psych nursing 2

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severe

"Fight or Flight" response. Autonomic nervous system excessively stimulated, vital signs increased, diaphoresis increased, urinary urgency and frequency, diarrhea, dry mouth appetite decreased pupils dilated, muscles rigid, tense. Hearing decreased, pain sensation decreased. This is what type of anxiety? (mild, moderate, severe, panic)

d (This is reaction formation, a type of defense mechanism that occurs when clients turn their feelings or impulses into their opposites, such as Joan's statement about her boss.)

It has now been 1 year since Joan's initial presentation to the clinic. The APRN-PMH is conducting her regular follow-up interview with Joan and listening to Joan describe her work situation. The nurse recognizes that the client is using reaction formation as a defense mechanism. On which statement by the client is the nurse basing this assessment? A) "She did those things because she doesn't like my seniority." B) "I am working harder than ever to make my boss happy." C) "I don't care anymore about what she does to upset me." D) "I just tell the boss that nothing she does will upset me."

c (Seasonal affective disorder occurs during the months, when sunlight diminishes. Clients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer.)

It is likely that a client with seasonal affective disorder will begin to feel better in the A. fall. B. winter. C. spring. D. summer.

a (Antipsychotic medications target symptoms related to disorders of thinking such as psychosis and behaviors associated with agitation and disorganization or speech and behavior.)

The client also begins an atypical antipsychotic, risperidone (Risperdal), because she reported hearing a "scary voice" upon admission. Although the client remains very withdrawn and noncommunicative, the nurse must explain the purpose of Risperdal. Which explanation is best? A) "This medication will help you think more clearly." B) "Several medications can help you sleep better." C) "This will control impulsive feelings you may experience." D) "It will enhance the effectiveness of the antidepressant."

b (This client is suffering from anxiety. The correct answer is anxiolytic. Option 1 is a sedative-hypnotic, which would not be prescribed. The client is not suffering from psychosis or hallucinations, so option 3 is inappropriate. Option 4 is inappropriate for the signs and symptoms described.)

The client is reporting vague dread; she is pacing and hyperventilation. Her jaw is clenched, and she is wringing her hands. The nurse concludes that this client is in need of which of the following types of medications? A. A barbiturate B. An anxiolytic C. An antipsychotic D. A CNS stimulant

tca, not first-line, side effects, AmitriptyLINE, NortriptyLINE, ProtriptyLINE , ImipraMINE, ClomipraMINE , DesipraMINE, SINEquan

tca, orthostatic, urinary retention older, no double dose, photosensitivty, cardio toxicity, narrow glaucoma, no pregnant

valproic acid, strong, fast, anticonvulsant, males, causes, weight gain, liver issues, good rapid cycler, significant mania, disphoric symptoms, anger

c (Rationale: Caffeine is an antagonist of antianxiety medication.Text page: 237)

.The physician orders lorazepam (Ativan) 1 mg po qid for 1 week for a client with generalized anxiety disorder. The nurse should a. question the physician's order because the dose is excessive. b. explain the long-term nature of benzodiazepine therapy. c. teach the client to limit caffeine intake. d. tell the client to expect mild insomnia.

1 (Rationale: The immediate safety of the patient and other patients on the unit is the priority. Limits regarding patient-to-patient contact and relations should be communicated and behavior should be monitored. While excessive spending of money is commonly found in mania, it is not an immediate safety issue. "Being at one with the world" may be part of a delusional, false thoughts, system that commonly happens during mania. Delusions should be monitored, but this one does not sound dangerous and in need of any particular action. Flight of ideas, or jumping from topic to topic, is also a common symptom in mania. While they may make communication difficult, they are not a priority concern.)

1. Which behavior exhibited by a patient with mania should the nurse choose to address first? 1. Indiscriminate sexual relations 2. Excessive spending of money 3. Declaration of "being at one with the world" 4. Demonstration of flight of ideas

c (The client's inability to recall is an example of repression, which is the unconscious and involuntary forgetting of painful events, ideas, and conflicts)

3 days after a stressful incident a client can no longer remember why it was stressful. The nurse, in relating to this client, can be most therapeutic by identifying that the inability to recall the situation is an example of the defense mechanism of: A. Denial B. Regression C. Repression D. Dissociation

b (Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. Text page: 216)

A 20-year-old was sexually molested at age10 but he can no longer remember the incident. The ego defense mechanism in use is A. projection. B. repression. C. displacement. D. reaction formation

b (Projection is the process of attributing one's own thoughts about one's self to others)

A 23yr old female client is admitted to a psychiatric unit after several episodes of uncontrolled rage at her parent's home. She is diagnosed as having a borderline personality disorder. While watching a television newscast describing an incident of violence in the home, the client states, "People like that need to be put away before they kill someone." The nurse identifies that the client is using: A. Denial B. Projection C. Introjection D. Sublimation

A = Age. High-risk groups include 19-years-old or younger; 45-years-old or older, especially the elderly of 65-years or older. These people are have higher chance for: A. Schizophrenia B. Suicide C. Bipolar D. Insomnia

c (Rationale: Substance abuse often coexists with posttraumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.Text page: 223)

A Gulf War veteran is entering treatment for posttraumatic stress disorder. An important facet of assessment is to a. ascertain how long ago the trauma occurred. b. find out if the client uses acting out behavior. c. determine use of chemical substances for anxiety relief. d. establish whether the client has chronic hypertension related to high anxiety.

d (Exaggerated belief in one's own importance, identity, or capabilities, is seen with grandiosity.)

A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying A. flight of ideas. B. distractibility. C. limit testing. D. grandiosity.

b (Manic clients may hallucinate during the delirious state but generally do not hear voices. Psychoeducation would not be going on during the time the client is delirious.)

A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? A. The side-effects are unpleasant B. The voices tell the client to stop taking it C. The client prefers to feel "high" and energetic D. The client feels well and denies the possibility of recurrence

c (Rationale: Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Text page: 213)

A client approaches a nurse and blurts "You have got to help me! Something terrible is happening. I am falling apart. I can't think. My heart is pounding and my head is throbbing." The nurse should assess the client's level of anxiety as A. mild. B. moderate. C. severe. D. panic.

b (Aggressive, violent behavior is often seen with PCP ingestion. The client will respond best to a safe, low-stimulus environment such as that provided by seclusion until the effects of the drug wear off. Talking down is never advised because of the client's unpredictable violent potential. Naltrexone is an opiate antagonist. Text page: 415)

A client brought to the emergency department at the university hospital after PCP ingestion tries to run up and down the hallway. The nursing intervention that would be most therapeutic is A.taking him to the gym on the psychiatric unit. B.obtaining an order for seclusion and close observation. C.assigning a psychiatric technician to "talk him down." D.administering naltrexone as needed per hospital protocol.

A ( Client does not seem to understand the medication is necessary to prevent mood swings)

A client has a bipolar disorder for which the practitioner prescribes mood-stabilizing medication. The nurse completes a teaching session with a client concerning the medical regimen. Which client comment indicates to the nurse that further teaching is needed? A. "I know I won't have to stay on this medication for too long." B. "I realize that I will need to keep in touch with my physician" C. "Taking medication without using other forms of therapy may not be as effective" D. "Taking the medication is better than experiencing the highs and lows I have been having"

a (A depressed client usually has little energy. After even a short exercise period, the client may feel exhausted and need rest.)

A client has a severe sleep pattern disturbance and psychomotor retardation. The nurse has developed a plan for him to spend 20 minutes in the gym at 1 PM. The hour immediately after the exercise period should be scheduled for A. rest. B. group therapy. C. individual therapy. D. occupational therapy.

d (Hyperpyrexia and convulsions are dangerous symptoms seen in central nervous system stimulant overdose. Text page: 413)

A client has been using cocaine intranasally for 4 years. Two months ago she started freebasing. For the past week she has locked herself in her apartment and has used $8000 worth of cocaine. When brought to the hospital she was unconscious. Nursing measures should include A.induction of vomiting. B.administration of ammonium chloride. C.monitoring of opiate withdrawal symptoms. D.observation for hyperpyrexia and seizures.

d (As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy)

A client is admitted with a bipolar disorder, depressed episode. The nursing history indicates a progressive increase in depression over the past month. What should the nurse expect the client to display? A. Elated affect related to reaction formation B. loose associations related to a thought disorder C. Physical exhaustion related to decreased physical activity D. Paucity of verbal expression related to slowed thought process

a (Rationale: Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. Text page: 219)

A client is demonstrating a moderate level of anxiety. She tells the nurse "I am so anxious that I could fly! I do not know what to do." A helpful response for the nurse to make would be a. "What things have you done in the past that helped you feel more comfortable?" b. "Let's try to focus on that adorable little granddaughter of yours." c. "Why don't you sit down over there and work on that jigsaw puzzle?" d. "Try not to think about the feelings and sensations you're experiencing."

c (Paxil is a SSRI, by blocking the re-uptake of serotonin, levels of this neurotransmitter increase in the brain)

A client is diagnosed with dementia secondary to vascular disease has comorbid Major Depressive Disorder. He has a flat affect, depressed mood, and short-term memory loss. Paroxetine (Paxil) is prescribed for the depression. A family member says, "I don't remember the reason this medicine might help." What is the nurse's best response? A. "it improves circulation to the brain." B. "it elevates blood glucose levels in cells of brain." C. "It works on the serotonin levels in the brain." D. "It will increase oxygen levels in the brain."

b (Rationale: GAD is characterized by symptomology that lasts 6 months or longer.Text page: 220)

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports: a. that his symptoms started right after he was robbed at gun point b. being so worried he hasn't been able to work for the last 12 months c. that eating in public makes him extremely uncomfortable d. repeatedly verbalizing his prayers helps him feel relaxed

c (Rationale: A response that helps the client identify the precipitant stressor is most therapeutic. Text page: 219)

A client is displaying symptomology reflective of a panic attack. In order to help the client regain control the nurse responds: a. "You need to calm yourself." b. "What is it that you would like me to do to help you?" c. "Can you tell me what you were feeling just before your attack?" d. "I will get you some medication to help calm you."

a (Rationale: Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms.Text page: 238)

A client is experiencing a panic attack. The nurse can be most therapeutic by a. telling the client to take slow, deep breaths. b. verbalizing mild disapproval of the anxious behavior. c. asking the client what he means when he says "I am dying." d. offering an explanation about the role of the sympathetic nervous system in symptom formation.

c (Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite is common in the depressed)

A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? A. Rigidity and a narrowing of perception B. Alternating episodes of fatigue and high energy C. Diminished pleasure in activities and alteration in appetite D. Excessive socialization and interest in activities of daily living

1 (The margin between the therapeutic and toxic levels of lithium are very narrow. Serum lithium levels should be monitored once or twice a week after initial treatment until dosage and serum levels are stable, maintenance 0.6-1.2 mEq/L. Lithium is similar in chemical structure to sodium, behaving in the body in much the same manner and competing with sodium at various sites in the body. If sodium intake is reduced, or the body is depleted of normal sodium, lithium is reabsorbed by the kidneys, and this increases the potential for toxicity.)

A client is newly prescribed lithium carbonate (lithium). Which teaching point by the nurse takes priority? 1. "Make sure your salt intake is consistent" 2. "Limit your fluid intake to 2000 ml/day" 3. "Monitor your caloric intake because of potential weight gain " 4. " Get yourself in a routine to assist in avoiding relapse"

d (Rationale: Panic level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety.Text page: 213)

A client is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide eyed and seems terror stricken. He repeats "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as a. mild. b. moderate. c. severe. d. panic.

b (Sertraline is an antidepressant of the SSRI type. These agents work within 1 to 4 weeks. Option 1 is an insufficient amount of time, while options 3 and 4 are excessive as well as similar.)

A client is taking sertraline (Zoloft). The nurse explains to the client that how much time will pass before the onset of the medication occurs? A. 5 to 7 days B.1 to 4 weeks C. 4 to 6 weeks D. 4 to 8 weeks

a (A nontolerant drinker would evidence staggering, ataxia, confusion, and stupor at this blood alcohol level. Text page: 412)

A client was in an automobile accident. Although he has the odor of alcohol on his breath, his speech is clear and he is alert and answers questions posed to him. The law enforcement officer requests that the emergency department staff draw a blood sample for blood alcohol level determination. The level is determined to be 0.30 mg%. What conclusion can be drawn? A.The client has a high tolerance to alcohol. B.The client ate a high-fat meal before drinking. C.The client has a decreased tolerance to alcohol. D.No conclusions can be drawn from the data

d (Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants.)

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions she will take the medication along with the St. John's wort she uses daily. The nurse should A. agree that taking the drugs at the same time will help her remember them daily. B. caution the client to drink several glasses of water daily. C. suggest that the client also use a sun lamp daily. D. explain the high possibility of an adverse reaction.

a (Believing one can control drug use despite addiction to the substance is based on denial, escaping unpleasant reality by ignoring its existence. Text page: 407)

A client who is dependent on alcohol and drinks several six-packs of beer daily tells the nurse "Alcohol is no problem to me. I can quit anytime I want to." The nurse can assess this statement as indicating A.denial. B.projection. C.rationalization. D.reaction formation.

b (This response demonstrates empathy; in addition it focuses on the client's feelings)

A client with a bipolar mood disorder, maniac episode, says to the nurse, "I don't know what I'm doing here. I never felt better in my life; I've got the world on a string around my finger." What is the most therapeutic response to this comment? A. "Have you ever felt this way before?" B. "You are feeling pretty elated right now." C. "You've got the whole world on a string." D. "Why do you think you're feeling so good?"

b (Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, hypertensive crisis, and eventually a cerebrovascular accident.)

A client with severe depression has been regulated on a monamine oxidase inhibitor because trials of other antidepressants proved unsuccessful. She has a pass to go out to lunch with her husband. Given a choice of the following entrees, which can she safely eat? A. avocado salad plate. B. fruit and cottage cheese plate. C. kielbasa and sauerkraut. D. liver and bacon plate.

a (Rationale: Ataque de nervios, attack of the nerves, is a culture-bound syndrome that is seem in under educated, disadvantaged females of Hispanic ethnicity. Text page: 227)

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to: a. suddenly tremble severely b. Exhibit stoic behavior c. Report both nausea and vomiting d. Laugh inappropriately

a, c, d (Side effects include ejaculatory disorders, male genital disorders, and urinary frequency)

A depressed client has been receiving the SSRI paroxetine (PAxil). The nurse monitors this client for the side effects associated with this drug. Select all that apply. A. Sexual dysfunction B. Depressed Respiration C. Insomnia and restlessness D. Hypertension or hypotension E. Irregular menses or secondary amenorrhea

c (These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression.)

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with A. senile dementia. B. hypertensive crisis. C. psychomotor agitation. D. central serotonin syndrome.

c (Learned helplessness results in depression when the client feels no control over the outcome of a situation.)

A depressed client tells the nurse "There is no sense in trying. I am never able do anything right!" The nurse can identify this cognitive distortion as an example of A. self-blame. B. catatonia. C. learned helplessness. D. discounting positive attributes.

a (Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate.)

A depressed client tells the nurse "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by A. suggesting "Let's look at what you just said, that you can 'never do anything right.'" B. querying "Tell me what things you think you are not able to do correctly." C. asking "Is this part of the reason you think no one likes you?" D. saying "That is the most unrealistic thing I have ever heard."

d (The acute phase of depression therapy,6-12 weeks, is directed towards the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization.)

A depressed client tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment: A. for more than 4 months B. that is directed toward relapse prevention C. that focuses on prevention of future depression D. to reduce depressive symptoms

b (The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable.)

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will A. exhibit optimistic, energetic, playful behavior. B. adhere to follow-up medical appointments. C. take medication more than 50% of the time. D. use alcohol to moderate occasional mood "highs."

2 (Rationale: St. John's Wort has generally been shown to be effective as an antidepressant in cases of mild or moderate depression, but usefulness in severe depression has not yet been established. Studies have not shown whether it is safe to use during pregnancy or for children. Medications and supplements should not be mixed, because adverse reactions can occur. Because the FDA does not regulate St. John's Wort, safety cannot be guaranteed.)

A female patient tells the nurse that he would like to begin taking St. John's Wort for depression. What teaching should the nurse provide? 1. "St. John's wort should be taken several hours after your other antidepressant." 2. "St. John's wort has generally been shown to be effective in treating depression." 3. "This supplement is safe to take if you are pregnant." 4. "St. John's wort is regulated by the FDA, so you can be assured of its safety."

a (A matter of fact approach helps avoid a cycle in which the nurse expresses concern to a client who feels unworthy, which increases feelings of unworthiness)

A male client with the diagnosis of a bipolar disorder, depressed episode, is found lying on the floor in his room in the psychiatric unit. He states, "I don't deserve a comfortable bed; give it to someone else." The nurse's best response is: A. "Everyone has a bed. This one is yours" B. "Your are not allowed to sleep on the floor." C. "I don't understand why you are on the floor." D. "You are a valuable person. You don't need to lie on the floor."

b (Denial involves escaping unpleasant reality by ignoring its existence.Text page: 215)

A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use of A. altruism. B. denial. C. undoing. D. suppression

a (Whenever aggressive verbal or physical behaviors are demonstrated, a desirable goal is cessation of those behaviors. Verbal and physical aggression are most apt to occur when staff are trying to structure the client's behavior for his or her own safety or the safety of others.)

A manic client in the acute phase is verbally and physically aggressive to himself. The nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors has been identified. A desirable short-term goal would be that the client will A. Making no attempts at self harm within 12 hrs of admission. B. sleep soundly for 12 of the next 24 hours. C. willingly take prescribed medication as offered by staff within 24 hours of admission. D. develop psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

c (Distractibility works as the nurse's friend. Rather than discuss the invitation, the nurse may be more effective by redirecting the client.)

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be A. "What an offensive thing to suggest!" B. "I don't have sex with clients." C. "It's time to work on your art project." D. "Let's walk down to the seclusion room."

A medical emergency, peaks 2 -3 days, anxiety anorexia, hyperactivity A. Alcohol withdrawal B. Alcohol withdrawal delirium

c (The nurse should ask the technician to complete the report, since the technician witnessed the client fall.)

A mental health technician proceeds to help Nick take a shower. The technician gathers towels and belongings and helps him to the shower. As Nick opens the door to the bathroom and steps inside the door, he slips and falls on the floor. The technician reports this to the nurse. The nurse assess Nick who does not report any pain or injuries. The primary care provider is also notified. The nurse knows that an incident (variance) report must be completed. Who should the nurse ask to complete the incident report? A) The nurse should complete the full report. B) The nurse should help Nick complete the document. C) The nurse should ask the technician helping the client to complete the report. D) The nurse and health care provider should write the accounts of the incident.

b (Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.)

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies prevalence is A. "That is a good observation. Depression does mostly strike people older than 50 years." B. "Depression is seen in people of all ages, from childhood to old age." C. "Depression is most often seen among the middle adult age group." D. "The age of onset for most depressive episodes is given as 18 years."

b (Spending time with the client without making demands is a good way to show acceptance.)

A nurse caring for a nearly mute depressed client wishes to show acceptance of the client. An intervention that would meet this objective would be to say A. "I will be spending time with you each day to try to improve your mood." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "It is important for you to share your thoughts with someone who can help you evaluate whether your thinking is realistic."

a (Eye contact reflect a willingness to be open and connect with another person; usually this occurs when trust exists)

A nurse has been caring for a female client with the diagnosis of major depressive disorder. The nurse evaluates that a trusting relationship is beginning to develop when the client: A. Establishes eye contact with the nurse B. Accompanies the nurse to the dining room C. Responds to the nurse when asked a question D. Permits the nurse to get dressed in the morning

c (A simple daily routine is the least stressful and least anxiety producing)

A nurse is caring for several extremely depressed clients. The nurse determines that these clients seem to do best in seetings where they have: A. Multiple stimuli B. Varied activities C. Simple daily routines D. Opportunities for decision making

1 (Rationale: Problem solving involves figuring out how to deal with the situation. Asking what the patient's plans are to find a new job allows the patient to contemplate how to solve this problem. Calling others who are caring and may be helpful reflects the use of using social support. Redefining the situation to see the positive side and using it to one's advantage reflects the use of reframing. Discounting the situation by stating that it will be just fine reflects the negative stress response of wishful thinking.)

A patient has told the nurse that she knows she is going to lose her job, which scares her because she needs to work to pay her bills. Which nursing response reflects the positive stress response of problem solving? 1. "What are your plans to find a new job?" 2. "Can you call your parents to support you during this time?" 3. "Is it possible that this job loss is an opportunity to find a better paying job?" 4. "I'm sure everything will turn out just fine."

3 (Rationale: Biofeedback is accomplished through the use of sensitive instruments that provide immediate and exact information about muscle activity, brain waves, skin temperature, heart rate, blood pressure, and other bodily functions. The patient will not feel any type of electrical stimulation during the process of biofeedback.)

A patient is going to undergo biofeedback. Which patient statement requires further teaching by the nurse? 1. "This will measure my muscle activity, heart rate, and blood pressure." 2. "It will help me recognize how my body responds to stress." 3. "I will feel a small shock of electricity if I tell a lie." 4. "The instruments will know if my skin temperature changes.

1, 3, 5 (Rationale: Rationalization involves justifying one's illogical or maladaptive responses by developing acceptable explanations for them; this is evident in the patient's supporting his claim that he is not upset by stating that the visit was unimportant to him. Projection involves taking the unacceptable feelings that are within oneself and projecting them onto others, so that others, in the patient's view, possess them instead of the patient; this is in evidence here in the patient saying that he is not the angry one but that his family is angry with him instead. Denial is escaping anxiety by ignoring or denying its existence; an example of this is the patient's reporting that he is not angry. Introjection involves incorporating within oneself some distressing element from one's environment, e.g., a person who was raised by excessively critical parents assumes a very critical view of herself in adulthood. Regression involves coping by returning to an earlier developmental or functional stage, e.g., a patient who has been criticized by a peer assumes a fetal position and begins to rock back and forth. Dissociation involves responding to stress by separating oneself from one's reality, e.g., during an episode of abuse, a child psychologically detaches herself from the present and enters a fantasy state wherein she feels safe and is able to defend herself from abusers).

A patient, who seems to be angry when his family again fails to visit as promised, tells the nurse that he is fine and that the visit wasn't important to him anyway. When the nurse suggests that perhaps he might be disappointed or even a little angry that the family has again let him down, the patient responds that it is his family that is angry, not him, or else they would have visited. What defense mechanism(s) is this patient using to deal with his feelings? Select all that apply. 1. Rationalization 2. Introjection 3. Projection 4. Regression 5. Denial 6. Dissociation

b (An enabler is one who helps a substance-abusing client avoid facing the consequences of drug use. Text page: 418)

A person who covertly supports the substance-abusing behavior of another is called a(n) A. patsy. B. enabler. C. participant. D. minimizer.

c (Cyclothymia refers to mood swings involving hypomania and dysthymia of 2 years' duration. The mood swings are not severe enough to prompt hospitalization.)

A person who has numerous hypomanic and dysthymic episodes can be assessed as having A. bipolar II disorder. B. bipolar I disorder. C. cyclothymia. D. seasonal affective disorder.

c (Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.Text page: 216)

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is using A. projection. B. rationalization. C. reaction formation. D. undoing.

a (Option 1 is the only desirable outcome listed.)

A possible outcome criteria for a client with anxiety disorder is A. Client demonstrates effective coping strategies. B. Client reports reduced hallucinations. C. Client reports feelings of tension and fatigue. D. Client demonstrates persistent avoidance behaviors.

a (Rationale: Clients who must engage in compulsive rituals for anxiety relief are rarely afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. Text page: 220)

A potential problem that should be investigated for a client with severe obsessive-compulsive disorder is a. sleep disturbance. b. excessive socialization. c. command hallucinations. d. altered state of consciousness.

b ( For clients with bipolar disorders, it has been shown that long-term lithium therapy flattens the highs of the euphoric episodes and minimizes the lows of the depressed episodes)

A practitioner plans to have a client with the diagnosis continue taking lithium after discharge. The nurse identifies that the teaching about the medication plan is understood when the client states, "I know that this medication: A. Should be stopped if illness is suspected B. May need to be taken for the rest of my life C. Causes no serious side effects when taken correctly D. Will require me to increase the dosage at the beginning of a manic episode

d (The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is severely limited, and misinterpretation of reality may occur.)

A symptom associated with panic attacks is A. obsessions. B. apathy. C. fever D. fear of impending doom.

d (Withdrawal is the physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in amount.Text page: 403)

A syndrome that occurs after stopping use of a drug is A.amnesia. B.tolerance. C.enabling. D.withdrawal.

c (The client taking disulfiram has to avoid hidden sources of alcohol. Many cough syrups contain alcohol. Text page: 426)

A teaching need is revealed when a client taking disulfiram states A."I usually treat heartburn with antacids." B."I take ibuprofen or acetaminophen for headache." C."Most over-the-counter cough syrups are OK for me to use." D."I have had to give up using aftershave lotion."

1 (Rationale: All of the medications listed can be used to treat anxiety disorders, but benzodiazepines are the only type that are potentially addictive.)

A variety of medications are used in the treatment of severe anxiety disorders. Which class of medication used to treat anxiety is potentially addictive? 1. Benzodiazepines 2. Selective serotonin reuptake inhibitors (SSRIs) 3. Beta-blockers 4. Antihistamines 5. Buspirone

a, b, c

The neuro-transmitters of mania are: (Select all that apply) A. Serotonin B. Dopamine C. Norepinephrine D. GABA E. Epinephrine

c (Considering Maslow's hierarchy, physiologic needs should be addressed first, so this is the priority problem because the client is receiving inadequate sleep. Eating 50% of her meals is acceptable, provided that the client is not losing weight.)

According to the nursing progress notes, Anna demonstrates decreased social interaction, rarely talks, needs assistance to her room, appears confused, and only slept 30 minutes in the past 24 hours. The daily graphics indicate that she has slept an average of 2 hours in the past week. She is eating 50% of her meals. According to this data, what is the priority nursing problem? A) Disturbed thought processes. B) Impaired social interaction. C) Sleep disturbance. D) Nutrition imbalance.

a (The nurse must determine if the client has adequate support systems.)

Addiction treatment and interventions for maintenance are generally based on the idea of addiction as a disease, abstinence from all alcoholic substances, participation in a 12-step program such as Alcoholics Anonymous, and confrontation of denial and other defense mechanisms. By the fourth day of hospitalization, Nick has safely detoxed from alcohol and denies current thoughts of suicidal ideation. The nurse knows that he experienced a situational crisis, and the goal is for him to return to a pre-crisis level of functioning. Which question should the nurse ask Nick in order to determine whether or not he is able to return to a pre-crisis level of functioning? A) "Do you have support and people who can help you?" B) "How have you handled other crises?" C) "When did you begin to feel sad?" D) "What are some of your previous strengths?"

a (When assessing for suicidal ideation, the nurse must first determine if the client has a means to harm themselves, then the true desire to do self-harm. The second phase of suicide prevention involves making a no-self harm plan. Lastly, the presence/absence of a support system is useful information.)

After 4 weeks of therapy, Joan calls the clinic's emergency line. She is crying and reports that she "has nothing to live for." Which question should the nurse ask Joan first? A) How do you plan to hurt yourself? B) Do you want to carry out your plan? C) Is there anyone there with you? D) How can we make sure that you don't harm yourself?

d (If the client agrees to talk with staff if thoughts of self-harm occur, constant observation for safety can be changed. Risk for self-harm should continue to be assessed every shift)

After several days of constant observation, the nurse reassesses the need to maintain safety precautions. What will ensure that the client will be safe? A) Anna reports feeling less depressed and sleeping better. B) Staff document that Anna's mood is less depressed. C) There are no items in Anna's room to cause self-harm. D) Anna agrees to talk with staff if thoughts of self-harm occur.

b (The client should minimize or avoid substances with tyramine for 10 to 14 days after discontinuation of the medication.)

After several days of taking an MAO Inhibitor, Anna refuses to continue taking the medication and the medication is discontinued. Which specific nursing consideration is most important? A) Monitor blood pressure and orthostatic blood pressure. B) Maintain a low- or tyramine-free diet for 10 to 14 days. C) Arrange for liver function tests for hepatic dysfunction. D) Assess the client's mood and affect.

b (Antabuse inhibits the absorption of alcohol and raises the level of acetaldehyde, causing a severe reaction when alcohol is ingested.)

After three days in the Crisis Stabilization Unit, Nick exhibits no further withdrawal symptoms. The nurse collaborates with the social worker and health care provider to determine discharge plans. Nick wants to return to his job as soon as possible. Because he feels strongly tempted to drink at work, he requests disulfiram (Antabuse) therapy. He asks the nurse how Antabuse works. How should the nurse respond? A) Decrease cravings for alcohol. B) Inhibit absorption of alcohol. C) Block the effects of endorphins. D) Prevent client from drinking.

Alcohol Withdrawal Hallucinosis: Auditory, visual, tactile hallucinations (may describe as nightmares or vivid dreams) A. Onset: 6-24 hr; peaks 24-36; last 2wks B. Onset: 8-24hr, peak 24hr; occurly singly or burst over 1-6hr C. Onset: About 48hr, last up to 1 day, can last 2wks D. Onset:3-5 days, lasts 2-3 days, can last up to 50 days

Alcohol Withdrawal Medical Emergency: disorientation, delusions, (usually paranoid type); visual hallucinations continuation of early withdrawal symptoms but more pronounced A. Onset: 6-24 hr; peaks 24-36; last 2wks B. Onset: 8-24hr, peak 24hr; occurly singly or burst over 1-6hr C. Onset: About 48hr, last up to 1 day, can last 2wks D. Onset:3-5 days, lasts 2-3 days, can last up to 50 days

Alcohol Withdrawal Seizures: Generally major motor seizures A. Onset: 6-24 hr; peaks 24-36; last 2wks B. Onset: 8-24hr, peak 24hr; occurly singly or burst over 1-6hr C. Onset: About 48hr, last up to 1 day, can last 2wks D. Onset:3-5 days, lasts 2-3 days, can last up to 50 days

moderate

Alert; perception narrowed, focused. Optimum state for problems solving and learning. Attentive. This is what type of anxiety? (mild, moderate, severe, panic)

a (Manic clients often respond well to the invitation to write. They will fill reams of paper. While writing they are less physically active.)

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to A. write. B. exercise. C. direct unit activities. D. orient a new client to the unit.

c (Abstinence is a highly desirable long-term goal/outcome. It is a better outcome than short-term goal because lapses are common in the short term. Text page: 420)

An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will A.discuss the addiction with significant others. B.state an intention to stop using illegal substances. C.abstain from the use of mood-altering substances. D.substitute a less-addicting drug for the present drug.

b (The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate to perform with any client with higher levels of anxiety.)

An important question to ask in the assessment of a client with anxiety disorder is A. "How often do you hear voices?" B. "Have you ever considered suicide?" C. "How long has your memory been bad?" D. "Do your thoughts always seem jumbled?"

b (Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind.)

An obsession is defined as A. thinking of an action and immediately taking the action. B. a recurrent, persistent thought or impulse. C. an intense irrational fear of an object or situation. D. a recurrent behavior performed in the same manne

1, 2, 3, 4, 5, 6 (Rationale: Many medical conditions can cause or mimic anxiety. In an older adult, who would be more likely to have medical illnesses than a younger person, both diagnosed and undiscovered, it is especially important to rule out contributing medical conditions before assuming that symptoms resembling anxiety are of a mental health origin. Since disorders of the respiratory,circulatory, endocrine, metabolic, and neurological systems can all mimic anxiety or cause anxiety symptoms, further assessment of all these body systems is indicated. A professional in the role of patient advocate would use assertive communication techniques to alert the APRN to consider other possible causes for the patient's presentation before concluding that primary anxiety is behind the patient's symptoms. )

An older adult in the outpatient internal medicine clinic complains of feeling a sense of dread and fearfulness without apparent cause. It has been growing steadily worse and is to the point where it is interfering with the patient's sleep and volunteer work. After a brief interview and cursory physical exam, the APRN diagnoses the patient with generalized anxiety disorder and suggests a referral to the mental health clinic. Which response(s) by the clinic nurse would be appropriate? Select all that apply. 1. Complete a neurological history and neurological examination. 2. Examine the patient's extremities for edema, and listen to her lungs. 3. Observe the patient's respirations, and obtain a pulse oximetry reading. 4. Review the patient's current medications, and observe the patient's gait. 5. Suggest that a battery of blood tests, including a CBC, be ordered and reviewed. 6. Ask the APRN to review the nurse's findings before ordering the referral.

b (Risk for injury is a diagnosis of high priority for manic clients because of their hyperactivity. Lack of injury is a highly desirable outcome.)

An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client A. reports racing thoughts. B. is free of injury. C. is highly distractible. D. ignores food and fluid.

a (Opiate overdose results in lowered blood pressure with a rise in pulse rate along with respiratory depression. Text page: 414)

An unconscious client is admitted to the emergency department. The admitting diagnosis is "rule out opiate overdose." Which item of assessment data would be most consistent with opiate overdose? A.Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min B.Blood pressure, 120/80 mm Hg; pulse, 84 beats/min; respirations, 20 breaths/min C.Blood pressure, 140/90 mm Hg; pulse, 76 beats/min; respirations, 24 breaths/min D.Blood pressure, 180/100 mm Hg; pulse, 72 beats/min; respirations, 28 breaths/min

a (Auditory hallucinations are inconsistent with depression, and are more likely to occur with psychoses. However, clients may experience a psychotic depression in which there is evidence of psychosis.)

Anna is assessed by the nurse, social worker, and healthcare provider. Based on their assessments, hospitalization is recommended for psychotic depression. Which behavior is inconsistent with depression? A) Hearing a man's voice. B) Poor concentration. C) Poor grooming and hygiene. D) Slow motor activity.

d (The female counselor is an unlicensed staff member who can assume responsibility for the client's safety and maintain documentation. A female staff member is less threatening when the client desires as much privacy as possible.)

Anna is placed on constant observation for safety precautions, so the nurse must assign a staff member to remain with her at all times. Which staff member is best to assign to Anna? A) Registered nurse. B) Unlicensed male counselor. C) Medication nurse. D) Unlicensed female counselor.

b (Prozac is an SSRI antidepressant.)

Anna signs the treatment form and is admitted to the mental health unit. During the first days of hospitalization, she begins antidepressant therapy with Prozac, 10 mg. What classification of drugs is the antidepressant fluoxetine (Prozac)? A) Tricyclic. B) Selective serotonin reuptake inhibitor (SSRI). C) Nonbenzodiazepine. D) Atypical.

a (Initially, the nurse can convey hope for the client and reinforce that depression is a self-limiting disorder. The intent is not to cheer the client to offer hope, but to convey hope in a calm and reassuring manner.)

As the nurse initially communicates with the depressed Anna, which communication technique is important? A) Reinforce that she will progressively feel better. B) Calmly reassure her that everything will be fine. C) Explain that antidepressants are the best treatment option. D) Offer options for treatment that will support her needs.

c (Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world.)

Assessment of thought processes of a client with depression is most likely to reveal A. good memory and concentration. B. delusions of persecution. C. self-deprecatory ideation. D. sexual preoccupation.

c (Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: a negative, self-deprecating view of self, a pessimistic view of the world, and the belief that negative reinforcement will continue.)

Beck suggests that the etiology of depression is related to A. sleep abnormalities. B. serotonin circuit dysfunction. C. negative processing of information. D. a belief that one has no control over outcomes.

b, e (Anorexia and bulimia are both contraindications for Wellbutrin XL because of a higher incidence of seizures experienced by clients treated for bulimia. Clients with a history of seizures are at higher risk for seizures when taking Wellbutrin XL.)

Before Joan has the prescription for bupropion (Wellbutrin XL) filled, the nurse should ensure that the client has not experienced which problem(s)? (Select all that apply.) A) Tachycardia. B) Anorexia or bulimia. C) Peptic ulcer disease. D) Hypertension. E) Seizures.

d (Benzodiazepines act by binding to ã-aminobutyric acid-benzodiazepine receptor sites and produce a calming effect.Text page: 426)

Benzodiazepines are useful for treating alcohol withdrawal because they A.block cortisol secretion. B.increase dopamine release. C.decrease serotonin availability. D.bind to ã-aminobutyric acid-benzodiazepine receptors.

b (-Cocaine exerts two main effects on the body, both anesthetic and stimulant.)

Cocaine exerts which of the following effects on a client? A.Stimulation after 15 to 20 minutes B.Stimulation and anesthetic effects C.Immediate imbalance of emotions D.Paranoia

Cognitive restructuring helps a individual evaluate how rational and valid their thoughts, re-framing negative thoughts

a, b, d, f (A severe headache, nausea and vomiting, chest pain, and hypotension are unpleasant consequences of taking an aldehyde dehydrogenase inhibitor, disulfiram)

Consequences of drinking alcohol while taking disulfiram (Antabuse) include which of the following? (Select all that apply.) A) Severe headache. B) Nausea and vomiting. C) Bradycardia. D) Chest pain. E) Hypertension. F) Hypotension.

c (Rationale: Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions.)

D is going to be interviewed for a promotional position. As he enters the interview room he feels as though all his senses are very sharp. He is mildly tense but eager to begin the interview. D can be assessed as showing a. denial. b. compensation. c. normal anxiety. d. selective inattention.

d (Panic level anxiety is the most extreme level and results in markedly disturbed thinking.Text page: 213)

Delusionary thinking is a characteristic of: A. chronic anxiety. B. acute anxiety. C. severe anxiety. D. panic level anxiety

a (At this point, the client should be assessed for possible hospital admission.)

During the conversation with the nurse on the clinic's emergency line Joan tells the nurse that she has thought about taking an overdose. She tells the nurse that she has prescriptions for Xanax, and Wellbutrin XL. The nurse knows that an overdose of this combination of drugs could be lethal. How should the nurse respond to Joan? A) "Go to the hospital now because this is a serious situation." B) "I am going to call the police because I am concerned about your safety." C) "I think that I need to contact your family to tell them what you said." D) "Get rid of all that medication by flushing it down the toilet."

d (Dysthymia is a chronic condition that by definition has to have existed for more than 2 years.)

Dysthymia cannot be diagnosed unless it has existed for A. at least 3 months. B. at least 6 months. C. at least 1 year. D. at least 2 years.

c (The client should be encouraged to make an appointment so the client can discuss in depth the problems she is currently having. During the appointment, the need to reestablish care and a therapeutic relationship can be determined.)

Eight months after being discharged from the clinic, Joan calls the clinic and "wants to talk." How should the nurse respond to Joan's request? A) Allow Joan to talk as much as she needs to talk. B) Keep the conversation focused on superficial topics. C) Instruct the client to make an appointment for follow-up. D) Terminate the call as quickly as possible.

moderate

Feelings of readiness and challenge; energized. Engage in competitive activity and learn new skills. Voice, facial expression interested or concerned This is what type of anxiety? (mild, moderate, severe, panic),

mild

Feelings of relative comfort and safety. Relaxed, calm, appearance, and voice. Performance automatic habitual behaviors occur. This is what type of anxiety? (mild, moderate, severe, panic)

panic

Feels helpless with total loss of control. May be angry, terrified, may become combative or totally withdrawn, cry, or run. Completely disorganized. Behavior is usually extremely active or inactive. This is what type of anxiety? (mild, moderate, severe, panic)

severe

Feels threatened, startles with new stimuli feels an overload, activity may increase or decrease, may pace, run away, wring hands, moan, shake, stutter, become very disorganized or withdrawn, freeze in position/be unable to move. May appear and feel depressed. Demonstrates denial; may complain of aches or pains, may be agitated or irritable. Need for space increased. Eyes may dart around room, or gaze may be fixed. May close eyes to shut out environment. This is what type of anxiety? (mild, moderate, severe, panic

GAD, over 6 months, restlessness, fatigue, irritability

a (Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception.Text page: 214)

Generally, ego defense mechanisms: A. often involve some degree of self-deception. B. are rarely used by mentally healthy people. C. seldom make the person more comfortable. D. are usually effective in resolving conflicts

d (Limit unnecessary interactions will decrease stimulation and thus agitation)

How can a nurse minimize agitation in a disturbed client? A. Ensure constant staff contact B. Discuss the reasons for suspicious beliefs C. Increase environmental sensory stimulation D. Limit unnecessary interactions with the client

c (Rationale: Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener.Text page: 216)

If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to a. make jokes to relieve tension. b. miss appointments. c. justify illogical ideas and feelings. d. behave in ways that are the opposite of his or her feelings.

d (Flumazenil is the only drug available that acts as an antagonist to the benzodiazepines. Options 1 and 2 are benzodiazepines themselves, while option 3 is a selective serotonin reuptake inhibitor, SSRI, type of antidepressant.)

If an overdose of benzodiazepines is suspected, the nurse obtains which of the following medications to reverse that drug's effects as ordered? A. Diazepam (Valium) B. Triazolam (Halcion) C. Fluvoxamine (Luvox) D. Flumazenil (Romazicon)

3 (Rationale: Guided imagery is a process in which a person envisions images that are calm and peaceful. Focusing on a visual object or sound while becoming acutely aware of one's breathing pattern are associated with meditation. Development of deep abdominal breathing, also known as diaphragmatic breathing, is a form of breathing exercise.)

If it is determined that a patient will benefit from guided imagery, what teaching should the nurse provide? 1. Focus on a visual object or sound. 2. Become acutely aware of your breathing pattern. 3. Envision an image of a place that is peaceful. 4. Develop deep abdominal breathing.

a (Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred.)

Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of A. panic attacks with agoraphobia. B. obsessive-compulsive disorder. C. posttraumatic stress response. D. generalized anxiety disorder.

b (This statement suggests that the client's initial complaints have been resolved.)

Joan is admitted to the hospital for 5 days. She returns to the mental health clinic for a follow-up visit. She is now on 10 mg escitalopram (Lexapro) at bedtime and 150 mg bupropion (Wellbutrin XL) in the morning. Which statement by the client best suggests that the medication combination is working? A) "Thinking about committing suicide was a stupid thing." B) "The things that happen at work don't bother me so much." C) "I am having more success at getting things done" D) "Next time I feel so hopeless, I will call the clinic."

a (Learning how to say good-bye is a healthy coping skill.)

Joan is discharged from the clinic program after 6 more months because she feels she recognizes what aspects of her work caused her anxiety and she is able to deal with these problems at her job. The nurse-client relationship is terminated with Joan's discharge from the mental health clinic. What makes termination important to the nurse-client relationship? A) Termination teaches the client to resume a normal lifestyle. B) Those with mental illness have difficulties with termination. C) Saying good-bye allows for release of feelings of loss. D) Termination prevents further episodes of depression.

c (The individual with severe anxiety can only focus on a narrowed area of concern, such as Joan only focusing on her employer and coworkers.)

Joan meets with the APRN-PMH; during the session Joan tells the nurse that she has an extreme amount of stress at work. She has filed multiple harassment complaints against her boss. She states that she feels she has to "hold" herself to a "higher set of standards" than her coworkers because her boss uses a stricter set of standards for her performance appraisal. The nurse recognizes that Joan is experiencing what level of anxiety? A) Mild. B) Moderate. C) Severe. D) Panic.

a (Joan appears to be having significant anxiety as a result of her perception of her age, level of maturation, and its effect at her job. This perception is the only ideology the nurse can help Joan to overcome.)

Joan states that she is worried because she feels she is being singled out because she is the oldest of her coworkers, "Everyone thinks I should be doing better than I am because of my age." Which nursing diagnosis should the nurse add to Joan's plan of care? A) Anxiety related to maturational crisis. B) Hopelessness related to stress at work. C) Powerlessness related to work conflict. D) Social isolation related to work tension.

c (The nurse must understand the client's perception of the sources of her anxiety in order to help the client.)

Joan tells the nurse that she "believes in doing her job right." Joan goes on to say that she sees her boss as "out to get me because I am 52 years old." The nurse further inquires about the statements made by Joan about her feeling regarding the work environment. Which behavior should the nurse illicit from the client? A) Participating in developing a plan for managing anxiety. B) Identifying physical symptoms of stress. C) Stating the sources for present anxiety. D) Expressing the relationship between anxiety and stressors.

d (It is important for the nurse to understand the client's perception of the problems before making further recommendations.)

Joan tells the nurse that she sweats all the time and occasionally has chest pains. She also complains of numbness in her arms and hands. How should the nurse respond to Joan's comments? A) "Your complaints are probably due to anxiety." B) "When did you have your last check-up?" C) "Don't worry about those things right now." D) "Tell me more about your chest pain."

3 (Rationale: John is grieving for his lost co-workers and experiencing survivor's guilt, a common reaction when events cost some their lives while sparing others. He is also evidencing some symptoms associated with anxiety, such as tremor and being sometimes preoccupied with the stressful event. However, he is not experiencing key features of PTSD such as re-experiencing the tragedy, avoidance of focusing on or talking about the event, or emotional numbing. Acute stress disorder is characterized by the presence of at least three dissociative elements in response to a stressor, such as feeling unreal, being less aware of one's surroundings, or feeling a sense of unreality relative to oneself or one's environment. In this case, John is experiencing only two such symptoms and has others that are not part of acute stress disorder. As noted, John is experiencing grief and mild-to-moderate anxiety in response to the tragedy he witnessed; however, given the intensity of this tragedy, it is important to monitor John for signs of PTSD, because he is at risk for developing this disorder, which usually manifests within 3 months of the traumatic event. Failure to monitor for PTSD would place John at risk of developing this potentially disabling anxiety disorder, which in some patients can even lead to suicidal behavior. Therefore, although his levels of anxiety and grief are not pathological at this time, because he is at risk for PTSD, he does requirement further intervention in the form of periodic reassessment and support)

John, a construction worker, is on duty when a wall under construction suddenly falls, crushing a number of co-workers. Shaken initially, he seems to be coping well with the tragedy but later begins to experience tremors, nightmares, and periods during which he feels numb or detached from his environment. He finds himself frequently thinking about the tragedy and feeling guilty that he was spared while many others died. Which statement about this situation is most accurate? 1. John is experiencing posttraumatic stress disorder (PTSD) and requires therapy. 2. John has acute stress disorder and should be treated with antianxiety medications. 3. John is experiencing anxiety and grief and should be monitored for PTSD symptoms. 4. John is experiencing mild anxiety and a normal grief reaction; no intervention is needed.

b (Rationale: Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Text page: 213)

K has been getting mediocre grades in school. When she applies for admission at the upper division level, she is rejected on the basis of inadequate grades. Thereafter, K studies harder and receives better grades. K's behavioral change is rooted in: a. a rude awakening. b. normal anxiety. c. trait anxiety. d. altruism.

b, c

Major neurotransmitters associated with mood (Select all that apply) A. GABA B. Serotonin C. Norepinephrine D. Dopamine E. Epinephrine

Meditation is successful in promoting stress reduction because it A. prevents endorphin release. B. changes the client's energy field. C. quiets the sympathetic nervous system. D. activates the parasympathetic nervous system.

More common in females, onset age 20, hypomania and depression, alcohol abuse, commit suicide, thyroid disease A. Bipolar 2 B. Bipolar 1 C. Mania D. Cyclothymia

More common in males, onset age 18, act of violence: A. Bipolar 2 B. Bipolar 1 C. Mania D. Cyclothymia

b (Further assessment is needed to make a diagnosis of alcoholism, because the CAGE questionnaire is only a screening tool to identify alcohol abuse.)

Nick answers "yes" to two of the four questions on the CAGE questionnaire. What should the nurse do next? A) Take precautions for possible alcohol withdrawal. B) Further assess the client's drinking behaviors. C) Obtain blood alcohol content with a breathalyzer. D) Obtain a urine drug screen for polysubstance use.

a (-Tremors are an early sign of alcohol withdrawal. Text page: 410)

Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of A.tremors. B.seizures. C.blackouts. D.hallucinations.

a (A major site of alcohol absorption is in the small intestine, which interferes with adequate thiamine and all B vitamin absorption. Vitamin B deficiency can cause Wernicke's disease.)

On the second day of hospitalization, the nurse prepares to give Nick thiamine and a multivitamin. Magnesium chloride (Slow Mag) is also ordered to enhance the effectiveness of the thiamine. What is the rationale for giving thiamine (B1) and a multivitamin? A) Reduce the risk of Wernicke's disease. B) Prevent occurrence of delirium tremens. C) Lessen alcohol withdrawal symptoms. D) Help increase the client's appetite.

b (The nurse should begin constant observation immediately for safety precautions because the client is at risk for self-harm. The other interventions are important, but it is most important for a staff member to remain with the client.)

One morning the nurse is doing unit rounds and finds Anna sitting at the edge of her bed with a sheet around her neck. What is the first nursing action? A) Ask, "Are you feeling suicidal?" B) Stay with Anna. C) Take the client to the seclusion room. D) Document the incident in the chart.

c (Hypertension would be on Axis III, which includes physiologic problems.)

One morning the nurse takes Anna's morning blood pressure, which is 141/108. After reviewing the progress notes, there were several days when it was elevated. The nurse wants to validate if she has hypertension. Which DSM-IV-TR axis would the nurse use to interpret for the presence of hypertension? A) Axis I. B) Axis II. C) Axis III. D) Axis IV.

c (This is the first question in the questionnaire. In CAGE, C is for cut down.)

One of the simplest tools that a nurse can use to screen for alcoholism is the CAGE questionnaire. CAGE is an acronym that represents the four questions it contains. What is the first question that the nurse should ask Nick? A) "Have people annoyed you by criticizing your drinking?" B) "Have you ever felt bad or guilty about your drinking?" C) "Have you ever thought that you should cut down on your drinking?" D) "Have you ever had a drink first thing in the morning to steady your nerves or get rid of a hangover?"

c (Rationale: Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying.Text page: 226)

Panic attacks in Latin American individuals often involve a. repetitive involuntary actions. b. blushing. c. fear of dying. d. offensive vebalizations.

Peaks after 24-48hrs and ten rapidly and dramatically disappears unless it progresses. Grand mal seizures appear 7 to 48hrs after cessation. A. Alcohol withdrawal B. Alcohol withdrawal delirium

panic

Perception totally scattered or closed. Unable to take in stimuli. Problem solving and logical thinking highly improbable. Perception or unreality about self, environment, or event. Dissociation may occur. This is what type of anxiety? (mild, moderate, severe, panic)

severe

Perceptual field greatly narrowed. Problem solving difficult. Selective attention, focus on one detail, block out threatening stimuli. Distortion of time, things seem faster or slower than actual. Dissociative tendencies vigilambulism, automatic behavior. This is what type of anxiety? (mild, moderate, severe, panic)

mild

Perceptual field is broad. Awareness of multiple environmental and internal stimuli. Thoughts may be random but controlled. This is what type of anxiety? (mild, moderate, severe, panic)

panic

Person may be pale, BP decreases; hypotension. Muscle coordination poor. Pain, hearing sensations minimal. This is what type of anxiety? (mild, moderate, severe, panic)

Provides immediate and exact information regarding muscle activity, brain waves, skin temperature, heart rate, BP, and other bodily functions.Most effective for people with low to moderate hypnotic ability. A. Progressive Muscle Relaxation B. Guided Imagery C. Breathing Exercises D. Biofeedback

b (Liver disease can cause a change in tissues of the liver and result in an elevation of AST. The amount of AST in the blood is directly related to the number of damaged cells.)

Routine admission prescriptions include regular diet, nutrition consult, vital signs every 4 hours, CBC with differential, urinalysis, and urine drug screen. Since Nick reports a history of liver disease, the nurse reviews his lab results. 8. The nurse recognizes that which finding supports Nick probably has liver disease? A) Hyperkalemia. B) Increased aspartate aminotransferase (AST). C) Reduced alkaline phosphatase. D) Decreased uric acid.

c (A client with severe depression of any etiology will not have the mental or physical energy to engage in health-seeking behaviors. Further, her negative view of self and the world would preclude such thinking.)

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with postpartum depression. A. Impaired parenting B. Ineffective role performance C. Health-seeking behaviors D. Risk for impaired parent/infant/child attachment

b (When moderate anxiety is present the individual's perceptual field is reduced and the client is not able to see the entire picture of events.Text page: 213)

Selective inattention is first noted when experiencing anxiety that is: A. mild. B. moderate. C. severe. D. panic

d (Headaches can happen early in treatment, and clients must often be encouraged to continue taking their medication.)

Several days after starting the medication, Joan calls the office and tells the nurse that the Wellbutrin XL is giving her headaches. How should the nurse respond to Joan's complaint of headaches? A) "This medication often causes clients to have headaches." B) "Are you taking your medication daily at the same time?" C) "Have you been having any other physical problems?" D) "The headaches usually go away within a few days."

d (The most objective assessment related to the client's intake is frequent weighing to document any changes in weight that should be monitored more closely.)

Since Anna is eating 50% of her meals, which priority nursing intervention should be included on the treatment plan? A) Assess her appetite daily. B) Include double portions of food. C) Consult the unit dietician. D) Weigh weekly and document.

3 (Rationale: In this situation, the patient is demonstrating a severe level of anxiety as evidenced by his hyperventilation, increased purposeless motor activity, inability to focus to respond to his environment, and intensified somatic complaints. Patients at a severe level of anxiety are usually unable to focus sufficiently to engage in a conversation or process complex information. They respond better to short, direct statements or commands. Although the patient might benefit from sedating medication, as presented here, this intervention is more likely to be perceived as an ultimatum or a threat than a form of assistance and is likely to worsen his anxiety rather than calm him. Delaying the trial pass to the group home might also calm the patient but is not an appropriate first response; given that doing so would delay the patient's discharge, it would be better to withhold this response until less disruptive calming measures had been tried.)

Since learning that he will have a trial pass to a new group home tomorrow, Bill's usual behavior has changed. He has started to pace rapidly, has become very distracted, and is breathing rapidly. He has trouble focusing on anything other than the group home issue and complains that he suddenly feels very nauseated. Which initial nursing response is most appropriate for Bill's level of anxiety? 1. "You seem anxious. Would you like to talk about how you are feeling?" 2. "If you do not calm down, I will have to give you prn medicine to calm you." 3. "Bill, slow down. Listen to me. You are safe. Take a nice, deep breath." 4. "We can delay the visit to the group home if that would help you calm down."

a (It is best to plan rest periods according to the client's energy level, since some clients feel best in the morning and others feel best in the evening.)

Since the client has decreased energy, which intervention is best? A) Plan a scheduled rest period. B) Allow for short, frequent naps. C) Minimize caffeine in the morning. D) Excuse the client from exercise.

d (Self-monitoring tools promote independence and teach the client to track symptoms.)

The APRN-PMH changes the client's antidepressant to bupropion (Wellbutrin XL) 300 mg once a day and orders alprazolam (Xanax) 0.25 mg twice a day prn for the client's anxiety. When Joan picks up the prescription at the front desk she asks the nurse when to take the Xanax. How should the nurse answer Joan's question about when take the Xanax? A) "Twice a day only when you begin to feel anxious." B) "Before breakfast and after dinner when you feel your anxiety level begin to rise." C) "No more than twice per day for anxiety that is uncomfortable." D) "Measure your anxiety on a scale, then decide when to use Xanax, but do not exceed twice a day."

c (Continuing the medication for a minimum of 1 year decreases the chance for future episodes of depression.)

Six months after her initial presentation, Joan comes to the clinic for her regular visit. While waiting to be seen she tells the RN-PMH that she wants to stop taking her medication. How should the nurse respond to the client's statement? A) "The medication can be stopped now if you want to." B) "You must take your medicine for the rest of your life." C) "Most clients do better by taking the medicine for a year." D) "You can talk to the HCP about stopping your medicine."

b (Studies of clients with posttraumatic stress disorder suggest that the stress response of the hypothalamus-pituitary-adrenal system is abnormal.)

Studies of clients with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal? A. Brainstem B. Hypothalamus-pituitary-adrenal system C. Frontal lobe D. Limbic system

a (Symptoms of opioid withdrawal resemble the "flu," with runny nose, tearing, diaphoresis, muscle aches, cramps, chills, and fever.)

Symptoms that would signal opioid withdrawal include A.lacrimation, rhinorrhea, dilated pupils, and muscle aches. B.illusions, disorientation, tachycardia, and tremors. C.fatigue, lethargy, sleepiness, and convulsions. D.synesthesia, depersonalization, and hallucinations.

Tensing group muscles, starting with feet ending at face, as tightly as possible for 8 seconds and suddenly releasing them. Helpful for tension headaches. A. Progressive Muscle Relaxation B. Guided Imagery C. Breathing Exercises D. Biofeedback

c (Zolpidem, Ambien, is a sedative-hypnotic medication used to treat insomnia. Therefore, disturbed sleep pattern is the appropriate priority nursing diagnosis. There is not enough information in the question to determine whether self-care deficit, risk for violence, or deficient fluid volume would be pertinent for the client. )

The client is taking zolpidem (Ambien). What would be a priority nursing diagnosis for this patient? A. Self-care deficit B. Risk for violence C. Disturbed sleep pattern D. Deficient fluid volume

b (Prior to initiating therapy with Carbamazepine, tegretol, baseline LFTs and a CBC should be performed. These labs should be monitored periodically throughout treatment. A risk of increased in blood glucose is associated with several atypical antipsychotics. A baseline thyroid profile is recommended before initiation of lithium therapy)

The client who has a diagnosis of bipolar I disorder has a new order for the antimaniac drug, Carbamazepine (Tegretol). Before beginning to administer the medication, the nurse checks to see that which laboratory results are in the client's record? A. Blood glucose B. Liver function studies C. Bleeding and clotting time D. Thyroid profile

b (These defenses are termed mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses.Text page: 215)

The defense mechanisms that can only be used in healthy ways are A. suppression and humor. B. altruism and sublimation. C. idealization and splitting. D. reaction formation and denial.

a (Lithium, a mood stabilizer, is the first-line drug for use in treating bipolar disorder.)

The first-line drug used to treat mania is A. lithium. B. carbamazepine. C. lamotrigine D. clonazepam.

b (wellbutrin can increase the risk of seizures in patients with seizure disorder or patients at risk of seizures)

The hospitalized client has begun taking an atypical antidepressant Bupropion (Wellbutrin) as an antidepressant agent. The nurse monitors this client for which adverse effect indicating that the client is taking an excessive amount of medication? A. Constipation B. Seizure activity C. Increased weight D. Dizziness when getting upright

panic

The individual who is in a state of ______ has intense physical symptoms of anxiety such as chest pain, diaphoresis, and shortness of breath without an identifiable cause. This is what type of anxiety? (mild, moderate, severe, panic)

b (The priority nursing action is the assessment of the client's anxiety level.Text page: 213)

The initial nursing action for a newly admitted anxious client is to A. assess the client's use of defense mechanisms. B. assess the client's level of anxiety. C. limit environmental stimuli. D. provide antianxiety medication.

d (Fear is a response to an objective danger; anxiety is a response to a subjective danger.)

The major distinction between fear and anxiety is that fear: A. is a universal experience; anxiety is neurotic. B. enables constructive action; anxiety is dysfunctional. C. is a psychological experience; anxiety is a physiological experience. D. is a response to a specific danger; anxiety is a response to an unknown danger.

The major neurotransmitter associated with suicide is low levels of: A. GABA B. Serotonin C. Norepinephrine D. Dopamine

d (Relapses can point out problems to be resolved and can result in renewed efforts for change. Text Page: 424)

The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses A.are an indicator of treatment failure. B.are caused by physiological changes. C.result from lack of good situational support. D.can be learning situations to prolong sobriety

b (Rationale: Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population.Text page: 225)

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal: a. a history of childhood trauma b. a sibling with the disorder c. an eating disorder d. a phobia as well

d (Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects. Text page: 236)

The nurse caring for a client with a panic attack might anticipate that the psychiatrist would order a stat dose of a. standard antipsychotic medication. b. tricyclic antidepressant medication. c. anticholinergic medication. d. a short-acting benzodiazepine medication.

a (The nurse must assess the content of the auditory hallucinations for the presence of command hallucinations)

The nurse completes a physical assessment. When asked what brought her to the hospital, Anna replies, "Things just aren't right" and begins to cry. After further conversation, Anna describes her mood as "very sad now." She rarely goes out or invites friends to visit. She admits that she feels like strangers are saying bad things about her. Sometimes she hears a man's voice that is a "little bit scary." What question should the nurse ask as a priority nursing assessment? A) "What is the voice saying to you?" B) "How long have you been hearing the voice?" C) "Have you ever been hospitalized for depression?" D) "Where do you see these strangers?"

d (The client is at risk for self-harm, because he had thoughts of jumping off the bridge. Risk for self-harm is a priority problem for hospitalization.)

The nurse completes the assessment and reports the findings to the health care provider. The health care provider talks with Nick and decides to admit him to the crisis unit with an admitting diagnosis of alcohol dependency and depression with suicidal ideation. What data supports the need for admission to the hospital? A) Drinking alcohol and potential withdrawal. B) Ineffective denial about severity of problem. C) Elevated vital signs and liver disease. D) Thoughts of wanting to jump off a bridge.

c (Trazodone is an atypical antidepressant that is used more for insomnia than for depression. Abuse potential is minimal, so option 4 is incorrect. Option 1 for safety reasons, is not a good practice when taking trazodone as a sleep aid, and option 2 is incorrect because taking more fluids will not increase the effectiveness of the medication.)

The nurse concludes that the client understands the desired effects and major side effects of trazodone (Desyrel) when he makes which of the following statements? A. "I know I will be able to get up and go downstairs to the bathroom during the night as long as I leave a nightlight on." B. "I am drinking more fluids now that I am taking this medication so it will work the way it is supposed to." C. "This medicine should help me sleep without having to worry about becoming addicted to it, and if I have a problem with priapism, I will notify my doctor immediately." D. I will feel more energetic after 3 or 4 weeks of taking this medication, and I understand I must take it only as prescribed so that I will not become addicted to it."

b (The medication normally works within 30 minutes to 1 hour after administration, making option 2 correct. Option 1 is incorrect because the client should not be watching stimulating shows on television before trying to fall asleep. Option 3 is incorrect because the medication will not work instantly. Option 4 is incorrect because the client should not take a sedative and then stay active for 30 minutes to 1 hour after taking the medication.)

The nurse determines that the client understands the effects of flurazepam (Dalmane) ordered at a dose of 30 mg by which of the following client statements? A. "After I take my medications at bedtime, I should be able to watch the boxing match or late night TV show, then go to bed and sleep." B. "Once I take my medicine, I should be able to go to bed and read, and I will fall asleep within 1 hour." C. "I will take my medicine, go to bed, and go to sleep." D. "I will take my medicine, make my lunch for tomorrow, take my shower, and get my clothes ready for work tomorrow, and they go to bed."

c (Initial client teaching requires the expertise of the nurse.)

The nurse enters Nick's room to assess his readiness for teaching related to local 12-step programs, and observes the UAP already providing Nick with information about local programs. What action should the nurse take? A) Document that the initial client teaching was completed by the UAP. B) Praise the UAP for saving the nurse time to complete higher priority tasks. C) Instruct the UAP that initial client teaching must be performed by the nurse. D) Request that the UAP be assigned to another unit.

a (Benzodiazepines potentiate the effects of GABA, which has a calming effect.)

The nurse gives Nick a benzodiazepine for alcohol withdrawal symptoms. What is the therapeutic action of benzodiazepines? A) Potentiate effects of GABA. B) Block reuptake of dopamine. C) Block reuptake of serotonin. D) Activate opioid receptors.

1, 3, 5 (Rationale: The plan of care has been effective when the patient can identify signs and symptoms of relapse, describe the purpose of his medications, and describe problem-solving techniques. Stating that his wife does not mind his drinking indicates that the patient has not assumed responsibility for the consequences of substance addictions that may contribute to future relapse. Stating that he does not have a disease indicates that the patient does not fully understand the)

The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? Select all that apply. 1. Patient identifies three signs and symptoms of relapse. 2. Patient states, "My wife doesn't mind if I still drink a little." 3. Patient describes the purpose of each medication he has been prescribed. 4. Patient states, "I no longer have a disease." 5. Patient identifies two ways to problem-solve a specific situation.

1 (Rationale: Patients experiencing mania have the ability to staff split, or divide the staff into "good guys" or "bad guys." Providing consistency among all staff members is imperative. Limits must be set and carried out by all staff members if the plan of care is to be effective. Because the nurse cannot control the patient's emotions, the preferred approach is to establish and maintain limits for the duration of admission. )

The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? 1. Provide consistency among staff members when working with the patient. 2. Negotiate limits so the patient has a voice in the plan of care. 3. Allow only certain staff members to interact with the patient. 4. Attempt to control the patient's emotions.

4 (Rationale: Psychotic features of MDD include the presence of disorganized thinking, delusions, and/or hallucinations. Catatonic MDD is marked by nonresponsiveness and extreme psychomotor retardation. Atypical MDD refers to people who have dominant vegetative symptoms such as overeating and oversleeping. Melancholic MDD is characterized by severe apathy, weight loss, profound guilt, and, often, suicidal ideation)

The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which type of major depressive disorder (MDD)? 1. Catatonic 2. Atypical 3. Melancholic 4. Psychotic

2 (Rationale: During the stage of alarm, sympathetic nervous system activity increases. Heart rate, respirations, and blood pressure increase to enhance strength and speed, while pupils dilate to provide a broad view of the environment. Blood is shunted away from the digestive tract to the more essential organs, which results in a slowing in digestion and dry mouth. )

The nurse is caring for a patient who is experiencing a crisis. Which symptoms would indicate that the patient is in the stage of alarm? 1. Constricted pupils 2. Dry mouth 3. Decrease in heart rate 4. Sudden drop in blood pressure

2 (Rationale: Confusion is an anticipated adverse effect of lithium. Other potential adverse effects include polyuria, diarrhea, and hypothyroidism.)

The nurse is caring for a patient who is taking lithium. Which adverse effect would the nurse anticipate? 1. Oliguria 2. Confusion 3. Constipation 4. Hyperthyroidism

2 (Rationale: Flashbacks occur in a drug-free state and involve visual distortions, time expansion, loss of ego boundaries, and intense emotions. Often flashbacks are mild and perhaps pleasant, but at other times, individuals experience repeated recurrences of frightening images or thoughts. Tolerance occurs when a patient's physiological reaction to a drug decreases with repeated administration of the same dose. Withdrawal causes physiological changes to occur when blood and tissue concentrations of a drug decrease in individuals who have maintained heavy and prolonged use of a substance. The term synergistic effect is utilized when drugs are taken together and the effect of either or both drugs is intensified.)

The nurse is caring for a patient with an addictive disorder who is currently drug-free. The patient is experiencing repeated occurrences of vivid, frightening images and thoughts. Which term would the nurse use to document this finding? 1. Tolerance 2. Flashbacks 3. Withdrawal 4. Synergistic effect

3 (Rationale: Males are diagnosed with substance abuse concerns at higher rates than females and are twice as likely to meet criteria for a drug use disorder. When compared to other ethnic groups in the general U.S. population, Native Americans and Alaskan Natives have the highest prevalence of alcohol dependence and are more likely to have used illicit substances)

The nurse is caring for four patients. Which patient should be seen first, based upon substance-abuse risk potential? 1. Female patient of Caucasian descent 2. Female patient of Japanese descent 3. Male patient of Native American descent 4. Male patient of African American descent

4 (Rationale: The life stressor situation perceived most difficult is the death of a spouse. All other losses, despite the fact that they still impact the patient, are perceived as less difficult than that of a spouse)

The nurse is caring for four patients. Which patient would be at highest risk for psychosocial compromise? The patient who has experienced: 1. the death of a friend. 2. a divorce. 3. a recent job layoff. 4. the death of a spouse.

a (Given the client's statement, the nurse needs to further assess the client's relationship with the boss.)

The nurse is concerned about Joan's apparent continuing difficulties with her boss. In considering Joan's statements about her interactions with her boss, which standard of the ANA Psychiatric - Mental Health Nursing care should the nurse apply to the current situation? A) Assessment. B) Nursing Diagnosis. C) Outcome Identification. D) Planning.

b (Parnate is an MAOI and patients should avoid foods with tyramine such as salami, a cured meat)

The nurse is conducting discharge teaching for a client taking an antidepressant Tranylcypromine (Parnate). The nurse determines that the client understands the instruction given if the client says not to eat which food while taking the medication? A. Potatoes B. Salami C. Baked chicken D. Apples

b( Prozac an SSRI with the most common side effects being sexual dysfunction and GI dysfunction, cramping, diarrhea, nausea)

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking Fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side effects of the medication? A. Cardiovascular symptoms B. Gastrointestinal dysfunctions C. Problems with mouth dryness D. Problems with excess sweating

1 (Rationale: Safety is always the highest priority in planning care. All other interventions may be included in the plan of care, but the priority is to keep the patient safe.)

The nurse is planning care for a patient experiencing the acute phase of mania. Which is the priority intervention? 1. Prevent injury. 2. Maintain stable cardiac status. 3. Get the patient to demonstrate thought self-control. 4. Ensure that the patient gets sufficient sleep and rest

2 (Rationale: Safety is always the highest priority in planning care. Even if the patient has not exhibited a risk for self-harm, the potential for this must be addressed with patients who have depression.)

The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be the priority on the nurse's discharge plan of care? 1. Pharmacological teaching 2. Safety risk 3. Awareness of symptoms increasing depression 4. The need for interpersonal contact

b (A VDRL, RPR, is a serum screening test for syphilis, which can be undetected and dormant and cause cognitive impairment in later stages. If the screening serum test is positive, a more specific test is required to make the diagnosis of syphilis.)

The nurse is reviewing Anna's admission lab work on the third day of hospitalization. Admission labs include thyroid profile, urinalysis, chemistry panel, pregnancy test, urine drug screen, and VDRL (RPR). The nurse understands that a VDRL is routinely done on admission for which reason? A) Routine screenings for STDs are necessary. B) It is a screening test for syphilis. C) Abnormal thyroid levels require treatment. D) If positive, isolation is necessary.

2 (Rationale: Selective serotonin reuptake inhibitors, SSRIs, should be given 2 to 5 weeks before starting an MAOI to avoid serotonin syndrome. Therefore, the nurse should question this initial order. Low initial doses of a tricyclic antidepressant, ECT to treat suicidal thoughts, and Elavil to address agitation are all considered appropriate therapies.)

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? 1. A low starting dose of a tricyclic antidepressant 2. An SSRI given initially with an MAOI 3. Electroconvulsive therapy to treat suicidal thoughts 4. Elavil to address the patient's agitation

d (The nurse is encouraging the client to focus on her feelings so she will be able to recognize when stressful events occur and deals with the feelings.)

The nurse knows that Joan is still easily upset by her boss' behavior. How should the nurse respond to Joan? A) "This is different from the way you have previously talked about your boss." B) "I wonder what going back to work with your boss is like for you." C) "Can you tell me more about how you plan to interact with your boss?" D) "How do you feel when your boss says something that upsets you?"

d (African-Americans are more likely than Caucasians to develop high blood pressure. Other risk factors include a sedentary lifestyle and alcohol consumption.)

The nurse knows that there are several risk factors for high blood pressure. Which risk factor does Anna have? A) Depression. B) Decreased energy. C) Female. D) African-American.

a (This response changes the subject; it is better to continue the same subject)

The nurse manager is evaluating a primary nurse's ability to develop a therapeutic relationship. A client with a bipolar mood disorder, maniac phase, has been hyperactive and sarcastic. This behavior has been decreasing and the client states, "My husband and I have problems because we see things differently." What response indicates to the nurse that the primary nurse is not being therapeutic? A. "Do you know why you are feeling calmer today?" B. "Not getting along with one's spouse is upsetting." C. "Can you explain what you mean by seeing things differently?" D. "Tell me about a specific time when you have had problems with your husband."

a (Involuntary treatment can be initiated if the client is unable to meet basic self-care needs in such a way that he/she is a danger to self. It can also be initiated if a client presents an intentional danger to self or others.)

The nurse must ask the client to sign consent for treatment. If the client refuses treatment, which behavior justifies short-term involuntary treatment? A) Unable to meet basic self-care. B) Experiencing auditory hallucinations. C) Living alone and lack of social support. D) Prior hospitalizations for depression.

d (The client should avoid any product with alcohol: cough medicines, rubbing compounds, vinegar, aftershave lotions, and some mouthwashes.)

The nurse must explain the potential consequences of drinking alcohol and all products with alcohol. Which product is acceptable for Nick to use? A) Cough medicine. B) Mouthwash. C) Aftershave lotion. D) Petroleum jelly.

b (Headache, nausea, and muscle aches are common side effects. Confusion and disorientation are short-term)

The nurse must teach the client about possible adverse effects from the ECT treatments. Which information should be included in the teaching plan? A) The severity of side effects depends on the depth of depression. B) Headache, nausea, and muscle aches may occur after the treatment. C) The discomfort from ECT is similar to any surgical procedure. D) ECT is usually given once a week for 6 to 8 weeks.

a, e (Insomnia is a common side effect of Zoloft therefore it is prescribed to be taken in the morning so it will not interrupt with sleep. Sexual dysfunction is also a common side effect, not only of Zoloft, but of other SSRIs.)

The nurse needs to teach a client about newly prescribed SSRI Sertraline (Zoloft). Which information is essential to include in the teaching? Select all that apply. A. Sertraline is most often taken as a morning dose B. Constipation is a common side effect of Sertraline C. Fever and flu-like symptoms are bothersome but not dangerous side effects of Sertraline D. Clients taking Sertraline will usually recognize improvement within one week E. It is possible that sexual side effect will occur

b (Since Nick has compromised liver function, a short-acting benzodiazepine such as Ativan is best to give for withdrawal, because it does not have active metabolites that can affect a diseased liver. Lorazepam, Ativan, is often given if a client has known liver disease or decreased liver function.)

The nurse performs the withdrawal assessment and observes that Nick has moderate tremors and reports nausea. Which intervention should the nurse implement? A) Ask the primary health care provider if Nick could be prescribed chlordiazepoxide (Librium). B) Administer lorazepam (Ativan) 2 mg PO. C) Reassess vital signs in 2 hours. D) Place Nick on a continuous pulse oximetry monitor.

b (A restricted salt diet can help minimize hypertension and reduce fluid retention.)

The nurse reports the elevated blood pressure to the healthcare provider, and Anna is prescribed hydrochlorothiazide (Hydro-Chlor) 25 mg daily (a diuretic). The nurse collaborates with the dietician about Anna's meal plan. Which recommendation is best to minimize the risk of hypertension? A) 1200 calorie diet. B) No added salt to diet. C) Low cholesterol diet. D) High protein, low fiber diet.

c (GI disturbances such as nausea and diarrhea, as well as genitourinary side effects such as sexual dysfunction, are common with SSRIs. SSRIs do not have significant anticholinergic, cardiovascular, or sedative side effects)

The nurse should be aware of common side effects of SSRI antidepressants such as Prozac. Which side effects commonly occur in clients who are taking SSRI antidepressants? A) Anticholinergic effects. B) Extrapyramidal side effects. C) Gastrointestinal disturbances. D) Neuroleptic malignant effects.

a (Keep the client's room door open so that the client will remain in eye sight at all times. Even if the client goes to the bathroom, the door should be kept open.)

The nurse stays with Anna until another staff member arrives and safety precautions are initiated. The staff must keep Anna in eye sight at all times and document her activity every 15 minutes. When Anna wants to change clothes and get ready for sleep at night, what should the staff do? A) Keep the door to Anna's room open. B) Allow only 3 minutes for Anna to dress. C) Only allow Anna to change in the bathroom. D) Allow Anna to change in the unit bathroom.

a (SSRIs are more widely prescribed than tricyclics because they have fewer side effects, and tricyclics can be lethal in an overdose because they are cardiotoxic.)

The nurse understands that SSRIs are now more widely prescribed than tricyclics for antidepressant therapy. What is the rationale? A) Tricyclics are more lethal in an overdose. B) SSRIs are less likely to be abused. C) Tricyclics are less potent than SSRIs. D) SSRIs more effectively treat depression.

b (Client body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis.)

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client with severe depression. The most reliable evaluation of outcomes will be based on A. energy level. B. weekly weights. C. observed eating patterns. D. client statement of appetite.

a (The effects of opiates can be negated by a narcotic antagonist such as naloxone. Text page: 404)

The only class of commonly abused drugs that has a specific antidote is A.opiates. B.hallucinogens. C.amphetamines. D.benzodiazepines.

b (Manic clients often manage to dress and apply makeup in ways that create a colorful, even bizarre, appearance.)

The physician tells the nurse "Mrs. G's appearance is that of a typical manic client." The nurse can expect Mrs. G to be attired in clothing that is A. dark colored and modest. B. colorful and outlandish. C. compulsively neat and clean. D. ill-fitted and ragged.

c (Rationale: Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. Text page: 238)

The plan of care for a client with obsessive-compulsive disorder who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? a. Having client repeatedly touch "dirty" objects b. Not allowing client to seek reassurance from staff c. Not allowing the client to wash hands after touching a "dirty" object d. Telling the client that he or she must relax whenever tension mounts

d (The symptoms of anxiety can be caused by a number of physical disorders or are said to be caused by an underlying physical disorder. The treatment for secondary anxiety is treatment of the underlying cause.)

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is A. legal protection. B. to establish nursing diagnoses of priority. C. to provide information about client psychosocial background. D. to determine if the anxiety is of primary or secondary origin.

a (Risk for injury is high, related to the client's hyperactivity and poor judgment.)

The priority nursing diagnosis for a hyperactive manic client during the acute phase is A. risk for injury. B. ineffective role performance. C. risk for other-directed violence. D. impaired verbal communication.

d (Tolerance is defined as the need to take higher and higher doses of a drug to achieve the desired effect. Text page: 403)

The term tolerance, as it relates to substance abuse, refers to A.use of a substance beyond acceptable societal norms. B.the additive effects achieved by taking two drugs with similar actions. C.the signs and symptoms that occur when an addictive substance is withheld. D.the need to take larger amounts of a substance to achieve the same effects.

The triangular SIGN has 3 LINEs, LINEs, LINEs The tricycle is MINE, MINE, MINE (tca, not first-line, side effects, AmitriptyLINE, NortriptyLINE, ProtriptyLINE , ImipraMINE, ClomipraMINE , DesipraMINE, SINEquan)

The triangular SIGN has 3 LINEs, LINEs, LINEs The tricycle is MINE, MINE, MINE

d (With an MAOI such as phenelzine, the client must eliminate foods that contain tyramine. Intake of tyramine containing foods could lead to severe hypertension and other complications. All of the other considerations are not major teaching considerations for MAOIs.)

The visiting nurse is evaluating for client safety. The client is taking phenelzine (Nardil). A priority of the nurse's teaching includes which of the following: A. Limiting daily intake of salt B. Encouraging a fluid intake of at least 2000mL C. Encouraging the client to have scheduled blood tests on time D. Eliminating foods containing tyramine

a (Many clients find that taking lithium with or shortly after meals minimizes gastric distress.)

What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach? A. Take it with meals B. Take it with an antacid C. Take it 30 minutes before meals D. Take it 2 hours after meals

a (Lithium should not be given to clients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally.)

To plan care for a manic client the nurse must consider that lithium cannot be started until A. the physical examination and laboratory tests are analyzed. B. the initial doses of antipsychotic medication have brought behavior under control. C. seclusion has proven ineffective as a means of controlling assaultive behavior. D. electroconvulsive therapy can be scheduled to coincide with lithium administration.

a (Most fruits are safe, except figs, especially if overripe, and bananas in large amounts. Some foods with tyramine can be used with caution.)

Unsafe foods have high tyramine content, and safe foods have little or no tyramine. Which food would be considered safe? A) Most fruits. B) Most cheeses. C) Aged meats. D) Imported beers.

Usually begins in adolescence or early adulthood; increased risk of being diagnosed as bipolar A. Bipolar 2 B. Bipolar 1 C. Mania D. Cyclothymia

moderate

Vital signs normal or slightly elevated. Tension experienced; may be uncomfortable or pleasurable, labeled as "tense or excited". This is what type of anxiety? (mild, moderate, severe, panic)

mild

Vital signs normal. Minimal muscle tension. Pupils normal, constricted. This is what type of anxiety? (mild, moderate, severe, panic)

a( The client would be living in the community during the maintenance phase. Keeping follow-up appointments is highly desirable.)

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? A. Withhold medication and notify the physician B/ Continue to administer medication as ordered Advise the client to limit fluids for 12 hours Advise the client to curtail salt intake for 24 hours

b (Epidemiology reports tell us the onset of most anxiety disorders is before age 40 years.Text page: 230)

What can be said about the age of onset of most anxiety disorders? Onset is A. before age 20 years. B. before age 40 years. C. after age 40 years. D. scattered throughout the lifespan.

b (In many instances where one anxiety disorder is present, a second one coexists. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.)

What can be said about the comorbidity of anxiety disorders? A. Anxiety disorders exist alone. B. A second anxiety disorder may coexist with the first. C. Anxiety disorders virtually never coexist with mood disorders. D. Substance abuse disorders rarely coexist with anxiety disorders.

3 (Rationale: Lithium, although not a cure, is effective in controlling hypersexuality and feelings of anxiety, elation, grandiosity, and expansiveness. It takes 7 to 14 days and sometimes longer to reach therapeutic levels in the patient's blood.)

What critical information should the nurse provide about the use of lithium? 1. "You will still have hypersexual tendencies, so be certain to use protection when engaging in intercourse." 2. "Lithium will help you to only feel the euphoria of mania but not the anxiety." 3. "It will take 1 to 2 weeks and maybe longer for this medication to start working fully." 4. "This medication is a cure for bipolar disorder."

c (Clients who suffer from anxiety may experience increased anxiety when taking this antidepressant.)

What information should the nurse discuss with Joan about Wellbutrin XL? A) Take at bedtime. B) May cause hand tremors. C) Anxiety level may increase. D) Use every other day.

d (If indicators of impaired practice are observed, the observations need to be reported to the nurse manager. Intervention is the responsibility of the nurse manager and other nursing administrators. However, clear documentation, specific dates, times, events, consequences, by co-workers is crucial. The nurse manager's major concerns are with job performance and client safety. Reporting an impaired colleague is not easy, even though it is our responsibility. To not "see" what is going on, nurses may deny or rationalize, thus enabling the impaired nurse to potentially endanger lives while becoming sicker and more isolated. Impairment can occur whether the nurse is under the influence of alcohol or a narcotic drug. Text page: 417)

What is the ethical obligation of the nurse who has seen a peer divert a narcotic compared with the ethical obligation when the nurse observes a peer to be under the influence of alcohol? A.The nurse should immediately report the peer who is diverting narcotics and should defer reporting the alcohol-using nurse until a second incident takes place. B.Neither should be reported until the nurse has collected factual evidence. C.No report should be made until suspicions are confirmed by a second staff member. D.Supervisory staff should be informed as soon as possible.

c (The major action of SSRIs is to selectively inhibit the reuptake of serotonin and increase the availability of serotonin.)

What is the major action of SSRI antidepressants? A) Enhance GABA. B) Potentiate serotonin and norepinephrine. C) Increase availability of serotonin. D) Stimulate the release of serotonin.

a (The most important consideration is the availability of resources to the client after discharge. These resources can include counseling with significant others, group therapy, and self-help groups such as Alcoholics Anonymous.)

What is the most important consideration for discharge planning? A) Resources available to the client after discharge. B) Client's knowledge of the ongoing disease process. C) Longest period of sobriety and potential for relapse. D) Acceptance of Alcoholics Anonymous for abstinence.

c (Assessment for dangerousness to oneself or others is always the first priority when assign the depressed client.)

What is the most important question the nurse should ask the client once the client is taking the medication Wellbutrin XL? A) "How have things changed since starting the Wellbutrin XL?" B) "Have you felt more anxious on the increased Wellbutrin XL?" C) "Have you had any suicide thoughts since starting Wellbutrin XL?" D) "Has your energy improved since increasing your Wellbutrin XL?"

d (The priority problem is thoughts of self-harm. Safety to the client and others is a priority in crisis situations.)

What is the priority nursing problem for the initial crisis plan for a suicidal alcoholic? A) Drinking alcohol to ineffectively cope. B) Ineffective denial about severity of problem. C) Elevated vital signs and liver disease. D) Thoughts of wanting to jump off a bridge.

a (Alcohol intake represses GABA, which inhibits dopamine and keeps dopamine levels low. When alcohol is eliminated, dopamine rebounds above the normal level, resulting in excitation and alterations in thought, perception, and orientation.)

What mechanism of action accounts for symptoms of alcohol withdrawal delirium? A) Increased dopamine. B) Increased GABA. C) Decreased norepinephrine. D) Increased serotonin.

d (Nutrition is very important, because a client with alcohol dependency drinks alcohol instead of eating nourishing food, causing malabsorption of essential vitamins. Deficiency and malabsorption of vitamin B can cause Wernicke's disease, a severe problem with decreased cognitive functioning.)

What other priority nursing diagnosis should be addressed within 72 hours of admission for a suicidal alcoholic? A) Ineffective denial. B) Risk for injury. C) Ineffective coping. D) Altered nutrition.

a (Thyroid levels can help detect hypothyroidism, which can lead to depression.)

What role do thyroid levels play in depression? A) Hypothyroidism can lead to feeling sluggish and depressed. B) Hyperthyroidism can cause fatigue, weight gain, and depression. C) The results can be helpful for determining medication therapy for depression. D) Baseline thyroid levels are required prior to antidepressant medication therapy.

c (In addition to tremors, nausea, and vomiting, other symptoms of early withdrawal include elevated vital signs, diaphoresis, insomnia, and decreased concentration.)

What should the nurse anticipate if Nick experiences symptoms of early withdrawal from alcohol? A) Mild disorientation and confusion. B) Tactile or auditory hallucinations. C) Tremors, nausea, and vomiting. D) Sleeping more than usual.

d (This statement encourages the client to talk openly about her anxiety.)

What should the nurse say to elicit the most subjective information from the client? A) "What is making you anxious?" B) "It sounds like your anxiety is making you depressed." C) "How has your anxiety affected your normal activities?" D) "Tell me more about your anxiety."

d (Explosive headache, palpitations, sudden elevation of blood pressure, chest pain, nausea, and vomiting are some of the symptoms of a hypertensive crisis related to tyramine consumption.)

What signs and symptoms should the nurse expect to assess if a client taking an MAO antidepressant ingests foods containing tyramine? A) Muscle stiffness and shuffling gait. B) Diarrhea and increased thirst. C) Confusion and sore throat. D) Headache and palpitations.

b (Depression commonly accompanies medical disorders. The other options are false statements.)

What statement about the comorbidity of depression is accurate? A. Depression most often exists in an individual as a single entity. B. Depression is commonly seen among individuals with medical disorders. C. Substance abuse and depression are seldom seen as comorbid disorders. D. Depression may coexist with other disorders but is rarely seen with schizophrenia.

d (The nurse should monitor orientation and vital signs until they return to an acceptable level, or for a specified time according to hospital protocol.)

When Anna awakens from the ECT treatment, the nurse should be prepared to perform which nursing action? A) Give Tylenol for headache and muscle aches. B) Begin twenty-four-hour seizure precautions. C) Provide stimulation to increase alertness. D) Take vital signs and assess orientation.

a (When a client is very depressed, it is necessary to assist with daily activities because the client has decreased energy. Physical care is more important with severe depression.)

When Anna awakens in the morning, she sits for periods of time at the edge of her bed. She does not initiate combing her hair, getting dressed, or going to breakfast. Which nursing intervention is important? A) Help the client with daily activities. B) Bring the client's meal to her room. C) Give two choices of clothes to wear. D) Respond to the client nonverbally.

a, e (Nick can keep his tennis shoes. Tennis shoes without laces do not typically pose a threat. Nick can keep a personal photo. This does not pose a threat and may help him feel more comfortable in his environment.)

When Nick is admitted to the Crisis Unit, the nurse understands that it is best to maintain a quiet, calm environment to help him relax and decrease nervous system irritability. The nurse must assign a room and search his belongings. Which item(s) can the nurse allow Nick to keep in his room? (Select all that apply.) A) Unlaced tennis shoes. B) Aftershave lotion. C) Home vitamins. D) Pack of cigarettes. E) A personal photo.

d (Rapid cycling infers 4 or more mood episodes in a 12 month period as well as more severe symptomology.)

When a client experiences 4 or more mood episodes in a 12 month period, the client is said to be: A. dysynchronous. B. incongruent. C. cyclothymic. D. rapid cycling.

b (Verbal limit setting should always precede more restrictive measures.)

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention should be A. questioning client motive. B. verbal limit setting. C. physical confrontation. D. seclusion.

a (Early alcohol withdrawal can begin as early as 4 to 6 hours after substance use is withdrawn.)

When should the nurse begin assessment for withdrawal? A) Within 4 to 6 hours of the client's last drink. B) 12 hours after admission. C) If blood pressure is elevated. D) When hand tremors are visible.

c (It takes 1 to 3 weeks for antidepressant effects to begin. It is suggested that depression occurs when a depletion of neurotransmitters in the synapse causes the transmitter receptors to increase. As the antidepressants make more transmitters available, it takes the receptors several weeks to return their numbers back to normal and allow normal synaptic activity.)

When the client receives fluoxetine (Prozac), the nurse must explain the purpose and when to expect therapeutic effectiveness. When should the client begin to feel less depressed? A) 4 weeks. B) 3 to 4 days. C) 1 to 3 weeks. D) 6 weeks.

c (Anhedonia is the term for the lack of ability to experience pleasure.)

When the clinician mentions that a client has anhedonia, the nurse can expect that the client A. has poor retention of recent events. B. has weight loss of 10 lb or more from anorexia. C. obtains no pleasure from previously enjoyed activities. D. has difficulty with tasks requiring fine motor skills.

a (Preparation for ECT is similar to a surgical procedure, i.e. NPO for 6 to 8 hours prior to treatment with the exception of receiving cardiac medications or antihypertensive agents. Prostheses should be removed, and the client should void immediately before receiving ECT)

When the nurse prepares a client for ECT, what should be expected? A) Preparation is similar to a brief surgical procedure. B) Clear liquid diet 12 hours before treatment. C) The client cannot receive any medications. D) All fluids are withheld 4 hours before treatment.

a (Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.)

When the nurse remarks to a depressed client "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to A. wait quietly for the client to reply. B. prompt the client if the reply is slow. C. repeat the question if the client does not answer promptly. D. seek information from the client's significant others.

b (The nurse can delegate this activity to one of the mental health technicians or UAPs while medications are being administered.)

When the nurse takes Nick his medications, he states that he wants to take a shower. He demonstrates mild tremors and reports feeling a little "shaky." Since the nurse needs to give medications to a few other clients, what is the nurse's best response? A) "I'll help you after I finish administering these medications." B) "Let me find one of the staff to help you." C) "Let's wait until you are feeling less shaky." D) "How shaky are you feeling right now?"

d (This understanding will allow the nurse to directly address the question. Responses based on the other statements would be tangential or untrue.)

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that A. no research exists to suggest genetic transmission. B. much depends on the socioeconomic class of the individuals. C. highly creative people tend toward development of the disorder. D. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

d (Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability)

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? A. Meditation B. Breathing exercises C. Journal keeping D. Biofeedback

a (Vital signs are an objective measure of alcohol withdrawal, especially when the diastolic blood pressure, pulse, and temperature are near or above 100.)

Which assessment is most important for safe alcohol detoxification? A) Vital signs at least every 4 hours. B) Type of alcohol ingested. C) Amount and last use of alcohol. D) History of delirium tremens.

d (A passive-aggressive person deals with emotional conflict by indirectly and unassertively expressing aggression toward others. Procrastination is an expression of resistance.Text page: 215)

Which behavior would be characteristic of an individual who is displacing anger? A. Lying B. Stealing C. Slapping D. Procrastinating

a (Hyperactivity and distractibility are basic to manic episodes.)

Which behavior would be most characteristic of a client during a manic episode? A. Going rapidly from one activity to another B. Taking frequent rest periods and naps during the day C. Being unwilling to leave home to see other people D. Watching others intently and talking little

2 (Rationale: Safety is always the priority when caring for patients. Although the patient may develop or present with cirrhosis, Wernicke's encephalopathy, and/or Korsakoff's psychosis, the nurse must first plan care for prevention of self-harm. )

Which condition would the nurse be most concerned about when caring for a patient who abuses alcohol? 1. Cirrhosis of the liver 2. Suicidal potential 3. Wernicke's encephalopathy 4. Korsakoff's psychosis

b (The drugs most frequently used to facilitate a sexual assault, rape, are flunitrazepam, Rohypnol, "roofies", a fast-acting benzodiazepine, and ã-hydroxybutyrate, GHB, and its congeners. They are odorless, tasteless, and colorless, mix easily with drinks, and can leave a person unconscious in a matter of minutes. Perpetrators use these drugs because they rapidly produce disinhibition and relaxation of voluntary muscles; they also cause the victim to have lasting anterograde amnesia for events that occur. Text page: 417)

Which drug is most apt to have been ingested by a young woman who comes to the emergency department with the report that although she has no recollection of the incident, she believes she was sexually assaulted at a party? A.LAAM B.GHB C.ReVia D.Clonidine

b (The goals of acute management of alcohol detoxification begin with stabilizing the client physically and maintaining normal vital signs.)

Which goal is most important for alcohol detoxification? A) Discourage drug-seeking behaviors. B) Physiologic stabilization. C) Monitor liver function tests. D) Enhancement of coping skills.

a (From the subjective data presented, the client's difficulty with peers is the only anxiety-related diagnosis that the nurse can impact.)

Which nursing diagnosis for the client's anxiety should the nurse record? A) Ineffective coping related to interpersonal conflicts. B) Post-trauma syndrome related to 9/11. C) Hopelessness related to perceived failure. D) Ineffective role performance related to lack of children.

b (A client with psychomotor retardation has vegetative signs of depression and is often constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene. Depressed clients usually do not have death anxiety. They are more likely to welcome the idea of dying.)

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation? A. Constipation B. Death anxiety C. Activity intolerance D. Self-care deficit: bathing/hygiene

c (Rationale: Anxiety disorders often interfere with the usual role performance of clients. Consider the client with agoraphobia who cannot go to work, or the client with obsessive-compulsive disorder who devotes time to the ritual rather than to parenting. Text page: 230)

Which nursing diagnosis would be most useful for clients with anxiety disorders? a. Excess fluid volume b. Disturbed body image c. Ineffective role performance d. Disturbed personal identity

a (Informed consent must be obtained, and the client must sign consent to receive Antabuse therapy.)

Which nursing intervention is most important to obtain before beginning disulfram (Antabuse) therapy? A) Obtain Nick's written consent to comply with instructions. B) Ensure Nick will not have access to alcohol after discharge from the hospital. C) Determine the longest period of sobriety and need for abstinence. D) Help Nick identify triggers leading to possible alcohol abuse.

d (Rationale: This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try." Text page: 238)

Which nursing intervention would be helpful when caring for a client with an anxiety disorder? a. Express mild amusement over symptoms b. Arrange for client to spend time away from others c. Advise client to minimize exercise to conserve endorphins d. Reinforce use of positive self-talk to change negative assumptions

c (Withdrawal from central nervous system depressants is complicated, requiring carefully titrated detoxification with a similar drug. Abrupt withdrawal can lead to death. Text page: 410)

Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support? A.Opiates B.Marijuana C.Barbiturates D.Hallucinogens

1 (Rationale: Patients who are exhibiting hyperalertness, jerky movements, and are startled easily are most likely in a state of alcohol withdrawal, a condition which peaks in 24 to 48 hours after cessation or reduction of alcohol intake and then rapidly and dramatically disappears unless the withdrawal process progresses to alcohol withdrawal delirium. Tachycardia, diaphoresis elevated blood pressure, peripheral vascular collapse, electrolyte imbalance, paranoid delusions, fever, and fluctuating levels of consciousness are associated with alcohol withdrawal delirium, a condition that is considered a medical emergency and can result in death if not treated. )

Which patient behaviors should the nurse suspect as related to alcohol withdrawal? 1. Hyperalert state, jerky movements, easily startled 2. Tachycardia, diaphoresis, elevated blood pressure 3. Peripheral vascular collapse, electrolyte imbalance 4. Paranoid delusions, fever, fluctuating levels of consciousness

3 (Rationale: Although all statement may cause the nurse to assess further within the context of the conversation, rationalizations, slow, prolonged responses, and automatic responses such as "I figured you'd ask me about that" serve as red flags that further assessment must be done right away to provide clarification. )

Which patient response to the question, "Have you ever drunk more alcohol or used more drugs than you meant to?" should immediately cause the nurse to assess further? 1. "No, I have never used drugs or alcohol." 2. "I have drunk alcohol before but have never let myself get drunk." 3. "I figured you'd ask me about that." 4. "Yes, I did that once and will never do it again."

3 (Rationale: Learned helplessness often occurs during depression if the person feels no control over the outcome of a situation. Those exhibiting symptoms of learned helplessness feel that undesired events in their lives are self-created, and that nothing can be done to change it. By blaming herself, the patient has taken accountability for her husband's actions and assigned blame to herself. Stating that one is a horrible person, hating oneself, or feeling that the world is "out to get" them is reflective of Beck's cognitive triad as they contribute to depression.)

Which patient statement indicates learned helplessness? 1. "I am a horrible person." 2. "Everyone in the world is just out to get me." 3. "It's all my fault that my husband left me for another woman." 4. "I hate myself."

b (This question is important and can predict the onset of withdrawal symptoms, since withdrawal can begin as early as 4 to 6 hours after substance use.)

Which question is most likely to predict the onset of withdrawal symptoms if the client is dependent on alcohol? A) "How often do you usually drink?" B) "When did you last have something to drink?" C) "How much alcohol do you usually have?" D) "What is your experience with withdrawal?"

c (This question encourages Joan to explore the relationship between her age and her level of anxiety.)

Which question or statement by the nurse is most likely to encourage Joan to talk about the issues that are contributing to her anxiety? A) "What does your age have to do with your anxiety?" B) "Tell me what you think about when you think about being 52." C) "What does being 52 years old mean to you?" D) "Tell me what your age means to your boss."

c (The room placement that provides a nonstimulating environment is best. Being near the nurse's station means close supervision can occur.)

Which room placement would be best for a client experiencing a manic episode? A. A shared room with a client with dementia B. A single room near the unit activities area C. A single room near the nurse's station D. A shared room away from the unit entrance

a (The fact that fine hand tremor and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance.)

Which side effects of lithium can be expected at therapeutic levels? A. Fine hand tremor and polyuria B. Nausea and thirst C. Coarse hand tremor and gastrointestinal upset D. Ataxia and hypotension

2 (Clients must be reminded that they must talk with their physician before taking over-the-counter meds, to avoid a life-threatening hypertensive crisis. If a client consumes these foods or other meds during, or within 2 weeks after stopping, treatment with MAOIs, a life-threatening hypertensive crisis could occur. Marplan is an MAOI, and the intake of chocolate would cause a life-threatening hypertensive crisis.)

Which situation would place a client at high risk for a life-threatening hypertensive crisis? 1. A client is prescribed tranylcypromine (Parnate) and eats chicken salad 2. A client is prescribed isocarboxazid (Marplan) and drinks hot chocolate. 3. A client is prescribed venlafaxine (Effexor) and drinks wine. 4. A client is prescribed phenelzine (Nardil) and eats fresh roasted chicken.

a (People are accustomed to fast results from medication. Thirty minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance.)

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. Onset of action is from 1 to 6 weeks. B. They tend to be more effective for men. C. They may cause recent memory impairment. D. They often cause the client to have diurnal variation.

b (Rationale: Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be independently used. The other options require agreement of the treatment team.Text page: 238)

Which therapeutic intervention can the nurse independently use with a client with anxiety disorder? a. Flooding b. Modeling c. Thought stopping d. Systematic desensitization

a (The nurse should pour the drink in a paper cup, because Anna could use the can to hurt herself.)

While Anna is on constant observation, the nurse must assure that safety is maintained in the milieu. One afternoon the nurse notices that a visitor brings some cans of Anna's favorite soft drink. What should the nurse do? A) Pour the soft drink into a paper cup. B) Stay with Anna when she is drinking it. C) Explain to the visitor that this is not allowed. D) Ask Anna to return them to the visitor.

c (Abstinence is the safest treatment goal for all addicts. Abstinence is strongly related to good work adjustments, positive health status, comfortable interpersonal relationships, and general social stability.Text page: 420)

While helping an addicted individual plan for ongoing treatment, which of the following interventions is the first priority for a safe recovery? A.Securing ongoing support from at least two family members. B.The client needs to be employed. C.The client strives to maintain abstinence. D.A regular schedule of appointments with a primary care provider.

a (Alcohol should not be consumed when taking the medication because it may increase the risk of seizures.)

While the nurse is teaching the client about taking Wellbutrin XL, Joan asks if it is all right to drink alcohol when taking the medication. How should the nurse respond to Joan's question? A) Do not consume alcohol while taking the medication. B) In moderation, alcohol has no interaction with Wellbutrin XL. C) Consuming wine or beer in moderation is all right. D) The client has to make the decision to drink alcohol.

d (The purpose of cognitive restructuring is to change the individual's negative view of an event or situation to a view that remains consistent with the facts but that is more positive.)

Working with a client to help the client view an occurrence in a more positive light is called A. flooding. B. desensitization. C. response prevention. D. cognitive restructuring.

atypical, antidepressant, cymbalta, desyrel, effexor, remeron, wellbutrin, pristiq

atypical, antidepressant, effexor, pristiq, increase bp

atypical, antidepressant, remeron, Less sexual dysfunction, sedation, weight gain

anticonvulsant, valproic acid, carbamazepine, lamotrigine, can't tolerate, lithium

atypical antidepressant, cymbalta, help, lower, neuropathic pain,

atypical, antidepressant, cymbalta, decrease neuropathic pain

olanzapine, risperidone, atypical, antipsych, mood stabilizer, in bipolar

clonazepam, lorazepam, benzo, good for agitation, mania, anxiety, severe symptoms, sleep problems, in bipolar

carbamazepine, conjunction, lithium, rapid cycler, paranoid thinking, sleep, disturbances, sedative, good for people with liver issues, no weight gain, adverse, Steven johnsons, watch for rash

risperidone, elderly, olanzapine, fast, weight gain issues, bipolar

ssri, lexapro, celexa, prozac, zoloft, luvox, paxil, first in line for depression, ocd, gad

prefrontal cortex, not developed, teenager, reduced judgement, thoughts

ssri, not taken with maoi, side effects, sexual dysfunction, headache, nv

maoi, nardil, marplan, parnate, emsam-patch

maoi, orthostatic, edema, increase bp, stroke, convulsions, hypertensive crisis

lamotrigine, anticonvulsant, works well in depression dominant, rapid cycling, no weight gain, steven johnson

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