Mental Health Problems

A client is unwilling to go to his church because his ex-girlfriend goes there & he feels that she will laugh at him if she sees him. Because of this hypersensitivity to a reaction from her, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? 1. Avoidant 2. Borderline 3. Schizotypal 4. Obsessive-compulsive

1. Avoidant Rationale: The avoidant personality disorder is characterized by social withdrawal & extreme sensitivity to potential rejection. The person retreats to social isolation. Borderline personality disorder is characterized by unstable mood & self-image & impulsive & unpredictable behavior. Schizotypal personality disorder is characterized by the display of abnormal thoughts, perceptions, speech, & behaviors. Obsessive-compulsive personality disorder is characterized by perfectionism, the need to control others, & a devotion to work.

A client is admitted to a medical nursing unit w/ a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? 1. Psychosis 2. Repression 3. Conversion disorder 4. Dissociative disorder

3. Conversion disorder Rationale: A conversion disorder is the alteration or loss of a physical function that cannot be explained by any known pathophysiological mechanism. A conversion disorder is thought to be an expression of a psychological need or conflict. In this situation, the client witnessed an accident that was so psychologically painful that the client became blind. Psychosis is a state in which a person's mental capacity to recognize reality, communicate, and relate to others is impaired, interfering w/ the person's ability to deal w/ life's demands. Repression is a coping mechanism in which unacceptable feelings are kept out of awareness. A dissociative disorder is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness.

A manic client begins to make sexual advances toward visitors in the dayroom, When the nurse firmly states that this is inappropriate & will not be allowed, the client becomes verbally abusive & threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? 1. Place the client in seclusion for 30min 2. Tell the client that the behavior is inappropriate 3. Escort the client to their room, with the assistance of other staff 4. Tell the client that their telephone privileges are revoked for 24hrs

3. Escort the client to their room, with the assistance of other staff Rationale: The client is at risk for injury to self & others & should be escorted out of the dayroom. Seclusion is premature in this situation. telling the client that the behavior is inappropriate has already been attempted by the nurse. Denying privileges may increase the agitation that already exists in this client.

The nurse is caring for a client just admitted to the mental health unit & diagnosed w/ catatonic stupor. The client is lying on the bed in a fetal position. Which is the most appropriate nursing intervention? 1. Ask direct questions to encourage talking 2. Leave the client alone so as to minimize external stimuli 3. Sit beside the client in silence w/ simple open-ended questions 4. Take the client into the dayroom w/ other clients to provide stimulation

3. Sit beside the client in silence w/ simple open-ended questions Rationale: Clients who are withdrawn may be immobile & mute & may require consistent, repeated approaches. Communication w/ withdrawn clients requires much patience from the nurse. Interventions include the establishment of interpersonal contact. The nurse facilitates communication w/ the client by sitting in silence, asking simple open-ended questions rather than direct questions, and pausing to provide opportunities for the client to respond. Although overstimulation is not appropriate, there is no therapeutic value in ignoring the client. The client's safety is not the responsibility of other clients.

Which nursing interventions are appropriate for a hospitalized client w/ mania who is exhibiting manipulative behavior? (select all that apply) 1. Communicate expected behaviors to the client 2. Ensure that the client knows that they are not in charge of the nursing unit 3. Assist the client in identifying ways to setting limits on personal behaviors 4. Follow through about the consequences of behavior in a non-punitive manner 5. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups 6. Have the client state the consequences for behaving in ways that are viewed as unacceptable

1. Communicate expected behaviors to the client 3. Assist the client in identifying ways to setting limits on personal behaviors 4. Follow through about the consequences of behavior in a non-punitive manner 6. Have the client state the consequences for behaving in ways that are viewed as unacceptable Rationale: Interventions for dealing w/ the client exhibiting manipulative behavior include setting clear, consistent, & enforceable limits on manipulative behaviors; being clear w/ the client regarding the consequences of exceeding the limits set; following through w/ the consequences in a non-punitive manner; & assisting the client in identifying a means of setting limits on personal behaviors. Ensuring that the client knows that she or he is not in charge of the nursing unit is inappropriate; power struggles need to be avoided. Enforcing rules & informing the client that she or he will not be allowed to attend therapy groups is a violation of a client's rights.

The nurse observes that a client is pacing, agitated, & presenting aggressive gestures. The client's speech pattern is rapid, & affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? 1. Provide safety for the client & other clients on the unit 2. Provide the clients on the unit wi/ a sense of comfort & safety 3. Assist the staff in caring for the client in a controlled environment 4. Offer the client a less stimulating area in which to calm down & gain control

1. Provide safety for the client & other clients on the unit Rationale: Safety of the client & other clients is the immediate priority. The correct option is the only one that addresses the safety needs of the client as well as those of the other clients.

The nurse is conducting a group therapy session. During the session, a client diagnosed w/ mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement? 1. Setting limits on the client's behavior 2. Asking the client to leave the group session 3. Asking another nurse to escort the client out of the group session 4. Telling the client that they will not be able to attend any future group sessions

1. Setting limits on the client's behavior Rationale: Manic clients may be talkative & can dominate group meetings or therapy sessions by their excessive talking. If this occurs, the nurse initially would set limits on the client's behavior. Initially, asking the client to leave the session or asking another person to escort the client out of the session is inappropriate. This may agitate the client & escalate the client's behavior further. Barring the client from group sessions is also inappropriate action because it violates the client's right to receive treatment & is a threatening action.

The nurse is caring for a client diagnosed w/ paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include? 1. Increase socialization of the client w/ peers 2. Avoid using a whisper voice in front of the client 3. Begin to educate the client about social supports in the community 4. Have the client sign a release of information to appropriate parties for assessment purposes

2. Avoid using a whisper voice in front of the client Rationale: Disturbed thought process related to paranoid personality disorder is the client's problem, and the plan of care must address this problem. The client is distrustful & suspicious of others. The members of the health care team need to establish a rapport & trust w/ the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. these options are actions that are too intrusive for a client w/ this disorder.

When planning the discharge of a client w/ chronic anxiety, which is the most appropriate maintenance goal? 1. Suppressing feelings of anxiety 2. Identifying anxiety-producing situations 3. Continuing contact w/ a crisis counselor 4. Eliminating all anxiety from daily situations

2. Identifying anxiety-producing situations Rationale: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid a specific stimulus. Counselors will not be available for all anxiety producing situations, & this option does not encourage the development of internal strengths. Suppressing feelings will not resolve anxiety. Elimination of all anxiety from life is impossible.

A client diagnosed w/ delirium becomes disoriented & confused at night. Which intervention should the nurse implement initially? 1. Move the client next to the nurses' station 2. Use an indirect light source & turn off the tv 3. Keep the tv & soft light on during the night 4. Play soft music during the night, & maintain a well-lit room

2. Use an indirect light source & turn off the tv Rationale: Provision of a consistent daily routine & a low stimulating environment is important when a client is disoriented. Noise, including radio & tv, may add to the confusion & disorientation. Moving the client next to the nurses' station may become necessary but is not the initial action.

The nurse is planning activities for a client diagnosed w/ bipolar disorder w/ aggressive social behavior. Which activity would be most appropriate for this client? 1. Chess 2. Writing 3. Board games 4. Group exercise

2. Writing Rationale: Solitary activities that require a short attention span w/ mild physical exertion are the most appropriate activities for a client who is exhibiting aggressive behavior. Writing (journaling), walks w/ staff, & finger painting are activities that minimize stimuli & provide a constructive release for tension. The remaining options have a competitive element to them or are group activities & should be avoided because they can stimulate aggression & increase psychomotor activity.

A client says to the nurse, "The federal guards were sent to kill me." Which is the best response by the nurse to the client's concern? 1. "I don't believe this is true." 2. "The guards are not out to kill you." 3. "Do you feel afraid that people are trying to hurt you?" 4. "What makes you think the guards were sent to hurt you?"

3. "Do you feel afraid that people are trying to hurt you?" Rationale: It is most therapeutic for the nurse to empathize w/ the client's experience. The remaining options lack this connection w/ the client. Disagreeing w/ delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

The nurse is preparing a client w/ schizophrenia a hx of command hallucinations for discharge by providing instructions on interventions for managing hallucinations & anxiety. Which statement in response to these instructions suggests to the nurse that the client has a need for additional information? 1. "My medications will help my anxious feelings." 2. "I'll go to support group & talk about what I am feeling" 3. "When I have command hallucinations, I'll call a friend for help" 4. "I need to get enough sleep & eat well t help prevent feeling anxious"

3. "When I have command hallucinations, I'll call a friend for help" Rationale: The risk for impulsive & aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse or health care counselor, not a friend, should be contacted to discuss whether the client has intentions to hurt her or himself or others. Talking about auditory hallucinations can interfere w/ subvocal muscular activity associated w/ a hallucination. The client statements in the remaining options will aid in wellness but are not specific interventions for hallucinations, if they occur.

A client is admitted to the mental health unit w/ a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? 1. Encouraging quiet reading & writing for the first few days 2. Identification of physical activities that will provide exercise 3. No socializing activities until the client asks to participate in milieu 4. A structured program of activities in which the client can participate

4. A structured program of activities in which the client can participate Rationale: A client w/ depression often is withdrawn while experiencing difficulty concentrating, loss of interest or pleasure, low energy, fatigue, & feelings of worthlessness & poor self esteem. The plan of care needs to provide successful experiences in a stimulating yet structured environment. The remaining options are either too "restrictive" or offer little or no structure & stimulation.