NURS2242 Mental Health Exam #2

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? Select all that apply. 1.Assist the client in selecting foods from the food menu. 2.Offer high-calorie fluids throughout the day and evening. 3.Allow the client to eat alone in the room if the client requests to do so. 4.Offer small high-calorie, high-protein snacks during the day and evening. 5.Select the foods for the client to be sure that the client eats a balanced diet.

1,2,4 Rationale: In caring for a client with depression whose nutritional intake is poor, the nurse should remain with the client during the meal. The nurse also should assist the client in selecting foods from the menu because the client is more likely to eat the foods that he or she likes. Offering small high-calorie, high-protein snacks and high-calorie fluids throughout the day and evening are appropriate interventions for the client to maintain nutrition.

The nurse is preparing a client with depression for electroconvulsive therapy, which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? Select all that apply. 1.Have the client void. 2.Obtain an informed consent. 3.Administer tap water enemas. 4.Avoid discussing the procedure. 5.Remove dentures and contact lenses. 6.Withhold food and fluids for 6 hours.

1,2,5,6 Rationale: Enemas are not a component of the pretreatment care for a client scheduled for electroconvulsive therapy (ECT). The nurse should teach the client and family what to expect with ECT and allow the client to discuss his or her feelings regarding the procedure. The remaining options are a part of the pretreatment plan.

A client diagnosed with depression is scheduled to receive 3 sessions of electroconvulsive therapy. The nurse should tell the client that he or she will likely start to see improvement in approximately what time frame? 1. 1 week after the 3rd treatment session 2.3 weeks after the treatment sessions begin 3.Midway between the 2nd and 3rd treatment session 4.8 weeks after the treatment sessions are completed

1. 1 week after the 3rd treatment session Rationale: Psychiatrists generally prescribe electroconvulsive therapy (ECT) treatments 3 times a week, with an average series including 8 to 12 treatments. After 3 sessions of ECT, the client should start to demonstrate improvement in 1 week. The remaining options are incorrect.

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

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

Which characteristics would the nurse expect to note for a client with seasonal affective disorder? Select all that apply. 1.Affects males more often than females 2.Is related to abnormal melatonin metabolism 3.Usually results in debilitating symptomatology 4.Improves during the spring and summer months 5.Is a result of alterations in the available amounts of sunlight 6.A craving for carbohydrates lessens during sunnier and spring months

2,4,5,6 Rationale: Seasonal affective disorder (SAD) is believed to be a result of impaired melatonin metabolism because of decreased exposure to sunlight. Symptomatology that includes craving for carbohydrates lessens during the sunnier spring and summer months. This disorder does not result in debilitating symptomatology. It is believed that because clinical symptoms may not dramatically affect quality of life, many clients go undiagnosed, resulting in a lack of research to support that 1 gender is more greatly affected than the other.

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event? 1.Witnessing a murder 2.The death of a loved one 3.A fire that destroyed the client's home 4.A recent rape episode experienced by the client

2.The death of a loved one Rationale: A situational crisis arises from external rather than internal sources. External situations that could precipitate a crisis include loss or change of a job, the death of a loved one, abortion, change in financial status, divorce, addition of new family members, pregnancy, and severe illness. Options 1, 3, and 4 identify adventitious crises. An adventitious crisis refers to a crisis of disaster, is not a part of everyday life, and is unplanned and accidental. Adventitious crises may result from a natural disaster (e.g., floods, fires, tornadoes, earthquakes), a national disaster (e.g., war, riots, airplane crashes), or a crime of violence (e.g., rape, assault, murder in the workplace or school, bombings, or spousal or child abuse).

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

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

The nurse is caring for a client who was involuntarily hospitalized to a mental health unit and is scheduled for electroconvulsive therapy. The nurse notes that an informed consent has not been obtained for the procedure. Based on this information, what is the nurse's best determination in planning care? 1.The informed consent does not need to be obtained. 2.The informed consent should be obtained from the family. 3.The informed consent needs to be obtained from the client. 4.The primary health care provider will provide the informed consent.

3.The informed consent needs to be obtained from the client. Rationale: Clients who are admitted involuntarily to a mental health unit do not lose their right to informed consent. Clients must be considered legally competent until they have been declared incompetent through a legal proceeding. The best determination for the nurse to make is to obtain the informed consent from the client.

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1.Ask the client to leave the group for this session only. 2.Refer the client to another group that includes other manic clients. 3.Tell the client to stop monopolizing in a firm but compassionate manner. 4.Thank the client for the input, but inform the client that others now need a chance to contribute.

4.Thank the client for the input, but inform the client that others now need a chance to contribute. Rationale:If a client is monopolizing the group, the nurse must be direct and decisive. The best action is to thank the client and suggest that the client stop talking and try listening to others. Although telling the client to stop monopolizing in a firm but compassionate manner may be a direct response, the correct option is more specific and provides direction for the client. The remaining options are inappropriate since they are not directed toward helping the client in a therapeutic manner.

A nurse is conducting a family therapy session. the younger child tells the nurse about plans to make the older sibling look bad believing this will earn more freedom and privileges. the nurse should recognize this dysfunctional behavior as which of the following? A. Placation B. Manipulation C. Blaming D. Distraction

B Rationale: Manipulation is the dysfunctional behavior of using dishonesty to support an individual agenda

A nurse is planning group therapy for clients dealing with bereavement. Which of the following activities should the nurse include in the initial phase? A. Encourage the group to work toward goals B. Define the purpose of the group C. Discuss termination of the group D. Identify informal roles of members of the group E. Establish an expectation of confidentiality within the group

B, C, E Rationale: During the initial phase the tone of the group is set including expectation of confidentiality, the purpose is identified, and the ultimate termination of the group is discussed.

A nurse is caring for a client who has bipolar disorder. The client states," I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A. Why do you think you feel the need to give money away? B. I am here to provide care and cannot accept this from you. C. I can request that your case manager discuss appropriate charity options with you D. You should know that giving away your money is inappropriate.

B. I am here to provide care and cannot accept this from you. Rationale: This statement is matter of fact and concise and is a therapeutic response to a client who has bipolar disorder

A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A. a member who praises the input of others B. a member who follows the direction of the other members in the group C. A member who brags about accomplishments D. a member who evaluates the group's performance toward a standard

C. Rationale: an individual who brags about accomplishments is acting in an individual role that does not promote the progression of the group toward meeting goals.

A nurse on an acute mental health unit forms a group to fucus on self-management of medications. At each of the meetings two of the members conspire together to exclude the rest of the group. This is an example of the following concepts? A. Triangulation B. Group Process C. Subgroup D. Hidden Agenda

C. Rationale: a subgroup is a small number of people within a larger group who function separately from that group.

A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A. ECT is recommended initial treatment for bipolar disorder B. ECT is contraindicated for clients who have suicidal ideations C. ECT is effective for clients who are experiencing severe mania D. ECT is prescribed to prevent relapse of bipolar disorder.

C. ECT is effective for clients who are experiencing severe mania Rationale: pharmacological treatment is first line treatment for bipolar disorder. ECT is effective for clients with bipolar disorder and suicidal ideations. ECT is prescribed for clients experiencing acute episodes related to the bipolar disorder not for prevention of relapse.

GABA is a/an ______________ type of neurotransmitter. A. inhibitory B. excitatory C. modulatory

The answer is A. GABA is an inhibitory type of neurotransmitter.

Serotonin neurons are found in the brainstem in the _________________. A. raphe nucleus B. raphe pontis C. raphe obscuris D. raphe pallidus

The answer is A: raphe nucleus

Benzodiazepines can be used to treat all the following conditions except? A. Seizures B. Prior to an invasive procedure C. Anxiety D. Alzheimer's disease E. Insomnia

The answer is D. Benzodiazepines are not prescribed to treat Alzheimer's disease.

Considering client function, what is the expected outcome at the conclusion of crisis intervention therapy? a. Function is higher level than before the crisis. b. Function is only marginally below the pre-crisis level. c. Function is occurring without aid from identified support systems. d. Function is at the pre-crisis level.

d. Function is at the pre-crisis level. Rationale: The intent of crisis intervention is to return the individual to the pre-crisis level of functioning. While this goal is not always attainable, it remains the expected outcome of crisis intervention therapy.

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

1,3,4,6 Rationale: Interventions for dealing with the client exhibiting manipulative behavior include setting clear, consistent, and enforceable limits on manipulative behaviors; being clear with the client regarding the consequences of exceeding the limits set; following through with the consequences in a nonpunitive manner; and assisting the client in identifying a means of setting limits on personal behaviors. Ensuring that the client knows that she or he is not in charge of the nursing unit is inappropriate; power struggles need to be avoided. Enforcing rules and informing the client that she or he will not be allowed to attend therapy groups is a violation of a client's rights.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine. Which information would be important for the nurse to obtain during this client visit regarding the side and adverse effects of the medication? 1.Cardiovascular symptoms 2.Gastrointestinal dysfunctions 3.Problems with mouth dryness 4.Problems with excessive sweating

2.Gastrointestinal dysfunctions Rationale: The most common side and adverse effects related to fluoxetine include central nervous system and gastrointestinal system dysfunction. Fluoxetine affects the gastrointestinal system by causing nausea and vomiting, cramping, and diarrhea. Cardiovascular symptoms, dry mouth, and excessive sweating are not side and adverse effects associated with this medication.

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

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

A client with a history of anxiety appears to be in the second phase of crisis response. The nurse prepares for which client behavior? 1.The client will show the initial signs that coping methods are failing. 2.The client will employ new coping methods that will resolve the problem. 3.The client will experience severe anxiety as a result of failed coping methods. 4.The client will begin to implement coping methods that have been successful in the past.

2.The client will employ new coping methods that will resolve the problem. Rationale: In the first phase of the crisis response, the client implements usual coping methods to bring about relief from the problem and shows signs of anxiety when these methods are failing. The second phase of crisis response involves a redefining of the threat or implementation of new coping methods that can result in resolution of the problem. If resolution does not occur in the second phase, the client progresses to severe or panic levels of anxiety reflective of the third phase of the response.

A client arrives in the emergency department in a crisis state demonstrating signs of profound anxiety. What should the initial nursing assessment focus on? 1.The object of the crisis 2.The client's physical condition 3.The client's coping mechanisms 4.The presence of support systems

2.The client's physical condition Rationale: The initial nursing assessment of a client in a crisis state is to evaluate the physical condition of the client, the potential for self-harm, and the potential for harm to others. Once this has been determined and appropriate interventions have been initiated, the nurse would then proceed with the mental health interview that involves the remaining options.

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan to respond to the client's statement? 1.Reassure the client that things will get better. 2.Tell the client that this is not true and that we all have a purpose in life. 3.Identify recent behaviors or accomplishments that demonstrate the client's skills. 4.Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

3.Identify recent behaviors or accomplishments that demonstrate the client's skills. Rationale: Feelings of low self-esteem and worthlessness are common symptoms of a depressed client. An effective plan of care to enhance the client's personal self-esteem is to provide experiences for the client that are challenging but that will not be met with failure. Reminders of the client's past accomplishments or personal successes are ways to interrupt the client's negative self-talk and distorted cognitive view of self. Options 1 and 2 give advice and devalue the client's feelings. Silence may be interpreted as agreement.

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." Based on the client's behavior and statement, which intervention should the nurse include in the plan? 1.Suggesting a reduction of medication 2.Allowing increased "in-room" activities 3.Increasing the level of suicide precautions 4.Allowing the client off-unit privileges as needed

3.Increasing the level of suicide precautions Rationale: A client who is moderately depressed and has only been in the hospital 2 days is unlikely to have such a dramatic cure. When a depression suddenly lifts, it is likely that the client may have made the decision to harm herself or himself. Suicide precautions are necessary to keep the client safe. The remaining options are therefore incorrect interpretations.

A homeless shelter has sustained severe damage as a result of a fire, and most of the structure and people's belongings were destroyed. Ten of the individuals who are being displaced have a history of chronic mental illness. The mental health team coordinating support initially should focus their efforts on which action? 1.Assessing the clients' need for supportive therapy 2.Evaluating the clients for signs of stress overload 3.Providing the clients with shelter, clothing, and food 4.Planning means for the clients to receive their medications

3.Providing the clients with shelter, clothing, and food Rationale: The victims of community disaster are at a risk for stress-induced psychiatric crises. The needs of these individuals for food, clothing, and shelter should be addressed first to minimize the stress-producing effect these losses may have on the chronically mentally ill. Stress is a key factor in the relapse into crisis for these individuals. After these basic needs are met, the remaining options can then be implemented.

A client experiencing a great deal of stress and anxiety is being taught to use self-control therapy. Which statement by the client indicates a need for further teaching about the therapy? 1."This form of therapy can be applied to new situations." 2."An advantage of this technique is that change is likely to last." 3."Talking to oneself is a basic component of this form of therapy." 4."This form of therapy provides a negative reinforcement when the stimulus is produced."

4."This form of therapy provides a negative reinforcement when the stimulus is produced." Rationale: Negative reinforcement when the stimulus is produced is descriptive of aversion therapy. Options 1, 2, and 3 are characteristics of self-control therapy.

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? 1."Have you talked to your family about this?" 2."Everyone feels this way when they are depressed." 3."You will feel better once your medication begins to work." 4."You sound very upset. Are you thinking of hurting yourself?"

4."You sound very upset. Are you thinking of hurting yourself?" Rationale: Clients who are depressed may be at risk for suicide. It is critical for the nurse to assess suicidal ideation and plan. The nurse should ask the client directly whether a plan for self-harm exists. Options 1, 2, and 3 do not deal directly with the client's feelings.

Which is the best therapeutic approach for the nurse to use in crisis counseling? 1.Reassuring 2.Passive listening 3.Exploration of early life experiences 4.Active, with focus on the current situation

4.Active, with focus on the current situation Rationale: During crisis counseling, the best approach for the nurse to use is an active one, with a focus on the current situation. The remaining options would be inconsistent with the acute needs that emerge in a crisis. Passive listening would be contrary to the individual's acute stress and disorganization. Exploring the past would be insensitive to the current crisis and would be exploitative of a client in acute distress. Although reassurance may be needed, what is most important about the nurse's response in a crisis is the need for a direct focus on immediate needs.

Which is the primary goal of crisis intervention therapy? 1.Introduce new, effective coping methods to the client. 2.Assess the client to identify the causative stressors. 3.Establish a sustainable therapeutic nurse-client relationship. 4.Assist the client in returning to the level of precrisis functioning.

4.Assist the client in returning to the level of precrisis functioning. Rationale: The primary goal of crisis intervention therapy is returning the client to a level of functioning that is equal to or better than that experienced precrisis. This goal is reached through strategies that include the introduction of new coping methods directed toward the stressors that contributed to the crisis. The establishment of a therapeutic nurse-client relationship is a general goal for all nursing relationships.

Which pre-electroconvulsive therapy intervention will the nurse implement for a hospitalized client with depression? 1.Restrict the client smoking for 12 hours. 2.Enforce nothing by mouth (NPO) status for 16 hours. 3.Limit the client's participation in unit activities for 24 hours. 4.Assure that an electrocardiogram is performed within 24 hours.

4.Assure that an electrocardiogram is performed within 24 hours. Rationale:Before electroconvulsive therapy (ECT), blood tests are performed and an electrocardiogram is done to determine a baseline status of the client. Maintaining NPO status for 6 to 8 hours before treatment is adequate. The remaining options are incorrect.

Which activity should the nurse include in the plan of care for a client with mania who is experiencing psychomotor agitation? 1.Playing checkers with members of the staff 2.Reading in a quiet, low-stimulus environment 3.Engaging in a card game with other clients on the unit 4.Attending a clay-molding class that is scheduled for today

4.Attending a clay-molding class that is scheduled for today Rationale: When a client is experiencing psychomotor agitation, it is best to provide activities that involve the use of hands and gross motor movements. Such activities can include volleyball, finger painting, drawing, and working with clay. These activities provide an appropriate way for the client to discharge motor tension. Reading and simple card games are sedentary activities. Playing checkers requires concentration and more intensive use of thought processes.

A client gives the home health nurse a bottle of clomipramine. The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication? 1.Complaints of insomnia 2.Complaints of hunger and fatigue 3.A pulse rate less than 60 beats per minute 4.Frequent hand washing with hot, soapy water

4.Frequent hand washing with hot, soapy water Rationale: Clomipramine is a tricyclic antidepressant used to treat obsessive-compulsive disorder. Sedation sometimes occurs. Insomnia seldom is a side effect. Weight gain and tachycardia are side and adverse effects of this medication.

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? 1. Incessant talking and sexual innuendoes 2.Grandiose delusions and poor concentration 3.Outlandish behaviors and inappropriate dress 4.Nonstop physical activity and poor nutritional intake

4.Nonstop physical activity and poor nutritional intake Rationale: Mania is a mood characterized by excitement, euphoria, hyperactivity, excessive energy, decreased need for sleep, and impaired ability to concentrate or complete a single train of thought. The client's mood is predominantly elevated, expansive, or irritable. All of the options reflect a client's possible symptoms. However, the correct option clearly presents a problem that compromises physiological integrity and needs to be addressed immediately.

What is the expected outcome for an individual who has successful resolved all the maturational crises they have been presented with? (Select all that apply.) Select all that apply. A. The ability to pass through subsequent developmental stages B. The development of new, effective coping mechanisms C. The elimination of future maturational crises D. The development of basic human qualities E. The elimination to specific barriers to psychosocial growth

A,B,D Rationale: Successful resolution of these maturational tasks leads to development of basic human qualities. Erikson believed that the way these crises are resolved at one stage affects the person's ability to pass through subsequent stages. Each crisis provides the starting point for movement toward the next stage with the opportunity to learn new coping mechanisms and experience personal psychosocial growth. Each new stage of development results in a maturational crisis.

A nurse working on an acute mental health unit is admitting a client who has a major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A. Placing the client on one to one observation B. assisting the client to perform ADL's C. Encouraging the client to participate in counseling D. Teaching the patient about medication adverse effects.

A. Placing the client on one to one observation Rationale: the greatest risk for the client who has MDD and comorbid anxiety is injury due to self-harm. The highest priority intervention is placing the client on a one to one observation.

Which assessment data describes a client in phase IV of Caplan's phases of crisis? A. The client comes to the crisis clinic reporting depression and expresses that he does not want to go on living. B. The client reports experiencing a panic attack. C. The client reports experiencing increased anxiety and feelings of extreme discomfort the day after the tornado. D. The client reports experiencing anxiety symptoms the day after being fired.

A. Promoting client safety. Rationale: The nurse's initial task is to promote safety by assessing the patient's potential for suicide or homicide. The other options are all important components of the care plan, but safety of the patient takes the highest priority.

A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (SATA) A. Lithium carbonate B. paroxetine C. Risperidone D. Haloperidol E. Lorazepam

B, E Rationale: SSRI antidepressants may be prescribed to decrease anxiety and depression of a client who is experiencing a crisis. Benzodiazepines may be prescribed decrease the anxiety of a client who is experiencing a crisis

A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? A. Provide flexible client behavior expectations B. Offer concise explanations C. Establish consistent limits D. Disregard Client concerns E. Use firm approach with communication

B,C,E Rationale: using concise explanations improves the clients ability to focus and comprehend the information. Consistent limits decreases the risk of client manipulation. Using a firm approach with the client communication promotes structure and minimizes inappropriate client behaviors

A nurse is revieing the medical records of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A. Rape B. Marriage C. Severe physical illness D. Job Loss

B. Rationale: Marriage is a example of a maturational crisis which is a naturally occurring event during the life span

The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing which client behavior? A. Apologizing for being sarcastic B. Laughing at a joke C. Going to his room to "calm down" D. Writing down a telephone number

B. Rationale: Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation. While the other options demonstrate positive behaviors, none are directly associated with such a medication.

A 36 year old comes to the crisis clinic with reports of not sleeping, anxiety, and excessive crying. After a tornado devastated his hometown, the client was suddenly unemployed and homeless. Which of the following statements regarding crisis accurately describes the client's situation? A. He is experiencing a situational crisis with the added stress of financial burden. B. He is experiencing a situational crisis that is associated with both a natural disaster and a personal event. C. He is experiencing low self-esteem from the job loss, as well as anger because of the loss of his home. D. He is experiencing ineffective coping and should be hospitalized for intensive therapy.

B. He is experiencing a situational crisis that is associated with both a natural disaster and a personal event. Rationale: It is possible to experience more than one type of crisis situation simultaneously, and as expected, the presence of more than one crisis further taxes individual coping skills. The client lost his job (personal event) and also experienced the devastating effects of a tornado (natural disaster). The first option may be true but doesn't accurately describe the crisis criteria. There is nothing in the scenario suggesting he needs acute hospitalization at this time. He is experiencing not only a personal situational crisis but a natural disaster as well, which makes coping more difficult.

A nurse is caring for a client who has major depressive disorder. which of the following should the nurse identify as a risk factor for depression? A. Male Gender B. History of Chronic bronchitis C. Recent death in a client's family D. Family History of depression E. Personal history of panic disorder

C,D,E Rationale: Females are twice as likely as males to experience a depressive disorder. Depressive disorders are more likely to occur in those experience high levels of stress (when grieving), those with a family history of depression, or a history of an anxiety or personality disorder.

The nurse responsible for the care of a client prescribed clonazepam should evaluate treatment as being successful when the client demonstrates which behavior? A. Normal appetite B. Improved physical balance C. Less anxiety D. Reduced auditory hallucinations

C. Rationale: Clonazepam is a benzodiazepine thought to enhance the effects of GABA. GABA is associated with the production of a calming emotional state. None of the other options are associated with clonazepam.

A nurse is teaching a client who has a new diagnosis of premenstrual dysmorphic disorder(PMDD). Which of the following statements by the client indicates understanding of the teaching? A. I can expect my problems with PMDD to be worse when I'm menstruating B. I should avoid exercising when I am feeling depressed? C. I am aware that my PMDD causes me to have rapid mood swings. D. I should increase my caloric intake with a nutritional supplement when my PMDD is active

C. I am aware that my PMDD causes me to have rapid mood swings. Rationale: a clinical finding of PMDD is emotional lability. The client can experience rapid changes in mood. Clinical findings of PMDD are present during the luteal phase of the menstrual cycle just prior to menses. Weight gain can be common with PMDD so exercise and eating a healthy calorie controlled diet are important

A client comes to the crisis intervention clinic and tearfully tells the nurse, "It is so painful! I have thought about it, and I cannot see how I can go on without my partner." The nurse states, "You have resilience and will look back on this as a crisis you were able to manage." Analysis of this interaction reveals what evaluation of the nurse's response? A. It is offering a statement of positive outcome based on client coping ability. B. It has introduced a concept associated with traditional psychotherapy. c. It has failed to follow up on the client's verbal clues to suicidal thoughts. D. It demonstrates a good understanding of the effect of time on perception of a crisis.

C. It has failed to follow up on the client's verbal clues to suicidal thoughts. Rationale: Nurses who are uncomfortable with the idea of suicide may fail to pick up on a client's clues. This client clearly was open to discussing her suicidal thoughts, or she would not have said, "I cannot see how I can go on." The nurse's statement is not associated with the evaluation presented by any of the other options.

A nurse wants to use a democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when demonstrating which of the following actions? A. observes group techniques without interfering with the group process. B. Discusses a technique and then directs members to practice the technique C. asks for group suggestions of technique and then supports discussion D. suggests techniques and asks group members to reflect on their use.

C. asks for group suggestions of technique and then supports discussion Rationale: Democratic leadership supports group interaction and decision making to solve problems

A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. Care during the continuation phase focuses on treating continued manifestations of MDD B. The treatment of MDD during the maintenance phase lasts for 6-12 weeks C. the client is at greatest risk for suicide during the first weeks of an MDD episode D. Medication and psychotherapy are most effective during the acute phase of MDD

C. the client is at greatest risk for suicide during the first weeks of an MDD episode Rationale: The acute phase or the first weeks of MDD episode is when the client is most at risk for self harm. The focus of the continuation phase is relapse prevention. The maintenance phase of treatment can last a year or more. Medication and psychotherapy are used during the continuation phase to prevent relapse.

A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A. Wide fluctuations in mood B. Report of a minimum of five clinical findings of depression C. the client is at greatest risk for suicide during the first weeks of an MDD episode D. inflated sense of self-esteem

C. the client is at greatest risk for suicide during the first weeks of an MDD episode Rationale: manifestations of persistent depressive disorder last for at least 2 years in adults. wide fluctuations in mood are associated with bipolar disorder. MDD diagnosis requires a minimum of five clinical findings of depression. A decreased, not an inflated, sense of self-esteem is associated with persistent depressive disorder

A nurse is caring for a client with bipolar disorder. which of the following is a priority nursing action? A. set consistent limits for expected client behavior B. Administer prescribed medications on schedule C. Provide the client with step-by step instructions during hygiene activities D. Monitor the client for escalating behavior

D. Monitor the client for escalating behavior Rationale: Monitoring the client for escalating behavior addresses the client's priority need for safety and is therefore the priority nursing action.

A patient presents to the ER with severe stomach pain, diarrhea, insomnia, and ataxia. In addition, the patient reports experiencing electrical shock sensations and tingling in his body. The nurse collects the patient's medication history, which includes Fluoxetine. What IMPORTANT question should the nurse ask the patient next to help determine the cause of the patient's presenting signs and symptoms? A. "Have you consumed alcohol or any illegal substances in the past week?" B. "When was the last time you took Fluoxetine?" C. "Have you taken any over-the-counter cough medications or herbal substances in the past week?" D. "Are you allergic to shellfish?"

The answer is B. Based on the patient's signs and symptoms, the patient may be experiencing discontinuation syndrome which can happen if a patient suddenly quits taking an SSRI (Fluoxetine). The nurse should immediately ask the patient when the last dose of Fluoxetine was taken.

Which patient below is at MOST risk for an injury or toxicity due to being prescribed a Benzodiazepine? A. "A 28-year-old with a history of seizures." B. "A 78-year-old receiving dialysis." C. "A 45-year-old who is post-op day 2 from a femoral popliteal bypass." D. "A 36-year-old receiving treatment for gastritis."

The answer is B. Older adults are at risk for toxicity, dependence, and injuries (falls, accidents etc.) related to Benzos usage. The American Geriatric Society actually created a list called the BEERS List and Benzos is a group of medications the group recommends avoiding in older adults. In addition, this patient has compromised renal function and needs dialysis which increases their risk of toxicity/injury as well.

A 36-year-old patient is admitted to the ER. The patient is extremely diaphoretic, shivering, experiencing muscle rigidity, and irritability. The patient's heart rate is 140 and temperature 102.6 'F. The patient has a history of depression, diabetes, atrial fibrillation, and hypertension. The patient's family reports the patient has also been experiencing a constant dry cough and has been taking an over-the-counter medication in an attempt to get relief from the cough. The patient is currently taking Sertraline and the other medications below. What other medication taken by the patient should the nurse immediately notify the doctor about? A. Glyburide B. Dextromethorphan C. Metoprolol D. Lisinopril

The answer is B: dextromethorphan. Based on the patient's sign and symptom, serotonin syndrome may be presenting. This syndrome can occur when the patient takes an SSRI along with another medication like dextromethorphan. Dextromethorphan is an over-the-counter cough medicine. Both of these medications can increase serotonin levels.

Which statement below best describes the mechanism of action of how SSRIs work? A. "SSRIs inhibit the reuptake of GABA by blocking the reuptake of serotonin from the pre-synaptic neuron." B. "SSRIs enhance the reuptake of GABA by amplifying the action of the serotonin receptors found on the post-synaptic neuron." C. "SSRIs inhibit the reuptake of the neurotransmitter serotonin by the pre-synaptic neuron." D. "SSRIs enhance the reuptake of serotonin by the receptors on the post-synaptic neuron."

The answer is C. SSRIs, (selective serotonin reuptake inhibitors), inhibit the reuptake of the neurotransmitter serotonin by the pre-synaptic neuron. It does this by blocking the serotonin-transporter protein (SERT).

A patient has been taking an SSRI for the treatment of depression for about one month. The patient reports insomnia. To help provide relief from this side effect, when should the patient take this medication? A. At bedtime B. In the afternoon C. In the morning D. Stop taking the medication

The answer is C. Some types of SSRIs can cause insomnia. If this occurs, taking the medication in the morning may help this symptom. However, if the medication causes drowsiness, taking the medication at night may help with this symptom.

Your patient is prescribed a second dose of a Benzodiazepine. Before administration of the medication you assess the patient and find that the patient is extremely confused, agitated, and their speech is slurred. The patient is reporting seeing dark figures in their room and is unable to coordinate movements. Your next nursing action is to? A. Document the patient findings, continue to monitor the patient, and administer the medication as ordered B. Administer the medication as ordered, this is an expected side effect of this medication C. Hold the medication, notify the doctor, and document findings D. Skip this dose of the medication, continue to monitor the patient, document findings, and administer the next scheduled dose as ordered

The answer is C: Based on the findings the patient is experiencing toxicity or overdose of the Benzo. The nurse should not administer the dose but notify the doctor about the findings who will give additional ordered. In addition, the nurse should document.

Fill in the blank: After the pre-synaptic neuron releases serotonin, it enters the _______________ and some of the serotonin binds with receptors found on the post-synaptic neuron. The serotonin that did not bind with a receptor is removed from this space via a protein serotonin-transporter back into the ________________ for future use. A. synaptic vesicle; pre-synaptic neuron B. synaptic cleft; post-synaptic neuron C. axon terminal; pre-synaptic neuron D. synaptic cleft; pre-synaptic neuron

The answer is D. After the pre-synaptic neuron releases serotonin, it enters the SYNAPTIC CLEFT and some of the serotonin binds with receptors found on the post-synaptic neuron. The serotonin that did not bind with a receptor is removed from this space via a protein serotonin-transporter back into the PRE-SYNAPTIC NEURON for further use.

Which medication below is NOT considered a Benzodiazepine? A. Alprazolam B. Lorazepam C. Clorazepate D. Phenobarbital

The answer is D. Phenobarbital is a barbiturate. How you can recognize a Benzodiazepine is that the middle of the generic drug name will have either "ze" or "zo" and most end with "pam" or "lam" expect Clorazepate and Chlordiazepoxide.

The physician determines a patient needs to be started on a selective serotonin reuptake inhibitor (SSRI). As the nurse you know which medication below is NOT an SSRI? A. Citalopram B. Paroxetine C. Fluoxetine D. Rasagiline

The answer is D. Rasagiline is a MAOI (monoamine oxidase inhibitor) and is used to treat Parkinson's Disease.

The antidote for Benzodiazepines is what medication below? A. Protamine Sulfate B. Acetylcysteine C. Physostigmine D. Flumazenil E. Fomepizole

The answer is D: Flumazenil is the antidote for Benzos.

SSRIs can interact with other types of medications. What medications below should the nurse educate the patient to avoid while taking an SSRI? Select all that apply: A. St. John's Wort B. MAOIs (Monoamine oxidase inhibitors) C. Statins D. Benzodiazepines

The answers are A and B. If SSRIs are combined with St. John's Wort or MAOIs it can lead to serotonin syndrome (this occurs due to high serotonin levels). Therefore, patients should avoid these types of medications together.

You're providing education to a patient who is prescribed to take a Benzodiazepine for panic attacks. Which statements below require you to re-educate the patient about this medication? SELECT ALL THAT APPLY: A. "I will monitor my consumption of alcohol and limit myself to 5 beers a day." B. "Driving is not recommended while taking this medication." C. "I will take this medication with Oxycodone to help prevent panic attacks." D. "Signs of toxicity include slow heart rate, decreased respiration, extreme drowsiness, and slurred speech."

The answers are A and C. Patients taking Benzo should AVOID alcohol consumption and opioids (Oxycodone).

Select ALL the statements below that are INCORRECT about Benzodiazepines? A. "Benzodiazepines are CNS stimulants." B. "Benzodiazepines provide the most therapeutic and safest effects when prescribed with opioids." C. "Benzodiazepines can be used to treat seizures." D. "Narcan is the antidote used to reverse toxicity caused by Benzodiazepines."

The answers are A, B, and D. Benzodiazepines are CNS depressants, they should NOT be used with opioids (the FDA has issued a black box warning on this due to the increased risk of overdose), and Flumazenil is the antidote for Benzodiazepines.

A patient is currently taking Vilazodone and is experiencing nausea. The patient started taking the medication about 1 week ago. What education can the nurse provide the patient about this type of side effect? Select all that apply: A. "Nausea is not normal with SSRIs and may indicate intolerance to the medication." B. "Nausea is normal with SSRIs and tends to decrease overtime." C. "Avoid taking the medication with food to help decrease the occurrence of nausea." D. "Taking the medication with food will help decrease the nausea."

The answers are B and D. SSRIs definitely can cause nausea. However, it tends to decrease over a couple of weeks into therapy. Sometimes taking the medication with food will help decrease the nausea.

Which assumption serves as a foundation for the use of crisis intervention? a. The individual is mentally healthy but in a state of disequilibrium. b. Long-term dysfunctional adjustment can be addressed by crisis intervention. c. Crisis intervention nurses need to remain passive as the client deals with the crisis. d. An anxious person is unlikely to be willing to try new problem-solving strategies.

a. The individual is mentally healthy but in a state of disequilibrium. Rationale: The patient in a crisis situation is assumed to be mentally healthy, to have functioned well in the past, and to be presently in a state of disequilibrium. None of the other options present correction foundational statements for crisis intervention.

The nurse preparing to admit a client with a diagnosis of obsessive-compulsive disorder to the mental health unit should expect to note which behaviors in the client? 1.Sad and tearful 2.Suspicious and hostile 3.Frightened and delusional 4.Rigidness in thought and inflexibility

4.Rigidness in thought and inflexibility Rationale:Rigid and inflexible behaviors are characteristic of the client with obsessive-compulsive disorder (OCD). Clients with this disorder usually are not hostile unless they are prevented from engaging in the obsession or compulsion because this behavior is what decreases the anxiety. None of the other options are associated with OCD.

Two 16-year-old students were both involved in serious car accident. Both students have spoken with a counselor about the incident. One student has been able to move forward with little dysfunction as a result of the accident while the other has been experiencing anxiety and an inability to concentrate in school even after numerous counseling sessions. The difference in the way the accident affected both boys may be explained primarily by what factor? A. Personal perception of the event. B. One student received ineffective counseling. C. Individual personality. D. Existence of previous, unresolved emotion trauma.

A. Rationale: People vary in the way they absorb, process, and use information from the environment. Some people may respond to a minor event as if it were life threatening. Conversely, others may experience a major event and look at it in a calmer fashion. The other options may be true but are not the primary reason for two people responding differently to the same event.

A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching (SATA) A. use caffeine in moderation to prevent relapse B. Difficulty sleeping can indicate a relapse C. Begin taking your medication as soon as a relapse begins D. participating in psychotherapy can help prevent a relapse E. Anhedonia is a clinical manifestation of a depressive relapse.

B, D, E Rationale: the client should be alert for sleep disturbances which can indicate relapse. psychotherapy is effective in helping to prevent relapse. Anhedonia, which is the inability to feel pleasure is a manifestation of depression and can indicate a relapse of bipolar disorder.

The nurse caring for a client prescribed an antidepressant medication that produces anticholinergic side effects should assess for which possible side effects? (Select all that apply.) Select all that apply. A. Memory dysfunction B. Ejaculatory dysfunction C. Dry mouth D. Constipation E. Blurred vision

C,D,E Rationale: Anticholinergic effects are the effects produced by atropine: dry mouth, dry eyes, blurred vision, constipation, and urinary retention. None of the remaining options are associated with anticholinergic side effects.

What type of crises occur as an individual moves from one developmental level to another? A. Recurring B. Situational C. Reactive D. Maturational

D. rationale: Maturational crises are normal states in growth and development in which specific new maturational tasks must be learned when old coping mechanisms are no longer effective. This challenge is not specifically associated with any of the other options.

Benzodiazepines amplify the effect of what neurotransmitter? A. Serotonin B. Gamma-aminobutyric acid C. Acetylcholine D. Norepinephrine

The answer is B. Benzodiazepines amplify the effect of Gamma-aminobutyric acid (GABA).

A patient is prescribed Fluvoxamine for treatment of obsessive compulsive disorder. What should the nurse include in the patient education about this medication? A. Avoid consuming foods with tyramine B. Limit alcohol consumption to 8 oz. a day C. Expect signs and symptoms to improve within one month to 6 weeks D. Stop taking the medication if side effects are experienced

The answer is C. Option A is education for patients taking MAOIs (not SSRIs), Option B is wrong because any amount of alcohol needs to be avoided, Option D is wrong because the medication should be tapered off not abruptly stopped...this could lead to discontinuation syndrome. SSRIs take time to work and the patient should be aware it can take a month to six weeks to feel improvement.

What is the typical response when a stressful event occurs, and the individual is unable to resolve the situation by using their usual coping strategies? a. A state of emotional disorder results in trial-and-error problem solving. b. They will withdraw and act as though the problem does not exist. c. Their distress often causes them to resort to planning suicide. d. They develop severe personality disorganization.

a. A state of emotional disorder results in trial-and-error problem solving. Rationale: The description is that of the second stage of crisis, according to accepted crisis theory. In this stage the individual will adopt the trial-and-error method of problem solving since their usual strategies are no longer effective.

Which nursing action directed toward a client in crisis demonstrates signs of a problematic nurse-client relationship? a. Experiencing frustration about the decisions the client is making b. Giving the client a personal number to call when they "need to talk" c. Suggesting that the client attend an extra counseling session each month d. Offering to change the time of the counseling session for the second time in 3 weeks

b Rationale: Giving a client one's, personal telephone number is a reaction to the nurse's need to be needed and undermines the client's sense of self-reliance. None of the other behaviors demonstrate a breakdown in the nurse-client behavior but rather reactions to commonly experienced issues within that relationship.

What type of crisis is a newly unemployed person most likely to experience? a. Maturational b. Situational c. Unexpected d. Reactive

b. Rationale: Situational crises arise from external sources. Examples are death of a loved one, divorce, marriage, or a change in health status. Unemployment is not generally associated with any of the other options.

Which statement would suggest to the crisis intervention nurse the need to arrange for hospitalization of a client? a. "There are three possibilities that might help, but I can't decide what to do." b. "I'm feeling overwhelmed by all that has happened, and I need help sorting it out." c. "I see no solution for this situation if nothing changes by tomorrow." d. "I feel a little calmer than yesterday at this time, but things are still very difficult."

c. "I see no solution for this situation if nothing changes by tomorrow." Rationale: Whenever the client presents a danger to himself or herself or others, hospitalization must be considered. Such a danger may exist if the client expresses hopelessness as in the correct option. None of the other options express hopelessness.