Psychobiological Disorders; Foundations and Practice of Mental Health nursing

Before a treatment requiring informed consent can be performed, what information must the client be given? Select all that apply. 1 The cost of the treatment 2 Alternative treatment options 3 The risks and benefits of the treatment 4 The risks involved in refusing the treatment 5 The nature of the problem requiring the treatment

Alternative treatment options 3 The risks and benefits of the treatment 4 The risks involved in refusing the treatment 5 The nature of the problem requiring the treatment For consent to be legal it must be informed. The information provided to the client includes the nature of the problem or condition, the nature and purpose of the proposed treatment, and the risks and benefits of the treatment. Alternative treatment options, the probability that the proposed treatment will be successful, and the risks involved in not consenting to the treatment must also be provided. Cost of the treatment is not considered relevant to informed consent.

A 37-year-old man has been remanded by the court to the drug rehabilitation unit of a psychiatric facility for treatment of cocaine addiction. When taking his health history, what characteristics should the nurse expect the client to report? Select all that apply. 1 Anxiety 2 Weight loss 3 Palpitations 4 Sedentary habits 5 Difficulties with speech

Anxiety Weight loss Palpitations Cocaine, an alkaloid stimulant, can precipitate anxiety, hypervigilance, euphoria, agitation, and anger. The loss of appetite and increased metabolic rate associated with cocaine addiction both promote weight loss. Cocaine is a stimulant that has cardiac effects such as tachycardia and dysrhythmias. Sedentary habits are associated with barbiturate addiction. Difficulties with speech are associated with other addictions such as alcohol and methadone.

A client is out of touch with reality, spending most of the time pacing the hall and responding to auditory hallucinations. The client does not perform the activities of daily living. What should the nurse plan to do? 1 Set limits on the client's pacing until self-care is initiated 2 Disregard the behavior until the client seeks help in caring for own needs 3 Take away the client's privileges until the activities of daily living are completed 4 Assist the client in meeting physical needs until they can be performed independently

Assist the client in meeting physical needs until they can be performed independently Client safety and comfort needs are nursing priorities, according to Maslow's Hierarchy of Needs. At this time the client is not capable of being self-sufficient and needs assistance. Setting limits on the client's pacing until self-care is initiated is punitive when a client is out of touch with reality. Behavior may not be acknowledged, but it should never be disregarded or ignored. Taking away the client's privileges until the activities of daily living are completed is punitive when a client is out of touch with reality.

When caring for clients who are at risk for suicide, the nurse should consider that: 1 A client who fails in a suicide attempt will probably not try again. 2 Formal suicide plans increase the likelihood that a client will attempt suicide. 3 It is best not to talk to clients about suicide because it may give them the idea. 4 Clients who talk about suicide are not planning it; they are using the threat to gain attention.

Formal suicide plans increase the likelihood that a client will attempt suicide. A formal plan demonstrates determination, concentration, and effort, with conclusions already thought out. Failure to successfully complete the suicidal act can add to feelings of worthlessness and stimulate further acts. Verbalizing feelings may help reduce the client's need to act out. Many clients verbalize their suicidal thoughts as they are working on their decision and plan of action; a suicide attempt is not necessarily just to receive attention.

A client with schizophrenia sees a group of visitors sitting together talking. The client tells the nurse, "I know they're talking about me." Which altered thought process should the nurse identify? 1 Flight of ideas 2 Ideas of reference 3 Grandiose delusion 4 Thought broadcasting

Ideas of reference Ideas of reference, seen with psychotic thinking, is a delusional belief that others are talking about the client. Flight of ideas is the rapid thinking seen in clients in a manic state. Grandiose delusions are irrational beliefs that overestimate one's ability or worth. Thought broadcasting is the delusional belief that others can read one's thoughts

What should nurses consider when working with depressed young children? 1 It is important to include the family in the treatment plan. 2 The goal of therapy is for the child to gain insight into problems. 3 Depressed children are treated in much the same way as depressed adults. 4 Antidepressant medication is the treatment of choice for depressed children

It is important to include the family in the treatment plan. When a young child demonstrates symptoms of emotional discord, usually this is a response to some type of family dysfunction. Because of their cognitive development, children are usually incapable of insight into their problems. Psychiatric interventions are different for children than for adults. Psychotropic medications are not the treatment of choice for children because their side effects are more dangerous in children than in adults.

When planning continuing care for a moderately depressed client, the nurse should: 1 Encourage the client to determine leisure time activities. 2 Offer the client the opportunity to make some decisions. 3 Relieve the client of the responsibility of making any decisions. 4 Allow the client time to be alone to decide in which activities to engage.

Offer the client the opportunity to make some decisions. Allowing the client to make decisions that can be handled helps improve confidence. The client is depressed, and this can result in total inactivity. Relieving the client of the responsibility of making any decisions will demoralize the client; also, it is impossible for one individual to make all the decisions for another.

The multidisciplinary team decides to use a behavior modification approach for a young woman with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client? 1 Having the client role-play interactions with her parents 2 Providing the client with a high-calorie, high-protein diet 3 Restricting the client to her room until she has gained 2 lb 4 Forcing the client to talk about her favorite foods for 1 hour a day

Restricting the client to her room until she has gained 2 lb Restricting the client to her room until she gains 2 lb reinforces behaviors that will assist in the achievement of specific goals. Having the client role-play interactions with her parents is not part of a behavior modification program. Providing the client with a high-calorie, high-protein diet is not part of a behavior modification program. Anorexic clients talk freely about food; the problem is ingestion, not discussion.

What is the most appropriate intervention for the nurse to implement after finding a disturbed client in bed in the fetal position? 1 Sitting down in a chair by the client and saying, "I'm here to spend time with you." 2 Touching the client gently on the shoulder and saying, "I'm going to sit with you for a while." 3 Going to the client and saying, "I'll be waiting for you in the community room, so please get up and join me." 4 Leaving the client alone because the behavior demonstrates that the client has regressed too far to benefit from talking with the nurse

Sitting down in a chair by the client and saying, "I'm here to spend time with you." Leaving the client alone because the behavior demonstrates that the client has regressed too far to benefit from talking with the nurse

During an interview and assessment, a 60-year-old woman reports to the nurse, "I've been using St. John's wort to try to feel more like myself again. I'm not sure whether it's going to work." The nurse should pursue an assessment related to the woman's report of: 1 Depression 2 Sleep disturbances 3 Diminished cognitive ability 4 Sensory-perceptual disturbances

depression St John's wort is an herb that is marketed as a natural way to improve mood and ease feelings of depression. Because St. John's wort is considered a dietary supplement, it is not regulated by the Food and Drug Administration as drugs are. It has not been shown to exert positive effects in people with diminished cognitive abilities, sleep disturbances, or sensory-perceptual disturbances.

A depressed client is very resistive and complains about inabilities and worthlessness. The best nursing approach is to: 1 Involve the client in activities in which success can be ensured. 2 Listen to the client while postponing a planned activity for later. 3 Encourage the client to select an activity in which there is some interest. 4 Schedule the client's activities so that they can be implemented independently.

involve the client in activities in which success can be assured Some success is important to increase the client's self-esteem. Listening to the client while postponing a planned activity for later will support the client's feelings of uselessness. The client, who is in a major depression, does not have the interest or energy to be involved in the decision-making process or to act independently.

A 55-year-old man who has a long history of drug and alcohol abuse tells the nurse during an interview that he is taking ginkgo biloba. The nurse knows that ginkgo biloba is taken to treat: 1 Insomnia 2 Depression 3 Memory impairment 4 Anxiety and nervousness

memory impairment Ginkgo biloba is an herb used to treat age-related memory impairment and dementia. It has not been shown to be effective in treating insomnia, depression, or anxiety.

After an automobile collision involving a fatality and a subsequent arrest for speeding, a client has amnesia regarding the events surrounding the accident. Which defense mechanism is being used by the client? 1 Projection 2 Repression 3 Suppression 4 Rationalization

repression Repression is coping with overwhelming emotions by blocking awareness or memory of the stressful event. Projection is attributing one's own unacceptable feelings and thoughts to others. Suppression is consciously keeping unacceptable feelings and thoughts out of awareness. Rationalization is the attempt to mask unacceptable feelings or behaviors by providing excuses and explanations

An individual whose employment has been terminated because his company has been acquired by another company is brought by a family member to the mental health clinic because of extreme depression. While talking with the nurse the client says, "I'm a useless, worthless person. No wonder I lost my job." What type of delusion does the nurse identify? 1 Reference 2 Persecution 3 Alien control 4 Self-deprecation

self-depreciation The client's statement is self-derogatory and reflects a low self-appraisal. There is no evidence that the client feels that he is the object of attention from others in the environment, that the client feels harassed, or that the client feels that others are controlling or manipulative.

A nurse is assessing a client with bulimia nervosa. What should the nurse ask to obtain information about the client's intake habits and patterns? 1 "Are you trying to control other people through the use of food?" 2 "When you socialize, do you find that you eat more than when you eat by yourself?" 3 "Do you find yourself eating more right before the beginning of your menstrual cycle?" 4 "How frequently are you eating in response to your feelings rather than because you're hungry?"

"How frequently are you eating in response to your feelings rather than because you're hungry?" Clients with bulimia nervosa have a history of eating as a response to strong internal feelings rather than as a response to the sensation of hunger. Clients with anorexia, not bulimia, often feel powerless and tend to use restrictive eating as a way to enhance a personal sense of control, not to control others. Clients with bulimia nervosa usually eat excessive amounts of food when alone rather than with others. They know that their behavior is dysfunctional and attempt to hide it from others. Binge eating usually is not associated with a woman's menstrual cycle.

After an automobile accident a man is arrested for driving while intoxicated and is admitted to the hospital. When the client becomes angry and blames his family for his problems, the nurse can be most therapeutic by stating: 1 "You know that you are to blame for your alcohol abuse." 2 "You need help now or you're just going to get even sicker." 3 "I'll talk to your family about their behavior if you want me to." 4 "I can see that you're upset about your family, but we need to focus on what you need right now."

"I can see that you're upset about your family, but we need to focus on what you need right now." "I can see that you're upset about your family, but we need to focus on what you need right now" focuses on the client's feelings with a supportive, helpful approach and brings attention to the immediate care goals. The response "You know that you're to blame for your alcohol abuse" is a judgmental approach that alienates the client from the therapeutic process and prevents the establishment of a rapport. The response "You need help now or you're just going to get even sicker" is a judgmental approach that alienates the client from the therapeutic process and prevents the establishment of a rapport. The response "I'll talk to your family about their behavior if you want me to" reinforces the client's denial and avoidance of the problem and implies that others are responsible for the drinking. Test-Taking Tip: Do not select answers that contain exceptions to the general rule, controversial material, or degrading responses.

A family member brings a relative to the local community hospital because the relative "has been acting strange." Which statements meet involuntary hospitalization criteria? Select all that apply. 1 "I cry all the time; I'm just so sad." 2 "Since I retired I've been so depressed." 3 "I'd like to end it all with sleeping pills." 4 "The voices say I should kill all prostitutes." 5 "My boss makes me so angry—he's always picking on me."

"I'd like to end it all with sleeping pills." "The voices say I should kill all prostitutes." The statement about ending it all is a suicide threat; it is a direct expression of intent without action. Likewise, the threat to harm others must be heeded. Confiding feelings of sadness or depression does not indicate that the client plans to self-harm or harm others. The statement about the boss reflects the client's feelings of anger and the cause but does not indicate a threat to self or others.

A client is extremely depressed, and the practitioner prescribes a tricyclic antidepressant, imipramine. The client asks the nurse what the medication will do. The nurse responds: 1 "It will help you forget why you are depressed." 2 "It will help keep you alert and cure your insomnia." 3 "It will help you feel better after taking it for several days." 4 "It will help you feel better, make sure to report feelings of self-harm."

"It will help you feel better, make sure to report feelings of self-harm." This drug creates a general sense of well-being and helps lift depression. It blocks the reuptake of norepinephrine and serotonin into nerve endings, increasing their action in nerve cells. The client might not know the reason for depression, and the drug does not cause amnesia. Side effects of imipramine include drowsiness and insomnia. The situation does not indicate that the client is experiencing insomnia. Symptomatic relief usually begins after 2 to 3 weeks of therapy.

One morning a client with the diagnosis of acute depression says, "God is punishing me for my past sins." What is the best response by the nurse? 1 "Why do you think that?" 2 "You sound very upset about this." 3 "Do you believe that God is punishing you for your sins?" 4 "If you feel this way, you should talk to your spiritual advisor."

"You sound very upset about this. The response focuses on the client's feelings rather than the statement, and it serves to open channels of communication. "Why do you think that?" asks the client to decide what is causing the feelings; most people are unable to explain why they feel as they do. "Do you believe that God is punishing you for your sins?" simply echoes the client's statement and does not reflect feelings or stimulate further communication. "If you feel this way, you should talk to your spiritual advisor" does nothing to stimulate further communication; in fact, it tells the client to talk about the feelings with someone else.

A client with a diagnosis of bipolar I disorder, manic episode, is started on a regimen of an antipsychotic agent and lithium carbonate. The nurse explains to the client that the rationale behind this regimen is that the antipsychotic: 1 Potentiates the action of lithium for more effective results 2 Interacts with lithium to prevent progression to the depressive phase 3 Helps decrease the risk of lithium toxicity in the first week of therapy 4 Acts to quiet the client while allowing time for the lithium to reach a therapeutic level

Acts to quiet the client while allowing time for the lithium to reach a therapeutic level Antipsychotics usually are prescribed to calm agitated clients during the 3-week period it takes for the lithium to become effective. Antipsychotic drugs have a different, not a potentiating, mechanism of action. The drugs are used to control symptoms of mania, not to prevent depression. The neuroleptic drug has no effect on lithium toxicity

A client is admitted to the mental health unit with the diagnosis of anorexia nervosa. What typical signs and symptoms of anorexia nervosa does the nurse expect the client to exhibit? 1 Slow pulse, mild weight loss, and alopecia 2 Compulsive behaviors, excessive fears, and nausea 3 Amenorrhea, excessive weight loss, and abdominal distention 4 Excessive activity, memory lapses, and an increase in the pulse rate

Amenorrhea, excessive weight loss, and abdominal distention In anorexia nervosa, weight loss is excessive (15% of expected weight); nutritional deficiencies result in amenorrhea and a distended abdomen. Although pulse irregularities and alopecia are associated with anorexia, weight loss is excessive, not mild. Although compulsive behaviors are common, excessive fears and nausea are not associated with anorexia nervosa. Memory lapses are not associated with anorexia nervosa; excessive exercising and pulse irregularities are

During the first meeting of a therapy group, the members become quite uncomfortable. The nurse notes frequent periods of silence, tense laughter, and nervous movement in the group. The nurse concludes that these responses: 1 Require active leader intervention to relieve signs of obvious stress 2 Indicate unhealthy group processes and an unwillingness to relate openly 3 Are expected group behaviors because relationships are not yet established 4 Should be addressed immediately so members will not become too uncomfortable

Are expected group behaviors because relationships are not yet established The members have not established trust and are hesitant to discuss problems; the behaviors observed reflect anxiety and insecurity. Requiring active leader intervention to relieve signs of obvious stress can add to the anxiety and insecurity of group members. These behaviors are expected in the early stage of group interaction. Immediately addressing them may add to the anxiety and insecurity of the group members.

A woman is admitted to the emergency department with trauma that indicates possible abuse. List in priority order the appropriate nursing interventions. 1. Gathering a more in-depth history 2. Providing information about safe houses 3. Assisting in the treatment of the client's physical injuries 4. Encouraging the client to express her feelings

Assisting in the treatment of the client's physical injuries Gathering a more in-depth history Encouraging the client to express her feelings Providing information about safe houses Treatment of physical injuries is always the priority of care. Further information about the client's history is needed to determine whether she is in an abusive situation. Allowing the client to express her feelings in a safe environment establishes trust, which is the foundation of psychosocial interventions. Information about community resources will provide alternatives to remaining in the abusive situation.

A clinically depressed female client on a psychiatric unit of a local hospital uses embroidery scissors to cut her wrists. After treatment, when the nurse approaches, the client is tearful and silent. What is the best initial intervention by the nurse? 1 Note client's behavior, record it, and notify the practitioner. 2 Sit quietly next to the client and wait until she begins to speak. 3 Say, "You're crying. I guess that means you feel bad about attempting suicide and really want to live." 4 Comment, "I notice that you seem sad. Tell me what it's like for you and perhaps we can begin to work it out together."

Comment, "I notice that you seem sad. Tell me what it's like for you and perhaps we can begin to work it out together." Noting that the client seems sad and asking her to describe her feelings so the nurse and client can begin to work it out together recognizes feelings and behavior; it encourages the client to share feelings and promotes trust, which is essential for a therapeutic relationship. Although noting, recording, and notifying the practitioner of the client's behavior are important actions, they are not enough; nursing intervention with the client must be included. Without verbal encouragement, the depressed client will not respond to this intervention. Saying that because the client is crying she must feel bad about attempting suicide and really want to live assumes too much and may be inaccurate; an indirect approach should be used.

A client with the diagnosis of bulimia nervosa, purging type, is admitted to the mental health unit after an acute episode of binging. Which clinical manifestation is most important for the nurse to assess? 1 Weight gain 2 Dehydration 3 Hyperactivity 4 Hyperglycemia

Dehydration The nurse should be alert for dehydration caused by fluid loss through vomiting in the binge-purge cycle. Weight gain is not expected because purging frequently follows a binge. Hyperactivity is not expected because many individuals with bulimia withdraw and vomit after a binge. Hyperglycemia is not expected because of the vomiting that follows a binge.

One afternoon a male client on the inpatient psychiatric service complains to the nurse that he has been waiting for more than an hour for someone to accompany him to activities. The nurse replies, "We're doing the best we can. There are many other people on the unit who need attention, too." This response demonstrates the nurse's use of: 1 Impulse control 2 Defensive behavior 3 Reality reinforcement 4 Limit-setting behavior

Defensive behavior The nurse's response is not therapeutic because it does not recognize the client's needs but instead tries to make the client feel guilty for being demanding. Impulse control refers to a sudden driving force's being constrained or held back. Nothing in the nurse's statement demonstrates reality reinforcement or sets limits; the nurse is defensive, not therapeutic.

The only survivor of a motor vehicle collision is found to have posttraumatic stress disorder. The client verbalizes that one long-term goal is to have a sense of control over personal feelings related to the trauma. What should the nurse include in the client's plan of care? 1 Working on self-forgiveness 2 Exploring specific feelings related to survivor guilt 3 Discussing life situations that the client is able to manage 4 Focusing on the client's inability to limit escalating anxiety

Discussing life situations that the client is able to manage Focusing on situations that are manageable will enable the client to experience a sense of personal power. Working on self-forgiveness relates to feelings of self-blame and depression. Talking about survivor guilt will not allow the development of a sense of control over the trauma; instead, the client may focus on being a survivor through luck or chance. Focusing on negative responses will not help the client gain a sense of personal control over the feelings related to the trauma.

The husband of a woman who has been sexually assaulted arrives at the hospital after being called by the police. After reassuring him about his wife's condition, the nurse should give priority to: 1 Arranging for the rape counselor to meet with the wife 2 Discussing with him his own feelings about the situation 3 Helping him understand how his wife feels about the situation 4 Making him comfortable until the practitioner has finished examining his wife

Discussing with him his own feelings about the situation Partners may themselves feel angry and abused; these feelings should be quickly and openly discussed. Arranging for the rape counselor to meet with the wife should not be done yet; rape counselors work with the victim and partner together. The partner's feelings must be resolved before the partner can help the client, and the nurse may not fully know the wife's feelings. Making him comfortable until the practitioner has finished examining his wife may be reassuring, but it leaves the partner alone to deal with his feelings. Topics

A client visits the mental health clinic because of an aversion to arachnids. The client reports screaming hysterically when a spider is in the vicinity and indicates that this phobia is interfering with her job performance. What defense mechanisms does the nurse conclude that the client is using? 1 Undoing and sublimation 2 Displacement and projection 3 Repression and identification 4 Introjection and reaction formation

Displacement and projection The defense mechanisms of displacement and projection defense are related to phobias; displacement is the release of pent-up feelings onto something or someone else that is less threatening than the original source of the feelings, and projection is the attribution of one's own unacceptable characteristics or motives to another. Undoing and sublimation are not related to phobias; undoing is an attempt to atone for unacceptable acts or wishes; sublimation is the channeling of unacceptable impulses into constructive acceptable behaviors. Repression is the unconscious process of keeping from the consciousness ideas or impulses that are unacceptable to the individual; suppression is the conscious inhibition of an idea, impulse, or affect. Neither is related to phobias. Introjection is treating something outside the self as if it is actually inside the self; reaction formation is the expression of unacceptable desires by the use of opposite behaviors in an exaggerated way. Neither is related to phobias.

The nurse is planning care for a confused, delusional client. What should be included in the plan to render it as therapeutic as possible? 1 Minimizing stimuli by maintaining a quiet environment 2 Encouraging realistic activity based on the client's ability 3 Understanding that these adaptations make differentiating fantasy from reality difficult 4 Demonstrating that the client is worthy of receiving care by providing physical hygiene

Encouraging realistic activity based on the client's ability These clients need sensory stimulation to maintain orientation and should be encouraged to do as much as possible for themselves, depending on their ability. Surroundings should be bright to minimize confusion. Stimuli distract a delusional client. These clients usually are not completely out of contact with reality; it is important to differentiate fantasy from reality, but this is not the priority. Although it is important to ensure that clients receive physical hygiene and comfort, they should be encouraged to help themselves as much as possible.

What therapeutic nursing intervention may redirect a hyperactive, manic client? 1 Suggesting that the client write a short story 2 Having the client initiate group social activities on the unit 3 Asking the client to guide other clients as they clean their rooms 4 Encouraging the client to tear pictures out of magazines for a scrapbook

Encouraging the client to tear pictures out of magazines for a scrapbook Physical activity will help the client expend some of the excess energy without requiring him to make decisions or forcing other clients to deal with the behavior. The client's extreme activity limits his capacity for concentration or task completion. The client may disrupt the unit because of the excess activity and bossiness associated with this disorder. The client needs guidance and is not able to guide others.

A nurse is developing a care plan for a client with obsessive-compulsive behavior disorder. Which nursing intervention will most likely increase the client's anxiety? 1 Helping the client understand the nature of the anxiety 2 Limiting the client's ritualistic acts to three times a day 3 Involving the client in establishing the therapeutic plan 4 Providing the client with a nonjudgmental environment

Limiting the client's ritualistic acts to three times a day Limiting the client's ritualistic acts to three times a day sets an unrealistic limit that will increase anxiety by removing a defense that the client needs. Helping the client understand the nature of the anxiety is done in therapy as the client's condition improves. Insight is slowly developed to minimize anxiety. Involving the client in establishing the therapeutic plan will increase self-esteem and self-control, not increase anxiety. Providing the client with a nonjudgmental environment will reduce, not increase, anxiety, because the client will feel free to express feelings.

When a diagnosis of child abuse is established, the priority of nursing care is: 1 Promoting bonding with the child 2 Staying with the parents while they visit 3 Protecting the total well-being of the child 4 Teaching methods of discipline to the parents

Protecting the total well-being of the child Management of the abused child places protection of the child's total being above consideration of parents' rights or wishes. Protecting the child, not promotion of parental attachment, is the priority at this time. Supervision may be necessary, but it is only part of maintaining the child's well-being. Teaching methods of discipline is not appropriate at this time.

The spouse of a client who is dying tells the primary nurse that the spouse is asking the nurses to leave the pain medication on the bedside table and fears they are being saved for a suicide attempt. The nurse knows that the staff members have mixed feelings about the client's terminal status and prolonged pain. What is the most ethically appropriate intervention by the nurse? 1 Reporting the information about the medication to the nurse manager 2 Reminding the nurses that they should not leave the medication at the bedside 3 Asking the nurse manager to address the medication problem and the staff's feelings 4 Suggesting a nursing conference to discuss the medication problem and the staff's feelings

Suggesting a nursing conference to discuss the medication problem and the staff's feelings Suggesting a nursing conference to discuss the medication problem and the staff's feelings is a positive approach because it attempts to address staff members' feelings as well as the medication problem; the nurse therefore is taking an ethically appropriate action without being moralistic or authoritarian. Reporting the information about the medication to the nurse manager abdicates the primary nurse's responsibility and may prompt anger and guilt among the staff members. Reminding the nurses that they should not leave the medication at the bedside does not address the nurses' feelings. Asking the nurse manager to address the medication problem and the staff's feelings abdicates the primary nurse's responsibility and may create anger and guilt among the staff members.

A client demonstrating manic behavior is elated and sarcastic. The client is constantly cursing and using foul language and has the other clients on the unit terrified. Initially the nurse should: 1 Demand that the client stop the behavior immediately. 2 Tell the client firmly that the behavior is unacceptable. 3 Ask the client to identify what is precipitating the behavior. 4 Increase the client's medication or get a prescription for another drug.

Tell the client firmly that the behavior is unacceptable. A firm voice is most effective; the statement tells the client that it is the behavior, not the client, that is upsetting to others. Demanding that the client stop the current behavior is a useless action; the client is out of control and needs external control. The client does not know what is precipitating the behavior, and asking the client will be frustrating for him. The dosage of the client's medication should be increased or a prescription for another drug should be obtained if the client does not respond to firm limit-setting

A 6-year-old child who has autism exhibits frequent spinning and hand-flapping behaviors. What should the nurse teach the parents to do to limit these actions? 1 Hold the child. 2 Place the child in time-out. 3 Use another activity to distract the child. 4 Determine the reason for the child's behavior.

Use another activity to distract the child. Providing a constructive distraction will help redirect the autistic child's behavior. Physical contact is anxiety provoking for the autistic child. A time-out is punitive and is not constructive. The reason for this repetitive behavior is unknown.

An older woman who has been a widow for 20 years comes to the community health center with a vague list of complaints. Her only child, a son, died at birth. She has lived alone since her husband's death and performs all of her own daily tasks of living. She had a very active social life in the past but has outlived many of her friends and family members. When taking this client's health history, it is important for the nurse to ask: 1 "Do you feel alone?" 2 "Do you still miss your husband?" 3 "What unfulfilled hopes do you have?" 4 "How did you feel when your son died?"

What unfulfilled hopes do you have? The answer to "What unfulfilled hopes do you have?" will provide the nurse with an idea of the client's hopes and frustrations without being threatening or probing. "Do you feel alone?" "Do you still miss your husband?" and "How did you feel when your son died?" are all probing, disregard the client's complaints, and will provide little information for the nurse to use in the planning of care

The nurse notices that one of her clients, who has depression, is sitting by the window crying. The most appropriate response by the nurse is: 1 "It's OK. No need to cry or worry while you're here. We all feel down now and then." 2 "Please don't consider suicide. It really isn't an appropriate way out of your troubles." 3 "You seem to be experiencing a sad moment. I'll sit here with you for a while and talk if you would like." 4 "Why don't you go into the dayroom and join the card game going on? That'll take your mind off of your problems for a while."

You seem to be experiencing a sad moment. I'll sit here with you for a while and talk if you would like. The nurse is acknowledging that the client is feeling especially down and offering to be available for discussion or just to provide a presence. The response regarding suicide is judgmental and may discourage any effort by the client to initiate a discussion. Telling the client not to cry and suggesting a card game do not acknowledge the client's feelings and appear to trivialize the situation.

A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client? 1 Double bind 2 Ambivalence 3 Loose association 4 Inappropriate affect

ambivalence Ambivalence is the existence of two conflicting emotions, impulses, or desires. Double bind is two conflicting messages, not emotions, in a single communication. Loose associations are not two conflicting emotions but instead the loosening of connections between thoughts. Inappropriate affect is not two conflicting emotions but instead the inappropriate expression of emotions.

A client with schizophrenia is started on a regimen of chlorpromazine (Thorazine). After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate (Cogentin) 2 mg by mouth daily is prescribed. What should the nurse remember when administering these medications together? 1 Both medications are cholinesterase inhibitors. 2 Both medications have a cholinergic blocking action. 3 The antipsychotic effects of chlorpromazine will be decreased. 4 The synergistic effect of these medications will cause drooling

both medications have a cholinergic blocking action Both medications block central acetylcholine receptors. Neither medication inhibits cholinesterase; neostigmine (Prostigmin) acts in this manner. Although benztropine mesylate (Cogentin) can cause mental confusion when given in large doses, it does not reduce the antipsychotic effect of chlorpromazine (Thorazine). Both medications cause dry mouth.

A male college student who is smaller than average and unable to participate in sports becomes the life of the party and a stylish dresser. What defense mechanism does the nurse determine that the client is using? 1 Introjection 2 Sublimation 3 Compensation 4 Reaction formation

compensation By developing skills in one area, the individual compensates for a real or imagined deficiency in another, thereby maintaining a positive self-image. Had the student incorporated the qualities of the college athlete, that would be introjection. Sublimation is related to unacceptable impulses that may pose a threat. This person is trying to make amends not for unacceptable feelings (reaction formation) but rather for a believed deficiency and an inadequate self-image.

When a person who is nonathletic and uncoordinated is successful in a musical career, it may be related to the defense mechanism of: 1 Sublimation 2 Transference 3 Compensation 4 Rationalization

compensation Compensation is replacing a weak area or trait with a more desirable one. Sublimation is rechanneling unacceptable desires and drives into those that are socially acceptable. Transference is the unconscious tendency to assign to others in the current environment feelings and attitudes associated with another person. Rationalization is the use of justification to make tolerable certain feelings, behaviors, and motives.

A client with schizophrenia who is receiving an antipsychotic medication begins to exhibit a shuffling gait and tremors. The practitioner prescribes the anticholinergic medication benztropine (Cogentin) 2 mg daily. What should the nurse assess the client for daily when administering these medications together? 1 Constipation 2 Hypertension 3 Increased salivation 4 Excessive perspiration

constipation The anticholinergic activity of each drug is magnified, and adverse effects such as paralytic ileus may occur. Hypotension, not hypertension, occurs with anticholinergic medications. Dryness of the mouth, not increased salivation, occurs with anticholinergic medications. Decreased, not increased, perspiration occurs with anticholinergic medications.

What characteristic is most essential for the nurse caring for a client undergoing mental health care? 1 Empathy 2 Sympathy 3 Organization 4 Authoritarianism

empathy Empathy—understanding and to some extent sharing the emotions of another—encourages the expression of feelings. Empathy is an essential tool in caring for emotionally ill clients. Sympathy, or feeling sorry for someone, may further decrease the client's feelings of self-worth. Although organization may help the client accept limits and organize activities, it is not as important as empathy. An authoritarian approach will emphasize the client's weak ego and lack of self-esteem.

A nurse is caring for a client with a bipolar disorder depressive episode. What should the nurse's objective for this client be? 1 Feeling comfortable with the nurse 2 Investigating new leisure activities 3 Participating in small group activities 4 Initiating conversations about feeling

feeling comfortable with the nurse Before therapy can begin, a trusting relationship must be developed. A client with major depression will not have the impetus or energy to investigate new leisure activities. Participating in small group activities is not appropriate initially; the client does not have the physical or emotional energy to interact with a small group of people. Initiating conversations about feelings will not be successful unless the client develops a trusting, comfortable relationship with the nurse. Test-Taking Tip: Answer every question. A question without an answer is always a wrong answer, so go ahead and guess.

To begin to establish a therapeutic relationship with a withdrawn, reclusive client, the nurse must: 1 Help the client keep anxiety to a minimum. 2 Protect the client from self-destructive tendencies. 3 Ascertain what topics are of most interest to the client. 4 Obtain a complete history from the family before talking with the client.

help client client keep anxiety to a minimum Creating an environment that eases anxiety promotes a feeling of security; as this continues, a sense of trust in this individual is established. The client is not exhibiting self-destructive tendencies at this time. Ascertaining what topics are of most interest to the client is less important in the beginning phase of a relationship. Obtaining a complete history from the family before talking with the client is not important in establishing a therapeutic relationship.

The nurse manager of a psychiatric unit informs the primary nurse that a client will be admitted to the unit within an hour. The client's admission diagnosis is paranoid schizophrenia. What classic clinical findings should the nurse anticipate? Select all that apply. 1 Mutism 2 Posturing 3 Flat affect 4 Extreme negativism 5 Prominent delusions 6 Auditory hallucinations

prominent delusions auditory hallucinations Prominent delusions are the essential feature of paranoid schizophrenia; delusions are typically persecutory, grandiose, or both, but delusions with other themes, such as jealousy, religiosity, or somatization, also may occur. Auditory hallucinations are a characteristic associated with paranoid schizophrenia; usually they are related to the delusional theme. Mutism is associated more commonly with the subtype of catatonic schizophrenia. Psychomotor retardation and posturing are associated with catatonic schizophrenia. A flat affect is associated more commonly with the subtype of disorganized schizophrenia. Extreme negativism is associated more commonly with the subtype of catatonic schizophrenia.

What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder? 1 Encouraging the client to verbalize feelings of anxiety 2 Having the client list the behaviors used to reduce anxiety 3 Removing as many stimuli from the client's environment as possible 4 Administering PRN medications prescribed by the health care provider

removing as many stimuli from client environment as possible Removing as many stimuli from the client's environment as possible helps reduce the client's anxiety by limiting the factors that must be confronted; decreasing stimuli usually decreases anxiety. Encouraging the client to verbalize feelings of anxiety will not decrease anxiety and may in fact increase it. The anxiety level must be decreased before the client is asked to discuss coping strategies. Administering as-needed medications prescribed by the health care provider may or may not be necessary; it is not the first intervention before an assessment is completed.

Two days after admission to the detoxification program, a client with a long history of alcohol abuse tells the nurse, "I don't know why I came here." What is the most therapeutic response by the nurse? 1 "You feel that you don't need this program?" 2 "You realize that you are trying to avoid your problem?" 3 "I thought that you admitted yourself into the program." 4 "Don't you remember why you decided to come here in the first place?"

you feel that you don't need this program The statement "You feel that you don't need this program?" identifies the feeling of ambivalence associated with admitting that a problem with alcohol exists; this occurs early in treatment. Asking whether the client realizes that she has a problem, remarking that the client admitted herself into the program, and asking whether the client remembers why she decided to come in the first place puts the client on the defensive and interferes with communication.