exam 3 (combined)

1. A nurse is conducting an initial assessment on a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, the appropriate question to ask is:

"What leads you to seek help now?"

1. A RN student questions an instructor regarding the order of fluvoxamine (Luvox) 300 mg daily for the client diagnosed with OCD. Which instructor reply is most accurate?

- "SSRI doses, in excess of what is effective in treating depression, may be required for OCD."

1. When having a client with a panic attack, which nursing action should be implemented? SATA...

- Reduce stimuli - Administer antianxiety medicine as ordered

When caring for a patient who is experiencing a panic attack, the most appropriate nursing intervention at this time should be to: SATA

- Reduce stimuli in the immediate environment - Administer (anti-anxiety) medicine as ordered

1. To evaluate the effectiveness of Buspirone (Buspar), the nurse would consider the outcome criteria related to?

- Reduction of anxiety

1. A client comes in with severe anxiety following assault. An intervention is to?

- Remain with client until anxiety decreases

A patient comes to ER with severe anxiety following an assault. The patient is extremely agitated, trembling and hyperventilating. Appropriate nursing intervention?

- Remain with client until anxiety decreases

1. The goal of crisis intervention is to?

- Return to the previous level of functioning with some modifications and supports in place

1. Which symptom exhibited by client diagnosed with conversion disorder would predict poorest prognosis?

- Seizures

1. A client diagnosed with somatization disorder is most like to exhibit which personality disorder characteristic?

- Self-dramatizing, attention seeking, overly gregarious and seductivehistrionic

1. In the treatment of anxiety disorders, benzodiazepines (such as Lorazepam and Alprazolam) are indicated for ________ use and have _______ abuse potential.

- Short-term; high

1. A RN is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate the need for further follow up instructions?

- "I will need scheduled blood-work in order to monitor for toxic levels of this drug."

1. Statement by the client to the nurse that indicates a return to the pre-crisis level of functioning:

- "My boss tells me that I'm being considered for a promotion and a raise."

1. A client living on the beachfront seeks help with an extreme fear of crossing bridges which interferes with daily life. A psychiatric RN practitioner decides to try systemic desensitation. Which explanation of this therapy should the RN convey to this client?

- "Though a series of increasingly anxiety provoking steps, we will gradually increase your tolerance to anxiety."

1. Two students fail their introductory nursing course. One student plan to seek tutoring and retake the course next fall. The second student attempts suicide. Which of the following factors would have been influential in the development of the second student's crisis?

- A lack of adequate coping mechanisms

Someone who is suffering of anxiety symptoms (sweaty palms, palpitations, dizziness) was medically cleared. What might have been triggering this?

- A perceived threat

1. When teaching a client about Librium/Xanax, that the medication cannot just be stopped, explain that:

- Abruptly stopping the medication can cause rebound central nervous system excitation, causing seizure activity and feelings of resentment

1. A nurse is caring for a client with Somatoform disorder. Priority nursing intervention should be to?

- Accept client as an individual who is sick and needs help

1. A new patient has been admitted to psych unit with diagnosis of OCD. She begins to arrange her belongings in the drawers and closet. The nurse comes to check on her 45 minutes later and finds her folding and unfolding her clothes and rearranging them in the drawers. The appropriate nursing intervention at this time would be to:

- Allow the patient as much time as she wants to perform that ritual (Because this relieves anxiety.)

A college student is unable to take finals due to severe test anxiety. Instead of studying, the student relieves stress by attending two movies. Which priority nursing diagnosis should the RN on campus assigns for this client?

- Altered coping related to anxiety

The nurse is conducting a psychoeducational group about anxiety in the inpatient unit. Nursing education for the patient experiencing anxiety disorder includes the following:

- Anxiety is abnormal when it is out of proportion to the stimulus causing it and impairs functioning

A family member is seeking advice about elderly parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother? Which reply by nurse is appropriate?

- Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning

1. A client has a hx of excessive fear of water. What is the term that the RN should use to describe this specific phobia and under what subtype is this phobia identified?

- Aquaphobia, a natural environment type of phobia

1. The main goal of crisis intervention therapy is to:

- Assist the client in returning to the level of pre-crisis functioning

A nurse hears a clinician state, "This client has a phobia of elevators because he had a frightening experience in an elevator when he was a young child, or because he observed his mother's fear of elevators." The nurse understands that this statement would most likely be made by a clinician who is operating from which paradigm?

- Behavioral

1. A nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse determines that this type of crisis could be caused by:

- Being held hostage of a bank assault

A client tells a nurse that she refuses to eat in a restaurant because she is afraid others will laugh at the way she eats. The nurse understands that this behavior is associated with which condition?

- C) Social phobia

1. A client who is a Gulf War Vet is being assessed for PTSD. Which signs and symptoms would support this?

- Client fears a physical integrity threat to self - Client feels detached/ estranged from others - Client experiences fears and helplessness

1. How should an RN Differentiate a client DX with OCPD from a client DX with obsessive compulsive disorder?

- Clients dx with OCD experience both obsessions and compulsions, and clients dx with OCPD do not

How should the RN best identify the major maladaptive client response to panic disorder?

- Clients perceive having no control over life situations

1. A RN Instructor is teaching about meds to treat panic disorder. Which Student statement indicated learning has occurred?

- Clonazepam (klonopin) is particularly effective in the treatment of panic disorder

1. Assessment on a client with conversion disorder. SATA

- Conversion disorder is an expression of psychological conflict - Need and symptoms are not produced intentionally by the client

1. Neuro tests have rule out pathology in client's sudden lower extremity paralysis. Which nursing care should be included for this client?

- Deal with physical symptoms in a detached manner

1. A newly admitted OCD client packs and folds his clothes continuously for 45 minutes. Which RN intervention would best address this client's problem?

- Discuss the anxiety provoking triggers that precipitate ritualistic behavior

An RN is caring for a client diagnosed with GAD. Which of the following interventions would address this client signs and symptoms? SATA

- Encourage the client to identify signs and symptoms of escalating anxiety - Employ newly learned relaxation techniques - Cognitively reframe thoughts about situations that generate anxiety - Encourage the client to avoid caffeinated products

Since starting college, a patient has been unrealistically worried about his academic performance as well as his relationship with experiencing insomnia, irritability and has difficulty concentrating. Based on the nurse's assessment of?

- Engage in physical activity three times a week - Practicing relaxation techniques - Identifying signs and symptoms of escalating anxiety

1. A client starts college and is unrealistically worried about academic performance, is irritable, and experiencing insomnia. The client's treatment plan should be to?

- Engage in physical activity three times a week, practicing relaxation techniques, and identifying signs and symptoms of escalating anxiety

When providing care for an over anxious adolescent with separation anxiety

- Establish an atmosphere of calm, trust, and unconditional acceptance

1. Adolescent with separation anxiety

- Establish atmosphere of calm and trust and unconditional acceptance

1. A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following signs and symptoms should the nurse on campus expect the client to exhibit? SATA

- Fatigue - Insomnia - Irritability

1. A client diagnosed with PTSD is receiving paliperidone (Invega). Which signs and symptoms should the RN identify that warrant the need for this medication?

- Flash backs of killing the enemy

1. Since starting, a client has been unrealistically worried about his academic performance as well as his relationship. He cannot sleep or concentrate. He is irritable and on edge. This is associated with?

- Generalized anxiety disorder

Since starting, a client has been unrealistically worried about his academic performance as well as his relationship. He cannot sleep or concentrate. He is irritable and on edge. This is associated with which disorder?

- Generalized anxiety disorder

1. A patient continually talks about the pain she is experiencing yet her affect does not match the level of pain she is describing. When working with patients who are diagnosed with somatic symptom disorder, the nursing intervention should be to?

- Gradually limit focus on physical symptoms

1. Benzodiazepines?

- Have high abuse potential and should be used for short term

1. A client is receiving alprazolam (Xanax) for acute anxiety. What client history should cause the RN to question this order?

- History of alcohol dependence

The nurse is planning activities for a client with generalized anxiety disorder. The nurse is aware that the appropriate activity to assist client in relieving anxiety is:

- Hitting a punching bag

1. A client with generalized anxiety disorder is taking valium. When the next dose is due to administer, the client is sleeping soundly and is difficult to arouse. The nurse should?

- Hold the dose of medication, record reason, and assess the client

A client diagnosed with panic disorder states, "when an attack happens, I feel like I am about to die." Which is the most appropriate for the nurse to reply?

- I know it's frightening, but try to remind yourself this will only last a short time

1. Husband died 3 months ago, what is an adequate coping mechanism for the wife?

- I will find a support group

1. The nurse is caring for a patient with OCD. The patient walks around the unit checking and rechecking the lock on each door. Which nursing intervention is appropriate?

- Identify anxiety leading to ritualistic behavior

1. Maintenance goal for someone with a panic attack is?

- Identifying anxiety producing situation

The nurse is caring for a patient who is experiencing a panic attack. The most appropriate maintenance goal should focus on

- Identifying anxiety producing situation

1. A client diagnosed with OCD spends hours bathing and grooming. During 1 on 1, the client discusses rituals in detail but avoids any feelings rituals generate. Which defense mechanism should the RN identify?

- Intellectualization

1. When working with a client with somatization disorder, which is the most appropriate nursing intervention?

- Limit the amount of time to focus on the physical problem

1. The nurse is evaluating the patient for the therapeutic effects of an anxiolytic medication prescribed two weeks ago. Which of the following objective information would indicate that the medication is effective?

- Observing clients decreased psychomotor agitation

1. A client is diagnosed with hypochondriasis. Which of the following s/s is most likely to exhibit?

- Obsessive-compulsive traits - Anxiety - Depression

1. Which of the following combinations of somatoform disorder diagnosis and appropriate pharmacology treatment are correctly matched?

- Pain disorder treated with venlafaxine (Effexor) - Body dysmorphic disorder treated with clomipramine (Anafranil)

While stuck in traffic, a cab driver unexpectedly begins to feel lightheaded, tremulous, and sweaty. His heart begins pounding and his breathing becomes rapid and labored. He thinks that he is having a heart attack. Driving on the shoulder of the road, he immediately heads for an emergency department. After an extensive cardiac work up reveals no abnormalities. Which diagnosis should a nurse anticipate that a physician will assign to this patient?

- Panic Attack

A Cab driver stuck in traffic suddenly is lightheaded, tremors, diaphoretic, and experiences tachycardia and dyspnea. An extensive work up at ED reveals no pathology. Which medical DX is suspected what RN DX takes priority?

- Panic Disorder and RN dx of anxiety

1. Which RN diagnoses would identify the problems evidenced by the following signs and symptoms: Avoidance, poor concentration, nightmares, hypervigilance, exaggerated startle response, detachment, emotional numbing, and flashbacks?

- Post trauma syndrome

1. Which are examples of primary and secondary gains that clients diagnosed with somatoform pain disorders may experience?

- Primary: pain prevents attendance at family reunion - Secondary: receives get-well messages

1. The nurse understands the teaching plan of a patient who is beginning to take the prescription drug Disulfiram(Antabuse) should include:

- Reading the labels carefully on all OTC items

1. In treating of a patient with OCD, the nurse should allow the patient to?

- Spend the same amount of time on the ritual at the beginning of treatment and encourage the patient to spend incrementally less time on the ritual later in the treatment.

1. RN teaching client about appropriate use of benzos. Nurse evaluates teaching has been effective when the client states:

- States that alcohol is a substance to avoid while on the medication

A client is experiencing a severe panic attack. Which RN intervention would meet this clients most immediate needs?

- Stay with the client and offer reassurance of safety

1. A nurse is discussing treatment options for a client whose life has been negatively impacted by claustrophobia. The nurse would expect which of the following behavioral therapies to be commonly used in the treatment of phobias?

- Systematic desensitization - Imploding (Flooding)

1. An 80-year-old client tells the RN, "I am worried about my surgery tomorrow, I guess I'm not going to live forever". What is the nurse's best response?

- Tell me more about feeling worried

An older adult patient tells the nurse, "I am worried about my surgery tomorrow. I guess I am not going to live forever. An appropriate response by the nurse would be?

- Tell me more about feeling worried

1. New mother, what would nurse state for life transition crisis? SATA

- Tell me what you are experiencing - Connect to community resources

1. A woman developed a number of compulsive washing rituals over the years. She sought the help of a psychiatrist who diagnosed her with OCD. Based on her knowledge of OCD, the nurse is aware that these behavioral rituals served the purpose of?

- Temporary and partial relief of anxiety

1. A client diagnosed with GAD states "I know the best thing for me to do now is just to forget my worries." How should the nurse evaluate the statement?

- The client has distorted perception of problem resolution

1. Which would be considered an appropriate outcome when planning care for a patient diagnosis with somatization disorder?

- The client will list 3 potential adaptive coping strategies to deal with stress by day 2

1. A client diagnosed with OCD is admitted to the psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization?

- The client will wake early enough to complete rituals prior to breakfast

1. A nurse is working with a client diagnosed with somatization pain disorder. What predominant symptoms should the nurse expect to assess?

- The client's predominant symptom focuses on discomfort in one or more anatomical sites

1. Two students failed their introductory nursing course. One student plans to see tutoring and retake the course. The second student attempts suicide after receiving the failing grade. Which of the following factors influence the development of a crisis? SATA

- The individual's perception of the event - The availability of support systems - The availability of adequate coping mechanisms

1. A client is brought to the ED and diagnosed with a panic level of anxiety. What biological system domination would be responsible for this diagnosis?

- The sympathetic division of the autonomic nervous system

A RN instructor teaching about certain phobias. Which student statement should indicate that learning has occurred?

- These Clients have a panic level of fear that is overwhelming and unreasonable

1. A nurse instructor is teaching about hypochondriasis from a psychoanalytical perspective. What student statement about clients diagnosed with this disorder indicates learning has occurred?

- They express personal worthlessness through physical symptoms because physical problems are more acceptable than psychological problems.

1. The nurse determines that the most significant goal for a client experiencing a crisis is which?

- To restore the client to pre-crisis functioning

1. A client is taking Chlordiazepoxide (Librium) for GAD signs and symptoms. In which situation should the nurse identify a greatest risk for overdose?

- When the client combines the drug with alcohol

A client refuses to go on a cruise to the Bahamas with spouse due to fear that boat will sink, and all will drown. Using Cognitive theory perspective, how should the RN explain the etiology of this fear?

- Your spouse may be experiencing a distorted and unrealistic appraisal of the situation

1. How would a RN differentiate a client with panic disorder from a client with GAD?

1. differentiate a client with panic disorder from a client with GAD? - Depersonalization is commonly seen in a panic disorder and absent in GAD

1. In treating a patient with obsessive-compulsive disorder, the nurse should allow the patient to spend ______ time on the ritual at the beginning of treatment, and encourage the patient to spend ________ time on the ritual later in the treatment.

???

1. Which of the following is a correct assumption regarding the concept of crisis?

A. A crisis situation contains the potential for psychological growth or deterioration.

1. During the initial interview with a client in crisis, which intervention should the mental health nurse initially implement?

A. Assess the potential for self-harm.

1. The nurse has been caring for a patient experiencing posttraumatic stress disorder (PTSD). The nurse is aware that realistic outcomes for this patient would include:

A. Client not experiencing flashbacks B. Client not requiring the use of hypnotics to get sleep C. Client verbalizing the ability to experience a wide range of emotions

1. Marie, age 56, is the mother of five children. Her youngest child, who had been living at home and attending the local college, recently graduated and accepted a job in another state. Marie has never worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband has become very concerned and takes her to the local mental health center. This type of crisis is called:

A. Crisis of anticipated life transitions

1. Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called:

A. Crisis resulting from traumatic stress

1. Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called:

A. Dispositional crisis

1. A nurse is teaching a client about the prescribed benzodiazepine. Which of the following should the nurse include in the teaching plan? (SATA)

A. Do not stop taking this medication abruptly because serious complications may arise B. Do not use this medication in combination with alcohol or any other Central nervous system depressant C. Take only the dose your doctor has prescribed and for the period of time the doctor had indicated because addiction can occur

1. Crises occur when an individual:

A. Experiences a stressor and perceives coping strategies to be ineffective

1. The nurse determines which of the following is most essential when planning for a client who is experiencing a crisis?

A. Exploring previous coping strategies

1. Which question would be most effective when evaluating the outcome of crisis intervention?

A. Have you grown from the experience?"

1. In evaluating patient learning, the nurse asked the patient to answer the following statement. "When used in combination with anxiolytic medication, alcohol leads to _________ effects and caffeine leads to _______ effects." Filling the blank

A. Increased; decreased

1. Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called:

A. Maturational/developmental crisis

1. What might the nurse expect to give to a person experiencing toxicity from an intravenous dose of benzodiazepines?

A. Romazicon (Flumazenil)

1. Which treatment should RN Identify as most appropriate for clients DX with GAD?

Long term treatment with buspirone (Buspar)

1. A RN has been caring for a client diagnosed with PTSD. What short term, realistic, correctly written outcome should be included in this client plan of care?

The client will not require zolpidem (Ambien) to obtain adequate sleep by discharge

1. Carly has been diagnosed with somatic symptom disorder. As the nurse is talking with Carly and her family, which of the following statements suggest primary or secondary gains that the physical symptoms are providing for the client?

a. Carly's mother reports that someone from the family stays with Carly each night because the physical symptoms are incapacitating.