Nur 190 final

A client has been making sexual comments when communicating with the nurse. The nurse wants to spend some time talking to the client while respecting the client's right to privacy. Which setting would be the most appropriate setting for the nurse to talk with the client?

In a quiet corner of the dayroom at least 4 feet away from others

The parents of a child are concerned about their child's behavior now that he has started school. The nurse assesses and evaluates the child. Which of the following symptoms are characteristic of ADHD?

Inattentiveness, impulsiveness, and overactivity.

A child with attention deficit hyperactivity disorder is taking methylphenidate in divided doses. If the child takes the first dose at 8 AM, which behavior might the school nurse expect to see at noon?

Increased impulsivity or hyperactive behavior.

A young couple just ended their relationship after a 9-month engagement. One of the individuals is seeking short-term counseling to assist in grieving this loss. Which type of loss best describes what this client is experiencing?

Loss of security and sense of belonging

A basic assumption of Freud's psychoanalytic theory is that...

all human behavior can be caused and can be explained.

typically involves 2 weeks or more of a sad mood or lack of interest in life activities, with at least four other symptoms of depression such as anhedonia and changes in weight, sleep, energy, concentration, decision-making, self-esteem, and goals. Twice as common in women and has a one-and-a-half to three times greater incidence in first-degree relatives than in the general population.

Major depressive disorder:

While the nurse and client are in a therapy session, the nurse says to the client, "You become very anxious when we start talking about your drinking." Which of the following techniques is the nurse using? Making an observation

Making an observation

A client has asked about complementary and alternative therapies. The nurse replies that the client will need to discuss this with the physician and that the physician will order any additional therapies. Which of the following are complementary and alternative therapies? Select all that apply.

Massage and osteopathic therapy, music and art therapy, and aromatherapy.

Tendency to speak little or to convey little substance of meaning (poverty of content

alogia

A nurse is exploring treatment options with a client addicted to heroin. Which information regarding the use of methadone is important for the nurse to include?

Methadone will meet the physical need for opiates without producing cravings for more.

A client is admitted for a drug overdose with a barbiturate. Which is the priority nursing action when planning care for this client?

Monitor respiratory function.

A mother rushes her infant to the ED and states "Help, my baby is unresponsive!" Which of the following terms is applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim?

Munchausen's syndrome by proxy.

characterized by a pervasive pattern of grandiosity (in fantasy or behavior), need for admiration, and lack of empathy.

Narcissistic personality disorder:

A client with bipolar disorder has been taking lithium, and today his serum blood level is 2.0 mEq/L. (THIS IS LITHIUM TOXICITY!! REMEMBER YOUR LITHIUM LEVELS) What effects would the nurse expect to see?

Nausea, diarrhea, and confusion.

Brain chemicals, such as enkephalins and endorphins, that regulate the activity of neurons

Neuropeptides

the client's belief that his or her organs aren't functioning or are rotting away, or that some body part or feature is horribly disfigured or misshapen.

Nihilistic delusions

requirement to do no harm

Nonmaleficence

recurrent, persistent, intrusive, and unwanted thoughts, images, or impulses that cause marked anxiety and interfere with interpersonal, social, or occupational function.

Obsessions

: characterized by a pervasive pattern of preoccupation with perfectionism, mental and interpersonal control, and orderliness at the expense of flexibility, openness, and efficiency

Obsessive-compulsive personality disorder

Several medications are prescribed for a client who has anorexia. Which medication may be prescribed to help treat the client's distorted body image?

Olanzapine

The nurse is assessing a client's risk factors for developing a substance abuse disorder. Which family characteristic would the nurse identify as the most significant risk factor?

One parent who is an alcoholic.

compulsive buying; possessions are acquired compulsively without regard for cost or need for the item.

Oniomania

The nurse is assigned to care for a client experiencing disturbed thought processes. The nurse is told that the client believes that their food is being poisoned. Which communication technique would the nurse plan to use to encourage the client to eat?

Open-ended questions and silence

characterized by pervasive mistrust and suspiciousness of others.

Paranoid personality disorder

involve the client's belief that "others" are planning to harm him or her or are spying, following, ridiculing, or belittling the client in some way. Sometimes the client cannot define who these "others" are

Persecutory delusion

Persistent adherence to a single idea or topic; verbal repetition of a sentence, word, or phrase; resisting attempts to change the topic

Perseveration

: a chronic, persistent mood disturbance characterized by symptoms such as insomnia, loss of appetite, decreased energy, low self-esteem, difficulty concentrating, and feelings of sadness and hopelessness that are milder than those of depression.

Persistent depressive (dysthymic) disorder

Which of the following statements about anger, hostility, and aggression are accurate? Select all that apply.

Physical aggression involves harming other persons or property. Anger is an emotional response to a real or perceived provocation. Hostility is often referred to as verbal aggression

A client with a somatic symptom illness asks what is causing her physical symptoms. Which would be the appropriate explanation for the nurse to offer?

Physical symptoms are an involuntary way of dealing with psychic conflict.

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that she and the client were having an illicit affair. Which of the following is the best action by the nurse after learning of this relationship?

Privately offer support to the visitor who was having the affair with the client

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

Provide calm, brief, directive communication

The nurse in the mental health unit reviews the therapeutic and nontherapeutic communication techniques with a nursing student. What are therapeutic communication techniques?

Providing acknowledgment and feedback, maintaining a neutral response, Restating, and Listening.

occur before the age of 5 in response to the trauma of child abuse or neglect, called grossly pathogenic care. The child shows disturbed inappropriate social relatedness in most situations. Rather than seeking comfort from a select group of caregivers to whom the child is emotionally connected to, the child exhibits minimal social and emotional responses to others, lacks a positive effect, and may be sad, irritable, or afraid for no apparent reason.

Reactive attachment disorder

A client is being discharged on disulfiram. Which instruction for Antabuse should the client receive? .

Read products labels carefully to avoid all products containing alcohol

often center around the second coming of Christ or another significant religious figure or prophet

Religiosity

Which are important points for the nurse to consider when working with clients with disruptive behavior disorders and their families?

Remember to focus on the client's strengths and assets, as well as their problems, focus on positive actions to improve situations and/or behaviors, and avoid a "blaming" attitude toward clients and/or families.

A nurse suspects a coworker is signing out narcotics for clients and is using them herself. Which action should be taken by the nurse who has these suspicions?

Report the observations to the supervisor.

diagnosed when the client is severely ill and has a mixture of psychotic and mood symptoms. The signs and symptoms include those of both schizophrenia and a mood disorder such as depression or bipolar disorder. The symptoms may occur simultaneously or may alternate between psychotic and mood disorder symptoms

Schizoaffective disorder

characterized by a pervasive pattern of detachment from social relationships and a restricted range of emotional expression in interpersonal settings.

Schizoid personality disorder

distorted and bizarre thoughts, perceptions, emotions, movements, and behavior. It cannot be defined as a single illness; rather, it is thought of as a syndrome or as a disease process with many different varieties and symptoms.

Schizophrenia

The client exhibits an acute, reactive psychosis for less than the 6 months necessary to meet the diagnostic criteria for schizophrenia. If symptoms persist over 6 months, the diagnosis is changed to schizophrenia. Social or occupational functioning may or may not be impaired.

Schizophreniform disorder

: characterized by a pervasive pattern of social and interpersonal deficits marked by acute discomfort with and reduced capacity for close relationships as well as by cognitive or perceptual distortions and behavioral eccentricities.

Schizotypical personality disorder:

Disorder has two subtypes. In one, most commonly called winter depression or fall-onset, people experience increased sleep, appetite, and carbohydrate cravings; weight gain; interpersonal conflict; irritability; and heaviness in the extremities beginning in late autumn and abating in spring and summer. The other subtype, called spring-onset, is less common, with symptoms of insomnia, weight loss, and poor appetite lasting from late spring or early summer until early fall.

Seasonal affective disorder

involve the client's belief that his or her sexual behavior is known to others; that the client is a rapist, prostitute, or pedophile or is pregnant; or that his or her excessive masturbation has led to insanity.

Sexual delusions

The person with this diagnosis develops this delusion in the context of a close relationship with someone who has psychotic delusions, most commonly siblings, parent and child, or husband and wife. The more submissive or suggestible person may rapidly improve if separated from the dominant person.

Shared psychotic disorder

Feeling no joy or pleasure from life or any activities or relationships

anhedonia

Cluster B personality disorders

antisocial, borderline, histrionic, narcissistic

Feelings of indifference toward people, activities, and events

apathy

generally vague and unrealistic beliefs about the client's health or bodily functions. Factual information or diagnostic testing does not change these beliefs

Somatic delusions

For a client taking clozapine, which of the following symptoms should the nurse report to the physician immediately as it may be indicative of a potentially fatal side effect?

Sore throat and malaise (AGRANULOCYTOSIS!)

Which of the following personal characteristics influence a client's response to stressors?

Spirituality, resilience, hardiness, self-efficacy, and resourcefulness

A client asks the nurse why he has to go to therapy and cannot just take his prescribed antidepressant medication. Which would be the most therapeutic nursing intervention?

Stating, "Medications help your brain function better, but the therapy helps you achieve lasting behavior change."

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.

A client who is taking paroxetine reports to the nurse that he has been nauseated since beginning the medication. Which of the following actions is indicated initially?

Suggest that the client take the medication with food.

A client who has been discharged home on citalopram calls the nurse complaining that the medication causes her to feel too drowsy. The nurse should make which of the following suggestions?

Take the medication at night.

Social withdrawal, few or no relationships, lack of closeness

asociality

A client with severe and persistent mental illness has been taking antipsychotic medication for 20 years. The nurse observes during their therapy session that the client's behavior includes repetitive movements of the mouth and tongue, facial grimacing, and rocking back and forth. The nurse recognizes these behaviors as indicative of which of the following?

Tardive dyskinesia.

Which nursing intervention constitutes false imprisonment?

The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts the client to the room and tells the client to stay there or be put into seclusion.

Which of the following are criteria for instituting the short-term use of restraint or seclusion? Select all that apply.

The client is aggressive. The client is imminently dangerous to himself or herself or to others. All other means of calming the client have been unsuccessful.

A client's prognosis is said to be good due to a high degree of self-efficacy. Which of the following best characterizes self-efficacy? The client is self-motivated and asks for help when needed.

The client is self-motivated and asks for help when needed.

During morning care, a nursing assistant asks a client with dementia, "How was your night?" The client replies, "It was lovely. My husband and I went out to dinner and to a movie." The nurse, who overhears this conversation, would make which assessment regarding the client?

The client is using confabulation.

A client diagnosed with anorexia nervosa is newly admitted to an in-patient psychiatric unit. Which nursing intervention takes priority?

assessment and monitoring of vital signs and lab values to recognize and anticipate medical problems

A client is admitted to the psychiatric nursing unit. When collecting data from the client, the nurse notes that the client was admitted on an involuntary status. Based on this type of admission, which would the nurse expect to note? The client presents a harm to self.

The client presents a harm to self.

Which are appropriate long-term treatment outcomes for clients who have somatic symptom illness?

The client will identify the relationship between stress and physical symptoms, the client with verbally express emotional feelings, the client will demonstrate alternative ways to deal with stress, anxiety, and other feelings, and the client will assume responsibility for self-care activities.

The nurse in a psychiatric unit is assigned to care for a client admitted to the unit 2 days ago. During review of the client's record, the nurse notes that the admission was a voluntary one. Based on this type of admission, which would the nurse expect to note?

The client will participate in the treatment plan.

The nurse is assisting with the data collection on a client admitted to the psychiatric unit. After review of the obtained data, the nurse would identify which as a priority concern?

The client's report of self-destructive thoughts

A nurse working in an assisted living facility is holding an in-service for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest?

The clients may not recognize their family when they come to visit.

Which are possible sources of frustrations for nurses caring for persons with dementia?

The clients may seem not to hear or respond to anything the nurse does, it can be difficult to remain positive and supportive to clients and family because the outcome is so bleak, the clients do not retain explanations or instructions, so the nurse must repeat the same things continually, and the nurse may get little or no positive response or feedback from clients with dementia.

Which of the following are typical characteristics of the perpetrator of intimate partner abuse? Select all that apply.

The perpetrator often believes that the partner is his/her own property The perpetrator is emotionally immature and needs The perpetrator is often irrationally jealous, even of his/her own children

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."

When assessing a client's mental health status, which of the following describes the purpose of the psychosocial assessment?

To assess the client's mental capacity, to assess the client's behavioral function, and to assess the client's current emotional state.

compulsive hair pulling from scalp, eyebrows, or other parts of the body; leaves patchy bald spots that the person tries to conceal.

Trichotillomania

The client presented to the ER with reports of chest pain. The nurse performs a thorough physical examination for this client with a history of a somatic symptom illness. Which of the following is the best rationale for the physical exam?

Underlying pathology should be ruled out.

Honesty and truthfulness

Veracity

A nurse is reinforcing teaching with a client about manifestations of lithium toxicity. Which of the following manifestations should the nurse include in the teaching?

Vomiting and diarrhea.

A client with a long history of bulimia nervosa is seen in the emergency department. The client is seeing things that others do not, is restless, and has dry mucous membranes. Which is most likely the cause of this client's symptoms?

Vomiting, which may lead to dehydration and electrolyte imbalance.

Which of the following would be an example of circumstances in which a client could be subjected to involuntary hospitalization? Select all that apply.

When a client states that he or she intends to commit suicide and is making plans to do so. When a client is unable to control his or her rage and is assaulting everyone around him or her. When a client states that he or she intends to harm others by a deliberate act.

A nurse is assigned to care for a client whose sexual orientation differs from the nurse's sexual orientation. When should the nurse seek guidance from the supervisor?

When the nurse desires to assist the client to change values

Group members are actively discussing a common topic. Members are sharing that they identify with what others are saying. The nurse leader recognizes that the group is in which stage of group development?

Working

A client yells, "All the nurses here are so mean. None of you really care about us!" The most therapeutic response would be what? "

You seem very irritated."

right to self-determination and independence

autonomy

cluster C personality disorder

avoidant, dependent, obsessive-compulsive

Absence of will, ambition, or drive to take action or accomplish tasks

avolition

Disorder in which the client has one or more manic or mixed episodes usually accompanied by major depressive episodes

bipolar I disorder

Disorder in which the client has one or more major depressive episodes accompanied by at least one hypomanic episode

bipolar II disorder

Restricted range of emotional feeling, tone, or mood

blunted affect

Four phases of grieving: Numbness and denial of loss, emotional yearning for the lost loved one and protesting permanence of the loss, cognitive disorganization and emotional despair with difficulty functioning, and reorganization and reintegration.

bowlby

Decisions based on whether action is morally right or wrong, with no regard for consequences​

deontology

influences movement, learning, attention, and emotion

dopamine

Five stages of grieving: shock and disbelief, developing awareness, restitution, resolution of the loss, and recovery

engel

adrenaline

epinephrine

Pale or flushed face, yelling, swearing, agitation, threatening, demanding, clenched fists, threatening gestures, hostility, loss of ability to solve the problem or think clearly

escalation

obligation to honor commitments and contracts

fidelity

Absence of any facial expression that would indicate emotions or mood

flat affect

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, his back is arched, and his eyes have rolled back in their sockets. The client has recently begun drug therapy with haloperidol (Haldol). Based on this assessment, the first action of the nurse would be to...

give a PRN dose of benztropine IM.

A chemical that is responsible for the symptoms of an allergy

histamine

Four stages of loss and adaptation: outcry, denial and intrusion, working through, and completion.

horowitz

a period of abnormally and persistently elevated, expansive, or irritable mood lasting 4 days; does not impair the ability to function and does not involve psychotic features.

hypomania

Inability to concentrate or focus on a topic or activity, regardless of its importance

inattention

The nurse is assigned to care for a client admitted to the hospital after sustaining an injury from a house fire. The client attempted to save a neighbor involved in the fire, but despite the client's efforts, the neighbor died. Which action would the nurse take to enable the client to work through the meaning of the crisis?

inquiring about the client's feelings that may affect coping

fairness

justice

Five stages of grief: denial, anger, bargaining, depression, and acceptance

kubler ross

During rounds, the depressed client is discovered to have completed a suicide attempt in the bathroom. The staff on the inpatient psychiatric unit have been very busy and fell behind on periodic assessment for this client. Which type of lawsuit could the client's family file?

malpractice

a distinct period during which mood is abnormally and persistently elevated, expansive, or irritable

mania

One week after beginning therapy with thiothixene, the client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse should notify the physician because these symptoms are indicative of...

neuroleptic malignant syndrome.

helps control alertness and arousal

norepinephrine

An intoxicated client is brought to the emergency department by local police. The client is told that the primary health care provider (PHCP) will be in to see the client in about 30 minutes. The client becomes very loud and offensive and wants to be seen by the PHCP immediately. The nurse assisting to care for the client would take which appropriate nursing intervention?

offer to take the client to an examination room until he or she can be treated.

compulsive nail biting

onychophagia

cluster A personality disorder

paranoid, schizoid, schizotypal

Remorse; apologies; crying; quiet, withdrawn behavior

post crisis

1) A woman has just presented at the emergency department after being raped. The initial nursing action would be to...

provide emotional support

Six tasks of grieving: recognize, react, recollect and re-experience, relinquish, readjust, and reinvest.

rando

Lowering of voice; decreased muscle tension; clearer, more rational communication; physical relaxation

recovery

involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her.

referential delusions

Affects mood, hunger, sleep, and arousal

serotonin

A young client, diagnosed with oppositional defiant disorder, becomes angry and defiant over the rules of the day treatment program. The client is shouting at the nurse. Which action by the nurse can help defuse the situation?

suggesting that the client go to the gym and shoot baskets.

A nurse assesses that a depressed client is lethargic during the day and does not actively participate in unit activities. The notes from the night shift document that the client did not sleep well. The most probable interpretation of these data is...

the client's depressed mood is impairing restful sleep patterns.

A client stops abruptly in the middle of a sentence while speaking. The nurse should analyze this as indicative of which disorder?

thought blocking

The client tells the nurse, "I don't think you can help me. Every time I talk to you, I am reminded of my mother, and I hated her." The nurse should recognize this as...transference.

transference.

Restlessness, anxiety, irritability, pacing, muscle tension, rapid breathing, perspiration, loud voice, anger

triggering

Decisions based on the greatest good for the greatest number

utilitarianism

Four tasks of grieving: accept reality of the loss, work through the pain of grief, adjust to changes environment due to the loss, and emotionally relocate and move on

worden

Laboratory work is prescribed for a client who has been experiencing delusions. When the laboratory technician approaches the client to obtain a specimen of the client's blood, the client begins to shout, "You're all vampires. Let me out of here!" The nurse present at the time would respond with which question or statement?

"Are you fearful and think that others may want to hurt you?"

Which statement would indicate to the nurse that the client has understood somatic symptom illness?

"How I handle stress and emotions can affect my physical health."

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which of the following statements by the client would let the nurse know that this has been effective?

"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

The psychiatric nurse is greeted by a neighbor in a local grocery store. The neighbor says to the nurse, "How is Carol doing? She is my best friend and is seen at your clinic every week." Which is the appropriate nursing response?

"I cannot discuss any client situation with you."

The nurse is providing care for a client admitted to the hospital with a diagnosis of anxiety disorder. The nurse is talking with the client, and the client says, "I have a secret that I want to tell you. You won't tell anyone about it, will you?" Which is the appropriate nursing response?

"I cannot promise to keep a secret."

A client calls the emergency department of the local hospital reporting that after 16 years of heavy drinking, he is tired and wants to quit "cold turkey." What would be the best response by the nurse?

"It is not safe to stop drinking suddenly without medicine."

The client asks the nurse, "What does somatization mean?" What should the nurse reply?

"It means that stress and/or emotions are causing your symptoms."

A nurse, sitting with a client diagnosed with anorexia nervosa, notices that the client has eaten 80 percent of lunch. The client asks the nurse, "What do you like better, hamburgers or spaghetti?" Which is the best response by the nurse?

"Let's focus on your continued improvement. You ate 80 percent of your lunch."

The nurse has just completed her admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression?

"Others are just trying to keep me from looking good."

The client says to the nurse, "I feel really close to you. You are the only true friend I have." The most therapeutic response the nurse can make is,

"Since ours is a professional relationship, let's explore other opportunities in your life for friendship

A client is readmitted to the substance abuse program for the second time in 6 months for alcohol abuse. On admission, he tells the nurse, "I am so ashamed." What should the nurse reply?

"Tell me what has happened since your last admission."

The husband of a woman with a somatic symptom illness asks the nurse why the doctors cannot find anything wrong with her. Which would be the appropriate explanation for the nurse to offer?

"There is no physical cause. Mental distress is causing the symptoms, even though she is not aware of it."

A nurse is caring for a client who has paranoid schizophrenia and a new prescription for risperidone. The client asks the nurse what the medicine is supposed to do. Which of the following responses should the nurse make?

"This medication will clear your thinking."

A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is...

"What is it about the medicine that you don't like?"

A nurse has been waiting for over an hour for the ancillary department of laboratory to draw blood on a non-critical client with bipolar disorder in the ED. Which response is an example of assertive communication from the nurse to the laboratory personnel?

"When you are late to draw blood the family gets upset, and I don't like having to repeat that you are on your way."

Which statement by the nurse would be most appropriate to the family member who is the primary caregiver to a client with dementia?

"Yes, it is important for you to spend some time relaxing and doing what you like to do. This will help you to be better prepared to manage the demands of the caregiver role."

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."

A client says to the nurse, "I'm going to die, and I wish my family would stop hoping for a 'cure'! I get so angry when they carry on like this! After all, I'm the one who's dying." Which therapeutic response would the nurse make to the client?

"You're feeling angry that your family continues to hope for you to be 'cured'?"

A client lost control of his behavior, broke a window, and made verbal threats to staff and other clients. The client was placed in mechanical restraints by the nursing team. Which statement should the nurse make to explain the use of restraints to the client?

'This is a means of keeping you and others safe."

: characterized by a pervasive pattern of disregard for and violation of the rights of others and with the central characteristics of deceit and manipulation.

Antisocial personality disorders

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.

Demonstrates hypervigilance Experiences flashbacks Feels detached or empty inside Avoids people and places that arouse painful memories

A nurse asks an assigned client diagnosed with a Tic disorder, "How are you doing today?" The client responds with "doing today, doing today, doing today." Which of the following speech pattern disturbances is this an example of?

Echolalia

Imitation of the movements and gestures of another person whom the client is observing

Echopraxia

Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care?

Employ ongoing communication with team members to remain firm and consistent about expectations for clients and discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings.

A nurse is working with a client who has frequent angry outbursts. Which of the following statements is most helpful when working with this client?

Engaging the hostile person in dialogue

A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which mental health diagnosis is most probable for this client?

Illness anxiety disorder

A client has been referred to a mental health center by a juvenile court after being arrested for vandalism. At the mental health center, the client refuses to participate in scheduled activities. The client was seen pushing another client, causing the person to fall. Which approach by nursing staff would be most therapeutic?

Establishing firm limits.

A client is admitted to a psychiatric unit for treatment of a psychotic disorder. The client is at the locked exit door and is shouting, "Let me out! There's nothing wrong with me! I don't belong here!" The nurse identifies this behavior as which defense mechanism?

Denial

characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation

Dependent personality disorder:

During a session with a client, the client asks the nurse what she should do about her "cheating" husband. The nurse replies, "You should divorce him. You deserve better than that." The nurse used which nontherapeutic communication technique?

Giving advice

A major excitatory neurotransmitter; involved in memory

Glutamate

A nurse is caring for a group of clients in a mental health facility. Which of the following clients recommend the provider see first?

A client taking clozapine who has a sore throat and mild fever.

Which client is at highest risk for carrying out a suicide plan?

A client who says, "I am going to jump off the next bridge I see."

Which of the following losses are likely to result in disenfranchised grief? Select all that apply.

A couple who has just experienced pregnancy loss The homosexual partner of a man who just died from AIDS A family whose long-time pet snake has just died A nurse who has just witnessed the death of a patient

A client with depression has been taking an SSRI--fluoxetine--for the last 3 months and has noticed improvement of symptoms. The nurse inquires about any side effects. Which of the following would the nurse expect the client to report?

A decrease in sexual pleasure during intimacy.

A client is being evaluated for dementia. The nurse knows that a client who is able to complete very few tasks is most likely to have... A greater cognitive deficit

A greater cognitive deficit

Which of the following are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply.

Assertiveness training Decatastrophizing Positive reframing

characterized by the client's claim to association with famous people or celebrities, or the client's belief that he or she is famous or capable of great feats

Grandiose delusions

The nurse is preparing a client for the termination phase of the nurse-client relationship. Which task would the nurse appropriately plan for during this phase?

Assist with making appropriate referrals.

Fragmented or poorly related thoughts and ideas

Associative looseness

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

Avoid alcoholic beverages

The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior?

Alzheimer's dementia Schizophrenia Acute alcohol withdrawal

Holding seemingly contradictory beliefs or feelings about the same person, event, or situation

Ambivalence

Which of the following persons are most likely experiencing complicated grieving? Select all that apply.

An adult who insisted for many years that she hated her deceased parent. The spouse of a person who died 7 years ago and visits the grave several times a day. A driver whose spouse and children all died as a result of his driving drunk. The parent of a child who died after the having left the child in a car on a hot day.

characterized by a pervasive pattern of social discomfort and reticence, low self-esteem, and hypersensitivity to negative evaluation.

Avoidant personality disorder

A nurse is providing education to a group of parents who have children with ADHD. Which of the following statements would be accurate and should be included in the education?

ADHD is not the fault of the parents or the child, and that techniques and school programs are available to help, it is important for parents of children with ADHD to learn how to rebuild their child's self-esteem, and because raising a child with ADHD can be frustrating and exhausting, it often helps parents to attend support groups that can provide information and encouragement from other parents with the same problems.

A neurotransmitter that enables learning and memory and also triggers muscle contraction

Acetylcholine

diagnosis is appropriate when symptoms appear within the first month after the trauma and do not persist longer than 4 weeks

Acute stress disorder

a group of symptoms, such as stress, feeling sad, or hopeless, and physical symptoms that occur following a stressful life event; the reaction is stronger than would-be expected for the event that occurred.

Adjustment disorder

A nurse is reinforcing dietary teaching with a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). Which of the following foods should the nurse instruct the client to avoid while taking an MAOI?

Aged cheese.

A client is seen in the clinic with clinical manifestations of an inability to sit still and a rigid posture. As the nurse performs her assessment, which of these side effects would be correctly identified?

Akathisia

A client with a history of heavy alcohol use, whose last drink was 24 hours ago, is seen in the emergency department. The nurse assesses the client and finds the client is oriented but is tremulous, weak, and sweaty and has some gastrointestinal (GI) symptoms. Which of the following is typical of these symptoms?

Alcohol withdrawal syndrome

False sensory perceptions or perceptual experiences that do not exist in reality

Hallucinations

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?

Ham sandwich, cheese slices, milk

A client is actively involved in community service activities. The benefit of involvement in meaningful daily activities will most directly contribute to which of the following attributes? Hardiness

Hardiness

Which of the following interventions would be appropriate for a client with anorexia nervosa?

Having the client in view of staff for 90 minutes after each meal.

duty to benefit others or promote good

Beneficence

A client has a history of schizophrenia, controlled by haloperidol. During an assessment, the nurse notes continuous restlessness. Which medication would the nurse expect to be prescribed for this client?

Benztropine mesylate (anticholinergic)

Outlandish appearance or clothing; repetitive or stereotyped, seemingly purposeless movements; unusual social or sexual behavior

Bizarre behavior

A client with schizophrenia is being treated with olanzapine 10 mg. daily. The client asks the nurse how this medicine works. The nurse explains that the mechanism by which the olanzapine controls the client's psychotic symptoms is believed to be which of the following? .

Blocking dopamine receptors in the brain

a preoccupation with an imagined or slight defect in physical appearance that causes significant distress for the individual and interferes with functioning in daily life

Body dysmorphic disorder

people who feel "overcomplete," or alienated from a part of their body and desire amputation

Body identity integrity disorder

Which factors may contribute to the frequency of eating disorders in adolescents?

Body image disturbances, media portrayal of slimness as an ideal, seeking to develop a unique identity, body dissatisfaction in adolescent females, and seeking autonomy.

pervasive and enduring pattern of unstable interpersonal relationships, self-image, and affect; marked impulsivity; frequent self-mutilation behavior. (Mrs. Nobles' least favorite population to treat)

Borderline personality disorders:

The nurse is assisting a child with ADHD to complete his ADLs. Which is the best approach for nurse to use with this child?

Break the tasks into small steps

The client experiences the sudden onset of at least one psychotic symptom, such as delusions, hallucinations, or disorganized speech or behavior, which lasts from 1 day to 1 month. The episode may or may not have an identifiable stressor or may follow childbirth

Bried psychotic disorder

A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis?

Bulimia nervosa

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.

Depersonalization disorder Dissociative identity disorder Dissociative amnesia

compulsive skin picking, often to the point of physical damage; an impulse control disorder.

Dermatillomania/excoriation

A young woman telephones the emergency department and loudly tells the nurse, "I've been raped! Please help me!" Which of the following is the priority for the nurse to determine?

If the client was in a safe place, her condition, and if transportation is available

Which of the following would best assess a client's judgment?

Discussing hypothetical situations

a persistent angry or irritable mood, punctuated by severe, recurrent temper outbursts that are not in keeping with the provocation or situation, beginning before age 10.

Disruptive mood dysregulation disorder

The nurse is working in an intensive care unit and observes that some clients do not respond to injections of diazepam (Valium) when the injections are given by a particular nurse. This nurse returns from lunch exhibiting slurred speech and euphoria. Which is the best action for the nurse to take?

Call the manager and report the observations.

characterized by marked psychomotor disturbance, either excessive motor activity or virtual immobility and motionlessness. Motor immobility may include catalepsy (waxy flexibility) or stupor. Excessive motor activity is apparently purposeless and not influenced by external stimuli. Other behaviors include extreme negativism, mutism, peculiar movements, echolalia, or echopraxia.

Catatonia

Which of the following groups could benefit most from prevention programs?

Children, prior to first use.

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling and are formulating a collaborative plan. The child is experiencing signs of which of the following disorder?

Conduct disorder.

The nurse enters a client's room, and the client immediately demands to be released from the hospital. During review of the client's record, the nurse notes that the client was admitted 2 days ago for the treatment of an anxiety disorder and that the admission was a voluntary one. The nurse reports the findings to the RN and expects that the RN will take which action?

Contact the primary health care provider (PHCP).

Loss of emotional and physical control, throwing objects, kicking, hitting, spitting, biting, scratching, shrieking, screaming, inability to communicate clearly

Crisis

characterized by mild mood swings between hypomania and depression without loss of social or occupational functioning.

Cyclothymic disorder

ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety.

Compulsions

The client cannot remember important personal information (usually of a traumatic or stressful nature). This category includes a fugue experience where the client suddenly moves to a new geographic location with no memory of past events and often the assumption of a new identity.

Dissociative amnesia

The client displays two or more distinct identities or personality states that recurrently take control of his or her behavior. This is accompanied by the inability to recall important personal information.

Dissociative identity disorder

The client has one or more non-bizarre delusions—that is, the focus of the delusion is believable. The delusion may be persecutory, erotomania, grandiose, jealous, or somatic in content. Psychosocial functioning is not markedly impaired, and behavior is not obviously odd or bizarre

Delusional disorder

Fixed false beliefs that have no basis in

Delusions

The nurse is questioning the family of a client brought in with cognitive impairment as she assesses and evaluates the client's condition. Which distinguishes delirium from dementia?

Dementia has a gradual onset and is progressive in course.

The client has a persistent or recurrent feeling of being detached from his or her mental processes or body or sensation of being in a dream-like state in which the environment seems foggy or unreal. The client is not psychotic nor out of touch with reality.

De-personalization/de-realization

The client is talking to staff members individually and attempting to manipulate them. Which of the following are important in the limit-setting technique to deal with manipulative behavior?

Identifying the consequences if the limit is exceeded, identifying the expected or desired behavior, and stating the behavioral limit.

: characterized by a pervasive pattern of excessive emotionality and attention seeking.

Histrionic personality disorder

involves excessive acquisition of animals or apparently useless things, cluttered living spaces that become uninhabitable, and significant distress or impairment for the individual.

Hoarding disorder

Which of the following are components of the assessment of thought process and content?

How the client is thinking, clarity of ideas, what the client is thinking, and self-harm or suicide urges.

False impressions that external events have special meaning for the person

Ideas of reference

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

An inhibitory neurotransmitter in the brain.

GABA

Following a group therapy session, a client approaches the nurse and verbalizes a need for seclusion because of uncontrollable feelings. The nurse reports the findings to the RN and expects that the RN will take which action?

Get a written prescription (order) from the primary health care provider (PHCP) and obtain an informed consent.

A client is showing no facial expression when engaging in a game with peers during an outing at a park. The nurse uses which of the following terms when documenting the client's affect?

Flat affect

Continuous flow of verbalization in which the person jumps rapidly from one topic to another

Flights of ideas

Which of the following are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply.

Intergenerational transmission Alcohol and substance use Social isolation Abuse of power and control

The nurse at a university health services clinic has been asked to meet with a freshman class of women about warning signs of relationship violence. The nurse points out which of the following danger signs the students should be alert for in a date?

Is excessively jealous

Which of the following interventions is most effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply.

Planning group activities such as playing games Scheduling one-to-one interactions with the client Providing structure and consistency on the unit

the most common complication of pregnancy in developed countries. The symptoms are consistent with those of depression, with onset within 4 weeks of delivery.

Post-partum depression

a severe and debilitating psychiatric illness, with acute onset in the days following childbirth. Symptoms begin with fatigue, sadness, emotional lability, poor memory, and confusion and progress to delusions, hallucinations, poor insight and judgment, and loss of contact with reality. This medical emergency requires immediate treatment.

Post-partum psychosis

a disturbing pattern of behavior demonstrated by someone who has experienced a traumatic event; for example, a natural disaster, a combat, or an assault; begins 3 months or more following the trauma

Post-traumatic stress disorder

defined as recurrent, moderate psychological and physical symptoms that occur during the week before menses and resolving with menstruation. Approximately 20% to 30% of premenopausal women are affected.

Premenstrual dysphoric disorder

Which time periods during antidepressant therapy are persons most likely to commit suicide?

Prior to initiating antidepressant therapy but before the depression results in lack of energy, if the client has made a choice to discontinue antidepressant therapy without medical supervision and is becoming gradually more depressed, if the client does not adhere to the medication regimen and takes antidepressant medications irregularly, and after starting antidepressant therapy but not having reached the therapeutic level.