Mental Health PrepU Week 3 w/ Rationales

As part of a community outreach program, nurses are teaching stress management to the participants. A student asks how to cope with stressful life events. Which response by the nurse is the most accurate?

"Clients who have a large social network are better able to cope with stressful events." Social networks provide emotional support, assistance with material aid, services, information, and new social contacts increase personal resources, enhance the ability to cope with change, and influence the course of illnesses. The body's physiological response to stress is not controllable. Individuals will all encounter stress as a natural consequence of life. Therefore, development of coping skills are vital. During times of stress, the environment should be quiet and calm. Therefore, a busy schedule will increase stress levels.

A client with posttraumatic stress disorder (PTSD) has destructive thoughts and has potentiality for self-harm or suicide. What instruction should the nurse give to the client to ensure the client's safety?

"Come and sit with me when you are fearful or have disturbing thoughts." The client has a high probability of self-harm or suicide. Therefore, the nurse should ensure the client's safety. The nurse should ask the client to go to a safe place, like being with the nurse when destructive thoughts and impulses occur. It helps the client to calm down and wait until the destructive thoughts pass. The client may not be able to sleep when there are disturbing thoughts. Advising the client to eat candy would not relieve the client from having suicidal ideation. Asking the client to go to the terrace while having ideas related to suicide is not appropriate, as a terrace is an unsafe place to be.

The nurse is assessing a client who recently experienced their first panic attack while at the grocery store. What question should the nurse ask to identify complications of the disorder?

"Do you have any problems going out alone to public places?" To identify complications of the disorder when assessing a client who recently experienced the client's first panic attack while at a grocery store, the psychiatric nurse asks, "Do you have any problems going out alone to public places?"

A client is diagnosed with posttraumatic stress disorder (PTSD). What questions should the nurse ask the client to elicit information about the symptoms? Select all that apply.

"Do you have recurrent and intrusive thoughts of the trauma?" "Do you feel detached from others?" "Do you get irritated by trivial issues?" The three major symptoms of PTSD are reexperiencing of the trauma, emotional numbing, and hyperarousal. Therefore, the nurse should ask relevant questions to determine related behavior. Asking whether the client has recurrent and intrusive thoughts about the traumatic event helps to determine if the client is reexperiencing trauma. Feelings of being detached from others suggests emotional numbing. Getting irritated by trivial issues suggests hyperarousal. While a past history of surgery is important information, it does not help in establishing symptoms of PTSD. Exploring the client's childhood social relationships indicates the nurse is assessing for disorders resulting from childhood trauma such as reactive attachment disorder or disinhibited social engagement disorder, two diagnoses which differ from PTSD.

The nurse is providing education to a client prescribed clomipramine to help with obsessive-compulsive disorder. Which statement by the client indicates the teaching was effective?

"I may have a risk of suicidal thoughts with the medication." The client would have a risk of suicidal thoughts so needs to be aware so that these can be reported to the healthcare provider. The medication would take usually several weeks before the client notices therapeutic effects so should not expect to feel better in a week. The medication also has a side-effect of sedation so that the client should be careful with driving and operating heavy machinery. The medication is best taken with food, not on an empty stomach.

A client comes to the clinic for an evaluation of headache, fatigue, and an overall feeling of being "down." When assessing the client, which statement by the client would alert the nurse to suspect possible suicide? Select all that apply.

"I've been drinking about three or four more beers every night." "I'm so tired that all I ever want to do is sleep all the time." "Most times, I feel like I'm trapped with no way out." Warning signs for suicide include increased substance use (drinking three or four more beers every night), an inability to sleep or sleeping all the time, and feeling trapped. Social isolation or withdrawal (rather than going out with friends or looking for a new job) would suggest suicide.

A client asks the nurse whether the client needs to alter any of the client's activities because the client is taking lithium carbonate. Which response would be most appropriate?

"Increase your salt intake if an activity causes you to perspire heavily." If body fluid decreases significantly because of a hot climate, strenuous exercise, vomiting, diarrhea, or a drastic reduction in fluid intake, then lithium levels can rise sharply, causing an increase in side effects with progression to lethal lithium toxicity. Clients should increase salt intake during periods of perspiration, increased exercise, and dehydration.

The client asks the nurse, "What does having psychosomatic symptoms mean?" What is the nurse's best reply?

"It means that stress and/or emotions are causing your symptoms." Clients who do not cope well with stress or emotions develop physical symptoms that are real as a means of coping. Characterizing them as products of the imagination downplays the effect of the disorder. Stating that a client needs to get his or her life in order is not therapeutic and mischaracterizes the etiology of these illnesses. Stating that the client is not physically sick does not adequately or empathically address the role of the mind and emotions.

Which statement made by the nurse to the family of a client diagnosed with obsessive-compulsive disorder (OCD) demonstrates the best general understanding of the chronic nature of the disorder and its management?

"It's important to know that the symptoms will intensify during periods of stress." OCD is a chronic, progressive disease. Symptoms wax and wane over time, increasing during periods of stress. While the other statements are accurate, they do not provide the most general, encompassing information regarding the management of this chronic, progressive disorder.

Which statement by the nurse providing care for a client diagnosed with obsessive-compulsive disorder (OCD), indicates a need for additional education regarding the client's ritualistic hand washing?

"Let me help you find something less time consuming to do to manage your anxiety." People with OCD are usually aware that their ritualistic behavior appear senseless or even bizarre to others. Given that, family and friends may believe that the person "should just stop" the ritualistic behavior. "Just find something else to do" or other unsolicited advice only adds to the guilt and shame that people with OCD experience. It is important for the nurse (and other health professionals) to avoid taking that same point of view. Most times, people with OCD appear "perfectly normal" and therefore capable of controlling their own behavior. The nurse must remember that overwhelming fear and anxiety interfere with the person's ability to monitor or control their own actions. In addition, OCD is often chronic in nature, with symptoms that wax and wane over time. Just because the client has some success in managing thoughts and rituals doesn't mean they will never need professional help in the future.

A nurse observes that a client with posttraumatic stress disorder (PTSD) is experiencing dissociative symptoms. What instruction should the nurse give to the client to prevent being stuck in a daze?

"Look around the room." The client is experiencing a dissociative episode. There is a high probability that the client will be stuck in a daze in this situation. The nurse should ask the client to look around the room so that the client moves the eyes and avoids being locked in a daze or flashback. Telling the client to sleep would not prevent the client from being stuck in a daze. The client is dissociating, thus it is inappropriate to ask the client to express feelings. Making the client sit with the nurse is not useful, as this would not decrease the dissociative symptoms. This instruction should be given especially when the client has tendencies toward self-harm and suicide.

The client reports that the client feels anxious when interacting socially with others and "never seems to know what to say." Which question indicates the nurse has a sound understanding of interpersonal theory as it relates to anxiety?

"What kind of relationship do you have with your parents?" According to interpersonal theory, caregivers can communicate anxiety to infants or children through inadequate nurturing. Individuals who are exposed to poor parental nurturing may develop poor self-esteem or poor communication skills. The other options, although assessment-oriented questions, do not necessarily relate directly to this client's specific problem.

The nurse recognizes that which client is most likely experiencing generalized anxiety disorder (GAD)?

40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months The nurse recognizes that the client most likely experiencing GAD is a 40-year-old who has reported numerous absences from work, muscle aches, and difficulty falling asleep for the last 8 months. GAD is characterized by excessive worry and feelings of anxiety at least 50% of the time for 6 months or more. The client with GAD has three or more of the following symptoms: uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations. The military veteran is most likely experiencing posttraumatic stress disorder (PTSD), the older adult may be experiencing depression, and the business executive may have social phobia.

Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)?

A client who firmly believes that everyone who sees the client fixates on the size of the client's BDD is characterized by a disproportionate focus on a minor physical characteristic. Clients with BDD do not necessarily binge and purge or engage in dangerous weight loss. Underestimation of obesity is not typical of BDD.

Characteristics of a conversion disorder include what? Select all that apply.

A lack of stress over the physical loss Production of both a primary and secondary gain for the client Physical symptoms that are worse in the presence of the stressor Conversion disorder is characterized by an attitude of indifference over the physical loss also called "la belle indifference." Clients with conversion disorder benefit from the primary and secondary gain, this inadvertently reinforces the somatic experience rather than the psychosocial. For clients with this condition, the physical symptom may be reported worse when the stressors are present, even if the client is in denial that anything is causing such significant stress.

Which client is most likely to be at risk for drug dependence and difficulties with withdrawal?

A woman who has been taking lorazepam for several months after witnessing a traumatic motor vehicle accident The potential for dependence and difficulties with withdrawal is much higher with benzodiazepines than with beta-blockers or SSRIs.

A client with pain who has been diagnosed with somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When educating the client about the medication, which would the nurse emphasize?

Alcohol should be avoided The client will likely be prescribed a nonsteroidal analgesic and selective serotonin reuptake inhibitor medication. In both cases, the client should be reminded to avoid consuming alcohol as this can increase the sedative effects of the antidepressants and increase dehydration leading to dysfunctional metabolism of the medications. Photosensitivity is not associated with the use of monoamine oxidase inhibitors. Water intake needs to be monitored when lithium is used. Clients should also be encouraged to give the medications enough time to be effective because many medications require up to 6 weeks before the client has a response or a relief of symptoms.

A nurse is reviewing information about medications used to treat bipolar disorders. The nurse demonstrates understanding by identifying which medication classification as effective in stabilizing moods in people with bipolar disorder?

Anticonvulsants Several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of people with bipolar illness.

When explaining the difference between anxiety and fear, the mental health nurse shares what? Select all that apply.

Anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes Fear results in objective, physical responses caused by real danger Anxiety is likely to result from an attempt to overcome stress When explaining the difference between anxiety and fear, the mental health nurse shares that anxiety involves experiencing subjective, uncomfortable feelings resulting from unknown causes. At some point in time, all people experience anxiety, as this is a normal human response to a threat or stress. It is inaccurate to say that people who experience anxiety tend to use maladaptive coping mechanisms. Obsessive compulsive disorder is a complex anxiety disorder that not only has its roots in abandonment, but there are multiple factors contributing to why this anxiety disorder may be present in individuals.

A nurse is caring for a client with posttraumatic stress disorder (PTSD). The client does not express emotions and is not willing to talk to anybody. What nursing action would be most appropriate to help the client express the client's feelings?

Ask the client to write down all feelings and emotions on a piece of paper. A client with PTSD tends to withdraw from any kind of social conversation and is therefore unable to express feelings and emotions. As the client here is not willing to talk to anybody, the client should be asked to express feelings through writing. The client is not willing to talk to anybody and therefore would not be able to express feelings to a family member. The nurse should never refer this client for electroconvulsive therapy, as this therapy may be of no use and would hurt the client. Retelling the experience without crying will not help the client.

A client with obsessive-compulsive disorder (OCD) is preparing for exposure and response prevention behavioral therapy. What does the nurse recommend as the first step?

Chronicle situations that trigger obsessions. Exposure and behavioral prevention therapy begins by having the client maintain a diary to note the situations that trigger obsessions, time spent performing the ritual behavior, and avoidance behaviors. Relaxation techniques to assist in managing anxiety can be performed regardless of participation in exposure and response prevention therapy. This is also true of following a written schedule with specified times for completion. The client must be able to complete daily activities without assistance in a scheduled time frame.

Which is the primary gain associated with developing physical symptoms in response to stress?

Decrease anxiety The primary gain of somatic symptoms is always relief of stress, anxiety, or conflicting/unacceptable emotions. It is a misconception that these clients are motivated by a need to draw attention to themselves. Somatic symptoms are not linked to a need to accept dependency or to suppress underlying anger.

A nurse is assessing a client and determines that the client is experiencing severe anxiety based on which finding?

Distorted sensory awareness In severe anxiety, perception becomes increasingly distorted, sensory input diminishes, and processing of sensory stimuli becomes scattered and disorganized.

A client with obsessive-compulsive disorder (OCD) is being discharged from the health care facility. What does the nurse teach the client and the family?

Encourage the client to participate in follow-up therapy. Clients with OCD experience long-term difficulties in dealing with obsessive thoughts. The nurse helps the client identify supportive resources in the community. Medications are just as important as mastering behavior therapy. The client must not stop medications without consulting the health care provider. The nurse asks the client to practice relaxation techniques when the client's anxiety level is low and apply them when anxiety levels increase. The client must learn to tolerate obsessive thoughts and complete daily activities without help from others.

The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain?

Feeding the client during mealtime Secondary gains refer to the personal benefits that the client experiences from being considered sick. In this case, being fed is considered the secondary gain. Discussion about family and friends with the client is a treatment strategy that may help the client develop insight into the cause of the condition. Teaching the client techniques of meditation and relaxation is a treatment strategy that may help the client relieve stress. Discussing the coping strategies that the client used in the past may help the client identify and integrate those coping strategies in the future.

A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is most likely to cause the client anxiety?

Going to a crowded, outdoor market independently Agoraphobia is the fear of being alone in public places from which the person thinks escape would be difficult or help would be unavailable if he or she were incapacitated.

Clients with a somatization disorder typically do what?

Have a history of going to many different providers without satisfaction Clients living with a somatization disorder usually present exaggerated, inconsistent, yet complicated medical histories. They often seek treatment from multiple health care providers when their physical complaints are not addressed to their satisfaction.

How does the nurse help to decrease anxiety and build confidence in a client with obsessive-compulsive disorder?

Help the client find alternative methods to deal with anxiety. The nurse teaches the client alternative methods such as deep breathing to deal with anxiety. The nurse provides opportunities to allow the client to perform tasks enjoyed by the client. Accomplishing these tasks in a set time enhances confidence and self-esteem. The client is encouraged to develop social skills by interacting with other staff members and clients. The client is given a room that is quiet and dimly lit room to promote sleep and rest.

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what?

Illness anxiety disorder When individuals are fearful of developing a serious illness based on their misinterpretation of body sensations, the classification of illness anxiety disorder can be used to describe this preoccupation. The fear of having an illness continues despite medical reassurance, and this interferes with psychosocial functioning. The individual spends time and money on repeated examinations looking for feared illnesses. With factitious disorder, the illness or injury is intentionally caused to gain attention of health care workers. Functional neurologic symptom disorder or conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.

The nurse is planning a presentation to a group of nursing students on the topic of anxiety disorders. Which would the nurse include when describing panic disorder?

Individuals may believe they are having a heart attack when a panic attack occurs. Clients diagnosed with a panic disorder may believe they are having a heart attack when a panic attack occurs. Panic disorder peaks during the teenage years and does not usually manifest after the age of 30 years. Individuals with panic disorder (with or without agoraphobia) experience recurrent and unexpected panic attacks.

During the admission assessment of a 27-year-old client who has been diagnosed with an anxiety disorder, the nurse observes that the client is becoming increasingly restless and agitated. How should the nurse respond to this development?

Inform the client that the assessment can be postponed if the client is finding it overwhelming. If a client becomes agitated during an assessment, it is appropriate for the nurse to tell the client that the nurse can continue the assessment later. Performing the assessment faster or persisting is likely to exacerbate the client's anxiety. It would be inappropriate for the nurse to provide education regarding anxiety during a time that the client is restless and agitated. This indicates the client is experiencing moderate anxiety, narrowing the perceptual field to the immediate task. The client would not be receptive to any education provided. It would be inappropriate to tell the client that the client's current anxiety will serve a later purpose.

The nurse is assessing a client who gave birth to a baby 1 week ago. She has been feeling sad, fatigued, and has been crying often. The client is most likely experiencing what?

Postpartum blues Following childbirth, many women experience hormonal fluctuations that result in transitory mood disturbances. This is sometimes called "postpartum blues" and usually resolves by the end of the second or third postpartum week. For postpartum depression to be diagnosed, the client must report experiencing these and other symptoms for at least 4 weeks.

A group of students is reviewing information about the etiology of generalized anxiety disorder (GAD). The students demonstrate understanding of this information when they identify which as representing the bases for this disorder?

Intense worry and stress about work or simple family life Adults with GAD often worry about matters such as their job, household finances, health of family members, or simple matters (e.g., household chores or being late for appointments). The intensity of the worry fluctuates, and stress tends to intensify the worry and anxiety symptoms. Cognitive behavioral theory regarding the etiology of GAD proposes that the disorder results from inaccurate assessment of perceived environmental dangers. Although there are no specific sociocultural theories related to the development of GAD, a high-stress lifestyle and multiple stressful life events may be contributors. Kindling results from overstimulation or repeated stimulation of nerve cells by environmental stressors.

A client states that the client copes with anxiety by cleaning compulsively, which irritates the client's spouse. What does the nurse consider this?

Maladaptive, because it is an avoidance response Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. Functional responses tend to be voluntary, conscious behaviors that address and acknowledge the stressful situation and help clients to find solutions. Dysfunctional responses tend to be involuntary, inflexible, avoidance-type solutions that impair productivity. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms. In other words, it is not appropriate to expect a client to just stop worrying, compulsively checking doors, or otherwise trying to cope with anxiety.

The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says the client still has terrible neck pain, but the client will be better once he gets "a big insurance settlement." What condition might the nurse suspect?

Malingering Malingering is suspected when the client is exaggerating physical complaints for some type of material gain. Hypochondriasis is a preoccupation with the fear that one has a serious disease. La belle indifference is a seeming lack of concern or distress about a functional loss. A conversion reaction involves unexplained, usually sudden, deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly.

A client is admitted to the mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what?

Munchausen's syndrome by proxy The client who attempts to injure someone else, usually a child, to gain the attention of the health care provider most likely has factitious disorder by proxy, or Munchausen's syndrome by proxy. Typically, this disorder affects mothers. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

A client with bipolar disorder is experiencing a major depressive episode. Which would the nurse expect to assess? Select all that apply.

Obsessive rumination Hypersomnia Difficulty concentrating During a major depressive episode, a client would exhibit obsessive rumination, insomnia or hypersomnia, diminished ability to concentrate, or indecisiveness. Flight of ideas and engaging in widespread shopping sprees would characterize mania.

The nurse has read in a client's admission record that the client has been taking propranolol for psychiatric, rather than medical, reasons. The nurse should recognize that the client likely has a history of which mental health condition?

Panic disorder Propranolol is used in the treatment of panic disorder, but it is not a common pharmacological intervention for OCD, acute stress disorder, or nightmares.

What relaxation technique does the nurse teach the client with obsessive-compulsive disorder (OCD)?

Practicing deep breathing The nurse teaches the client deep breathing for relaxation. The nurse encourages the client to practice deep breathing when anxiety increases. The client is taught to maintain a diary to note down situations that trigger obsessions. The nurse sets a timetable for the client's daily routine. This helps to ensure that the client completes tasks within a scheduled time. The effect of music on clients with OCD is not known.

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate?

Stay with the client, emphasizing that the client is safe and that the nurse will remain with the client. It is important to stay with the client and remain calm to help relax the client. Trying to mimic the client's symptoms would further add to the client's anxiety level. It is also important to stress that you will stay with the client and that the client is safe. The nurse should use clear, concise directions and short sentences. Medical jargon, such as telling the client this is an acute exacerbation with a positive prognosis, should be avoided.

A client has been admitted to a hospital with the inability to move the client's right arm. The client has a diagnosis of conversion reaction. Which consequence of this condition would be an example of primary gain?

Relief from anxiety Primary gain is the immediate gain by the client to remove himself or herself from an overwhelming situation. In this case, relief from anxiety would be an example of primary gain. The other three answers reflect secondary gain, or mechanisms to remove the client from stress and provide an opportunity to meet dependency needs.

A nurse is developing a plan of care for a client with panic disorder that will include pharmacologic therapy. Which would the nurse most likely expect to administer?

Selective serotonin reuptake inhibitor (SSRI) Although all of the agents can be used to treat panic disorder, SSRIs are recommended as the first drug option for treatment. Benzodiazepines (antianxiety agents) are used only for short periods of time. MAOIs are reserved for clients who do not respond to SSRIs or serotonin-norepinephrine reuptake inhibitors. The use of TCAs is declining.

The primary reason for considering cultural issues when caring for the client with somatization disorders is what?

Somatization disorders differ in type and frequency of symptoms and depend on the culture in which they are expressed. The type and frequency of symptoms in somatization disorders differ depending on the culture in which they are expressed. For example, there is a higher reported frequency of somatization disorder in Greek and Puerto Rican men than in men in the United States. Therefore, the symptom reviews must be adjusted to the culture.

The psychiatric mental health nurse will perform the initial assessment of a client who has just been diagnosed with posttraumatic stress disorder. Which area would the nurse most likely address first?

Specific events of the trauma Provided the client is willing, the nurse should begin the assessment by addressing the trauma. This should ideally precede other areas such as substance use, sleep, and coping.

A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply.

Talk to the client in a comforting manner. Take the client to a quiet space. Reassure the client of being safe. Given the sudden change in the client's behavior when discussing a stressful transition such as hospital discharge, this client is experiencing panic level of anxiety. In this case, the nurse should keep talking to the client in a comforting manner even though at the time, the client may not be able to process what is being said. Taking the client to a quiet space can decrease environmental stimuli to help reduce anxiety. Providing reassurance to the client that the feeling will pass and that the client is safe is therapeutic and can also decrease anxiety. The nurse should remain with the client until the panic recedes. There is no evidence that the client is experiencing suicidal ideation.

A nurse finds that a client with posttraumatic stress disorder (PTSD) is behaving abnormally and suspects that the client has had a flashback of the traumatic event. Which behavioral manifestations of the client would lead the nurse to make this interpretation? Select all that apply.

The client appears terrified. The client is crying loudly. The client attempted to run away. A client with PTSD usually has dreams, nightmares, and flashbacks associated with the traumatic event that cause intense distress. A client who has had a flashback of the traumatic event appears terrified, may cry or scream, or may attempt to hide or run away. Pain and fatigue are not symptoms related to having a flashback.

A psychiatric-mental health nurse is assessing a client who has been referred for care following a violent assault. Which finding would the nurse most likely document as reflecting the diagnostic criteria for posttraumatic stress disorder (PTSD)? Select all that apply.

The client describes oneself as being constantly "on edge." The client states, "All I can think about these days is the attack." The client states "completely avoiding the neighborhood where the attack occurred." Hyperarousal, avoidance of places associated with a trauma, and pervasive reminders of a trauma are criteria for PTSD. The nurse should address the client's social isolation and limited support network, but these are not diagnostic criteria for PTSD.

A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client?

The client has no adaptive coping mechanisms. Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.

A client with posttraumatic stress disorder (PTSD) is treated with psychotherapy. Which behaviors would indicate that the client is well stabilized? Select all that apply.

The client is able to express grief in a nondestructive manner. The client demonstrates an increased ability to cope with stress. The client voluntarily establishes contact with friends and family. Behaviors such as the ability to express grief and showing increased ability to cope with stress indicate that the client is well stabilized and that the therapy is successful. Voluntarily establishing contact with friends and family indicates that the client has started becoming social and is trying to become an active citizen in society. If the client reports feeling cautious in social settings, a sense of safety has not yet been achieved indicating further stabilizing is needed. Being extremely silent and preferring to remain isolated are symptoms related to PTSD. Persistence of these signs indicates ineffectiveness of the therapy.

The nurse is assessing a client who spends several hours arranging and rearranging items around the house. What does the nurse anticipate is the cause of this compulsive behavior?

The client is preoccupied with perfection. The client who is obsessed with perfection performs compulsive rituals such as arranging and rearranging items around the house. The client who has a fear of contamination is obsessed with cleanliness. This client repeatedly washes hands and cleans and scrubs the surroundings. The client who is obsessed with blasphemous thoughts engages in repeated prayers or confession.

A client with obsessive-compulsive disorder (OCD) spends several hours each day cleansing the home and washing the hands. The client tells the nurse, "I don't think you quite realize how many bacteria, viruses, and fungi live around us." What is the nurse's most accurate interpretation of this client's statement?

The client may lack insight into the OCD. The client's statement is an attempt to present a rational justification for the client's actions. This suggests a lack of insight. There is no direct association between this client's statement and physiologic factors. A lack of insight is a challenge for treatment, but it does not necessarily mean that the client will be unresponsive to treatment. Rituals often have no direct relationship with a past event in the client's life.

The nurse is working with an outpatient who has a history of depression and suicide attempts. What assessment finding should the nurse interpret as indicating a high degree of planning for a future attempt?

The client recently purchased a large bottle of over-the-counter analgesics Acquisition of a large amount of medication strongly suggests planning of a suicide attempt. The client's referral to being a burden suggests suicidality but does not directly indicate a specific plan. Withdrawing from a support group and expressing skepticism about psychopharmacology suggest a worsening of the client's condition but not necessarily a suicide plan.

A client with conversion disorder talks at length about a loss of vision. The nurse talks to the client about good hygiene practices and encourages the client to talk about any topic of interest. What is the nurse's intention for this intervention? Choose the best answer.

The client should pay less attention to the physical problem. By discussing good hygiene practices and encouraging the client to speak on any topic of interest, the nurse is trying to avoid discussing the client's physical symptom. The client with conversion disorder may have good hygiene habits; the nurse is not trying to teach the client about good hygiene habits. The nurse's intervention is not aimed at making the client feel comfortable with the nurse or to make the client express the physical problems. The purpose of the nurse's intervention is to help minimize secondary gain and decrease the client's focus on the symptom.

A mental health nurse has identified a nursing diagnosis of hopelessness related to poor self-concept for a client with depression. Which outcome would be most appropriate for this nursing diagnosis?

The client will reframe negative thoughts in a more positive way. An appropriate outcome for hopelessness would be for the client to reframe and redefine an event positively rather than negatively, which can help the client view the situation in an alternative way, thereby fostering hope. Discussing the cause of fatigue is unrelated to hopelessness. Identifying factors contributing to depression would reflect a knowledge deficit. The ability to differentiate reality from fantasy would be inappropriate for this client. There is nothing to support that the client is not focused in the here and now.

A client developed conversion blindness after witnessing the death of the client's twin in a car accident. When teaching the client's parent about the client's illness, the nurse explains what?

The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. Conversion blindness is an unconscious process; it will not disappear with ophthalmologic care. Conversion symptoms are unconsciously designed to reduce anxiety, so "the client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis" is appropriate.

A psychiatric nurse has assessed a client with posttraumatic stress disorder (PTSD). Before referring the client to psychotherapy, the nurse refers the client to a substance dependence treatment program. Why does the nurse refer the client to an addiction treatment program before referring for psychotherapy? Select all that apply.

The nurse believes that addiction can decrease the effectiveness of the psychotherapy. The nurse believes that the client is not expressing feelings because of the effect of the addiction. Addiction can affect all areas of a client's life and thus can decrease the effectiveness of psychotherapy. Clients usually use substances to repress emotions, therefore elimination of the substance abuse would facilitate the client's ability to express feelings. The nurse should be able to determine whether the client has an addiction during the assessment. This information would guide the nurse as to whether or not to refer the client to an addiction treatment program. For clients with PTSD, stopping the addiction is not sufficient to treat the condition. The inability to make the right decision regarding treatment is a less likely reason for referring the client to an addiction treatment program before referring for psychotherapy.

A nurse is counseling a client who was diagnosed with posttraumatic stress disorder (PTSD). During the session, the client states that the client feels worthless and starts crying. The nurse reassures the client that the client is a survivor rather than a victim. What intervention is the nurse using?

The nurse is promoting the client's self-esteem. By reassuring the client and considering the client as a survivor, the nurse is promoting the client's self-esteem. A client with PTSD usually feels hopeless and worthless because of low self-esteem. By using reassuring and explaining that the client is strong enough to survive the traumatic event, the nurse induces a feeling of self-worth in the client. Grounding techniques are used when the client exhibits dissociative symptoms. Distraction techniques are used when the client has intrusive and persistent thoughts about the traumatic event. A supportive touch is helpful when the client has flashbacks of the stressful events.

In speaking with a client with moderate anxiety, the client becomes tangential discussing unrelated topics. To help the client's attention from wandering, which is an effective intervention?

The nurse should speak in short and simple sentences. Speaking in short, simple, and easy-to-understand sentences has been shown to be effective with clients with moderate anxiety whose attention wanders. Not leaving the client alone unless the anxiety is reduced and speaking in a soft voice are interventions used with a client with severe anxiety. If the client has panic-level anxiety, the nurse should give primary attention to the safety of the client and move the client to a nonstimulating environment.

The nurse is caring for a client with conversion disorder. The nurse asks the client about the client's relationships with family and friends. What is the nurse trying to determine with this question? Choose the best answer.

The nurse wants to learn if the client has any conflicts with family or friends. Conversion disorders are usually related to interpersonal conflict arising among family or friends. The nurse asks the client about family and friends in order to find out whether any conflicts have caused the disorder in the client. Conversion disorder is not inherited, thus the nurse is not trying to find out if similar symptoms are evident in the family. Asking about family and friends would divert the client's attention from the disability, but this is not the nurse's chief intention here. Asking about family and friends would be useful to decrease the chances of secondary gain, but this again is not the nurse's chief intention in this scenario.

What does the nurse find on assessment of the thought processes of a client with obsessive-compulsive disorder (OCD)?

The obsessions become intense as the client tries to stop the behavior. Clients with OCD do not willingly have obsessions or images, and their obsessions become more intense when they try to prevent them. Clients with OCD do not experience effects in memory or intellectual functioning. However, they have difficulty concentrating when the obsessions are strong. For most, the obsessions arise out of nowhere, during other activities.

Which would not be included in the plan of care for a client diagnosed with acute anxiety?

Touching the client in an attempt to comfort the client The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns.

When giving a community lecture about posttraumatic stress disorder (PTSD) for clients and their families, a nurse would include which topics for discussion? Select all that apply.

Trying to identify triggers that lead to re-experiencing the trauma. Trying various treatment options if one does not help. When caring for a client with a PTSD, be sure to include the following topic areas in the teaching plan: Identification of individual triggers and cues that lead to re-experiencing trauma; Safety plans for stressful periods; Recovery plans that focus on personal strengths; Risk factors for re-occurrence of symptoms; Various treatment options if one does not help, others exist; Avoidance of substances such as alcohol and drugs; Nutrition; Exercise; Sleep hygiene; Follow-up appointments; Community services

What kinds of thoughts does the nurse identify in a client with obsessive-compulsive disorder (OCD)? Select all that apply.

Unwanted Intrusive Impulsive The client with OCD has unwanted, intrusive, and impulsive thoughts and images. These thoughts are unreasonable and cause marked anxiety. Interesting and intelligent thoughts are not characteristic of what is described when clients experience episodes of ritualistic behavior to neutralize anxiety.

The nurse is teaching relaxation techniques to a client with obsessive-compulsive disorder (OCD). When does the nurse teach relaxation techniques to the client?

When the client is experiencing low anxiety levels. The nurse teaches relaxation techniques when the client's anxiety level is low. This helps the client learn the technique more effectively and the client begins to use these techniques when anxiety increases. The nurse does not interrupt the client during a repetitive ritual because it agitates the client. The nurse does not teach relaxation techniques after the client has taken medication. The client has disturbed sleep so the nurse promotes a comfortable and quiet environment for the client.

The client has begun to wash the hands every hour due to the fear of germs becoming embedded in the client's skin leading the client to develop cancer. The nurse interprets this behavior as indicating which condition?

a compulsion. Compulsions are ritualistic behaviors that people feel compelled to perform either in accord with a specific set of rules or in a routine manner. A repeated action performed as the result of a persistent thought is termed a compulsion. Obsessions refer to recurrent, intrusive, and persistent ideas, thoughts, images, or impulses. Compulsions are the behaviors people with obsessive-compulsive disorder will carry out in order to neutralize the anxiety caused by the obsessions. Panic attacks typically are characterized by a discrete period of intense apprehension or terror without any real accompanying danger, accompanied by at least four of 13 somatic or cognitive symptoms. Acute stress disorder occurs within the first month of exposure to extreme trauma: combat, rape, physical assault, near-death experience, or witnessing a murder.

During an interview, a client diagnosed with obsessive-compulsive disorder tells the nurse, "I'm constantly worrying that something bad will happen to my mother and that she will die. So, I'm always praying so that this won't happen." The nurse interprets this as which obsessive-compulsive symptom dimension?

aggressive/sexual/religious/checking Obsessive-compulsive symptoms tend to fall into different patterns obsessive-compulsive symptom dimensions. Aggressive/sexual/religious/checking dimension involves excessive worries or fears that something very bad will happen such as a death of a relative or accident. Individuals may have intrusive thoughts about inappropriate violent, sexual or religious content and may need to do something repeatedly, such as praying or confessing to avoid or dismiss these thoughts. Symmetry/ordering/arranging is expressed by the need to be perfect or exact with concerns about symmetry. The individual will take a great deal of time to continually rearrange objects until they are organized in a symmetrical or "just right" fashion. The contamination/cleaning dimension involves worrying about being physically sick, contaminated by dirt or bacteria and is expressed through ritualized washing or cleaning excessively. Collecting/hoarding involves collecting or storing many things or useless objects.

A nursing instructor is reviewing a case study with students about a client with mania who was admitted to a mental health unit. The instructor asks the students what medical diagnosis is most likely responsible for the mania. Which would be the best answer by a student?

bipolar disorder In most cases, mania is a symptom that manifests in people with underlying bipolar disorder. Mania is reflected in periods of euphoria, exuberant activity, grandiosity, and a false sense of well-being. There can be periods of mood instability and irritability as well.

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

caffeine The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. The other types of foods are also potentially harmful to physical as well as psychological health, but the worst offender is caffeine.

A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as:

depersonalization Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.

A nurse is assessing a client who is suspected of having somatic symptom disorder (SSD). Which would the nurse expect to report as the most common report?

pain Although any symptom may be reported, pain is the most common problem in clients with this disorder.

The overall goals of care for individuals experiencing a stress response are to focus on interventions to develop ...

positive coping skills The overall goals of care for those individuals actively experiencing a stress response are to eliminate or moderate the stressor (if possible), to reduce untoward effects of the stress response, and to facilitate the maintenance or development of positive coping skills.

Which is the name given to a direct external benefit that being sick provides, such as relief from anxiety?

primary gain Primary gains are the direct external benefits that being sick provides. Secondary gains are the internal or personal benefits received from others because one is sick. Malingering is the intentional production of false or grossly exaggerated physical or psychological symptoms. The la belle indifference is a seeming lack of concern or distress for sudden deficits in sensory or motor function, as seen in conversion disorder.

The personal benefit derived from blocking psychological conflict from conscious awareness is called what?

secondary gain Secondary gains are the internal or personal benefits received from others because one is sick, such as attention from family members and comfort measures.

An adolescent experiencing severe abdominal pain after the client's parents' argument is an example of what?

somatization An adolescent who experiences severe abdominal pain after the client's parents' argument or a client who receives nurturing from a spouse only when the client has back pain are examples of somatization. This is not an example of depression, schizophrenia, or bipolar disorder.

The nurse is interviewing a client who is being treated for obsessive-compulsive disorder (OCD). The client's compulsions involve cleanliness rituals, which the client justifies by describing potential contaminants in great detail. The nurse interprets the client's statement as implying that:

the client may lack insight into the diagnosis. The client's attempt to justify the client's obsessions and compulsions suggests a lack of insight. This does not mean, however, that the client's disease will worsen over time or that inpatient treatment is needed. Objective evidence does not dissuade clients from their obsessions or rituals.