NURS 7300: Unit 2 Review Questions

Which medication classification has most commonly been used to treat social phobia? a. Tricyclic antidepressants (TCAs) b. Selective serotonin reuptake inhibitors (SSRIs) c. Nonbenzodiazepines d. Monoamine oxidase inhibitors (MAOIs)

b. Selective serotonin reuptake inhibitors (SSRIs) SSRIs are used to treat clients with social anxiety disorder because they significantly reduce social anxiety and phobic avoidance. Benzodiazepines are also used to reduce anxiety caused by phobias.

Which of the following extrapyramidal side effects is noted by the client with bradykinesia and a shuffling gait? a. Acute dystonia b. Tardive dyskinesia c. Pseudoparkinsonism d. Akathisia

c. Pseudoparkinsonism Pseudoparkinsonism is noted by a resting tremor, rigidity, a masklike face, and a shuffling gait. Akathisia occurs when the client has motor restlessness evidenced by pacing, rocking, or shifting from foot to foot. Symptoms of acute dystonia are intermittent or fixed abnormal postures of the eyes, face, tongue, neck, trunk, and extremities.

Which is a primary risk factor for suicide? a. Poverty b. Economic deprivation c. Social isolation d. Unemployment

c. Social isolation Social isolation is a primary risk factor for suicide. Other social factors associated with suicide risk include economic deprivation, unemployment, and poverty, especially among young people.

The nurse is planning care for a client who has been diagnosed with trichotillomania. Which outcome should the nurse include in the client's plan of care? a. Client will accurately describe the etiology and clinical course of trichotillomania b. Client will consistently refrain from skin picking c. Client will reestablish mutually supportive relationships with family members d. Client will demonstrate healthy coping strategies for dealing with stressors

d. Client will demonstrate healthy coping strategies for dealing with stressors While the etiology of trichotillomania is not fully understood, the problem is known to benefit from enhanced coping skills. Trichotillomania involves hair-pulling, not skin-picking. Relationships are vital to support and recovery, but healthy coping is even more important. It is beneficial for the client to understand the disease but it is more important to develop coping skills.

Which condition is an anticholinergic side effect associated with some antipsychotic medications? a. Increased tearing b. Photophobia c. Diarrhea d. Salivation

b. Photophobia Photophobia, dry mouth, decreased lacrimation, and constipation are anticholinergic side effects associated with some antipsychotic medications.

A client has experienced a first episode of major depression and has received medication and treatment, which has led to a complete remission of the symptoms. The client asks the nurse, "How much longer will I need to take the medication?" Which response by the nurse would be most appropriate? a. "You'll need to continue the medication for about 6 to 12 months to see how things go." b. "It's probably best to continue the medication for another month, gradually decreasing the dosage over that time." c. "The medication has eliminated your symptoms so you'll need to keep taking it for the rest of your life." d. "Since you have no more symptoms, you can stop taking the medications tomorrow."

a. "You'll need to continue the medication for about 6 to 12 months to see how things go." Even after the first episode of major depression, medication should be continued for at least 6 months to 1 year after the client achieves complete remission of symptoms. If the client experiences a recurrence after tapering the first course of treatment, the regimen should be reinstituted for at least another year, and if the illness reoccurs, medication should be continued indefinitely.

Which medication would the nurse expect to administer to a client with schizophrenia who is experiencing a dystonic reaction? a. Benztropine b. Aripiprazole c. Risperidone d. Trihexyphenidyl

a. Benztropine A client experiencing a dystonic reaction should receive immediate treatment with benztropine. Risperidone and aripiprazole are antipsychotics that may cause dystonic reactions. Trihexyphenidyl is used to treat Parkinsonism due to antipsychotic drugs.

A client is being seen in the mental health clinic. The client has been taking haloperidol (Haldol) for 8 months and now exhibits tongue protrusion, lip smacking, and rapid eye blinking. The nurse would document this as which chronic syndrome? a. Dystonia b. Tardive dyskinesia c. Neuroleptic malignant syndrome (NMS) d. Akathisia

b. Tardive dyskinesia Tardive dyskinesia involves irregular, repetitive involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, puckering of the lips, and rapid eye blinking. NMS, a serious complication that may result from antipsychotic medications, is characterized by rigidity and high fever. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first extrapyramidal symptom to occur, usually within a few days of initiating use of an antipsychotic.

The nurse is providing care for a client who has been diagnosed with obsessive-compulsive disorder related to elaborate rituals involved sorting and categorizing objects. What assessment finding should the nurse associate most closely with the development of this client's mental health disorder? a. The client has taken thyroid supplements for several years b. The client self-describes as a "melancholic, glass-half-empty type of person" c. The client was hospitalized for long periods as a teenager due to leukemia d. The client has been unable to sustain relationships with friends for more than a few years

b. The client self-describes as a "melancholic, glass-half-empty type of person" A "melancholic" personality is associated with depression, which often involves serotonin deficiency; low levels of serotonin are known to be associated with OCD. There is no noted association between childhood cancers and thyroid supplements and OCD. Relationship difficulties are more likely to be a result of OCD rather than a cause.

The prescription of clozapine (Clozaril) requires weekly blood samples for which time frame? a. 6 months b. 4 months c. 8 months d. 2 months

a. 6 months Although agranulocytosis can occur with any of the antipsychotics, the risk with clozapine is greater than with other antipsychotics. Therefore, prescription of clozapine requires weekly blood samples for the first 6 months of treatment and then every 2 weeks after that for as long as the drug is taken.

The nurse is conducting the initial interview with a client who has obsessive-compulsive disorder (OCD). When asked about rituals, the client provides a tangential monologue that does not directly address the nurse's question. What should the nurse do? a. Allow the client to speak and avoid the temptation to interrupt b. Ask the client if they would like to continue the interview at a more convenient time c. Ask the client how this information applies to the question that the nurse asked d. Repeat the question in order to redirect the client's monologue

a. Allow the client to speak and avoid the temptation to interrupt The nurse should either let the client continue talking or gently redirect the client. It is detrimental to rapport if the nurse calls off the interview or confronts the client with the dubious relevance of the information. Repeating the question is not a sufficiently gentle redirection.

Which mental health disorder is the most significant risk factor for suicide? a. Depressive disorder b. Schizophrenia c. Anxiety d. Mania

a. Depressive disorder Depressive disorder is a major risk factor of suicide. Anxiety, schizophrenia, and mania are significant risk factors, but to a lesser degree than depression.

A 36-year-old client has been receiving a selective serotonin reuptake inhibitor for treatment of depression. The client is exhibiting manifestations of serotonin syndrome. The nurse should be aware of which symptom of this syndrome? a. Hyperreflexia b. Constipation c. Bradycardia d. Hypothermia

a. Hyperreflexia Symptoms of serotonin syndrome include hyperreflexia, tachycardia, hyperthermia, and diarrhea. Serotonin syndrome can be life threatening. The treatment for serotonin syndrome is discontinuation of the medication and symptom management.

A client with schizophrenia is prescribed clozapine. The nurse would monitor the client closely for specific signs of what condition? a. Infection b. Nausea c. Hypotension d. Weight loss

a. Infection Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Therefore, the nurse needs to be alert for signs of infection, particularly bacterial infection. Hypotension may occur with any antipsychotic drug. Nausea is a common side effect of many drugs. Weight gain, not loss, can occur with olanzapine and clozapine.

Which medications are examples of monoamine oxidase inhibitors (MAOIs)? (Select all that apply.) a. Phenelzine b. Paroxetine c. Isocarboxazid d. Fluoxetine e. Sertraline

a. Phenelzine (Nardil) c. Isocarboxazid (Marplan) Examples of MAOIs are phenelzine and isocarboxazid. Fluoxetine, paroxetine, and sertraline (Zoloft) are examples of selective serotonin reuptake inhibitors.

A client with obsessive-compulsive disorder (OCD) is making a concerted effort to reduce the frequency and length of her rituals. What intervention should the nurse include to assist in these efforts? a. Teaching the client nonpharmacologic relaxation techniques b. Teaching the client how to complete the rituals in less time c. Administering mood stabilizers as prescribed d. Educate the client about the negative effects of obsessions and compulsions

a. Teaching the client nonpharmacologic relaxation techniques Reducing the frequency of rituals for a person with OCD causes anxiety. Clients consequently benefit from learning techniques that can reduce their stress in a healthy way. Mood stabilizers are not typically used in the treatment of OCD and nurses do not normally facilitate the performance of rituals. The client is likely aware of the negative consequences of obsessions and rituals, as evidence by the efforts to eliminate them.

A client with obsessive-compulsive disorder (OCD) spends several hours each day cleaning the home and washing their 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? a. The client may lack insight into obsessive-compulsive disorder b. The client is unlikely to respond to conventional treatment for OCD c. The client's OCD is the result of physiologic factors d. The client may have contacted a severe infection or contamination earlier in life

a. The client may lack insight into obsessive-compulsive disorder The client's statement is an attempt to present a rational justification for his actions. This suggests a lack of insight. There is no particular 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 specific event in the past.

In psychiatric-mental health, anticonvulsants are commonly used to treat clients with bipolar disorder and are considered mood stabilizers. Which medications are classified as anticonvulsants? (Select all that apply.) a. Valproate b. Carbamazepine c. Lamotrigine d. Clozapine e. Lithium

a. Valproate b. Carbamazepine c. Lamotrigine Valproate, carbamazepine, and lamotrigine are classified as anticonvulsants. Lithium is an antimania medication. Clozapine is an antipsychotic.

Concomitant use of antidepressants with monoamine oxidase inhibitors (MAOIs) can cause which life-threatening drug interaction? a. Risk of seizures b. Hypertensive crisis c. Hypotensive crisis d. Sedation

b. Hypertensive crisis All antidepressant medications interact with MAOIs, causing hypertensive crises. Concomitant use should be avoided.

A client has been started on an antipsychotic medication and is exhibiting muscle stiffness of the arms, slowness of gait, and tremors. Which extrapyramidal syndrome (EPS) is the client displaying? a. Dystonia b. Pseudoparkinsonism c. Akathisia d. Neuroleptic malignant syndrome (NMS)

b. Pseudoparkinsonism Symptoms of pseudoparkinsonism include the classic triad of Parkinson disease (rigidity, slowed movements, and tremor). The rigid muscle stiffness is usually seen in the arms. Akathisia is characterized by the inability to sit still or restlessness and is more common in middle-aged clients. Dystonia is impaired muscle tone that generally is the first EPS to occur, usually within a few days of initiating use of an antipsychotic. NMS is a serious complication that may result from antipsychotic medications. It is characterized by rigidity and high fever.

When developing a plan of care for a client diagnosed with panic disorder, which diagnosis would be considered the priority nursing diagnosis? a. Anxiety b. Risk for Self-Harm c. Social Isolation d. Powerlessness

b. Risk for Self-Harm People with panic disorder are often depressed and consequently are at high risk for suicide. Adolescents with panic disorder may be at higher risk for suicidal thoughts and attempt suicide more often than other adolescents. Other diagnoses that are appropriate for this client population, although not the priority, include Powerlessness, Social Isolation, and Anxiety.

Which anticholinergic side effects may occur with the use of antipsychotic drugs? (Select all that apply.) a. Runny nose b. Urinary retention c. Diarrhea d. Constipation e. Dry mouth

b. Urinary retention d. Constipation e. Dry mouth Anticholinergic side effect resulting from blockade of acetylcholine are common side effects associated with antipsychotic drugs. Others include dry mouth, slowed gastric motility, constipation, urinary hesitancy or retention, and nasal congestion. Diarrhea and a runny nose are not anticholinergic side effects.

A client is in the acute phase of mania and is receiving lithium. Which blood level of lithium is within the therapeutic range for acute mania? a. 0.4 mEq/L b. 0.2 mEq/L c. 0.9 mEq/L d. 1.5 mEq/L

c. 0.9 mEq/L During the acute phase of mania, lithium blood levels of 0.8 to 1.4 mEq/L are usually attained and maintained until symptoms are under control.

Clients taking monoamine oxidase inhibitors (MAOIs) for depression must be placed on a diet that is low in which dietary factor? a. Sugar b. Fat c. Tyramine d. Sodium

c. Tyramine Tyramine has a vasopressor effect that induces hypertension. If the individual ingests food that contains high levels of tyramine while taking MAOIs, severe headaches, palpitations, neck stiffness and soreness, nausea, vomiting, sweating, hypertension, stroke, and (in rare instances) death may result. Clients who are taking MAOIs are placed on a low-tyramine diet. Sodium, fat, and sugar are generally not restricted in clients receiving MAOIs.

A client's mental health disorder is characterized by the client's excessive cleaning of her surroundings. How can the nurse best address the biochemical aspects of the client's disorder? a. Educate the client about the relationship between cerebral glucose metabolism and mental health b. Dialogue with the client about isolation, undoing and reaction forming c. Administer anticonvulsants as prescribed d. Administer sustained serotonin reuptake inhibitors (SSRIs) as prescribed

d. Administer sustained serotonin reuptake inhibitors (SSRIs) as prescribed The client likely has obsessive-compulsive disorder, which is often treated with SSRIs, not anticonvulsants. Isolation, undoing and reaction forming are components of psychodynamic theory. Neuropathologic theory focuses on the role of cerebral glucose metabolism.

A client is receiving clozapine. For which life-threatening blood disorder should the nurse be alert when assessing this client? a. Diabetes b. Hypotension c. Weight gain d. Agranulocytosis

d. Agranulocytosis Agranulocytosis is an acute reaction that causes the individual's white blood cell count to drop to very low levels and concurrent neutropenia, a drop in neutrophils in the blood, to develop. Hypotension, weight gain, and diabetes are not blood disorders but are potential side effects of antipsychotics.

After educating a client with bipolar disorder on his prescribed lithium therapy, the nurse determines that additional education is needed when the client makes what statement? a. "I need to cut back on my salt intake when it's really hot outside." b. "I need to avoid drinking any alcohol." c. "I can use sugarless candies to help with any metallic taste." d. "I need to report any problems with severe diarrhea or slurred speech."

a. "I need to cut back on my salt intake when it's really hot outside." Clients should increase their intake of salt during periods of perspiration (e.g., when it is hot outside) and periods of increased exercise and dehydration. Severe diarrhea and slurred speech suggest moderate toxicity, which needs to be evaluated. Alcohol interacts with lithium, causing increased serum levels of the drug, placing the client at risk for toxicity. Sugarless candies and throat lozenges can help to combat metallic taste.

A client diagnosed with schizophreniform disorder must experience symptoms for at least 1 month. The nurse knows the duration of the symptoms must be less than how long? a. 6 months b. 12 months c. 2 weeks d. 4 weeks

a. 6 months The essential features of schizophreniform disorder are identical to those of criteria A for schizophrenia, with the exception of the duration of the illness, which can be less than 6 months. Symptoms must be present for at least 1 month to be classified as a schizophreniform disorder.

Which client is most likely to be diagnosed with body dysmorphic disorder (BDD)? a. A client who firmly believes that everyone fixates on the size of his or her ears b. A client who is more than 150 pounds overweight but who believes they are healthy c. A client who is dangerously underweight but persists in weight loss efforts d. A client who has a pattern of overeating and then inducing vomiting

a. A client who firmly believes that everyone fixates on the size of his or her ears 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.

The nurse is creating a plan of care for a client who has been diagnosed with posttraumatic stress disorder after he caused a motor vehicle accident in which a person died. What should the nurse include in the client's plan of care? (Select all that apply.) a. Administer sustained serotonin reuptake inhibitors as prescribed b. Assess the client for acute or chronic pain c. Encourage the client to abstain from drinking alcohol d. Educate the client about the importance of sleep hygiene e. Administer tricyclic antidepressants as prescribed

a. Administer sustained serotonin reuptake inhibitors as prescribed b. Assess the client for acute or chronic pain c. Encourage the client to abstain from drinking alcohol d. Educate the client about the importance of sleep hygiene Clients with PTSD frequently have sleep disruptions that can benefit from improved sleep hygiene. SSRIs are sometimes used in the treatment of PTSD, but tricyclic antidepressants are not normally used. Pain is a frequent accompaniment to PTSD and abstinence from alcohol is preferred.

Which substances may increase serum lithium levels? (Select all that apply.) a. Alcohol b. Haloperidol c. Furosemide d. Ibuprofen e. Fluoxetine

a. Alcohol c. Furosemide e. Fluoxetine (Prozac) Furosemide, alcohol, and fluoxetine may increase serum lithium levels. Haloperidol increases neurotoxicity despite normal serum levels and dosage. Nonsteroidal anti-inflammatory drugs such as ibuprofen decrease renal clearance of lithium. Ibuprofen increases serum lithium levels by 30% to 50% in 3 to 10 days.

A psychiatric-mental health nurse is teaching the family of client about strategies for engaging with a family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). What action should the nurse encourage the client's family to take? a. Anticipate that the client is likely to be irritable and withdrawn at times b. Ensure the client takes benzodiazepines at the same time each day c. Expect that the client will sleep for short periods of time, several times per day d. Create social interaction for the client even if the client is actively opposed to socializing

a. Anticipate that the client is likely to be irritable and withdrawn at times Clients with PTSD are prone to irritability and social withdrawal. In most cases, it is counterproductive and unethical to force a client into social situations if he or she is openly opposed to them. Sleep disruptions are expected, but there are no recognized patterns of frequent naps; insomnia is typical. Benzodiazepines are not normally used for the treatment of PTSD.

When administering and monitoring antidepressant therapy in a client, which actions would be most appropriate for the nurse to do? (Select all that apply.) a. Ask the client about the use of any herbal supplements. b. Observe the client for cheeking medications. c. Check plasma drug levels one hour before the next dose. d. Assess orthostatic vital signs before beginning therapy. e. Obtain liver function studies at least once a week.

a. Ask the client about the use of any herbal supplements. b. Observe the client for cheeking medications. d. Assess orthostatic vital signs before beginning therapy. When administering and monitoring a client receiving antidepressant therapy, the nurse should observe the client for cheeking or saving medications for a later suicide attempt. Orthostatic vital signs should be obtained as a baseline before initiating therapy, and regularly after therapy begins. Laboratory testing should occur periodically; it does not need to be assessed at least once a week. Specimens for monitoring plasma drug levels should be drawn as close as possible to 12 hours away from the last dose. Herbal substances can interact with antidepressants and their use should be avoided.

Which statement is true about delusional disorder? a. Behavior is relatively normal except when focused on the delusion. b. Psychosocial functioning is often markedly impaired. c. The disease onset is usually gradual. d. The individual's personality changes dramatically.

a. Behavior is relatively normal except when focused on the delusion. The course of delusional disorder is variable. The onset can be acute, or the disorder can occur gradually and become chronic. Clients usually live with delusions for years, rarely receiving psychiatric treatment unless their delusion relates to their health (somatic delusion), or they act on the basis of their delusion and violate laws or social rules. Apart from the direct impact of the delusion, psychosocial functioning is not markedly impaired. Behavior is remarkably normal except when the client focuses on the delusion. At that time, the client's thinking, attitudes, and mood may change abruptly. Personality does not usually change, but the client is gradually, progressively involved with the delusional concern.

Which characteristics are key diagnostic criteria of schizophrenia? (Select all that apply.) a. Continuous signs for at least 6 months b. Major depression occurring concurrently with active symptoms c. One or more major areas of social or occupational functioning markedly below previously achieved levels d. Delusions present for a significant portion of time during a 1-month period e. A direct physiologic effect of a substance or medical condition

a. Continuous signs for at least 6 months c. One or more major areas of social or occupational functioning markedly below previously achieved levels d. Delusions present for a significant portion of time during a 1-month period Key diagnostic criteria include continuous signs for at least 6 months, one or more major areas of social or occupational functioning markedly below previously achieved levels, and delusions present for a significant portion of time during a 1-month period. Other criteria include the absence, or insignificant duration, of major depressive, manic, or mixed episodes occurring concurrently with active symptoms, and that the disease is not a direct physiologic effect of a substance or medical condition.

A client diagnosed with schizophrenia is in anticholinergic crisis. The nurse would expect which finding to be noted upon assessment? a. Facial flushing b. Incontinence c. Bradycardia d. Hypothermia

a. Facial flushing Clinical manifestations of anticholinergic crisis include facial flushing, tachycardia, urinary retention, and hyperthermia (fever).

The majority of suicides in men are attributed to what means? a. Firearms b. Drowning c. Hanging d. Overdose

a. Firearms Men complete 78% of all suicides; 56% of these deaths are by firearms. The other means of suicide do not account for the majority of suicides in men.

While conducting a presentation on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic). The nurse informs the audience that the physical symptoms of a panic attack can mimic which condition? a. Heart attack b. Appendicitis c. Gastrointestinal flu d. Stroke

a. Heart attack The physical symptoms can mimic those of a heart attack. These symptoms are physically taxing and psychologically frightening to clients. Recognition of the seriousness of panic attacks should be communicated to the client.

The nurse is working with a client who is experiencing large amounts of stress due to relational, financial and physiologic factors. How can the nurse best enhance this client's resilience? a. Help the client to think about herself in a positive way. b. Assess the client's family history of maladaptive coping. c. Connect the client with individuals who have similar or greater levels of stress. d. Explore the client's major childhood events during cognitive behavioral therapy.

a. Help the client to think about herself in a positive way. A positive identity is one of the major predictors of resilience; anything the nurse can do to enhance the client's self-identity is likely to enhance his or her resilience. Childhood events are not the major determinant of resilience, and cognitive behavioral therapy is likely beyond the scope of the nurse. The client is likely to find support from others in similar circumstances, but this may or may not increase the client's internal resilience. Assessment is necessary, but will not increase resilience without interventions.

A nurse is working with a client diagnosed with bipolar disorder and his family on relapse prevention. Which component would the nurse encourage the family to include in their emergency plan? (Select all that apply.) a. Information about other health problems b. List of emergency contacts c. Self-care strategies d. Past medications taken e. Treatment preferences

a. Information about other health problems b. List of emergency contacts e. Treatment preferences An emergency plan should include a list of emergency contacts; a current list of all medications including dosages; information about other health problems; symptoms indicating that others need to take responsibility for care; and treatment preferences. Although past medications taken may be important, it is more important to have the current list of medications. Self-care strategies would be a component of the psychoeducational plan but not necessarily the emergency plan.

Which treatment setting is preferred for persons who are severely psychotic? a. Inpatient admission b. Partial hospitalization c. Residential apartments d. Intensive outpatient programs

a. Inpatient admission Inpatient admission is the treatment setting of choice for clients who are severely psychotic, or who are an immediate threat to themselves or others. Intensive outpatient programs, such as partial hospitalization, and residential apartments would not be immediate options for this client.

A client diagnosed with panic disorder has been receiving medication therapy, which is now being discontinued. The nurse would be alert for possible withdrawal symptoms if the client was receiving which medication? a. Lorazepam b. Duloxetine c. Fluvoxamine d. Escitalopram

a. Lorazepam Discontinuation of benzodiazepines, such as lorazepam, places the client at risk for withdrawal symptoms. Withdrawal is not associated with duloxetine, an SNRI, or escitalopram or fluvoxamine, SSRIs.

A client is exhibiting rapid shifts in mood. Which term does the nurse use to document this? a. Mood lability b. Irritable mood c. Expansive mood d. Elevated mood

a. Mood lability Mood lability is a term used for rapid shifts in mood that often occur with bipolar disorder. Elevated mood refers to exaggerated feelings of well-being (euphoria) or feeling ecstatic or high (elation). An expansive mood is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual or occupational interactions. An irritable mood is indicated by being easily annoyed and provoked to anger, especially when wishes are challenged or thwarted.

A client with bipolar disorder is prescribed divalproex sodium (Depakote) as part of the treatment plan. Before administering the medication, which tests should be done? (Select all that apply.) a. Platelet count b. Blood glucose level c. Liver function tests d. Urinalysis e. Complete blood count

a. Platelet count c. Liver function tests e. Complete blood count Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy with divalproex sodium. Clients with known liver disease should not be given divalproex sodium. There is no need to obtain a urinalysis or blood glucose level. Depakote can lead to hepatotoxicity and thrombocytopenia.

When assessing risk of suicide, which assessment components are important? (Select all that apply.) a. Previous attempt b. Unemployment c. Degree of hopelessness d. Lethality of method e. Seriousness of suicidal ideation

a. Previous attempt c. Degree of hopelessness d. Lethality of method e. Seriousness of suicidal ideation Assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt, suicide planning and implementation, and availability and lethality of the suicide method.

Which condition would the nurse assess in a client with a plasma lithium level of 2.7 mEq/L? (Select all that apply.) a. Seizures b. Incoordination c. Fasciculations d. Nystagmus e. Tinnitus

a. Seizures c. Fasciculations (muscle twitching) d. Nystagmus (repetitive eye movements) A plasma lithium level of 2.7 mEq/L indicates severe toxicity manifested by seizures, nystagmus, and fasciculations. Tinnitus and incoordination are noted with moderate toxicity, with plasma drug levels ranging from 1.5 to 2.5 mEq/L.

According to psychodynamic theorists, anxiety develops from which of the following? a. Separation and loss b. Learned response c. Exposure to panicogenic substances d. Interoceptive conditioning

a. Separation and loss Psychodynamic theories explain that anxiety develops after separation and loss. A great number of clients link their initial panic attack with recent personal losses. Classic conditioning theory suggests that one learns a fear response by linking an adverse, or fear-provoking, event with a previously neutral event. Interoceptive conditioning pairs a somatic discomfort, such as dizziness or palpitations, with an impending panic attack. Identification of neurotransmitter involvement in panic disorder has evolved from the neurochemical studies with panicogenic substances known to produce panic attacks.

A nurse is assessing a client who reports the sensation of "bugs crawling under my skin" and intense itching and burning. The client states, "I know bugs have invaded my body." There is no evidence to support the client's complaint. The nurse interprets this as which type of delusion? a. Somatic b. Grandiose c. Nihilistic d. Persecutory

a. Somatic Somatic delusions involve bodily functions or sensations, such as insects having infested the skin. The client vividly describes crawling, itching, burning, swarming, and jumping on the skin surface or below the skin. The client maintains the conviction that he or she is infested with parasites in the absence of objective evidence to the contrary. Nihilistic delusions focus on impending death or disaster. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. The central theme of persecutory delusions is the client's belief that he or she is being conspired against, cheated, spied on, followed, poisoned, drugged, maliciously maligned, harassed, or obstructed in pursuit of long-term goals.

It is important for the client in acute mania, receiving lithium, to obtain blood levels within which time frame? a. Twice weekly b. Monthly c. Weekly d. Every 3 weeks

a. Twice weekly In acute mania, it is important for the client to obtain serum levels twice weekly in the acute phase. In uncomplicated maintenance, serum levels should be obtained every 2 to 3 months.

Which variable could be a potential cause of lithium toxicity? (Select all that apply.) a. Vomiting b. Hot climate c. Strenuous exercise d. Hypernatremia e. Diarrhea

a. Vomiting b. Hot climate c. Strenuous exercise e. Diarrhea 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 and a progression to lethal lithium toxicity. The higher the sodium levels, the lower the lithium levels will be.

A client with schizophrenia is prescribed a second-generation antipsychotic. The client's mother asks, "About how long will it take until we see any changes in the symptoms?" Which response by the nurse is most appropriate? a. "You should see improvement in about 36 to 48 hours." b. "The symptoms should subside almost immediately." c. "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms." d. "It will take about 6 to 12 weeks until the drug is effective."

b. "Generally, it takes about 1 to 2 weeks to be effective in changing symptoms" Generally, it take about 1 to 2 weeks for antipsychotic drugs to effect a change in symptoms. During the stabilization period, the selected drug should be given an adequate trial, generally 6 to 12 weeks, before considering a change in the drug prescription. If treatment effects are not seen, another antipsychotic agent may be tried.

A client is prescribed carbamazepine as part of the treatment plan for bipolar disorder. The nurse obtains a complete blood count and differential before initiating therapy. The nurse would instruct the client to return to the outpatient facility for repeat blood testing at which time? a. 3 months b. 1 month c. 6 months d. 12 months

b. 1 month Liver function tests and complete blood counts with differential are minimal pretreatment laboratory tests. They should be repeated about 1 month after initiating treatment, and at 3 months, 6 months, and yearly.

Which individual(s) is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? (Select all that apply.) a. A client who is fixated on revenge toward a business partner whom the client blames for the company's bankruptcy b. A client in law enforcement who experiences panic attacks when thinking about the time the client was forced to shoot a violent suspect c. A client who has quit a job in order to avoid office where the client was attacked and robbed d. A client who, after a violent home invasion and assault, is unable to relax without first barricading the home e. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device

b. A client in law enforcement who experiences panic attacks when thinking about the time the client was forced to shoot a violent suspect c. A client who has quit a job in order to avoid office where the client was attacked and robbed d. A client who, after a violent home invasion and assault, is unable to relax without first barricading the home e. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device The diagnostic criteria of PTSD include intrusive symptoms such as nightmares, hyperarousal, hypervigilance and avoidance of places that remind the person of the traumatic event. A fixation of revenge is not among the diagnostic criteria of PTSD.

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)? a. A teenage boy who has begun to be the object of bullying inside and outside the classroom b. A middle-aged woman with a history of anxiety who suffered a random physical assault c. A 12-year old girl who has recently moved cross-country and desperately misses her old friends d. An adult male client who has been admitted to the hospital three times for complications of surgery

b. A middle-aged woman with a history of anxiety who suffered a random physical assault Women are twice as likely as men to develop PTSD and a history of anxiety is a known risk factor. Physical assault is among the most common precursors to PTSD. Each of the other listed individuals is facing crises that have the potential to result in trauma, but none has the same constellation of risk factors as the middle-aged woman.

A client receiving benzodiazepine therapy as treatment for panic disorder comes to the emergency department for evaluation. The nurse suspects the client is experiencing benzodiazepine withdrawal based on findings? (Select all that apply.) a. Hypersomnia b. Agitation c. Irritability d. Sour taste e. Apprehension

b. Agitation c. Irritability e. Apprehension Withdrawal symptoms manifest in several ways, including psychological phenomena such as apprehension, irritability and agitation. Withdrawal from benzodiazepines does not cause a sour taste in the mouth. Insomnia would be more likely than hypersomnia.

A loss of pleasure or interest noted in the client diagnosed with depression would be documented as which characteristic? a. Discouragement b. Anhedonia c. Hopelessness d. Flat affect

b. Anhedonia The person with depression has a sustained period of feeling depressed, sad, or hopeless and may experience anhedonia (loss of interest or pleasure). The client may report "not caring anymore" or not feeling any enjoyment in activities that were previously considered pleasurable. Flat affect is the complete or near absence of affective expression. Hopelessness and discouragement would not be the correct documentation for this symptom.

Which comorbid conditions are most commonly associated with bipolar disorder? (Select all that apply.) a. Eating disorders b. Anxiety disorders c. Personality disorders d. Schizophrenia e. Substance use

b. Anxiety disorders e. Substance use The two most common comorbid conditions are anxiety disorders and substance use. Individuals with a comorbid anxiety disorder are more likely to experience a more severe course. A history of substance use further complicates the course of illness and results in less chance for remission and poorer treatment compliance. Personality disorders, schizophrenia, and eating disorders are not the most common comorbid conditions.

Several questions can be used to assess a suicidal person's intent to die, severity of suicidal ideation, and degree of planning. Which question may be used to elicit information regarding the severity of suicidal ideation? a. Have you made any plans to kill yourself? b. Can you dismiss thoughts of killing yourself, or do they tend to return? c. Have you done anything to put the plan into action? d. How seriously do you want to die?

b. Can you dismiss thoughts of killing yourself, or do they tend to return? A question to ask the person regarding severity of suicidal ideation may include, "Can you dismiss thoughts of killing yourself, or do they tend to return?" The other questions focus on the intent to die and the degree of planning.

A nurse taking an admission history from a client suspects that the physician will diagnose major depression. For the physician to make this diagnosis, the nurse knows the client will have to demonstrate specific symptoms. Which symptoms will the client show? (Select all that apply.) a. Obsessive desire to exercise b. Disruption in concentration c. Disruption in sleep d. Disruption in appetite e. Excessive guilt

b. Disruption in concentration c. Disruption in sleep d. Disruption in appetite e. Excessive guilt Four of seven symptoms must be present along with the episodes of depressed mood to qualify for a diagnosis of major depressive disorder. Symptoms include disruption in sleep, appetite, concentration, or energy; psychomotor agitation or retardation; excessive guilt or feelings of worthlessness; and suicidal ideation.

When investigating biologic theories related to schizophrenia, which neuroanatomic finding would be consistent with this mental health disorder? a. Smaller third ventricle b. Enlarged lateral ventricle c. Enlarged hippocampus d. Enlarged brain volume

b. Enlarged lateral ventricle The lateral and third ventricles are somewhat larger, and total brain volume is somewhat smaller, in persons with schizophrenia than in those without schizophrenia. The thalamus and the medial temporal lobe structures, including the hippocampus, superior temporal and prefrontal cortices, also tend to be smaller.

A client is prescribed a selective serotonin reuptake inhibitor as treatment for depression. Which medication would the nurse most likely administer? a. Venlafaxine b. Escitalopram c. Phenelzine d. Maprotiline

b. Escitalopram Escitalopram is classified as a selective serotonin reuptake inhibitor. Venlafaxine is classified as a serotonin norepinephrine reuptake inhibitor. Maprotiline is a cyclic antidepressant. Phenelzine is a monoamine oxidase inhibitor.

A client has been referred for care because the primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, what action should the psychiatric-mental health nurse do first? a. Gently encourage the client to talk about the incident b. Establish therapeutic rapport with the client c. Reassure the client that this is an expected response to such an incident d. Elicit the objective facts about the incident

b. Establish therapeutic rapport with the client Therapeutic rapport is absolutely foundational to all other interactions between the client and the nurse. As such, it must precede the details of assessment. The nurse must be careful not to provide false reassurance, and any reassurance that is given must exist in a context of rapport.

Which type of therapy is the treatment of choice for specific phobia? a. Systematic desensitization b. Exposure therapy c. Implosive therapy d. Flooding

b. Exposure therapy Exposure therapy is the treatment of choice for clients with specific phobia. The client is repeatedly exposed to real or simulated anxiety-provoking situations until he or she becomes desensitized and anxiety subsides. Systematic desensitization exposes the client to a hierarchy of feared situations that the client has rated from least to most feared. Implosive therapy is a provocative technique useful in treating clients with agoraphobia; the therapist identifies phobic stimuli for the client and then presents highly anxiety-provoking imagery to the client, describing the feared scene as dramatically and vividly as possible. Flooding is a technique used to desensitize the client to the fear associated with a particular anxiety-provoking situation. Desensitization is done by presenting feared objects or situations repeatedly without session breaks until the anxiety dissipates.

Which symptoms must be present in a client diagnosed with serotonin syndrome? (Select all that apply.) a. Hyporeflexia b. Fever c. Agitation d. Constipation e. Diaphoresis f. Ataxia

b. Fever c. Agitation e. Diaphoresis f. Ataxia The symptoms include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

Which antidepressant medication is classified as a selective serotonin reuptake inhibitor (SSRI)? a. Phenelzine b. Fluoxetine c. Tranylcypromine d. Isocarboxazid

b. Fluoxetine (Prozac) Fluoxetine is included among the SSRIs. Phenelzine, isocarboxazid and tranylcypromine are monoamine oxidase inhibitors (MAOIs).

A client diagnosed with delusional disorder is telling everyone that he is the president of the United States. This client is exhibiting which type of delusion? a. Somatic b. Grandiose c. Jealous d. Nihilistic

b. Grandiose Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. A less common presentation is the delusion of a special relationship with a prominent person, or actually being a prominent person. Nihilistic delusions focus on impending death or disaster. Persons who have somatic delusions believe they have a physical ailment. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover.

When preparing a class presentation about schizophrenia, which information would the nurse most likely include? a. Delusions are more commonly noted in younger children with schizophrenia. b. Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood. c. Schizophrenia is more commonly diagnosed in children than in adolescents. d. Very few individuals with schizophrenia reach older adulthood.

b. Improvement in symptoms can occur as a client with a history of schizophrenia reaches older adulthood. People with schizophrenia do reach older adulthood and others develop schizophrenia late in life. For older clients who have had schizophrenia since young adulthood, this may be a time in which they experience some improvement in symptoms or decrease in relapse fluctuations. The diagnosis of schizophrenia in children before adolescence is rare. If it does occur, hallucinations tend to be more visual and delusions are less developed.

Electroconvulsive therapy (ECT) has been shown to be an effective treatment for people with severe depression. However, ECT is contraindicated in which disease process? a. Anxiety disorder b. Increased intracranial pressure c. Hypertension d. Diabetes

b. Increased intracranial pressure ECT is contraindicated for clients with increased intracranial pressure. Other high-risk groups include those with recent myocardial infarction, recent cerebrovascular accident, retinal detachment, or pheochromocytoma. ECT is prescribed as a treatment modality for depression.

Which medications are the mainstays of pharmacotherapy for the client diagnosed with bipolar disorder? (Select all that apply.) a. Fluoxetine b. Lamotrigine c. Divalproex d. Carbamazepine e. Lithium carbonate

b. Lamotrigine c. Divalproex d. Carbamazepine e. Lithium carbonate The mainstays of pharmacotherapy are the mood-stabilizing drugs, including lithium, divalproex, carbamazepine, and lamotrigine. Antidepressants, such as fluoxetine, are not recommended in those with bipolar depression because of a risk of switching to mania.

A client with bipolar disorder I is experiencing a depressive episode. Which medication would the nurse expect to be prescribed? a. Carbamazepine b. Lamotrigine c. Lithium d. Valproate

b. Lamotrigine (Lamictal) Although lithium, valproate and carbamazepine are used to treat bipolar disorder, lamotrigine is often prescribed for a depressive episode.

A client with a history of panic disorder tells the nurse, "When I feel anxious and panicky, I say to myself, 'I can handle these symptoms.'" The nurse interprets this as which type of statement? a. Systematic desensitization b. Positive self-talk c. Distraction d. Panic control treatment

b. Positive self-talk During states of increased anxiety and panic, individuals can learn to counter fearful or negative thoughts by using planned and rehearsed positive coping statements, called positive self-talk. "This is only anxiety, and it will pass," "I can handle these symptoms," and "I'll get through this" are examples of positive self-talk. Distraction behaviors take the focus off the physical sensations. Some activities include initiating conversation with a nearby person or engaging in physical activity (e.g., walking, gardening, or house cleaning). Panic control treatment involves intentional exposure (through exercise) to panic-invoking sensations such as dizziness, hyperventilation, tightness in the chest, and sweating. Identified patterns become targets for treatment, where clients are taught to use breathing training and cognitive restructuring to manage their responses. Systematic desensitization, another exposure method used to desensitize clients, exposes the client to a hierarchy of feared situations that the client has rated from least to most feared. The client is taught to use muscle relaxation as levels of anxiety increase through multisituational exposure.

People who complete suicide often have extremely low levels of which neurotransmitter? a. Norepinephrine b. Serotonin c. GABA d. Acetylcholine

b. Serotonin People who complete suicide often have extremely low levels of the neurotransmitter serotonin. Impairments in the serotonergic system contribute to suicidal behavior. People who make near-lethal suicide attempts have much lower levels of the neurotransmitter dopamine and omega-3. Low levels of the other neurotransmitters have not been implicated in completed suicides.

A client diagnosed with delusional disorder who uses excessive health care resources most likely has which type of delusions? a. Nihilistic b. Somatic c. Grandiose d. Jealous

b. Somatic Persons who have somatic delusions believe they have a physical ailment. Clients with somatic delusions use excessive health care resources. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Nihilistic delusions focus on death or calamity. Clients presenting with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery; a less common presentation is the delusion of a special relationship with a prominent person, or actually being a prominent person.

Which statement is a myth regarding suicide? a. The suicide rate is lowest in December. b. Suicidal people are fully intent on dying. c. Most suicidal people are undecided about living or dying. d. Many people who die by suicide have given definite warnings of their intentions.

b. Suicidal people are fully intent on dying. A myth regarding suicide is that suicidal people are fully intent on dying. Most suicidal people are undecided about living or dying. Facts about suicide include that the suicide rate is the lowest in December and that many people who die by suicide have given definite warnings of their intentions.

Which intervention is a cognitive intervention for clients diagnosed with depression? a. Activity scheduling b. Thought stopping c. Social skills training d. Problem solving

b. Thought stopping Cognitive interventions such as thought stopping and positive self-talk can dispel irrational beliefs and distorted attitudes, and in turn reduce depressive symptoms during the acute phase of major depression. Behavioral interventions include activity scheduling, social skills training, and problem solving.

Women make how many attempts for every suicide attempt by their male counterparts? a. Four b. Three c. Two d. One

b. Three Women make three attempts to every attempt by men. Women are less likely to complete a suicide, partly because they are more likely to choose less lethal methods.

A client who is prescribed a tricyclic antidepressant is brought to the emergency department with a suspected overdose. Which symptom would the nurse assess to support this suspicion? (Select all that apply.) a. Headache b. Urinary retention c. Blurred vision d. Pale, moist skin e. Diarrhea

b. Urinary retention c. Blurred vision In acute overdose, almost all symptoms develop within 12 hours. Anticholinergic effects are prominent and include dry mucous membranes, warm and dry skin (not pale, moist skin), blurred vision, decreased bowel motility (not diarrhea), and urinary retention. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Headache is a side effect of MAOIs.

Carbamazepine (Tegretol) has a boxed warning for which adverse effect? a. Skin rash b. Birth defects c. Agranulocytosis d. Liver damage

c. Agranulocytosis Carbamazepine has a boxed warning for aplastic anemia and agranulocytosis, but frequent, clinically unimportant decreases in white blood cell counts occur. The increased risk of birth defects may occur with use of divalproex. Lamotrigine has a boxed warning for skin rash. Liver damage may occur with carbamazepine but is not noted with a boxed warning.

Which of the following is a behavioral symptom of anxiety? a. Impatience b. Tremors c. Avoidance d. Apprehension

c. Avoidance Behavioral symptoms of anxiety include avoidance, restlessness, postural collapse, and hyperventilation. Tremors are a physical symptom of anxiety. Apprehension and impatience are affective symptoms.

Which food might be incorporated into the plan of care for a client diagnosed in the manic phase of bipolar disorder? a. Steak b. Broccoli c. Bananas d. Spaghetti

c. Bananas For a client who is unable to sit long enough to eat, snacks and high-energy foods that can be eaten while moving should be provided.

A client with posttraumatic stress disorder (PTSD) tells the nurse that he often feels like he has left his body and is looking at things from a distance. The nurse interprets this as which state? a. Intrusion b. Depersonalization c. Dissociation d. Hyperarousal

c. Dissociation Dissociation is a disruption in the normally occurring linkages among subjective awareness, feelings, thoughts, behavior, and memories (APA, 2013). A person who dissociates is making himself "disappear." That is, the person has the feeling of leaving his body and observing what happens to him from a distance. In PTSD, intrusion involves thoughts, memories, or dreams of traumatic events occurring involuntarily, especially when there are cues that symbolize or resemble the events, causing psychological and sometimes physiologic distress. Depersonalization is the experience of the self or the environment as strange or unreal. Hyperarousal refers to the permanent state of being on permanent alert, as if the danger might return at any time.

Positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by hyperactivity of which neurotransmitter? a. Acetylcholine b. Norepinephrine c. Dopamine d. Epinephrine

c. Dopamine Positive symptoms of schizophrenia, such as delusions and hallucinations, are thought to be caused by dopamine hyperactivity in the mesolimbic tract at the D2 receptor site in the striatal area, where memory and emotion are regulated. Hyperactivity of acetylcholine, norepinephrine, and epinephrine are not associated with schizophrenia.

A client has been diagnosed with posttraumatic stress disorder (PTSD) after a house fire. Which nursing intervention is most appropriate? a. Help the client explore complementary and alternative therapies to prevent dependence on medications b. Arrange a consult with an occupational therapist to manage the client's return to work c. Facilitate the client's introduction to a support group of other people recovering from PTSD d. Focus on the client's hopes and plans for the future during interviews and other interactions

c. Facilitate the client's introduction to a support group of other people recovering from PTSD Support groups are known to benefit many clients with PTSD, and for most people this is more relevant than occupational therapy. PTSD often necessitates medication, but the medication classes that are used do not create a risk for dependence. Focusing on the future is appropriate in some interactions and at some points in the client's recovery, but there are many contexts where this would not be relevant or appropriate.

Which of the following is the most common obsession experienced by a client diagnosed with obsessive-compulsive disorder (OCD)? a. Fear of snakes b. Fear of water c. Fear of contamination d. Fear of abandonment

c. Fear of contamination The most common obsession is fear of contamination and results in compulsive hand washing. Fear of contamination usually focuses on dirt or germs, but other materials may be feared as well, such as toxic chemicals, poison, radiation, and heavy metals.

Which medication is considered a first-generation antipsychotic drug used to treat psychosis in the United States? a. Clozapine b. Olanzapine c. Fluphenazine d. Aripiprazole

c. Fluphenazine Fluphenazine is a first-generation antipsychotic medication. The other listed drugs are second-generation antipsychotics.

A client has posttraumatic stress disorder (PTSD) following a disaster that resulted in mass casualties. What question should the nurse prioritize when exploring physical dimensions of this client's PTSD? a. Have you noticed any significant change to your bowel habits, either constipation or diarrhea? b. Have you been able to integrate physical exercise into your daily routine? c. How would you describe the quality and quantity of your sleep since the incident? d. Would you say that you're eating a fairly nutritious diet these days?

c. How would you describe the quality and quantity of your sleep since the incident? Sleep is profoundly affected by PTSD; sleep assessment is a key aspect of physical assessment. It is also necessary to assess the client's diet and activity, but sleep is more likely to be an issue. Bowel function is a secondary concern for most clients.

Which action could be incorporated into the plan of care for a client receiving an antidepressant who is experiencing orthostatic hypotension? a. Get daily exercise b. Eat a nutritionally balanced diet c. Increase hydration d. Take medication with food

c. Increase hydration Increasing hydration and sitting or standing up slowly are nonpharmacologic interventions for orthostatic hypotension. Taking medications with food would counteract nausea and vomiting. Daily exercise and eating a nutritionally balanced diet would help with weight gain seen in clients taking antidepressants.

Both valproate and carbamazepine may be lethal if high doses are ingested. Toxic symptoms appear in 1 to 3 hours and include which effects? a. Bradycardia b. Urinary frequency c. Neuromuscular disturbances d. Tinnitus

c. Neuromuscular disturbances Symptoms include neuromuscular disturbances, dizziness, stupor, agitation, disorientation, nystagmus, urinary retention, nausea and vomiting, tachycardia, hypotension or hypertension, cardiovascular shock, coma, and respiratory depression. Tinnitus is not seen in lethal doses of these drugs.

A client with schizophrenia is experiencing delusions. The client states, "There's a huge apocalypse coming and the end of the world is near." The nurse interprets this statement as which type of delusion? a. Grandiose b. Persecutory c. Nihilistic d. Somatic

c. Nihilistic A nihilistic delusion involves the belief that one is dead or a calamity is impending. A grandiose delusion involves the belief that one has exceptional powers, wealth, skill, influence, or destiny. A persecutory delusion involves the belief that one is being watched, ridiculed, harmed or plotted against. A somatic delusion involves the belief about abnormalities in bodily structure or functions.

A client with bipolar disorder is experiencing acute mania. The client is unable to sit still, moving from place to place. Medication therapy has been prescribed but not yet initiated. Which component would the nurse include in the plan of care to meet the client's physical needs? a. Encouraging frequent rest periods b. Instituting a sleep hygiene program c. Providing high-energy snacks d. Increasing environmental stimuli

c. Providing high-energy snacks For the client experiencing acute mania, the nurse would provide snacks and high-energy foods, because it is highly likely that the client is unable to sit long enough to eat. Sleep hygiene is a priority but may not be realistic until medications take effect. Due to the client's activity level, frequent rest periods would be unlikely. Limiting stimuli would be helpful in decreasing agitation.

The nurse is caring for a client diagnosed with bipolar disorder. The client is experiencing a manic episode. The nurse would be especially alert for signs indicating which condition? a. Dehydration b. Sleep disruption c. Self-injury d. Weight loss

c. Self-injury During a manic episode, client safety is a priority. Risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may believe that life is not worth living. During a manic episode, the client may believe that he or she has supernatural powers, such as the ability to fly. Although changes in sleep, fluid balance (such as dehydration) and inadequate nutrition manifested by weight loss would be important to assess, safety and prevention of self-injury are the priority.

A nurse is preparing a presentation about suicide for a local community group. Which statement would the nurse most likely include? a. Hispanic individuals have the highest rates of suicide. b. Men often use pills to commit suicide. c. Suffocation is a common means of suicide in children. d. Women typically use firearms in their attempts.

c. Suffocation is a common means of suicide in children. There are ethnic and cultural differences regarding suicide behavior. Men often use firearms, and women often use pills or other poisonous substances to commit suicide. Children often use suffocation. Data on suicide completion rates are reported highest in persons from American Indian, Alaskan Natives, and non-Hispanic white descent. These rates are lowest for persons from Hispanic, non-Hispanic black, and Asian and Pacific Islander descent.

A new client with a long history of obsessive-compulsive disorder (OCD) is describing to the nurse a complex ritual of locking and unlocking a door after the client enters a room alone. What is the nurse's most therapeutic response? a. Is there a history of OCD or any other mental health disorders in your family? b. What would you say to me if I had similar rituals with locking and unlocking doors? c. The process you're describing sounds like it must require quite a bit of time and energy. d. It sounds like you're trying to address a problem that in all likelihood doesn't exist.

c. The process you're describing sounds like it must require quite a bit of time and energy. Saying, "The process you're describing sounds like it must require quite a bit of time and energy" encourages the client to elaborate on the effect that his rituals have on his life. Rapport is likely to be harmed if the nurse focuses on "a problem that doesn't exist." Focusing on the prevalence of mental health disorders is likely to inhibit communication at this fragile, early stage of the nurse-client relationship. Turing the tables by asking "What would you say to me if I had similar rituals with locking and unlocking doors?" is not a recognized therapeutic technique.

Which statement is accurate regarding women and suicide? a. They are more likely to die from attempted suicide than men. b. They attempt suicide less often than men. c. They are less likely to complete suicide than men. d. They are more likely to choose a more lethal method than men.

c. They are less likely to complete suicide than men. Women are less likely to complete a suicide than men, partly because they are more likely to choose a less lethal method. Women are less likely to die from an attempted suicide than men, but they attempt suicide more often.

The most common age at onset for major depressive disorder is among people who are in what age group? a. Teens b. Thirties c. Twenties d. Forties

c. Twenties The highest onset of depression occurs in people who are in their twenties.

Which client is most likely to benefit from the administration of sustained serotonin reuptake inhibitors (SSRIs)? a. A client whose unusual pattern of hair loss has been attributed to a mental health disorder b. A client whose family is deeply concerned that the client may have hoarding disorder c. A client who has diffuse skin lesions as a result of excoriation disorder d. A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive behavioral therapy

d. A client whose obsessive-compulsive disorder (OCD) has not responded to cognitive behavioral therapy OCD is responsive to treatment with SSRIs. Trichotillomania, excoriation disorder, and hoarding are not normally treated with SSRIs.

Which client is most likely to benefit from psychosurgery? a. A client who has filled many of the rooms in the home with items that the rest of the family deems "trash" b. A client who has pulled out most of their hair and compulsively pulls on their eyelashes c. A client who picks at the skin compulsively and has frequently caused bleeding d. A client whose obsessive-compulsive disorder consumes most of the client's waking hours

d. A client whose obsessive-compulsive disorder consumes most of the client's waking hours Psychosurgery is an option for severe OCD but is not typically used for the treatment of trichotillomania, hoarding or skin-picking disorder.

A client with a diagnosis of PTSD has been brought to the emergency department (ED) by concerned family members, who state that the client is experiencing a "nervous breakdown." The ED nurse should prioritize what aspect care during the initial care of the client? a. Assessing the client's current drug regimen and allergy status b. Developing therapeutic rapport with the client and family c. Identifying the client's coping ability and functional status d. Assessing the client's risk for self-harm and ensuring safety

d. Assessing the client's risk for self-harm and ensuring safety In an emergency context, the assessment of suicidality and the risk for self-harm is a priority. The nurse should perform each of the other listed actions, but measures to ensure the client's safety are paramount.

Which medication classification used in the treatment of panic disorder can cause physical dependence? a. Selective serotonin reuptake inhibitors (SSRIs) b. Tricyclic antidepressants (TCAs) c. Serotonin--norepinephrine reuptake inhibitors (SNRIs) d. Benzodiazepines

d. Benzodiazepines Selective serotonin reuptake inhibitors (SSRIs), serotonin--norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs) and antianxiety medication (benzodiazepines) have been shown to be effective in panic disorders. Benzodiazepines are well tolerated but physical dependence is a potential side effect, and they carry the risk of withdrawal symptoms upon discontinuation of use.

The nurse is caring for a client receiving a tricyclic antidepressant and is monitoring for anticholinergic side effects. Anticholinergic effects include which effects? a. Hyperactive bowel sounds b. Urinary incontinence c. Moist skin d. Blurred vision

d. Blurred vision Anticholinergic effects are prominent with tricyclic antidepressants. These include potentiation of CNS drugs, dry mucous membranes, warm and dry skin, blurred vision, decreased bowel motility, and urinary retention.

Which statement is accurate regarding a person with delusional disorder? a. Mental status is usually affected. b. Personality is generally affected. c. High intelligence is noted. d. Few, if any, psychological deficits are noted.

d. Few, if any, psychological deficits are noted. Clients with delusional disorder show few, if any, psychological deficits. In these clients, average or marginally low intelligence is characteristic. Mental status is not generally affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact.

A client has no expression when conversing with the nurse. This would be documented as which type of affect? a. Labile b. Inappropriate c. Blunted d. Flat

d. Flat Flat affect is absent or nearly absent affective expression. Blunted affect is a significantly reduced intensity of emotional expression. Inappropriate affect refers to discordant affective expression accompanying the content of speech or ideation. Labile affect is varied, rapid, and abrupt shifts in affective expression.

Clients diagnosed with schizophrenia may experience disordered water balance that may lead to water intoxication. Which effect may occur as a result of water intoxication? a. Weight loss b. Oliguria c. Hypernatremia d. Hyponatremia

d. Hyponatremia Hyponatremia is a life-threatening complication of unknown cause. When a client ingests an unusually large volume of water, the kidneys' capacity to excrete water is overwhelmed, and serum sodium levels rapidly fall below the normal range.

The nurse is caring for a client diagnosed with bipolar disorder who has been prescribed divalproex (Depakote). The nurse knows that the client should have which test completed before initiating drug therapy? a. Cardiac enzymes b. Thyroid level c. White blood cell (WBC) count d. Liver function

d. Liver function Baseline liver function tests and a complete blood count with platelets should be obtained before starting therapy, and clients with known liver disease should not be given divalproex sodium. There is a boxed warning for hepatotoxicity. Thyroid level, WBC counts, and cardiac enzymes do not have to be performed routinely before starting this medication.

During which type of anxiety does the person's perceptual field actually increase? a. Moderate b. Panic c. Severe d. Mild

d. Mild During mild anxiety, the person's perceptual field widens slightly, and the person is able to observe more than before and to see relationships. During moderate anxiety, the perceptual field narrows slightly. The person does not notice what goes on peripheral to the immediate focus but can do so if attention is directed there by another observer. The perceptual field is greatly reduced in severe anxiety. During panic anxiety, the perceptual field is reduced to a detail, which is usually "blown up."

Schizoaffective disorder has symptoms typical of both schizophrenia and which type of disorder? a. Eating disorders b. Anxiety disorders c. Substance use disorders d. Mood disorders

d. Mood disorders Schizoaffective disorder has symptoms typical of both schizophrenia and mood disorders, but it is a separate disorder. Symptoms of anxiety, substance use, and eating disorders are not typically part of schizoaffective disorder.

Which medication would the nurse expect to administer as prescribed as first-line medication therapy for panic disorder? a. Venlafaxine b. Alprazolam c. Imipramine d. Paroxetine

d. Paroxetine (Paxil) Although other medications may be used to treat panic disorder and other anxiety disorders, the SSRIs are recommended as the first drug option in the treatment of clients with panic disorder. Venlafaxine is a serotonin--norepinephrine reuptake inhibitor; imipramine is a tricyclic antidepressant; alprazolam is a benzodiazepine.

A client diagnosed with schizophrenia is having delusions that he is being plotted against by the government. This would be documented as which type of delusion? a. Nihilistic b. Somatic c. Grandiose d. Persecutory

d. Persecutory A persecutory delusion is a belief that one is being watched, ridiculed, harmed, or plotted against. The belief that one has exceptional powers, wealth, skill, influence, or destiny is a grandiose delusion. A nihilistic delusion is the belief that one is dead or a calamity is impending. A somatic delusion is the belief about abnormalities in bodily functions or structures.

Which is the greatest predictor of a future suicide attempt? a. Suicide planning b. Degree of hopelessness c. Seriousness of suicidal ideation d. Previous attempt

d. Previous attempt The greatest predictor of a future suicide attempt is a previous attempt, partly because that individual already has broken the "taboo" around suicidal behavior. Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, and suicide planning.

A client who just went through an upsetting divorce is threatening to commit suicide with a handgun. The client is involuntarily admitted to the psychiatric unit. Which nursing diagnosis has the highest priority? a. Spiritual distress related to conflicting thoughts about suicide and sin b. Hopelessness related to recent divorce c. Ineffective coping related to inadequate stress management d. Risk for suicide related to highly lethal plan

d. Risk for suicide related to highly lethal plan Safety is the priority. The overall goals for the client who is suicidal is to first keep the client safe and later to help him or her develop new coping skills that do not involve self-harm. Hopelessness, ineffective coping, and spiritual distress would not be priority diagnoses for this client.

Which concern is the priority for people with mood disorders? a. Occupational functioning b. Basic care c. Social functioning d. Safety

d. Safety The overriding concern for people with mood disorders is safety because these individuals may experience self-destructive thoughts and suicidal ideation. Social and occupational functioning and basic care would not take priority.

The nurse is caring for a client who has a diagnosis of posttraumatic stress disorder (PTSD) and has been referred for care. During the client interview, what statement by the client should the nurse prioritize for follow-up? a. I understand why I feel this way, but that certainly doesn't make it any easier b. I thought I could do this on my own, but I can see now why the doctor suggested medication c. I've never been a person who has trouble sleeping, but I wake up so early in the morning these days d. Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves.

d. Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves. All of the client's statements are significant, of course, but the statement implying habitual alcohol use warrants priority due to the high prevalence and harmful consequences of substance abuse among people with PTSD.

Which terms describes a nonfatal, self-inflicted destructive act with an explicit or implicit intent to die? a. Parasuicide b. Suicidal ideation c. Suicidality d. Suicide attempt

d. Suicide attempt A suicide attempt is a nonfatal, self-inflicted destructive act with explicit or implicit intent to die. Suicidal ideation is thinking about and planning one's own death. Suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death.

Which element would be most important to assess and document in a client with depression? a. Sleep disturbance b. Weight changes c. Appetite d. Suicide risk

d. Suicide risk In determining severity of depressive symptoms, nursing assessment should explore physical changes in appetite and sleep patterns and decreased energy. Considering the possibility of suicide should always be a priority with clients who are depressed. Assessment and documentation of suicide risk should always be included in client care.

The client is taking an MAOI for depression. The nurse educates the client to avoid foods containing which substance while taking this medication? a. Potassium b. Sugar c. Calcium d. Tyramine

d. Tyramine If coadministered with food or other substances containing tyramine, MAOIs can trigger a hypertensive crisis, which may be life threatening. MAOIs given with foods containing calcium, potassium, or sugar do not cause a hypertensive crisis.

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which element should be included in the care plan? a. Frequent assessment for delusional thinking or hallucinations b. Administration of monoamine oxidase inhibitors (MAOIs) as prescribed c. Educating the client about appropriate social interactions d. Vigilant monitoring for potential indications of self-harm

d. Vigilant monitoring for potential indications of self-harm The risk for suicide or other forms of self-harm is high in clients with PTSD. MAOIs are not used to treat the disorder and delusions and hallucinations rarely occur. Social isolation is common among clients with PTSD; inappropriate social interactions, however, are less common.

A client has been prescribed clozapine for treatment of schizophrenia. The client must be taught to monitor which blood levels weekly while taking this drug? a. Hemoglobin b. Hematocrit c. Platelets d. WBC

d. WBC Agranulocytosis can develop with the use of all antipsychotic drugs, but it is most likely to develop with clozapine use. Clients taking clozapine should have regular blood tests. White blood cell and granulocyte counts should be measured before treatment is initiated, and at least weekly or twice weekly after treatment begins.