Mental Health Ch 13, 14, 15

A student is preparing to give a class presentation. A few minutes before the presentation is to begin, the student seems nervous and distracted. The student is looking at, and listening to, the peer speaker and occasionally looking at note cards. When the peer speaker asks a question of the group, the student is able to answer correctly in a high pitched voice. The professor understands that the student is likely experiencing which level of anxiety?

Moderate

Which of the following statements about the typical history of illness is consistent with OCD?

OCD treatment is usually outpatient.

The nurse is teaching a client with an anxiety disorder ways to manage anxiety. The nurse suggests which of the following schedules for practicing stress management techniques?

Practice the techniques when relatively calm.

severe anxiety

trouble thinking and reasoning; tightened muscles; increased vital signs; restless, irritable, angry

positive reframing

turning negative messages into positive ones

For a client with dissociative identity disorder, the nurse understands that the disturbed personal identity is most likely related to which characteristic?

unresolved childhood abuse issues

negative anxiety

headaches, pain, drugs, alcohol etc

adaptive anxiety

imagery, listening to music, walks, etc

A nurse caring for a client with generalized anxiety disorder tells a supervisor "I find myself feeling uncomfortable and anxious when the client starts trembling and perspiring. I develop cold clammy hands and my pulse races." In such an interaction, the client will most likely develop which of the following?

increased anxiety

kleptomania

insane impulse to steal

panic disorders

involves 15-30 minute episodes of intense escalating anxiety with emotional fear and physiologic discomfort

assertiveness training

learn to negotiate interpersonal situations using assertiveness I statements

resistance stage

lungs take in more air, blood to muscles (prepare to fight); if person adapts and relaxes, systemic response abates

decatastrophizing

making a more realistic appraisal of the situation ex. what is the worst thing that can happen

onychophagia

nail biting

A nurse is caring for a client who is a veteran with thoughts of missiles screaming and exploding. The client re-experiences feelings of terror first experienced in combat one year ago. Upon assessment, the nurse knows these recurrent events are part of which disorder?

posttraumatic stress disorder

A client is seeking treatment for a specific phobia. The nurse in the anxiety disorders clinic documents that the client's anxiety is related to exposure to the phobic object. Which is a realistic outcome for anxiety self-control in this situation?

practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object

A nurse detects that a client is experiencing panic-level anxiety. Which intervention should be immediately implemented?

provide calm, brief, directive communication

dermatillomania

skin picking

alarm reaction stage

stress stimulates body to prepare for defense (adrenaline/glucose)

A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called which of the following?

systematic desensitization

When working with a client with posttraumatic stress disorder (PTSD), who has frequent flashbacks, the nurse should include which intervention?

teaching various relaxation techniques

A nurse is working with a client to develop assertive communication skills. The nurse documents achievement of treatment outcomes when the client makes a statement such as which of the following?

"I feel upset when you interrupt me."

A client asks the nurse, "Why do I have to go to counseling? Why can't I just take medications?" The best response by the nurse would be...

"Medications combined with therapy help you change how well you function."

Which of the following statements by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that she had arrived at the scene of an automobile-pedestrian accident and unsuccessfully performed CPR on a victim three days ago? The nurse and her colleague are sitting in the break room and no one else is present.

"Tell me what you saw."

An anxiolytic agent, lorazepam, has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective?

"This medication will relax me, so I can focus on problem solving."

A client is currently experiencing a panic attack. Which of the following is the most appropriate response by the nurse?

"You are safe. Take a deep breath."

Three years after the death of her father in an ICU, the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed containing a patient with the same diagnosis as her father. The nurse saw her father's facial features on the patient and had a sense of panic. In a few moments, the nurse realized that the patient in the bed was not her father. Which of these manifestations of PTSD was this nurse experiencing?

A flashback

Which of the following theories about anxiety is based upon intrapsychic theories?

A person's innate anxiety is the stimulus for behavior.

The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. A) Alarm reaction stage B) Resistance stage C) Coping stage D) Exhaustion stage E) Panic stage

A) Alarm reaction stage B) Resistance stage D) Exhaustion stage

Which of the following are events that a person may experience, witness, or be confronted by that may trigger posttraumatic stress disorder (PTSD)? Select all that apply. A) Being a survivor of a tsunami that resulted in thousands of deaths B) Being stranded at the office during a typical winter storm that was anticipated C) Being a marine in a combat situation where the entire platoon was wiped out, except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11

A) Being a survivor of a tsunami that resulted in thousands of deaths C) Being a marine in a combat situation where the entire platoon was wiped out, except for one person D) Being hidden in a closet and hearing the entire family murdered by someone who broke into the home E) Watching televised segments of the moment when the plane hit the second tower on 9/11

The nurse is educating a client and family about managing panic attacks after discharge from treatment. The nurse includes which of the following in the discharge teaching? Select all that apply. A) Continued development of positive coping skills B) Weaning off of medications as necessary C) Lessening the amount of daily responsibilities D) Continued practice of relaxation techniques E) Development of a regular exercise program

A) Continued development of positive coping skills D) Continued practice of relaxation techniques E) Development of a regular exercise program

Which of the following statements about the use of defense mechanisms in persons with anxiety disorders is accurate? Select all that apply. A) Defense mechanisms are a human's attempt to reduce anxiety. B) Persons are usually aware when they are using defense mechanisms. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. E) The use of defense mechanisms should be avoided. F) Defense mechanisms can control the awareness of anxiety.

A) Defense mechanisms are a human's attempt to reduce anxiety. C) Defense mechanisms can be harmful when overused. D) Defense mechanisms are cognitive distortions. F) Defense mechanisms can control the awareness of anxiety.

A man is discovered wandering the street, looking confused and stepping out into traffic. When emergency responders approach the man, he cannot recall his name or where he lives. The responders transport the man to the mental health crisis unit for further evaluation. Which of the following is the man potentially suffering from? Select all that apply. A) Depersonalization disorder B) Dissociative identity disorder C) Repressed memories D) Dissociative amnesia E) False memory syndrome

A) Depersonalization disorder B) Dissociative identity disorder D) Dissociative amnesia

The nurse correctly identifies that which of a client with OCD's self-soothing behaviors may involve self-destruction of the body? Select all that apply. A) Dermatillomania B) Trichotillomania C) Onychophagia D) Kleptomania E) Oniomania

A) Dermatillomania B) Trichotillomania C) Onychophagia

The student nurse correctly identifies that which of the following are characteristics of hoarding disorder? Select all that apply. A) Excessive acquisition of animals or apparently useless things B) Cluttered living spaces that become uninhabitable C) Significant distress or impairment for the individual D) Obsessive cleaning of environment E) Disposing of articles that are of no value

A) Excessive acquisition of animals or apparently useless things B) Cluttered living spaces that become uninhabitable C) Significant distress or impairment for the individual

Which techniques would be most effective for a client who has situational phobias? Select all that apply. A) Flooding B) Reminding the person to calm down C) Systematic desensitization D) Assertiveness training E) Decatastrophizing

A) Flooding C) Systematic desensitization

Which of the following are important for the nurse to remember when teaching relaxation and behavioral techniques to a client with OCD? Select all that apply. A) It is important to teach the client to use relaxation techniques when the client's anxiety is low. B) The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. C) The client must be willing to engage in exposure and response prevention. D) The client must be forced to use relaxation techniques. E) It is unnecessary to assess the baseline of ritualistic behaviors in the client with OCD.

A) It is important to teach the client to use relaxation techniques when the client's anxiety is low. B) The nurse may teach the client about relaxation techniques when the client is experiencing anxiety. C) The client must be willing to engage in exposure and response prevention.

Which of the following are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply. A) Positive reframing B) Decatastrophizing C) Assertiveness training D) Humor E) Unlearning

A) Positive reframing B) Decatastrophizing C) Assertiveness training

A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply. A) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal D) Feeling mildly anxious E) Occurs 2 weeks after the trauma

A) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts B) Showing emotional numbing such as feeling detached from others C) Being on guard, irritable, or experiencing hyperarousal

When a client is experiencing a panic attack while in the recreation room, what interventions are the nurse's first priorities when considering the client's safety? Select all that apply. A) Remain with the client to assess needs B) Request a prescription for an antianxiety agent. C) Offer the client therapy to calm down D) Turn off any televisions or radios in the immediate area E) Engage the client in recreational activities.

A) Remain with the client to assess needs D) Turn off any televisions or radios in the immediate area

A fireman survived a fire after escaping a blaze. Several other firefighters were trapped in the burning building and died. After working with this firefighter in counseling, the nurse evaluates which of the following as positive outcomes for this client? Select all that apply. A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community. D) The client will report nightmares and flashbacks of the fire.

A) The client will verbalize feelings of stress related to returning to work. B) The client will express guilt openly through nondestructive means. C) The client will identify a social support system within the community.

The nursing student correctly identifies that which of the following statements is true of the etiology of OCD? Select all that apply. A) The cognitive model for OCD etiology focuses on childhood and environmental experiences of growing up. B) The etiology of OCD is not definitively explained at this time. C) OCD is caused by immune dysfunction. D) The primary etiology of OCD is genetics. E) Cognitive models may partially explain why people develop OCD.

A) The cognitive model for OCD etiology focuses on childhood and environmental experiences of growing up. B) The etiology of OCD is not definitively explained at this time. E) Cognitive models may partially explain why people develop OCD.

Which of the following are reasons that the nurse must understand why and how anxiety behaviors work? Select all that apply. A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities C) To help the nurse to mask his or her own feelings of anxiety D) So the nurse can identify that his or her own needs are more important than the clients E) To help nurses to function at a high level

A) To provide better care for the client B) To help understand the role anxiety plays in performing nursing responsibilities E) To help nurses to function at a high level

A nurse interviewing a client with suspected posttraumatic stress disorder (PTSD) should be alert to findings indicating the client has which traits? Select all that apply. A) experiences flashbacks B) demonstrates hypervigilance C) feels detached or empty inside D) feels driven to repeat behaviors E) avoids people and places that arouse painful memories F) experiences sympathetic nervous system symptoms suggestive of a heart attack

A) experiences flashbacks B) demonstrates hypervigilance C) feels detached or empty inside E) avoids people and places that arouse painful memories

Which of the following interventions by the nurse will increase the client's sense of security?

Allowing the client to perform the rituals

The nursing student answers the test item correctly when identifying which of the following statements as true?

Anxiety cannot be completely eliminated from life.

The nurse is working with a young client with anxiety. Which of the following best explains the etiology of anxiety disorders from an interpersonal perspective?

Anxiety is learned in childhood through interactions with caregivers.

The nurse is aware that a person who repeatedly seeks cosmetic surgery to correct a perceived flaw in his or her appearance may have which of the following disorders?

Body dysmorphic disorder

The nurse is working with several clients with anxiety disorders. Which of the following are interpersonal theories regarding the etiologies of major anxiety disorders? Select all that apply. A) Sigmund Freud's theory B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory D) Pavlov's theory

B) Henry Stack Sullivan's theory C) Hildegard Peplau's theory

Which of the following might the nurse recognize when dealing with a client, as longer-term responses to trauma and stress? Select all that apply. A) Acute stress disorder B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder

B) Posttraumatic stress disorder C) Adjustment disorder D) Reactive attachment disorder E) Dissociative disorder

The client is experiencing night terrors. Which of the following would the nurse know are the major elements of posttraumatic stress disorder (PTSD)? Select all that apply. A) Trying to avoid any places, people or situations that may trigger memories of the trauma B) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts C) Becoming increasingly more isolated D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal

B) Re-experiencing the trauma through dreams or recurrent and intrusive thoughts D) Emotional numbing such as feeling detached from others E) Being on guard, irritable, or experiencing hyperarousal

Which of the following outcomes would take priority for a client who has survived trauma or abuse? Select all that apply. A) The client will demonstrate healthy, effective ways of dealing with the stress. B) The client will be physically safe. C) The client will establish a social support system in the community. D) The client will distinguish between ideas of self-harm and taking action on those ideas. E) The client will express emotions nondestructively.

B) The client will be physically safe. D) The client will distinguish between ideas of self-harm and taking action on those ideas.

The client has shown much improvement for OCD. Which of the following would be appropriate outcomes for a client with OCD? Select all that apply. A) The client will stop engaging in the compulsive activity. B) The client will spend less time performing rituals. C) The client will complete daily routine activities within a realistic time frame. D) The client will conceal the behavior from all persons to avoid anxiety. E) The client will demonstrate effective use of behavior therapy techniques.

B) The client will spend less time performing rituals. C) The client will complete daily routine activities within a realistic time frame. E) The client will demonstrate effective use of behavior therapy techniques.

Which of the following are features of the thinking of a person who has OCD, according to the cognitive model? Select all that apply. A) The person with OCD employs a minimalist approach to all aspects of his or her life. B) The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. C) The person with OCD is always aware that his or her behavior is related to OCD. D) The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. E) The person with OCD has an inflated personal responsibility.

B) The person with OCD believes one's thoughts are overly important and has a need to control those thoughts as they overestimate the threat posed by their thoughts. D) The person with OCD is concerned with perfectionism and has an intolerance of uncertainty. E) The person with OCD has an inflated personal responsibility.

The nurse is preparing for outpatient placement of the client with OCD. Which of the following treatment modalities is most effective for OCD?

Behavioral techniques and medication

When teaching a client with generalized anxiety disorder, which is the highest priority for the nurse to teach the client to avoid?

Caffeine

The nurse has a student with her today and is teaching assessment skills. The student nurse correctly identifies that which one of the following statements is true regarding clients with OCD?

Clients with OCD seem normal on the outside but suffer from overwhelming fear and anxiety.

When a psychiatrist prescribes alprazolam for acute anxiety experienced by a client with agoraphobia, health teaching should include which instructions?

avoid alcoholic beverages

The client has been defensive toward communication with the nurse today. Which one of the following can be a positive outcome of using defense mechanisms?

Defense mechanisms can help a person to reduce anxiety.

Which of the following should be an action of a nurse who is having feelings of judgment regarding a client's contributory behavior to an automobile accident that resulted in deaths?

Discussing the nurse's personal feelings with a peer or a counselor

Which of the following statements about posttraumatic stress disorder (PTSD) is accurate?

Estimates are that up to 60% of people at risk develop PTSD.

A client asks how his prescribed alprazolam helps his anxiety disorder. The nurse explains during teaching of medications, that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders?

GABA

Before eating a meal, a client with obsessive-compulsive disorder must wash her hands for 14 minutes, comb her hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important objective for this client?

Gradually decrease the amount of time spent for performing rituals.

The nurse plans to teach a client about dietary modifications to manage diabetes. Teaching would be most effective if the client displayed which of the following characteristics?

Heightened focus

A nurse is providing education about trauma and its effects to a community group in a community that has just been hit by a devastating tornado. One of the participants asks about what kind of support a survivor of the tornado will need. Which would be the best response of the nurse?

If a person is reluctant to share his or her feelings, he or she may be denying his or her importance and may be at increased risk for future problems such as PTSD.

What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder?

In PTSD, the symptoms occur 3 months or more after the trauma.

The student nurse correctly identifies that which one of the following statements applies to the parasympathetic nervous system?

It is activated at the end of the resistance stage.

The traumatized client has suddenly changed demeanor and voice pitch. Which of the following is true about the use of touch with a client with dissociative identity disorder?

It is best not to touch the client without his or her permission.

The nurse is providing education to a group of persons from several community agencies about hoarding by elder persons. Which of the following is important for the nurse to emphasize?

It is not beneficial to tell the client that his thoughts and rituals interfere with his life or that his ritual actions really have no lasting effect on anxiety.

The nurse is caring for clients in the out-patient unit. Which of the following would be key points for the nurse to remember when working with persons who are suffering from anxiety disorders?

Remember to practice techniques to manage stress and anxiety in your own life.

The nurse is teaching about postoperative wound care. As the wound is uncovered, the client begins mumbling, breathing rapidly, and trying to get out of bed, and the client does not respond when the nurse calls his name. Which of the following should be the nurse's first action?

Replace the dressing on the wound.

A client says to the nurse, "I just can't talk in front of the group. I'm trembling and I feel like I'm going to pass out." The nurse assesses the client's anxiety to be at which level?

Severe

Which of the following statements regarding the individual responses to trauma and stressors is a positive outcome?

Some individuals may develop enhanced coping as a result of dealing with the stressor.

The nurse enters the client's room and finds the client anxiously pacing the floor. The client begins shouting at the nurse, "Get out of my room!" The best intervention by the nurse would be to...

Stand at the doorway and say, "You seem upset."

The nurse knows that which one of the following statements is true about stress and anxiety?

Stress is the wear and tear that life causes on the body.

Which of the following is the desired outcome for a client with OCD?

That the OCD symptoms no longer interfere with the client's responsibilities

The nurse is caring for her first client with obsessive-compulsive disorder. During the treatment team meeting, the nurse shares her frustration as to the client's inability to stop washing his hands. The nurse manager offers which one of the following explanations?

The client feels terrible but cannot stop washing his hands to try to get rid of his anxiety.

The client and nurse have interacted for several months. Which of the following is the most important variable in determining the likelihood of success in improving life for a client with OCD?

The client must be willing to make changes in his or her behavior.

The nursing student understands correctly when identifying which objective is appropriate for all clients with anxiety disorders?

The client will experience reduced anxiety and develop alternative responses to anxiety-provoking situations.

A nurse is caring for a client diagnosed with body dysmorphic disorder and perceives to have a disturbed body image due to a reddened face. Which is a long-term outcome for this client?

The client will verbalize acceptance of the reddened face by the three month follow-up appointment.

Which of the following is essential for the nurse to communicate to the client with OCD and to the client's family?

The importance of medication compliance and that it may be necessary for medication to be changed to find the one that works best.

A nurse is working with the family of a client with obsessive-compulsive disorder (OCD). Which concept should the nurse incorporate in the teaching plan?

The thoughts, images, and impulses tend to worsen with stress.

Which of the following is an important part of therapeutic communication for clients who have OCD?

To encourage the client to discuss his or her obsession with the nurse.

Which of the following interventions would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse?

To help them to refocus their view of themselves from being victims to being survivors

Which of the following statements about the assessment of persons with anxiety and anxiety disorders is most accurate?

When an elder person has an onset of anxiety for the first time in his or her life, it is possible that the anxiety is associated with another condition.

mild anxiety

a sensation that something is different and warrants special attention

A nurse is visiting an elderly client at home. The client has been seen hoarding, and the smell is offensive when the nurse comes to visit. Which is an indicator of hoarding?

a single path throughout the yard and house

A psychiatric nurse visits a client at home. The client tells the nurse that he or she experiences chest pain, shortness of breath, and sweating whenever leaving home. The client has been unable to go to work for six weeks. The nurse recognizes this problem as which behavior?

agoraphobia

A client states, "I will just die if I don't get this job." The nurse then asks the client, "What will be the worst that will happen if you don't get the job?" The nurse is using this response to...

appraise his situation more realistically.

A nurse is caring for a client who believes her feet are enormous compared with the rest of her body. She has visited an orthopedic surgeon to see if surgery is possible. She spends hours trying to buy shoes that make her feet look smaller, and she prefers social interactions where she can sit with her feet concealed under a table. The nurse assesses that the client's symptoms are consistent with which disorder?

body dysmorphic disorder

exhaustion stage

body stores are depleted, person very tired

A client is learning to cope with anxiety and stress. The expected outcome is that the client will...

change reactions to stressors.

oniomania

compulsive buying

A client who suffers from frequent panic attacks describes the attack as feeling disconnected from himself. The nurse notes in the client's chart that the client reports experiencing...

depersonalization

A client tells a nurse about recent episodes of strange behavior that the client cannot recall, but has discussed with family. The client reports being told of going out late at night dressed, but not in the usual wardrobe. Upon return, the client cannot recall any of the event. The nurse suspects the client is dealing with which personality disorder?

dissociative identity disorder

A nurse is caring for a client who has been diagnosed with OCD. The nurse is preparing a plan of care. Which is a safety priority for the nurse to observe?

eating, drinking, and elimination

moderate anxiety

feeling that something is definitely wrong; nervous or agitated

panic anxiety

fight, flight, or freeze response; increased vital signs; dilated pupils; cognitive processes focusing on defense

Trichotillomania

hair pulling disorder