harmful by placing the client in a seclusion room. b. Check on Theresa every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas. d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions. e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide.

b. Check on Theresa every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. e. Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide.

Theresa, who has been hospitalized following a suicide attempt, is placed on suicide precautions on the psychiatric unit. She admits that she is still feeling suicidal. Which of the following interventions is most appropriate in this instance? a. Obtain an order from the physician to place Theresa in restraints to prevent any attempts to harm herself b. Check on Theresa every 15 minutes of assign a staff person to stay with her on a one-to-one basis c. Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicide ideas d. Do not allow Theresa to participate in any unit activities while she is on suicide precautions

b. Check on Theresa every 15 minutes of assign a staff person to stay with her on a one-to-one basis

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of adjustment disorder with depressed mood. The priority nursing diagnosis for Nina would be: a. Risk-prone health behavior related to loss of dependency. b. Complicated grieving related to breakup of marriage. c. Ineffective coping related to problems with dependency. d. Social isolation related to depressed mood.

b. Complicated grieving related to breakup of marriage.

Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned, and takes her to the local mental health center. This type of crisis is called: a. Dispositional crisis b. Crisis of anticipated life transitions c. Psychiatric emergency d. Crisis resulting from traumatic stress

b. Crisis of anticipated life transitions

The most appropriate crisis intervention with Amanda (from question 3) would be to: a. Encourage her to recognize how lucky she is to be alive b. Discuss stages of grief and feelings associated with each c. Identify community resources that can help Amanda d. Suggest that she find a place to live that provides a storm shelter

b. Discuss stages of grief and feelings associated with each

Which of the following medications is used to treat Tourette's disorder? a. Methylphenidate (Ritalin) b. Haloperidol (Haldol) c. Imipramine (Tofranil) d. Phenytoin (Dilantin)

b. Haloperidol (Haldol)

In determining degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? a. Low risk b. High risk c. Imminent risk d. Unable to be determined

b. High risk

Jana, age 5, is sent to the school nurses office with an upset stomach. She has vomited and soiled her blouse. When the nurse removes her blouse, she notices that Jana has numerous bruises on her arms and torso, in various stages of healing. She also notices some small scars. Jana's abdomen protrudes on her small, thin frame. From the objective physical assessment, the nurse suspects that: a. Jana is experiencing physical and sexual abuse. b. Jana is experiencing physical abuse and neglect. c. Jana is experiencing a motional neglect. d. Jana is experiencing sexual and emotional abuse.

b. Jana is experiencing physical abuse and neglect

Which of the following individuals is at highest risk for suicide? a. Nancy, age 33, Asian American, Catholic, middle socioeconomic group, alcoholic b. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastic cancer of the pancreas c. Carol, age 15, African American, Baptist, high socioeconomic group, no physical or mental health problems d. Mike, age 55, Jewish, middle socioeconomic group, suffered myocardial infarction a year ago

b. John, age 72, white, Methodist, low socioeconomic group, diagnosis of metastic cancer of the pancreas

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include? (select all that apply) a. Don't eat chocolate while taking this medication b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. Don't take this medication with the migraine drugs "triptans" d. Go to the lab each week to have your blood drawn for therapeutic level of this drug e. This drug causes a high degree of sedation, so take it just before bedtime

b. Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect c. Don't take this medication with the migraine drugs "triptans"

A newly admitted depressed client isolates herself in her room and just sits and stares into space. How best might the nurse begin a therapeutic relationship with this client? a. Say, "come with me. I will go with you to group therapy." b. Make frequent short visits to her room and sit with her c. Offer to introduce her to the other clients d. Help her to identify stressors in her life that precipitate crises

b. Make frequent short visits to her room and sit with her

A young woman who has just undergone a sexual assault is brought into the emergency department by a friend. The priority nursing intervention would be: a. Help her to bathe and clean herself up b. Provide physical and emotional support during evidence collection c. Provide her with a written list of community resources for survivors of rape d. Discuss the importance of a follow up visit to evaluate for sexually transmitted disease is

b. Provide physical and emotional support during evidence collection

5. Anna has been grieving the death of Lucky for 3 years. She is unable to take care of her normal activities because she insists on visiting Lucky's grave daily. What is the most likely reason that Anna's daughter has put off seeking help for Anna? a. Women are less likely than men to seek help for emotional problems. b. Relatives often try to normalize behavior rather than label it mental illness. c. She knows that all older people are expected to be a little depressed. d. She is afraid that the neighbors will think her mother is "crazy."

b. Relatives often try to normalize behavior rather than label it mental illness.

In an effort to help the child with mild to moderate intellectual developmental disorder develop satisfying relationships with others, which of the following nursing interventions is most appropriate? a. Interpret the child's behavior for others b. Set limits on behavior that is socially inappropriate c. Allow the child to behave spontaneously, for he or she has no concept of right or wrong d. This child is not capable of forming social relationships

b. Set limits on behavior that is socially inappropriate

The child with ADHD has a nursing diagnosis of impaired social interaction. Which of the following nursing interventions are appropriate for this child? (Select all that apply) a. Socially isolate the child when interactions with others are inappropriate b. Set limits with consequences on inappropriate behaviors c. Provide rewards for appropriate behaviors d. Provide group situations for the child

b. Set limits with consequences on inappropriate behaviors c. Provide rewards for appropriate behaviors d. Provide group situations for the child

The physician orders sertraline (Zoloft) 50mg bid for margaret, a 68-year old woman with Major Depressive Disorder. After 3 days taking the medication, Margaret says tot he nurse, "I don't think this medicine is doing any good. I don't feel a bit better." What is the most appropriate response by the nurse? a. Cheer up, Margaret. You have so much to be happy about. b. Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms. c. I'll report that to the physician, Margaret. Maybe he will order something different. d. Try not to dwell on your symptoms, margaret. Why don't you join the others down in the dayroom?

b. Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms.

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? a. Keep the client's bathroom locked so she cannot wash her hands all the time. b. Structure the client's schedule so that she has plenty of time for washing her hands. c. Place the client in isolation until she promises to stop washing her hands so much. d. Explain the client's behavior to her, since she is probably unaware that it is maladaptive.

b. Structure the client's schedule so that she has plenty of time for washing her hands.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spritual distress

b. Survivor's guilt

A nurses is teaching the parents of the child who has a new prescription for desipramine. The nurse should instruct the parents that which of the following adverse effects is the priority to report the provider? a. constipation b. suicidal thoughts c. photophobia d. dry mouth

b. The greatest risk to the client is injury from suicide attempt therefore this is the priority this medication can cause suicidal thoughts and behaviors which puts the client at risk the parent should monitor report any indications of increased depression or thoughts of suicidal behavior

A major difference between normal and maladaptive grieving has been identified by which of the following? a. There are no feelings of depression in normal grieving b. There is no loss of self-esteem in normal grieving c. Normal grieving lasts no longer than 1 year d. In normal grief the person does not show anger toward the loss

b. There is no loss of self-esteem in normal grieving

Success of long-term psychotherapy with Theresa (who attempted suicide following a breakup with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend b. Theresa has an increased sense of self worth c. Theresa does not take antidepressants anymore d. Theresa told her old boyfriend how angry she was with him for breaking up with her

b. Theresa has an increased sense of self worth

Success of long-term psychotherapy with Theresa (who attempted suicide following a break-up with her boyfriend) could be measured by which of the following behaviors? a. Theresa has a new boyfriend. b. Theresa has an increased sense of self-worth. c. Theresa does not take antidepressants anymore. d. Theresa told her old boyfriend how angry she was with him for breaking up with her.

b. Theresa has an increased sense of self-worth.

Which of the following activities would be most appropriate for the child with ADHD? a. Monopoly b. Volleyball c. Pool d. Checkers

b. Volleyball

The most appropriate nursing intervention with Ginger (from question 7) would be to: a. Suggest she move to a college closer to home b. Work with Ginger on unresolved dependency issues c. Help her find someone int he college town from whom she could seek assistance rather than calling her mother regularly d. Recommend that the college physician prescribe an antianxiety medication for Ginger

b. Work with Ginger on unresolved dependency issues

Sondra, who lives in Maine, hears on the evening news that 25 people were killed in a tornado in south Texas. Sondra experiences no anxiety upon hearing of this stressful situation. This is most likely because Sondra: a. is selfish and does not care what happens to other people b. appraises the event as irrelevant to her own situation c. assesses that she has the skills to cope with the stressful situation d. uses suppression as her primary defense mechanism

b. appraises the event as irrelevant to her own situation

A nurse is assessing a client who takes lithium carbonate for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity to this medication? a. severe hypertension b. coarse tremors c. constipation d. muscle spasms

b. coarse tremors

a nurses is caring for A school age child who has a new prescription for atomoxetine? The nurse should monitor the client for which of the following adverse effects of this medication? a. kidney toxicity b. liver damage c. seizure activity d. adrenal insufficiency

b. liver damage is an adverse effect of this drug the nurse should monitor for manifestation such as jaundice upper abdominal tenderness darkening of urine and elevated liver enzymes

Management of stress is extremely important in today's society because: a. evolution has diminished human capability for "fight or flight" b. the stressors of today tend to be ongoing, resulting in a sustained response c. we have stress disorders that did not exist in the days of our ancestors d. one never knows when one will have to face a grizzly bear or saber-toothed tiger in today's society

b. the stressors of today tend to be ongoing, resulting in a sustained response

5. Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse? a. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." b. "Let's sit down here together and you can tell me about this new pain you are experiencing. You'll just have to miss group therapy today." c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time." d. "I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?"

c

A child with bipolar disorder also has attention deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? a. No medication would be given for either condition. b. Medication would be given for both conditions simultaneously. c. The bipolar condition would be stabilized first before medication for the ADHD would be given. d. The ADHD would be treated before consideration of the bipolar disorder.

c

A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate. d. Explain to her that if she wears this outfit, she must remain in her room.

c

A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? a. Delusions of reference b. Loose association c. Anosognosia d. Auditory hallucinations

c

A nurse is caring for a client who is to begin taking fluoxetine for treatment of generalized anxiety disorder. Which of the following statements indicates the client understands the use of this medication? a. " I will take the medication at bedtime." b. " I will follow a low-sodium diet while taking this medication." c. " I will need to discontinue this medication slowly." d. " I will be at risk for weight loss with long-term use of this medication. "

c

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? a. Narcissistic behavior b. Fear of rejection from staff c. Attempt to reduce anxiety d. Adverse effect of antidepressant medication

c

Leon, a veteran of the way in Iraq, has been diagnosed with PTSD. He has been hospitalized on the psychiatric following an attempted suicide. In the middle of the night, he wakes up yelling and tells the nurse he was having a flashback to when his unit transport drove over an improvised explosive device (IED) and most of his fellow soldiers were killed. He is breathing heavily, perspiring, and his heart is pounding. The nurse's most appropriate initial intervention in which of the following? a. Contact the doctor on call to report the incident b. Administer the prn order for chlorpromazine c. Stay with Leon and reassure him of his safety d. Have Leon sit outside the nurse's station until he is called

c

Margaret, age 68, is diagnosed with Bipolar I Disorder, current episode manic. She is extremely hy- peractive and has lost weight. What is one way to promote adequate nutritional intake for Margaret? a. Sit with her during meals to ensure that she eats everything on her tray. b. Havehersister-in-lawbringallherfoodfromhomebecausesheknowsMargaret'slikesanddislikes. c. Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run." d. Tell Margaret that she will be on room restriction until she starts gaining weight.

c

Mike was injured during combat in Afghanistan. He has a diagnosis of TBI. Which of the following medications might the physician prescribe to improve Mike's memory and thinking capability? a. carbamazepine b. duloxetine c. donepezil d. bupropion

c

Sharon, a women with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, sharon tells the nurse, "he's been getting more and more violent lately. he's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. Iwas getting scared. So I just finally told him that I was going to take the kids and leave. He got furious and began beating me with his fists. " What part of the cycle is this? a. Phase 1. Sharon was trying to stay out of his way to keep everything calm b. Phase 1. A minor battering incident for which Sharon assumes the blame c. Phase 2. the acute battering incident that sharon provoked with her threat to leave d. Phase 3. The honeymoon phase

c

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg of chlorpromazine IM stat and then 50 mg PO bid; 2 mg benztropin PO bid prn. Why is the chlorpromazine ordered? a. to reduce extrapyramidal symptoms b. to prevent neuroleptic malignant syndrome c. to decrease psychotic symptoms d. to induce sleep

c

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking and mid sentence and listens intently. The nurse recognized from these signs that they client is likely experiencing: a. somatic delusions b. catatonic stupor c. auditory hallucinations d. pseudoparkinsoisn

c

When a client suddenly becomes aggressive and violent on the unit which of the following approaches would be best for the nurse to use first? a. provide large motor activities to relieve the clients pent-up tension b. administer a dose of pen chlorpromazine to keep the client calm c. call for sufficient help to control the situation d.convey to the client that his behavior is unacceptable and will not be permitted

c

A college student is seen in the emergency department following an incident of date rape. The nurse documents that during her assessment of the student, the student describes the entire chain of events with a blank facial expression. She ends her comments by saying, "It's like it didn't happen to me at all." Which order will the nurse expect for this client? a) NSAIDs b) SSRIs c) Antibiotics d) Narcotics

c) Antibiotics

A client who is extremely distraught after losing her spouse of 45 years is sobbing with her head in her hands. The client says, "I don't want to go sit with a bunch of other old widows; I want to sit with Harold." Based on this client's assessment findings, which collaborative therapy should the nurse recommend? a) Church attendance on Wednesdays and Sundays b) Placement in a long-term care facility c) Cognitive-behavioral therapy d) A group hobby session

c) Cognitive-behavioral therapy

The nurse is preparing to assess a client who is experiencing grief and loss. When the nurse enters the room, the client is on his knees at the end of the bed and sobbing "Why, God, why?" What should the nurse include in the assessment? (Select all that apply.) a) Spiritual assessment b) Financial assessment c) Family assessment d) Client assessment e) Community assessment

c) Family assessment d) Client assessment e) Community assessment

A school nurse is talking to a fifth-grade class about recognizing behavioral and psychological factors in themselves and their classmates that predispose them to violence. What characteristics should the nurse describe? (Select all that apply.) a) Living in a low-income community b) Having siblings who are heroin addicts c) History of being bullied d) History of bullying others e) Depression

c) History of being bullied d) History of bullying other e) Depression

The nurse is providing care to a pediatric client whose mother is terminally ill. Which intervention by the nurse allows the pediatric client to express grief? a) Telling the client that the parent will be in a better place. b) Administering medication to the client. c) Implementing imaginary games with the client. d) Allowing the client to talk about the loss.

c) Implementing imaginary games with the client

During change of shift, a unlicensed assistive personnel (UAP) finds a client who committed suicide by using a belt on the upper doorjamb in the hospital room. The nursing staff was in report and responded to the cries for help, but was not able to save the client. What should the hospital administrator do to assist the nursing staff? (Select all that apply.) a) Nothing, because the nursing staff was not at fault for the client's death b) Analyze the client's medical record for signs of pending suicide that were missed c) Notify social services for immediate grief counseling d) Encourage the staff to talk to each other about the experience and offer support e) Suggest all staff return to work

c) Notify social services for immediate grief counseling d) Encourage the staff to talk to each other about the experience and offer support

An alert and oriented older adult client is receiving home care services following a cerebrovascular accident that has left her with right-sided hemiparesis. She lives with her daughter and son-in-law. The nurse suspects that the client is being neglected when she observes that the client's hair and clothes are dirty and the client smells of urine. Which nonpharmacologic treatment would be a priority for this client? a) Interview the son-in-law to gain his perspective on the situation b) Confront the daughter with the suspicious c) Report the neglect to the appropriate agency d) Wait until enough trust has been developed to enable the client to approach the nurse first

c) Report the neglect to the appropriate agency

A 2-year-old is brought to the pediatric clinic with an upper respiratory infection. After assessing the child, the nurse suspects that this child may be a victim of child abuse. Which is a physical sign that usually indicates child abuse? a) Diaper rash b) A few bruises on shins c) Welts or bruises in various stages of healing on the child's back d) Scraped and scabbed knees

c) Welts or bruises in various stages of healing on the child's back

A nurse is working in an emergency department and is being trained on diagnostic tests used for various cases of abuse. Which diagnostic tests should be included for physical, not sexual, abuse? a) Vaginal swabs b) STD testing c) X-rays d) HIV testing

c) X-Rays

Precipitating stressors, past experiences, existing conditions, and genetic influences are components of the Transactional Model of Stress Adaptation, and influence an individual's response to stress. Identify each of these conditions in the following examples. a. precipitating stressor b. past experience c. existing conditions d. genetic influences ___ Mr. T is fixed in a lower level of development ___ Mr. T's father had diabetes mellitus ___ Mr. T has been fired from his last five jobs ___ Mr. T's baby was stillborn last month

c, d, b, a

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. "You are safe here. We will make sure nothing happens to you." b. "You're just lucky your roommate came home when she did." c. "What exactly do you plan to do?" d. "I don't understand. You have so much to live for."

c. "What exactly do you plan to do?"

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for six years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. "You'll get over him in time, Theresa." b. "Forget him. There are other fish in the sea." c. "You must be feeling sad about your loss." d. "Why do you think he broke up with you, Theresa?"

c. "You must be feeling sad about your loss."

Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life

c. A crisis situation contains the potential for psychological growth or deterioration.

Which grief reaction can the nurse anticipate in a 10-year-old child? a. Statements that the deceased person will soon return b. Regressive behaviors, such as loss of bladder control c. A preoccupation with the loss d. Thinking that they may have done something to cause the death

c. A preoccupation with the loss

Which of the following is not true regarding grieving by an adolescent? a. Adolescents may not show their true feelings about the death b. Adolescents tend to have an immortal attitude c. Adolescents do not perceive death as inevitable d. Adolescents may exhibit acting out behaviors as part of their grief

c. Adolescents do not perceive death as inevitable

The child with autism spectrum disorder (ASD) has difficulty with trust. With this in mind, which of the following nursing actions would be most appropriate? a. Encourage all staff to hold the child as often as possible, conveying trust through touch. b. Assign a different staff member each day so the child will learn that everyone can be trusted. c. Assign the same staff person as often as possible to promote feelings of security and trust d. Avoid eye contact, because this is extremely uncomfortable for the child, and may even discourage trust

c. Assign the same staff person as often as possible to promote feelings of security and trust

Nancy, who is dying of cancer, says to the nurse, "I just want to see my new grandbaby. If only God will let me live until she is born. Then I'll be ready to go." This is an example of which of Kubler-Ross's stages of grief? a. Denial b. Anger c. Bargaining d. Acceptance

c. Bargaining

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called: a. Crisis resulting from traumatic stress b. Maturational/developmental crisis c. Dispositional crisis d. Crisis reflecting psychopathology

c. Dispositional crisis

The nursing history and assessment of an adolescent with a conduct disorder might reveal all of the following behaviors except: a. Manipulation of others for fulfillment of own desires b. Chronic violation of rules c. Feelings of guilt associated with the exploitation of others d. Inability to form close peer relationships

c. Feelings of guilt associated with the exploitation of others

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie? a. Alprazolam (Xanax) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Olanzapine (Zyprexa)

c. Fluoxetine (Prozac)

1. Anna's dog, Lucky, her pet for 16 years, was killed by a car 3 years ago. Since that time, Anna has lost weight, rarely leaves her home, and talks excessively about Lucky. Why would Anna's behavior be considered maladaptive? a. It has been more than 3 years since Lucky died. b. Her grief is too intense over the loss of a dog. c. Her grief is interfering with her functioning. d. Cultural norms typically do not comprehend grief over the loss of a pet.

c. Her grief is interfering with her functioning.

In determining degree of suicidal risk with a suicidal client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as: a. Low b. Moderate c. High d. Unable to determine

c. High

Nina has been hospitalized with adjustment disorder with depressed mood following the breakup of her marriage. Which of teh following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.

c. Nina's symptoms will likely remit once she has accepted the change in her life.

Sharon a woman with multiple cuts and abrasions, arrives at the ED with her three small children. She tells the nurse her husband inflicted these wounds on her. In the interview, Sharon tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared, so I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the cycle of battering, what does this situation represent? a. Phase I: Sharon was desperately trying to stay out of his way and keep everything calm. b. Phase I: a minor battering incident for which Sharon assumes all the blame. c. Phase II: The acute battering incident that Sharon provoked with her threat to leave. d. Phase III: The honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again"

c. Phase II: The acute battering incident that Sharon provoked with her threat to leave.

7. Lucky sometimes refused to obey Anna's commands to come back to her, including when he ran into the street on the day of the accident. But Anna continues to insist, "He was the very best dog. He always minded me. He always did everything I told him to do." Which defense mechanism is Anna exhibiting? a. Sublimation b. Compensation c. Reaction formation d. Undoing

c. Reaction formation

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetery where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with major Depressive Disorder. The priority nursing diagnosis for Margaret would be: a. Imbalance nutrition: less than body requirements b. Complicated grieving c. Risk for suicide d. Social isolation

c. Risk for suicide

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. Give attention to the ritualistic behaviors each time they occur and point out their inappropriateness. b. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. Set limits on the amount of time Sandy may engage in the ritualistic behavior. d. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

c. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

9. For what reason would Anna's illness be considered a neurosis rather than a psychosis? a. She is unaware that her behavior is maladaptive. b. She exhibits inappropriate affect (emotional tone). c. She experiences no loss of contact with reality. d. She tells the nurse, "There is nothing wrong with me!"

c. She experiences no loss of contact with reality.

John., a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to: a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident c. Stay with John and reassure him of his safety d. Have John listen to a tape of relaxation exercises

c. Stay with John and reassure him of his safety

Andrew, a NY City firefighter, and his entire unit responded to the terrorist attacks at the World Trade Center. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured, but survived. Since that time, Andrew has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't!" This statement by Andrew suggests that he is experiencing: a. Spiritual distress b. Night terrors c. Survivor's guilt d. Suicidal ideation

c. Survivor's guilt

Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did that. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? a. Task I: Accepting the reality of the loss b. Task II: Processing the pain of grief c. Task III: Adjusting to a world without the lost entity d. Task IV: Finding an enduring connection with the lost entity in the midst of embarking on a new life

c. Task III: Adjusting to a world without the lost entity

The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is: a. The individual will experience no anxiety b. The individual will demonstrate hope for the future c. The individual will maintain anxiety at manageable level d. The individual will verbalize acceptance of self as worthy

c. The individual will maintain anxiety at manageable level

A client whose husband died 6 months ago is diagnosed with major Depressive Disorder. She says to the nurse, "I start feeling angry that Harold died and left me all along; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? a. Yes, he should have stopped smoking. Then he probably wouldn't have gotten lung cancer b. I can understand how you must feel c. Those feelings are a normal part of the grief response d. Just think about the good times that you had while he was alive

c. Those feelings are a normal part of the grief response

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Theresa says to the nurse, "When I get out of here, I'm going to try this again, and next time I'll choose a no-fail method." Which is the best response by the nurse? a. You are safe here. We will make sure nothing happens to you b. You're just lucky your roommate came home when she did c. What exactly do you plan to do? d. I don't understand. You have so much to live for

c. What exactly do you plan to do?

Theresa, age 27, was admitted to the psychiatric unit from the medical intensive care unit where she was treated for taking a deliberate overdose of her antidepressant medication, trazodone (Desyrel). She says to the nurse, "My boyfriend broke up with me. We had been together for 6 years. I love him so much. I know I'll never get over him." Which is the best response by the nurse? a. You'll get over him in time, Theresa b. Forget him. There are other fish in the sea c. You must be feeling very sad about your loss d. Why do you think he broke up with you, Theresa?

c. You must be feeling very sad about your loss

Nancy has just received a promotion on her job. She is very happy and excited about moving up in her company, but she has been experiencing anxiety since receiving the news. Her primary appraisal is that she most likely views the situation as which of the following? a. benign-positive b. irrelevant c. challenging d. threatening

c. challenging

A client learns of the death of a family member. Which manifestation of grief should the nurse expect in this​ client? Palpitations Agitation Crying Restlessness

crying

10. Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille? a. Chlorpromazine (Thorazine) b. Diazepam (Valium) c. Carbamazepine (Tegretol) d. Duloxetine (Cymbalta)

d

3. Nursing care for a client with somatic symptom disorder would focus on helping her to: a. Eliminate the stress in her life. b. Discontinue her numerous physical complaints. c. Take her medication only as prescribed. d. Learn more adaptive coping strategies.

d

6. Ellen has a history of childhood physical and sexual abuse. She was diagnosed with dissociative identity disorder (DID) 6 years ago. She has been admitted to the psychiatric unit following a suicide attempt. The primary nursing diagnosis for Ellen would be: a. Disturbed personal identity related to childhood abuse b. Disturbed sensory perception related to repressed anxiety c. Impaired memory related to disturbed thought processes d. Risk for suicide related to unresolved grief

d

A nurse is caring for a patient who is experiencing a panic attack. Which of the following actions should the nurse take? a. Discuss new relaxation techniques b. Show the client how to change his behavior c. Distract the client with a television show d. Stay with the client and remain quiet

d

A nurse working in a mental health clinic is providing teaching to a client who has a new prescription for diazepam for generalized anxiety disorder. Which of the following information should the nurse provide? a. Three to six weeks of treatment is required to achieve therapeutic benefit b. Combining alcohol with diazepam will produce a paradoxical response c. Diazepam has a lower risk for dependence than other antianxiety medications d. Report confusion as a potential indication of toxicity

d

Clint, a client on a phych unit, has been diagnosed with Schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response is: a. Thats ridiculous cling. no one is going to hurt you. b. The CIA isn't intereste in people like you clint c. Why do you think the CIA wants to kill you? d. I know you believe that Clint, but its really hard for me to believe

d

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM stat and then 50 mg po big; 2 mg benztropine po bid pen. Because benztropine was ordered on a pen basis, which of the following assessments by the nurse would convey a need for this med? a. the clients level of agitation increases b. the client complains of a sore throat c. the clients skin has a yellowish cast d. the client develops tremors and a shuffling gait

d

The primary focus of family therapy for clients with schizophrenia and their families is a. to discuss concrete problem-solving and adaptive behaviors for coping with stress b. to introduce the family to others with the same problem c. to keep the client and family in touch with the health-care system d. to promote family interaction and increase understanding of the illness

d

Which of the following psychosocial therapies has been shown to be helpful for clients with TBI? a. Eye movement desensitization b. Psychoanalysis c. Reality therapy d. Cognitive-behavioral therapy

d

In the emergency department, a nurse is handing a doctor sterile supplies to suture several young people who reportedly got into a gang-related altercation. Which statement by the nurse best shows the need for more education for the nurse? a) "Gang members protect each other's identity." b) "Gang culture values violence as a rite of passage." c) "I should not have negative preconceived ideas about gangs." d) "Gang members always lie about the cause of their injuries."

d) "Gang members always lie about the cause of their injuries"

A client tells the nurse that he engages in prayer and laughter every day. To which stress assessment question is this information applicable? a) "How well do your coping strategies work?" b) "What stress are you experiencing now?" c) "How long have the stressors been present in your life?" d) "How do you handle stress?"

d) "How do you handle stress?"

The nurse is providing care to a client who lost a child in a car crash 7 months ago. The client states that she has been feeling better over the last month, but that all of a sudden for the past week she has felt like the death just occurred. Which question allows the nurse to assess the reason for this resurgence of grief? a) "Did you recently sell your home?" b) "Have you been experiencing anger?" c) "How many hours of sleep are you getting each night?" d) "Is this time of year significant for any reason?"

d) "Is this time of year significant for any reason?"

The telephone advice nurse is fielding a complex question about possible intimate partner abuse. From the description that the caller is giving, it seems likely. What is the first priority of the advice nurse? a) Exploring the need for resources b) Giving information about helpful services c) Emphasizing that the caller is not to blame for the abuse d) Assuring safety from the partner's abuse

d) Assuring safety from the partner's abuse

A client tells the nurse that since he lost his job, he cannot sleep at night and has no energy to get out of bed. Which type of grief response should the nurse educate this client about based on the symptoms exhibited? a) Biophysical b) Psychological c) Behavioral d) Biological

d) Biological

A client learns of the death of a family member. Which manifestation of grief should the nurse expect in this client? a) Palpitations b) Restlessness c) Agitation d) Crying

d) Crying

The nurse is comforting the adult daughter of a client who has just passed away. When planning care, the nurse should include interventions based on which type of loss? a) Anticipatory b) Situational c) Perceived d) Developmental

d) Developmental

The nurse is planning care for a client who is experiencing overwhelming grief and loss after the death of a parent. Which intervention by the nurse helps reduce this client's anxiety? a) Teaching about safe administration and side effects of medications. b) Teaching family members to encourage the client's expressions of grief. c) Encouraging the client to resume normal activities when ready, to promote physical and psychological health. d) Helping the client gain insight into maladaptive behaviors.

d) Helping the client gain insight into maladaptive behaviors

A nurse is reading a newspaper report about a 60% decrease in domestic violence over the past few years. What kind of factor does this statistic represent? a) Predisposing factor b) Protective factor c) Precipitating factor d) Influencing factor (defines trends)

d) Influencing factor

The parents of a teenager are talking with the nurse in the urgent care clinic about the injuries their son sustained in a physical fight during his high school lunch hour. What can the nurse tell them about fighting in adolescence? a) Its prevalence is not known b) It is an unexpected event in that age group c) It is due to the effect of hunger on teenagers d) One third of high school students get into physical fights

d) One third of high school students get into physical fights

Which nonpharmacologic treatment is appropriate in an abuse situation involving an older adult? a) Provide counseling to the person committing the abuse b) Protect the client's privacy by not documenting the abuse c) Provide counseling for the victim d) Report the situation to the proper agency, and provide support for the victim

d) Report the situation to the proper agency and provide support for the victim

The nurse, who is caring for the spouse of a client who died of traumatic injuries, is reviewing Engel's theory on the stages of grief. For which stage of grief should the nurse plan priority care based on Engel's theory? a) Outcome b) Restitution c) Idealization d) Shock

d) Shock

The nurse is providing care to an older adult client who is experiencing new symptoms of grief. Which item in the client's history might be the cause of these symptoms? a) The loss of a spouse 5 years ago b) The loss of a pregnancy 20 years ago c) Being diagnosed with type 1 diabetes mellitus as a child d) The recent move to an assisted living facility

d) The recent move to an assisted living facility

A nurse is checking the patency of the IV in a client who has suffered a major chest trauma. Since the vital signs are showing evidence of shock, the nurse expects the physician to order medication to treat that condition immediately. For which kind of medication should the nurse expect a stat order? a) An opioid like morphine b) An antibiotic like amoxicillin c) A mineral replacement like potassium d) A vasopressor like epinephrine

d) a vasopressor like epinephrine

A woman who has a long history of being battered by her husband is staying at the women's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is: a. "I just can't believe you have decided to go back to that horrible man." b. "I'm just afraid he will kill you or the children when you go back." c. "what makes you think things have changed with him?" d. "I hope you have made the right decision. Call this number if you need help."

d. "I hope you have made the right decision. Call this number if you need help."

The most appropriate nursing intervention with Marie (from question 9) would be to: a. Refer her to her family physician for a complete physical examination. b. Suggest she seek outside employment now that her children have left home c. Identify convenient support systems for times when she is feeling particularly despondent d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children.

d. Begin grief work and assist her to recognize areas of self-worth separate and apart from her children.

Crises occur when an individual: a. Is exposed to a precipitating stressor b. Perceives a stressor to be threatening c. Has no support systems d. Experiences a stressor and perceives coping strategies to be ineffective

d. Experiences a stressor and perceives coping strategies to be ineffective

John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every 3 days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes tot he clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change? a. The sertraline is finally taking effect b. He is no longer in need of antidepressant medication c. He has completed the grief response over loss of his wife d. He may have decided to carry out his suicide plan

d. He may have decided to carry out his suicide plan

A woman who was sexually assaulted six months ago by a man with whom she was acquainted has since been attending a support group for survivors of rape. From this group, she has learned that the most likely reason the man raped her was: a. Because he had been drinking, he was not in control of his actions b. He had not had sexual relations with a girl in many months c. He was predisposed to become a rapist by virtue of the party conditions under which he was reared d. He was expressing power and dominance by means of sexual aggression and violence

d. He was expressing power and dominance by means of sexual aggression and violence

2. Anna states that Lucky was her closest friend, and since his death, there is no one who could ever replace the relationship they had. According to Maslow's hierarchy of needs, which level of need is not being met? a. Physiological needs b. Self-esteem needs c. Safety and security needs d. Love and belonging needs

d. Love and belonging needs

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called: a. Crisis resulting from traumatic stress b. Dispositional crisis c. Psychiatric emergency d. Maturational/developmental crisis

d. Maturational/developmental crisis

Ms. T. has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T. experiences panic anxiety when she encounters snakes. b. Ms. T. refuses to fly in an airplane. c. Ms. T. will not eat in a public place. d. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

d. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

Certain family dynamics often predispose adolescents to the development of conduct disorder. Which of the following patterns is thought to be a contributing factor? a. Parents who are overprotective b. Parents who have high expectations for their children c. Parents who consistently set limits on their children's behavior d. Parents who are alcohol dependent

d. Parents who are alcohol dependent

With implosion therapy, a client with phobic anxiety would be: a. Taught relaxation exercises. b. Subjected to graded intensities of the fear. c. Instructed to stop the therapeutic session as soon as anxiety is experienced. d. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

d. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

6. Lucky's accident occurred when he got away from Anna while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember the circumstances of his death. This is an example of what defense mechanism? a. Rationalization b. Suppression c. Denial d. Repression

d. Repression

Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time? a. Anxiety related to hospitalization evidenced by noncompliance. b. Low self-esteem related to feeling different from her peers evidenced by social isolation. c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication

d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication

Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent/child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems

d. Severity of the stressor and availability of support systems

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain Theresa's suicide attempt in which of the following ways? a. She feels hopeless about her future without her boyfriend b. Without her boyfriend, she feels like an outsider with her peers c. She is feeling intense guilt because her boyfriend broke up with her d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself

d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself

Theresa is hospitalized following a suicide attempt after breaking up with her boyfriend. Freudian psychoanalytic theory would explain Theresa's suicide attempt in which of the following ways? a. She feels hopeless about her future without her boyfriend. b. Without her boyfriend, she feels like an outsider with her peers. c. She is feeling intense guilt because her boyfriend broke up with her. d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

d. She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself.

A school nurse notices bruises and scars on a child's body, but the child refuses to say how she received them. Another way in which the nurse can get information from the child is to: a. Have her evaluated by the school psychologist. b. Tell her she may select a "treat" from the treat box (e.g. Sucker, balloon, junk jewelry) if she answers the nurses questions. c. Explain to her that if she answers the questions, she may stay in the nurses office and not have to go back to class. d. Use a "family" of dolls to role-play the child's family with her.

d. Use a "family" of dolls to role-play the child's family with her.

Engel identifies which of the following as successful resolution of the grief process? a. When the bereaved person can talk about the loss without crying b. When the bereaved person no longer talks about the lost entity c. When the bereaved person puts all remembrances of the loss out of sight d. When the bereaved person can discuss both positive and negative aspects about the lost entity

d. When the bereaved person can discuss both positive and negative aspects about the lost entity

A nurse is caring for a client who has a new prescription for lithium carbonate. When teaching the client about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? a. avoid the use of acetaminophen for headaches b. restrict intake of foods rich in sodium c. decrease fluid intake to less than 1500 mL daily d. limit aerobic activity in hot weather

d. limit aerobic activity in hot weather -the client should avoid activities that have the potential to cause sodium/water depletion, which can increase the risk for toxicity

Education for the client who is taking MAOIs should include which of the following? a. Fluid and sodium replacement when appropriate, frequent drug blood levels, signs and symptoms of toxicity. b. Lifetime of continuous use, possible tardive dyskinesia, advantages of an injection every 2 to 4 weeks. c. Short-term use, possible tolerance to beneficial effects, careful tapering of the drug at end of treatment. d. tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

d. tyramine-restricted diet, prohibitive concurrent use of over the counter medications without physician notification.

Cindy regularly develops N/V when she is faced with a stressful situation. Which of the following is most likely a predisposing factor to this maladaptive response by Cindy? a. Cindy inherited her mother's "nervous" stomach b. Cindy is fixed in a lower level of development c. Cindy has never been motivated to achieve success d. when Cindy was a child, her mother pampered her and kept her home from school when she was ill

d. when Cindy was a child, her mother pampered her and kept her home from school when she was ill

A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary info to a client? (Select all that apply) Reassure client that everything will be ok discuss prior use of coping mechanisms with the client ignore the clients anxiety so that she will not be embarrassed demonstrate a calm manner while using simple and clear directions gather information from the client using closed-ended questions

discuss prior use of coping mechanisms with the client demonstrate a calm manner while using simple and clear directions

What physical conditions could cause a similar tachycardia and nervousness as that found in an anxiety​ disorder? Select all that apply. Hedonism Hypoglycemia Hirsutism Hypothesis Hyperthyroidism

hyperthyroidism hypoglycemia

What are ways that a young child with posttraumatic stress disorder can convey to a nurse mental health professional a message about the traumatic event that caused the​ child's problem? Select all that apply. Playing Crying Jumping Dreaming Drawing

playing drawing

The nurse is assessing the mental health of a female adult client who has been under stress at work. The client wants to wash her hands every 2 to 3 minutes and wipes the flat surface areas in the clinic with a paper towel while talking to the nurse. Which aspect of​ obsessive-compulsive disorder​ (OCD) is this client​ exhibiting? Visual hallucinations Auditory hallucinations Illogical thinking Repetitive behavior

repetitive behavior

What is a risk factor for developing​ obsessive-compulsive disorder​ (OCD)? Substance abuse Allergies Vaccinations Sexual abuse

sexual abuse

The nurse educator is teaching a group of students about posttraumatic stress disorder​ (PTSD). Which statements from the students regarding factors associated with the pathophysiology of PTSD indicate appropriate​ understanding? Select all that apply. ​"Looking at photographs of a war​ zone" ​"Being taken hostage and​ tortured" ​"Watching the Twin Towers fall on television on​ 9-11" ​"Engaging in military​ combat" ​"Going to​ prison"

​"Being taken hostage and​ tortured" ​"Engaging in military​ combat" ​"Going to​ prison"

During a home​ visit, the nurse evaluates an older adult client who has been prescribed medication for diabetes mellitus and generalized anxiety disorder​ (GAD). Which statement by the client indicates that a modification to the plan of care may be​ required? ​"I had my wife prepare my medications when she was​ alive." ​"I have a headache at​ times." ​"I have been going to cognitivedash-behavioral ​therapy." ​"I sleep fine at night most of the​ time."

​"I had my wife prepare my medications when she was​ alive." Rationale The statement about the​ client's wife giving him his medications may indicate that the client is not currently taking them as prescribed. The nurse needs to modify the plan of care to ensure that the client takes his prescribed medications.​ Cognitive-behavioral therapy combined with pharmacotherapy is the most effective treatment strategy. Sleeping at night and having a headache do not indicate the need for modifying the plan of care.

What are some common pharmacologic therapies used to manage symptoms of​ anxiety? Select all that apply. ​Beta-blockers Antipsychotics Cortisol Benzodiazepines Antidepressants

​Beta-blockers Antipsychotics Benzodiazepines Antidepressants

The parents of an adolescent client dying from complications related to cystic fibrosis ask the nurse what signs to expect when their child is about to die. What should the nurse explain as signs of cardiovascular​ failure? Select all that apply. ​Clammy, cold skin Reduced blood pressure Mottling of the skin ​Cheyne-Stokes respirations Tachycardia

​Clammy, cold skin Reduced blood pressure Mottling of the skin

A nurse therapist is assessing an older client. The client and the nurse are from different cultures. What situation could complicate the​ nurse's assessment of the​ client? Select all that apply. ​Client's age difference from the therapist ​Client's work experience ​Client's normal, healthy cultural response ​Client's physical illness ​Client's cognitive changes

​Client's normal, healthy cultural response ​Client's physical illness ​Client's cognitive changes

Which clinical manifestations must the client demonstrate to meet the​ DSM-5 criteria for a PTSD​ diagnosis? Select all that apply. Recurrent compulsive behaviors Demonstrated drug or alcohol abuse ​Persistent, frightening thoughts and memories of the event Avoidance of situations related to the trauma Significant​ symptom-related distress or functional impairment

​Persistent, frightening thoughts and memories of the event Avoidance of situations related to the trauma Significant​ symptom-related distress or functional impairment