Final Exam
A nurse in a pediatric clinic is caring for a preschool-age child who has a new diagnosis ADHD. When teaching the guardian about this disorder, which of the following statements should the nurse include in the teaching?
"Because of this disorder, your child is at an increased risk for injury"
A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
"I should practice limit-setting to help prevent client manipulation."
A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder?
"I'm scared that you're going to leave me."
A nurse is caring for a client who has generalized anxiety disorder and is experiencing severe anxiety. Which of the following statements should the nurse make?
"Tell me about how you're feeling right now."
A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply.)
- "My family will be better off if I'm dead." - "I wish my life was over." - "If I kill myself then my problems will go away."
A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching?
- A no-suicide contract decreases the client's risk for suicide
What are types of ADHD?
- ADHD predominantly inattentive - ADHD predominantly hyperactive-impulsive - Combined type: Client exhibits both inattentive and hyperactive-impulsive behaviors
Negative Symptoms of Schizophrenia
- Affect is it blunted, alogia, which is the poverty of thought or speech such as a mumbling of a few words. - - Anergia: The lack of energy and anhedonia which is the lack of pleasure or joy avolition which is the lack of motivation.
In planning care for a client that has a somatic symptom disorder which are some of the findings you would expect as a nurse?
- Age older than 65 years - Anxiety disorder - Childhood trauma
What do you do as a nurse when someone tells you that they want to kill themself?
- Always use a follow-up question if the first answer is negative - Establish a trusting therapeutic relationship - Limit the amount of time an at-risk client spends alone - Involve significant others in the treatment plan
The charge nurse is reviewing Kubler Ross' five stages of grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? SELECT ALL THAT APPLY.
- Anger - Depression - Denial - Bargaining
A nurse planning care for a client that has a somatic symptom disorder which are some of the findings you would expect as a nurse? (Select all that apply)
- Anxiety disorder - Childhood trauma
What is Bulimia Nervosa?
- Client recurrently eats large amounts of food in a short period of time (binge eating) which can result in self-induced vomiting to get rid of the excess calories - Occurs on average of once per week for 3 months - Binge eating usually less than 2 hours but large amount of food
A nurse is assisting with the development of protocols to address the increasing number of suicides attempts in the community. Which of the following interventions should the nurses include as a primary intervention? (Select all that apply.)
- Conducting a suicide risk screening on all new clients - Educating high school teens about suicide prevention - Teaching middle-school educators about warning indicators of suicide
What are the five stages of Kubler Ross stages of grieving?
- Denial: The client has difficulty believing a terminal diagnosis or loss - Anger: Anger is directed toward self, others, or objects - Bargaining: The client negotiates for more time or a cure - Depression: The client is overwhelmingly saddened by the inability to change the situation - Acceptance: The client accepts what is happening and plans for the future
What are the four phases of the sexual response cycle?
- Desire (libido) - Arousal (excitement) - Orgasm - Resolution.
A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply.)
- Difficulty in getting along with other members of a group - Display of defense mechanisms when routines are changed - Difficulty understanding why it is inappropriate to have a personal relationship with staff
What is Naltrexone used for?
- Diminishes alcohol cravings - Blocks the effects of opiates - Useful in the acute recovery phase of alcohol dependence (first 12 weeks)
A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.)
- Excessive worry for 6 months - Restlessness - Sleep disturbance
What is Anorexia Nervosa?
- Fear of gaining weight or becoming fat - Disturbance in self-perceived weight or shape - Restricting - Binge-eating/purging
What are barriers of mental health care
- Fear of stigmatization - Lack of awareness of mental health services - Sociocultural scarcity - Scarcity of financial support - Lack of geographical accessibility
Standardized assessment tools that are appropriate for the older adult population include the following:
- Geriatric Depression Scale (short form) - Michigan Alcoholism Screening Test: Geriatric Version - MMSE
Positive Symptoms of Schizophrenia
- Hallucinations - Delusions - Alterations - Speech (clang language) - Bizarre Behavior
Characteristics/Manifestations of Autism Spectrum Disorder
- Inability to maintain eye contact - Repetitive actions - Strict observance of routine
Characteristics of ADHD
- Inattention - Hyperactivity - Impulsivity
Suicidal precautions
- Initiate one-on-one constant supervision - Document the client's location, mood, quoted statements, and behavior every 15 - min or per facility protocol - Search the client's belongings with the client present - Remove harmful supplies - Allow the client to use only plastic eating utensils - Count utensils when brought into and out of the client's room - Check the environment for possible hazards - Ensure that the client's hands are always visible, even when sleeping - Do not assign to a private room and always keep the door open - Ensure that the client swallows all medications - Identify whether the client's current medications can be lethal with exceedingly the - prescribed dose - Restrict visitors from bringing possibly harmful items to the client
A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority?
- Lethality of the method and availability of means
A nurse is assessing a client who has illness anxiety disorder. Which of the following are expected for this disorder? Select all that apply
- Obsessive thoughts about disease - History of childhood abuse - Avoidance of health care providers - Depressive disorder
A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribed? (Select all that apply)
- Paroxetine - Lorazepam
A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in teaching? SELECT ALL THAT APPLY
- Participating in psychotherapy can help prevent a relapse - Anhedonia is a clinical manifestation of depressive relapse - Difficulty sleeping can indicate a relapse
What are diagnosable paraphilia?
- Pedophilia - Exhibitionism - Voyeurism - Frotteurism - Fetishism - Sexual masochism - Sexual sadism - Transvestic disorder
Emotional factors of Dyspareunia?
- Psychological issues. Anxiety, depression - Stress - History of sexual abuse
Factors that lead anorgasmia?
- Relationship or intimacy issues - Cultural factors - Physical or medical conditions, and medications. Treatments can include education about
Treatments for anorgasmia?
- Sexual stimulation - Sexual enhancement devices - Individual or couple therapy - Medications
A nurse is planning care for the client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? SELECT ALL THAT APPLY
- Use a firm approach with communication - Establish consistent limits - Offer concise explanations
What are barriers to effective communication?
-Asking irrelevant personal questions -Offering personal opinions -Giving advice -Giving false reassurance -Minimizing feelings -Changing the topic· Asking "why" questions -Offering value judgements -Excessive questioning -Giving approval or disapproval
Grieving/Terminal Illness/Suicide
-Provide physical contact. -Honor spiritual requests of the patient. -Consider cultural factors -Set a comforting mood -Play music at a low volume. -Involve the dying person. If the person can still communicate, ask them what they need -Be present. Visit with the person, talk or read to them, listen -Sharing memories of good times is another way some people find peace -Caregivers may also feel overwhelmed keeping close friends and family informed. A family member or friend can help set up an outgoing voicemail message, a blog, an email list, a private Facebook page, or even a phone tree to help reduce the number of calls the caregiver must make
Separation anxiety disorder
A childhood disorder characterized by anxiety that's excessive for the child's developmental level and related to separation from parents or others who have parental roles
A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission?
A client who has borderline personality disorder and assaulted a homeless man with a metal rod
What is Obsessive-Compulsive Personality Disorder (OCPD)?
A consistent and extreme need for orderliness, perfectionism, and control (with no room for flexibility) that ultimately slows or interferes with completing a task.
Selective mutism
A consistent failure of children to speak in certain situations, such as school, even when they can speak in other situations, such as at home with close family members.
What is Dependent Personality Disorder?
A constant and excessive need to be cared for by someone else. It also involves submissiveness, a need for constant reassurance and the inability to make decisions.
HIPAA and Patient Relationships
A patient has the right to know with whom the nurse will share information and that confidentiality will be protected. Although the relationship is primarily between the nurse and patient, other staff need to know pertinent data
What is frotteurism?
A person who becomes sexually aroused by rubbing against a nonconsenting person, usually in a crowded place, may have a sexual disorder called frotteurism
Be familiar with the reasons why a person would become subject to a Baker Act enforcement.
A person who is at risk for themselves or others.
What is an orgasm?
A series of muscle contractions in the genital region that is accompanied by sudden release of endorphins
You as a nurse know when planning for therapeutic communication involves which of the following
ALL THE ABOVE: Empathy, not sympathy, A nonjudgmental attitude, Honesty
Somatic pain is the expression of psychological stress through physical manifestations. The physical manifestations of some somatic symptom disorders cannot be explained by underlying pathology. You as a nurse providing care for this patient what are some of the patients centered care initiatives?
Accept somatic manifestation as being real to the client
What is a Maturational crisis
Achieving new developmental stages, which requires learning new coping mechanisms
What is CIWA?
Alcohol withdrawal protocol is a way to diagnose the symptoms of alcohol withdrawal syndrome
Maturation/internal crisis is achieving a new development stage which requires learning additional coping mechanisms. Examples include getting married or retiring. What are the risk factors for this type of crisis?
All of the above (Accumulation of unresolved losses , Current life stressors ,Concurrent mental and physical health issues )
What is The Baker Act?
Allows people with mental illnesses to be held involuntary for up to 72 hours in a mental health treatment facility if they meet certain criteria
Examples of antianxiety medications
Alprazolam, Diazepam, Oxazepam
Therapeutic Communications
Always remember any response that will encourage your patient to verbalize will always be your correct answer
All of the following are risk factors for older adults and suicide except:
Anger management problem
Reflection
Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values
What are medications used for alcohol withdrawal therapy
Benzodiazepines - Chlordiazepoxide - Diazepam - Lorazepam - Oxazepam Adjunct Meds - Carbamazepine - Clonidine - Propranolol - Atenolol
A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply.)
C. Attempts to convince other clients to relinquish their belongings E. Blames others for personal past and current problems
Specific phobias
Characterized by major anxiety when you're exposed to a specific object or situation and a desire to avoid it.
Substance-induced anxiety disorder
Characterized by symptoms of intense anxiety or panic that are a direct result of misusing drugs, taking medications, being exposed to a toxic substance or withdrawal from drugs
What is COWS?
Clinical Opiate Withdrawal Scale, a numbered scale designed to help clinicians tailor opioid withdrawal
Autism Spectrum Disorder
Complex neurodevelopmental disorder, from genetic origin. Affecting individuals' ability to communicate and interact w/ others
What is Anorgasmia?
Delayed, infrequent or absent orgasms — or significantly less-intense orgasms —after sexual arousal and adequate sexual stimulation.
A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care?
Ensure that the client swallows' medication
What is The Marchman Act?
Florida law that provides means of involuntary and voluntary assessment and stabilization and treatment of a person allegedly abusing alcohol or drugs
What is a sexually transmitted disease?
Generally acquired by sexual contact. The bacteria, viruses or parasites that cause sexually transmitted diseases may pass from person to person in blood, semen, or vaginal and other bodily fluids
A nurse caring for a client who has bipolar disorder. The client states, I am very rich, and I feel I must give my money to you. Which of the following responses should the nurse make?
I am here to provide care and connect and accept this from you
Generalized anxiety disorder
Includes persistent and excessive anxiety and worry about activities or events — even ordinary, routine issues
You are working in a mental health facility, and you have a patient that you must monitor their CIWA scores, you should know that this assessment monitors for:
Indication of severe withdrawal (impending delirium tremens)
You as a nurse have to place a patient on suicide precautions which of the following is correct:
Initiate a one on one constant supervision around the clock, always having the client in the line of sight and close. Documentation should indicate that which staff member is accountable for the client, with a specific start and stop times period there is an increased risk for suicide during staff rotation times
A charge nurse is conducting a class on therapeutic communication with a group of newly licensed nurses. Which of the following aspects of communication should the nurse identify as a component of verbal communication?
Intonation
What is ADHD?
Involved the inability of a person to control behaviors requiring sustained attention
Social anxiety disorder (social phobia)
Involves high levels of anxiety, fear, and avoidance of social situations due to feelings of embarrassment, self-consciousness and concern about being judged or viewed negatively by others
Panic disorder
Involves repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes
Treatment for Vaginismus?
Kegels, vaginal dilators, and cognitive behavioral therapy (CBT)
A nurse is reviewing the medical records of multiple clients at a community mental health facility. Which of the following events is an example of a client experiencing a maturational crisis?
Marriage
Ineffective Coping
May be evidenced by inability to meet basic needs, inability to meet role expectations
A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action?
Monitor the client for escalating behavior
Self-Assessment of Feelings of Anger Towards a Patient
Objectivity is threatened by strong positive or negative feelings toward a patient. Supervision is necessary to work through countertransference feelings
A nurse is communicating with a client who was admitted for treatment of a substance abuse disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication?
Offering advice
What is a situational crisis?
Often unanticipated loss or change experienced
What is the best technique to utilize when communicating with your clients when you need them to open up or verbalize during your conversation?
Open ended questions
What is Dyspareunia?
Painful intercourse can occur for reasons that range from structural problems to psychological concerns.
What is Paranoid Personality Disorder?
Paranoia, a relentless mistrust and suspicion of others without adequate reason for suspicion.
What is Somatic Symptom Disorder?
Patient histories may include multiple treatments and surgeries, substance abuse, marital difficulties, suicide attempts, chronic pain, and impaired work and life functioning, including disability and high health care costs. These individuals frequently refuse psychiatric assistance because they believe their symptoms are medical, even when presented with negative test findings
Geriatric/Elderly Considerations
People over 65 (Geriatrics patients) should take extra care with medications, especially if they are taking many different medications (They have a higher risk of experiencing drug interactions and are often more sensitive to medications)
If a client is subject to the Marchman Act of 1993, the nurse would expect the following to occur:
Provides a means of involuntary and voluntary assessment and stabilization and treatment of a person allegedly abusing alcohol or drugs
What is Sundown Syndrome?
Refers to a state of confusion occurring in the late afternoon and lasting into the night
A nurse is assessing a 4-year old child for indications of autism spectrum disorder. For which of the following manifestations should the nurse assess?
Repetitive counting
A nurse in an acute mental health facility is communicating with the client. The client states, "I can't sleep. I stayed up all night." The nurse responds, "You're having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating?
Restating
A nurse is caring for a young adult client following the sudden death of his wife. The client feels paralyzed in his ability to cope with work and family responsibilities. Which of the following types of crises is the client experiencing?
Situational
All of the following behaviors may warrant a Baker Act by law enforcement except:
Sleeping on the sidewalk
A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms?
Splitting
A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take?
Stay with the client and remain quiet
Termination of a therapeutic nurse-patient relationship
Summarizing and evaluating progress help validate the experience for the patient and the nurse and facilitate closure. Termination must be discussed; avoiding discussion by spending little time with the patient promotes feelings of abandonment. Successful termination requires that the relationship be brought to closure without the possibility of dependency-producing ongoing contact
A client tells a nurse, don't tell anyone but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always threatening me. Which of the following actions should the nurse take?
Tell the client that this must be reported to the health care team because it concerns the health and safety of the client and others
A nurse here's a newly licensed nurse discussing a client hallucination in the hallway with another nurse. Which of the following actions should the nurse take first? - Tell the nurse to stop discussing the behavior
Tell the nurse to stop discussing the behavior
What is Bipolar 1
The client has at least one episode of mania alternating with major depression.
What is Bipolar 2
The client has one or more hypomanic episodes alternating with major depressive episodes.
Schizophrenia
The client has psychotic thinking or behavior present for at least 6 months. Areas of functioning, including school or work, self-care, and interpersonal relationships, are significantly impaired.
A nurse caring for a client who has anorexia nervosa (an eating disorder - similar to dysmorphic disorder). Which of the following examples demonstrates the nurse's use of interpersonal communication?
The nurse asked the client about personal body image perception
Schizophrenia is defined as psychotic thinking or behavior present for at least six months. Areas of functioning include school or work, self-care, and interpersonal relationships, are significantly impaired is this true or false?
True
T/F: STD's can lead to mental illness.
True
A nurse is caring for a client who has bipolar disorder and is in the manic phase. The client says he is bored. Which of the following activities is appropriate for the nurse to suggest to this client?
Walking with the nurse in the courtyard
What is exhibitionism?
a condition marked by the urge, fantasy, or act of exposing one's genitals to non-consenting people, particularly strangers
What is Schizotypal Personality Disorder?
a consistent pattern of intense discomfort with and limited need for close relationships.
What is paraphilia?
a person's sexual arousal and gratification depend on fantasizing about and engaging in sexual behavior that is atypical and extreme. Is considered a disorder when it causes distress or threatens to harm someone else
What is masochism?
a psychosexual disorder in which the erotic liberation is achieved having pain inflicted on oneself is a condition in which someone is sexually aroused to being tied up , beaten or made to suffer physical pain or humiliation, this desire can cause significant amount of distress
What is transvestism?
an individual experiences recurrent, intense sexual arousal from cross-dressing, or dressing as the opposite gender, and in which that person's urge to do so causes significant distress or impairment to their daily life.
What is gonorrhea?
an infection caused by a sexually transmitted bacterium that infects both males and females
What is vaginismus?
an involuntary tensing of the vagina.
What is pedophilia?
an unnatural or abnormal attraction towards children of either or both sexes, usually aged thirteen years or younger
What is the American Psychiatric Association?
current used system of classifying and diagnosis of mental disorders. The latest version published in DSM-5 emphasizes observable data and deemphasizes subjective and theoretical impressions
What are examples of situational crisis?
divorce or job change
what is transexualism?
extreme end of the spectrum of gender identity disorders characterized by, among other things, a pursuit of sex reassignment surgery (SRS).
What is an example of maturational crisis?
getting married or retiring
What is Sadomasochism?
inflicting and/or enduring painful activities, this does not have to be exclusively during intercourse
What is Narcissistic Personality Disorder?
involves a consistent pattern of perceived superiority and grandiosity, an excessive need for praise and admiration and a lack of empathy for others.
What is Antisocial Personality Disorder (ASPD)?
lack of respect toward others and don't follow socially accepted norms or rules.
Examples of AntiDepressants
paroxetine, bupropion, fluoxetine
What is homosexuality?
quality or characteristic of being sexually attracted solely to people of one's own sex
What is sexual response?
refers to the sequence of physical and emotional changes that occur as a person becomes sexually aroused and participates in sexually stimulating activities, including intercourse and masturbation
What is voyeurism?
sexual interest in or practice of watching other people engaged in intimate behaviors, such as undressing, sexual activity, or other actions usually considered to be of a private nature
What is lesbianism?
sexual or romantic attraction to other women or between women.
Anxiety disorder due to a medical condition:
symptoms of intense anxiety or panic that are directly caused by a physical health problem
What is Sadism?
taking sexual pleasure from humiliation, fear, or another form of mental harm to a person
What is transvestic fetishism?
the urge or desire to dress in the clothes of the opposite sex, or cross-dress, to achieve sexual excitement or arousal.
Agoraphobia
type of anxiety disorder in which you fear and often avoid places or situations that might cause you to panic and make you feel trapped, helpless, or embarrassed
What is premature ejaculation?
when semen leaves the body (ejaculate) sooner than wanted during sex.