Mental Health Exam 2 EAQ Notes

A client receives a new prescription for sertraline 50 mg daily. The client phones the nurse and says, "I read on the internet that this drug is for depression. I have social anxiety, not depression." Which response should the nurse provide? "The website was incorrect. Sertraline is an antianxiety medication rather than an antidepressant." "Thank you for informing us of this error. I will discuss the situation with your health care provider and call you back shortly." "Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." "It is important for you to take the medication. Try to have confidence in your health care provider's judgment about how to help you."

"Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." The nurse should explain to the client that selective serotonin reuptake inhibitors (SSRIs) are considered the first line of defense in most anxiety disorders, including social anxiety. Sertraline and paroxetine are SSRIs with calming effects. The website was not incorrect, and the prescription was not made in error. The nurse should provide a more complete response than telling the client to simply have confidence in the health care provider's judgment. p. 145

What is the most important question to ask during assessment of a client diagnosed with an anxiety disorder? "How often do you hear voices?" "Have you ever considered suicide?" "How long has your memory been poor?" "Do your thoughts always seem jumbled?"

"Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is important for any client with an anxiety disorder. Hearing voices, poor memory and jumbled thoughts may be related to anxiety but are not as important to the client's safety as risk for suicide. p. 142

A client has been receiving treatment for posttraumatic stress disorder (PTSD) after experiencing a sexual assault. Which statement most supports that the client is able to reassume pretrauma function? "I really like my therapist." "I'm feeling less anxious among strangers." "I'm hopeful that life will get back to normal." "I'm being considered for a promotion at work."

"I'm being considered for a promotion at work." Most patients will be able to eventually resume their previous lives after supportive services and crisis counseling or therapy. If survivors are relatively free of signs of PTSD and their lifestyles are close to their lifestyles before the rape, the recovery is considered successful. Being considered for a promotion indicates the client is able to effective work and engage in areas of interest. The remaining options, while positive statements, lack tangible proof of resuming pre-trauma levels of functioning. pp. 354-355

Buspirone is prescribed for a client diagnosed with anxiety. Which instruction should the nurse provide to this client? "Take this medication on an empty stomach." "Take this medication only when you feel anxious." "It will take 3 or more weeks for you to feel the full benefit." "Avoid consuming aged cheese products while you are taking this medication."

"It will take 3 or more weeks for you to feel the full benefit." Buspirone is an alternative antianxiety medication that does not cause dependence, but 3 or more weeks are required for it to reach full effects. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking MAOIs (monoamine oxidase inhibitors). p. 147

A client asks, "What exactly are neurotransmitters?" How does the nurse best answer the client's question? "Neurotransmitters are chemical messengers in the brain that help regulate specific functions." "Neurotransmitters are too complicated to explain easily. Just know that the medication will help your mood." "Neurotransmitters are the reason you are depressed." "I will ask your health care provider to give you a more in-depth explanation on neurotransmitters and their effects."

"Neurotransmitters are chemical messengers in the brain that help regulate specific functions." Neurotransmitters are chemicals released from neurons that function as neuromessengers and influence brain functions. Telling the client that the answer is too complicated belittles the client by implying he or she cannot understand, and this does not answer the question. Stating that neurotransmitters are the reason the client is depressed is too simplistic and does not answer the question of what neurotransmitters are. Asking the health care provider to give the education abdicates the nurse's responsibility to provide client education. pp. 37-39

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

"What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. The other answer options advocate distracting the client, which is not useful in addressing the anxiety. p. 133

While conducting an initial interview, the client, a war veteran, shares with the nurse that "Sometimes I still hear explosions, but I know I am safe in my home." What is the nurse's best response? "Your description indicates flashbacks, which are commonly associated with acute stress disorder. You need to have additional treatment." "Exposure to intermittent explosive devices often damages a person's ears. Let's arrange for some tests of your hearing and balance." "Your experience in the war is over and you are safe. It is time for you to recognize that experience is over and you should move on with your life." "You are describing flashbacks. These often happen after traumatic events such as war. I'd like to arrange for you to talk more about your feelings and reactions."

"You are describing flashbacks. These often happen after traumatic events such as war. I'd like to arrange for you to talk more about your feelings and reactions." This veteran is describing flashbacks, a major feature of posttraumatic stress disorder (PTSD). Flashbacks are dissociative experiences during which the event is relived and the person behaves as though he or she is experiencing the event at that time. Additional evaluation and treatment are indicated. The symptoms this client describes do not suggest acute stress disorder. Although hearing may be damaged, treatment of PTSD has a higher priority. Reactions to traumatic events may occur years after the experience. p. 123

Which chemical in tobacco causes addiction? A) Nicotine B) Cannabinoids C) Cocaine D) Opium

1) Nicotine NIcotine is found in tobacco and causes an addictive disorder. This chemical overpowers the reward pathway circuit, and releases the neurotransmitter dopamine which gradually becomes more important than the reward of pleasure. The increased saliency of the addictive process cancels the inhibitory function of the frontal cortex, leading to craving. Cannabinoids are the chemicals found in marijuana. Cocaine and opium are other substances that cause addiction. These are not found in tobacco. p. 305

The nurse working at a Veteran's Administration (VA) clinic assesses a client with posttraumatic stress disorder (PTSD). What is the approximate prevalence of PTSD in veterans of the Iraq and Afghanistan wars? 3% 7% 14% 24%

14% For veterans of the Iraq and Afghanistan wars, PTSD prevalence is about 14%. More veterans than 3% experienced PTSD. The prevalence of PTSD in the general population is approximately 7%. Fewer veterans than 24% experienced PTSD. p. 57

Based on the current understanding of neurotransmitters, what event is responsible for a client's symptoms of profound depression? An increase in dopamine level A decrease in serotonin level An increase in norepinephrine level A decrease in acetylcholine level

A decrease in serotonin levels A decreased serotonin level is highly associated with depression. Increased dopamine, increased norepinephrine, and decreased acetylcholine levels are not associated with depression. p. 42

How is obsession defined? A recurrent, persistent thought or impulse An intense irrational fear of an object or situation A recurrent behavior performed in the same manner Thinking of an action and immediately taking the action

A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. An intense irrational fear of an object or situation is a phobia. A recurrent behavior is a compulsion. Immediately taking an action is unrelated to obsession. p. 141

Which statement is true regarding the comorbidity of anxiety disorders? Anxiety disorders generally exist alone. A second anxiety disorder may co-occur with the first. Anxiety disorders virtually never coexist with mood disorders. Substance abuse disorders rarely coexist with anxiety disorders.

A second anxiety disorder may co-occur with the first. In many instances, when one anxiety disorder is present, a second one co-occurs. Health care providers and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment. Substance abuse also frequently co-occurs and has a negative impact on treatment. p. 137

When discussing the symptoms of posttraumatic stress disorder (PTSD), which statement by the nurse is correct? "The symptoms can occur almost immediately or can take years to manifest." "PTSD causes agitation and hypervigilance, but rarely chronic depression." "When experiencing a flashback, the client generally experiences a slowing of responses." "PTSD is an emotional response that does not cause significant changes in brain chemistry."

A) "The symptoms can occur almost immediately or can take years to manifest" The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. PTSD can cause agitation, hypervigilance, and chronic depression. Flashbacks are not associated with a slowing of responses. PTSD is associated with significant changes in brain chemistry. p. 125

A client diagnosed with a tumor of the cerebellum is likely to demonstrate which dysfunction of which process? A) Disequilibrium B) Abnormal eye movement C) Impaired social judgment D) Blood pressure irregularities

A) Disequilibrium The cerebellum is the organ primarily responsible for maintaining equilibrium. Eye movements are controlled by the midbrain. The frontal lobe controls social judgment. The medulla maintains blood pressure. p. 37

A client has a diagnosis of schizophrenia. The nurse knows this is likely attributed to which imbalance? A) Increased dopamine B) Increased serum potassium C) Increased gamma-aminobutyric acid (GABA) D) Decreased number of glutamate receptors

A) Increased dopamine Norepinephrine and dopamine are increased in schizophrenia. GABA is decreased in schizophrenia. Glutamate and potassium are not neurotransmitters associated with schizophrenia. p. 42

What is the basic functional unit of the nervous system? A) Neuron B) Synapse C) Receptor D) Neurotransmitter

A) Neuron Neurons are nerve cells. These cells are the basic unit of function in the nervous system. A neurotransmitter is a chemical substance that functions as a neuromessenger. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface. p. 37

Which structure associated with the brain responds to stimuli, conducts electrical impulses, and releases neurotransmitters? A) Neuron B) Synapse C) Cerebellum D) Receptor

A) Neuron Neurons are the basic functional unit of the nervous system responsible for sending and receiving messages as electrochemical events. Electrical signals within neurons are converted at synapses into chemical signals. The cerebellum is an area of the brain that contributes to both motor control and cognitive processing. Receptors are located on cell surfaces and receive electrical impulses. p.37

The nurse is caring for a sexually assaulted client who has been diagnosed with posttraumatic stress disorder (PTSD). The client reports waking up suddenly from sleep and crying out loudly two to three times every night. What documentation should the nurse include in the client's case file? The client frequently re-experiences the assault. The client avoids expressing emotions related to the assault. The client has reduced concentration and has difficulty sleeping. The client becomes aggressive occasionally without any reason.

A) The client frequently re-experiences the assault. The nurse should document that the client frequently re-experiences the incident of the assault. Avoiding the emotions related to the incident means that the client is not willing to be reminded about the incident. The client with avoidance behavior may avoid any place or object that remind them of the experience. The client is able to sleep but is suddenly awakened due to frightening nightmares. Therefore, the nurse should not document that the client has reduced concentration and has difficulty sleeping. In this situation, the client is not displaying aggressive behavior. p. 355

Which statements regarding the implementation of play therapy are correct? Select all that apply. A) A child learns coping mechanisms through playing with toys. B) Limits are set only to promote security and provide a sense of reality. C) The expression of feelings is supported through the use of a variety of toys. D) Therapists direct the focus of a child's play toward identified problem areas. E) Acting out situations with dolls and puppets substitutes for verbal discussions.

A, B, C, E The guiding principles of play therapy are: accept the child as he or she is and follow his or her lead; establish a warm, friendly relationship that fosters the expression of feelings completely; and set limits only to provide reality and security. Through the use of an appropriate medium, a child can express thoughts or emotions that he or she may not be able to express verbally. Dolls, puppets, and dollhouses provide a child with opportunities to act out conflicts and situations involving the family, work through feelings, and develop more adaptive ways of coping. Therapists direct a child's play toward the activity and play process rather than the identified problem areas. p. 414

Which traits are typically common among avoidant, obsessive-compulsive, and dependent personality disorders? Select all that apply. A) Depressed B) Shallow C) Eccentric D) Fearful E) Tense F) Irrational

A, D, E Avoidant, obsessive-compulsive, and dependent personality disorders are categorized as cluster C personality disorders. They are typically associated with anxious, fearful, tense, overcontrolled, and depressed behavior. Eccentric and irrational behaviors are typically seen in cluster A disorders. Shallow behavior is associated with cluster B disorders. p. 168

The nurse is preparing a community health presentation about substance abuse. Which substance use disorder does the nurse note in the presentation is the most common in the United States? Cocaine Opioid Alcohol Marijuana

Alcohol According to multiple studies, alcohol use disorder is the most common substance use disorder in the United States. Cocaine, opioid, and marijuana use disorders are not as prevalent. p. 312

A nurse is caring for a child diagnosed with posttraumatic stress disorder as a result of violence at home. What trauma interventions should the nurse plan for this child? Involve the family in caring for the child. Allow the child to draw and play. Encourage the child to conceal emotions. Limit the child's activities.

Allow the child to draw and play. Posttraumatic stress disorder usually occurs after a stressful or traumatic event. Allowing the child to draw and play would help in expression of feelings and improve the child's coping ability. When a child is traumatized due to violence at home, family involvement may disturb the child and should be avoided. The child should be encouraged to identify, explore, and share his or her emotions and to use a variety of activities as an outlet for them. p. 414

A client is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior? Thalamus Amygdala Hypothalamus Pituitary gland

Amygdala The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones. p. 137

Which scenario presents the most accurate example of altruism? After recovering from a gunshot wound, a police officer attends a local support group. After recovering from open-heart surgery, an individual plays tennis three times a week. An individual with a longstanding fear of animals volunteers at a community animal shelter. An individual who received a liver transplant volunteers at a local organ procurement agency.

An individual who received a liver transplant volunteers at a local organ procurement agency. Altruism is a healthy defense mechanism in which emotional conflicts and stressors are addressed by meeting the needs of others. With altruism, the person receives gratification either vicariously or from the response of others. Volunteering at a local organ procurement agency after receiving an organ transplant meets the needs of others. Attending a support group, playing tennis, and volunteering at an animal shelter to address one's own fears are all examples of meeting the individual's needs, but they are not necessarily altruistic. p. 133

When considering prevalence, the nurse will focus on providing community mental health screening for which disorder? Anxiety disorders Affective disorders Alcohol dependence Any substance abuse

Anxiety disorders Over a 12-month period, anxiety disorders have an 18.1% prevalence affecting an estimated 57 million people. Affective disorders have a 9.5% prevalence (30 million); Alcohol dependence has a 6.3% prevalence (16.5 million); any substance abuse has a prevalence of 9.4% (24.6 million). p. 12

A client diagnosed with schizophrenia complains to the nurse about persistent feelings of restlessness and says, "I feel like I need to move all the time." What is the nurse's next action? Add an activity group to the client's plan of care. Perform a full mental status evaluation of the client. Assess the client for other extrapyramidal symptoms. Educate the client about psychomotor agitation associated with schizophrenia.

Assess the client for other extrapyramindal symptoms. The nurse should assess the client for other extrapyramidal symptoms. Restlessness (akathisia) is a common extrapyramidal symptom. Adding activity to the client's plan of care could benefit the client but will not address the potential extrapyramidal symptoms, so this action can come later. Performing a full mental status evaluation of the client is unnecessary, because the client had been diagnosed with schizophrenia and is already discussing specific issues that the nurse can directly evaluate. Educating the client about psychomotor agitation is not relevant to the client's feelings of restlessness, because this is typically an issue for people experiencing catatonia. pp. 251, 263

A client diagnosed with anxiety is prescribed diazepam. What specific instruction should the nurse give to minimize the client's risk of experiencing excessive central nervous system (CNS) depression? Take the drug before going to sleep. Avoid consuming alcohol while on the drug. It is fine to take the drug before driving to work. Take the drug in conjunction with a tricyclic antidepressant.

Avoid consuming alcohol while on the drug. Diazepam is a benzodiazepine drug. If benzodiazepines are combined with other CNS depressants such as alcohol, then the inhibitory actions of the benzodiazepines can lead to life-threatening CNS depression such as coma. Taking the drug before going to sleep, avoiding activities requiring a high degree of alertness like driving, or taking the drug in conjunction with a tricyclic antidepressant are not instructions given to avoid CNS depression. The drug should ideally be taken before going to sleep so that drowsiness does not affect daily activities. However, this does not have to do with CNS depression. Benzodiazepines impair alertness; therefore, it should not be taken while doing activities that require a high degree of attention such as driving a car. Benzodiazepines should never be consumed with tricyclic antidepressants drugs, because their interaction may cause serious CNS depression symptoms, such as coma and respiratory distress. p. 46

How does a tricyclic antidepressant help to relieve depression? A) It prevents the destruction of monoamine oxidase. B) It prevents the destruction of norepinephrine. C) It stimulates the production of monoamine oxidase. D) It stimulates the production of norepinephrine.

B) It prevents the destruction of norepinephrine. Norepinephrine binds to the receptors of the postsynaptic neurons, which causes excitation of the postsynaptic neuron. Upon interaction with the monoamine oxidase enzyme, norepinephrine is removed from the receptors and is destroyed. The excitatory effect in the postsynaptic neuron also disappears. In order to prolong the action of norepinephrine, the interaction of norepinephrine with monoamine oxidase is inhibited. This is the mechanism of action of tricyclic antidepressants. Preventing the destruction or stimulating the production of monoamine oxidase would run counter to the goal of treatment. Inhibiting monoamine does not affect the production of norepinephrine, only its destruction. p. 43

Which neurotransmitter imbalance has been shown to be related to impulsive aggression? A) Low levels of γ-aminobutyric acid B) Low levels of serotonin C) High levels of dopamine D) High levels of acetylcholine

B) Low levels of serotonin Low serotonin levels have been implicated in several research studies as being a factor in impulsive aggression. There is no current research to support low levels of γ-aminobutyric acid, high levels of dopamine, or high levels of acetylcholine related to impulsive aggression. p. 376

The nurse understands that which neurotransmitters are decreased with a diagnosis of depression? A) Epinephrine, norepinephrine, and acetylcholine B) Norepinephrine, dopamine, and serotonin C) Acetylcholine, gamma-aminobutyric acid, and serotonin D) Gamma-aminobutyric acid (GABA), dopamine, and epinephrine

B) Norepinephrine, dopamine, and serotonin Norepinephrine, dopamine, and serotonin are all neurotransmitters involved in a diagnosis of depression. Acetylcholine is increased with depression, and GABA is associated with anxiety. p. 42

Citalopram exerts its antidepressant effect by selectively blocking the reuptake of which neurotransmitter? A) Gamma aminobutyric acid (GABA) B) Serotonin C) Glutamate D) Dopamine

B) Serotonin Selective serotonin reuptake inhibitors (SSRIs), such as citalopram, preferentially block the reuptake and degradation of serotonin, thereby improving depression. GABA is involved in anxiety responses. Glutamate regulation is involved in memory and learning. Dopamine regulation is involved in thought processes and movement. p. 44

Which pathology do biological theorists suggest is a cause of eating disorders? A) Dopamine excess B) Serotonin imbalance C) Normal weight phobia D) Body image disturbance

B) Serotonin imbalance Serotonin pathways are abnormal in both anorexia nervosa and bulimia nervosa. Brain scans of clients with these disorders reveal altered serotonin receptors and transporters. Dopamine excess is not associated with eating disorders. Normal weight phobia and body image disturbance may be involved, but they are not biological factors. p. 183

A nurse is working on a project to find the epidemiology of panic disorder in the Latin American community. Which signs should the nurse expect to observe in a client from this community experiencing a panic attack? Select all that apply. A) The client fears offensive body odor. B) The client has sensations of choking. C) The client feels numbness or tingling. D) The client has sensations of smothering. E) The client attributes the attack to magic or witchcraft.

B, C, D The Latin American community experiences sensations of choking, numbness or tingling, and smothering, as well as fear of dying. In Japanese and Korean culture, people have a fear of offensive body odor. Other cultures may attribute the panic attack related to magic or witchcraft. p. 138

Which statements about panic attacks are true? Select all that apply. A) A stressful situation is generally the trigger for a panic attack. B) They are characterized by a sudden onset of extreme apprehension. C) The symptomology of panic attacks is primarily psychological in nature. D) The fear is so intense that it interferes with a person's ability to function normally. E) People with a history of panic attacks develop a deep-seated fear of having an attack.

B, D, E A panic attack is the sudden onset of extreme apprehension or fear. The feelings are so severe that normal functioning is suspended. People who experience these attacks begin to "fear the fear" and become so preoccupied about future episodes of panic that they avoid what could be pleasurable and adaptive activities, experiences, and obligations. Typically, panic attacks appear randomly and are not necessarily in response to stress. Uncomfortable physical symptoms such as palpitations, chest pain, breathing difficulties, nausea, and feelings of choking, chills, and hot flashes may occur. p. 138

A nurse plans care for an adult who is diagnosed with a tumor in the cerebellum. The nurse should focus initial interventions on the client's anticipated problems with which function(s)? Social judgment Balance and equilibrium Proprioception and body awareness Regulation of pupil size and reflexes

Balance and equilibrium The cerebellum is involved primarily in regulation of skeletal muscle coordination and contraction as well as maintenance of equilibrium. It coordinates muscle contractions, so movement is smooth and purposeful. The frontal lobe manages social judgment. The parietal lobe directs proprioception and body awareness. The midbrain regulates pupil size and reflexes. pp. 35, 37

Which category of medication used to treat anxiety has a potential for addiction? Tricyclics Benzodiazepines Selective serotonin reuptake inhibitors Selective serotonin norepinephrine reuptake inhibitors

Benzodiazepines Benzodiazepines are commonly prescribed for anxiety because they have a quick onset of action; however, because of the potential for addiction, these medications ideally should be used only for short periods and are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create addiction. p. 145

Which medication may be helpful in school-age children suffering from obsessive or anxious symptoms? Stimulants Antipsychotics Beta blockers Nonstimulants

Beta blockers Beta blockers may be used in children with obsessive or anxious symptoms. Stimulants and nonstimulants are used in children with attention deficit-hyperactivity disorder. Antipsychotics may help children presenting with aggression and self-harm. p. 408

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? A) γ-Aminobutyric acid B) Dopamine C) Serotonin D) Acetylcholine

C) Serotonin Low serotonin levels have been noted among individuals who have committed suicide. While γ-aminobutyric acid, dopamine and acetylcholine are neurotransmitters, they are not believed to be associated with suicidal ideations. p. 364

The nurse caring for a client with Alzheimer disease can anticipate that the family will need information about which kind of medication? Antihypertensives Benzodiazepines Immunosuppressants Cholinesterase inhibitors

Cholinesterase inhibitors Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Cholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine. Antihypertensives, benzodiazepines, and immunosuppressants are not medications targeted for Alzheimer disease. p. 290

Which statement is true regarding obsessive-compulsive disorder (OCD)? Behaviors suggestive of OCD usually begin in infancy. Hospitalization is often necessary for persons diagnosed with OCD. Clients diagnosed with OCD should be assessed regularly for risk for suicide. Compulsions are repetitive thoughts, whereas obsessions are ritualistic behaviors.

Clients diagnosed with OCD should be assessed regularly for risk for suicide. People suffering from OCD may become desperate and attempt suicide. Risk for suicide should be assessed regularly in these clients. Obsessive-compulsive disorder can begin in childhood, with symptoms present as early as age 3, but symptoms would not be expected in infancy. People with obsessive-compulsive disorders rarely need hospitalization unless they are suicidal or have compulsions that cause injury. Compulsions are ritualistic behaviors an individual feels driven to perform in an attempt to reduce anxiety. Obsessions are thoughts, impulses, or images that persist, recur, and cannot be dismissed from the mind. p. 141

Upon examination, the nurse finds that the client who has acknowledged abusing drugs is experiencing nasal damage. Which substance does the nurse suspect is being abused? Lysergic acid diethylamide (LSD) Opium Hashish Cocaine

Cocaine Cocaine is a stimulant and is administered by smoking, injecting, or snorting. Snorting cocaine causes nasal damage. Lysergic acid diethylamide (LSD) is a hallucinogen, which is swallowed or absorbed through tissues in the mouth. Opium is an opioid, which is swallowed or smoked. Hashish is a cannabinoid, which is smoked or swallowed. p. 298

A war veteran comes to the clinic demonstrating signs of posttraumatic stress disorder (PTSD). What method of treatment does the nurse use when treating this client? Low-carbohydrate diet Herbal supplements Manipulative practices Cognitive behavioral therapy

Cognitive behavioral therapy Cognitive behavioral therapy is used to treat war veterans with posttraumatic stress disorder (PTSD). A low-carbohydrate diet is a method for weight reduction and the treatment of obesity. Herbal supplements are used to supply nourishment to the body, not as a cure for PTSD, though some may help calm nerves. Manipulative practices such as chiropractic treatment are done mainly to relieve pain. p. 126

After a sexual assault, a college student was treated in the emergency department, diagnosed with acute stress disorder, and referred for counseling. Which is the most likely approach to counseling for this client? Psychoanalysis Aversion therapy Stress-reduction therapy Cognitive behavioral therapy

Cognitive behavioral therapy Cognitive behavioral therapy uses a range of strategies such as psychoeducation, behavior modification, cognitive therapy, exposure therapy, and stress management to help the victim manage behavior and change maladaptive beliefs and thoughts resulting from the traumatic experience. Psychoanalysis is long-term therapy that focuses on early life development of pathology. Aversion therapy uses unpleasant conditioning or reinforcement, so it is not appropriate in this scenario. Stress-reduction therapy is one component of cognitive-behavioral therapy. p. 126

Which change in neurotransmitters occurs in Alzheimer disease? A) Decreased serotonin B) Increased dopamine C) Increased epinephrine D) Decreased acetylcholine

D) Decreased acetylcholine In Alzheimer disease, there is decreased action of acetylcholine. Decreased serotonin is associated with depression. Increased dopamine is associated with schizophrenia. Increased epinephrine is associated with stimulation of the sympathetic nervous system. p. 290

The nurse understands that tricyclic antidepressants, such as amitriptyline, cause which physiological response? A) Inhibiting monoamine oxidase inhibitors that breakdown norepinephrine B) Inhibiting nerve activity, which prevents over excitability or stimulation C) Blocking the reuptake of serotonin, which increases norepinephrine levels D) Inhibiting the reuptake of norepinephrine and serotonin

D) Inhibiting the reuptake of norepinephrine and serotonin Originally termed tricyclic antidepressants (TCAs), these agents are more accurately called cyclic antidepressants (CAs) because newer members of this class have a four-ring structure. TCAs, such as amitriptyline (Elavil) and nortriptyline (Pamelor), act primarily by blocking the presynaptic transporter protein receptors for norepinephrine, and to a lesser degree, serotonin. This blocking prevents norepinephrine from coming into contact with its degrading enzyme, MAO, and thus increases the level of norepinephrine at the synapse. MAOI inhibitors are implemented to break down norepinephrine. Tricyclic antidepressants do not inhibit nerve activity. Selective serotonin reuptake inhibitors block the reuptake of serotonin, increasing norepinephrine. p. 44

A nurse is caring for a client in palliative care. The client has been extubated and comfort care measures are in place. When the client expires, a family member is at the bedside. Which reaction by the family member does the nurse expect first? Denial Depression Acceptance Restlessness

Denial Although emotional responses vary from one individual to the next, a common first response is denial and the person is unable to accept his or her painful loss. Although depression is a reaction during the grief process, it is not the most common first response. Although acceptance is a reaction during the grief process, it is not the most common first response. Although restlessness is a reaction during the grief process, it is not the most common first response. p. 390

Upon studying the medical records of a client diagnosed with anxiety, the nurse finds that the client has been prescribed diazepam. How does this drug relieve anxiety? Diazepam binds with alpha (α) receptors. Diazepam binds with serotonin (5HT 1) receptors. Diazepam binds with gamma aminobutyric acid (GABA) receptors. Diazepam binds with dopamine (D 2) receptors.

Diazepam binds with gamma aminobutyric acid (GABA) receptors. Diazepam belongs to the class of benzodiazepines. These drugs relieve anxiety by binding to GABA receptors. GABA is the major inhibitory neurotransmitter in the central nervous system. Therefore, blocking the GABA receptors would prevent inhibition of the central nervous system and relieve anxiety. Diazepam does not bind with alpha (α), serotonin (5HT 1), or dopamine (D 2) receptors. Blocking α and 5HT 1 receptors (norepinephrine and serotonin receptors) would cause depression. Blocking D 2 receptors for dopamine would relieve symptoms of schizophrenia, such as hallucinations and delusions. p. 45

What information should the nurse give to the family of a client who has experienced a dissociative episode? Dissociation is a method for coping with severe stress. Dissociation suggests the possibility of early dementia. Brief periods of psychotic behavior may occur. There are a number of interventions to prevent self-mutilation and suicide attempts.

Dissociation is a method for coping with severe stress. Dissociation is a method for coping with severe stress. It is not necessarily associated with dementia, psychosis, or self-harm. p. 152

A client is experiencing a panic attack. Which nursing intervention will be most therapeutic? Encourage the client to take slow, deep breaths. Verbalize mild disapproval of the anxious behavior. Offer an explanation about why the symptoms are occurring. Ask the client what he or she means when he or she says "I am dying."

Encourage the client to take slow, deep breaths. Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. Verbalizing disapproval, offering an explanation about the symptoms, and asking the client what he or she means will not be helpful to the client during a panic attack and may exacerbate it. p. 149

An individual is running to escape a tornado. Which chemical is working to help this person? Epinephrine Amino acids Fatty acids Cortisol

Epinephrine Epinephrine is a short-term neurotransmitter working to help the client run and take flight to prevent injury. Amino acids and fatty acids are supplied to cells when cortisol is activated after the initial surge of epinephrine subsides. p. 121

The nurse is determining discharge living arrangements for a hospitalized mental health client. Which behavior demonstrated by the client would fulfill requirements for financial reimbursement for placement in a psychiatric home environment? Expresses paranoia regarding police Engages in numerous compulsive rituals Experiences both auditory and visual hallucinations Experiences panic attacks when among strangers outside of the home

Experiences panic attacks when among strangers outside of the of the home. To qualify for reimbursement, clients must have a psychiatric diagnosis, be under the care of a primary care practitioner, and be homebound. Because the client experiences panic attacks outside of the home, he or she may be homebound and therefore qualify for financial reimbursement. Paranoia regarding police, compulsive rituals, and auditory and visual hallucinations do not necessarily qualify a client for financial reimbursement in a psychiatric home environment. p. 54

What is the major distinction between fear and anxiety? Fear is a universal experience; anxiety is neurotic. Fear enables constructive action; anxiety is dysfunctional. Fear is a psychological experience; anxiety is a physiological experience. Fear is a response to a specific danger; anxiety is a response to an unknown source.

Fear is a response to a specific danger; anxiety is a response to an unknown source. Fear is a response to a specific danger; anxiety is a response to an unknown source. Fear and anxiety are both experienced to some degree in healthy individuals and may contribute to constructive action. Both fear and anxiety have psychological and physiological components. p. 131

Panic attacks in Latin American individuals often involve which symptom? Blushing Fear of dying Offensive verbalizations Repetitive involuntary actions

Fear of dying Fear of dying is often involved in panic attacks in Latin Americans. Blushing may be related to social phobias in Japanese and Korean cultures. Offensive verbalizations are typically not seen in panic attacks. Repetitive involuntary actions are typically not seen in panic attacks. p. 138

Which symptom is commonly associated with panic attacks? Fever Apathy Obsessions Fear of impending doom

Fear of impending doom Panic attacks are associated with an extreme fear of impending doom. Fever, apathy, and obsessions are not typically associated with panic attacks. p. 138

An adult reports frequent anxiety. Which neurotransmitter is most closely related to this symptom? Dopamine Glutamate Monoamine oxidase Gamma aminobutyric acid (GABA)

Gamma aminobutyric acid (GABA) The neurotransmitter GABA plays a role in modulating neuronal excitability and anxiety. Many antianxiety (anxiolytic) drugs increase the effectiveness of this neurotransmitter, primarily by increasing receptor responsiveness. Dopamine is involved in thought processes and regulation of movement. Glutamate is associated with memory and learning. Monoamine oxidase is an enzyme involved in regulating metabolism of norepinephrine. p. 42

The nurse is educating a group of adolescents about different kinds of substance abuse. In which category can magic mushrooms be classified? Stimulants Hallucinogens Cannabinoids Opioids

Hallucinogens Substances may be classified according to their mechanism of action. Magic mushrooms, a common street name of psilocybin, can be classified as hallucinogens for their severe hallucinogenic effects. Stimulants, cannabinoids, and opioids are other categories of substances. Cocaine, amphetamine, and methamphetamine are stimulants. Marijuana and hashish are cannabinoids. Heroin and opium are opioids. p. 308

Which abnormalities in brain structure and function have been found to be associated with borderline personality disorder? Select all that apply. Gray matter size Hippocampus size Frontal lobe function Amygdala size Prefrontal lobe function

Hippocampus size Frontal lobe function Amygdala size In people with borderline personality disorder, abnormal brain structure and function have been found. Findings include abnormalities in the size of the hippocampus, in the size and functioning of the amygdala, and in the functioning of the frontal lobes. Individuals with antisocial personality disorder have shown altered metabolism in the prefrontal regions of the brain. An image study identified reduced prefrontal gray matter within areas of the brain implicated in empathic processing, moral reasoning, and the processing of emotions such as guilt and embarrassment. p. 167

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? Overeating Hypervigilance Perfectionism Passivity

Hypervigilance Child abuse may be associated with irritability and hypervigilance. Overeating, perfectionism, and passivity are not typically associated with PTSD in children. p. 125

Cocaine exerts which of the following effects on a client? Drowsiness Increased metabolism Immediate imbalance of emotions Paranoia

Increased metabolism Cocaine exerts a stimulant effect on metabolism and may cause extreme weight loss. Cocaine does not cause drowsiness. Imbalanced emotions and paranoia may occur during cocaine withdrawal. p. 297

A nurse caring for a client who was sexually assaulted reports to the primary health care provider that the client is demonstrating hyperarousal-like behaviors. To which symptom is the nurse referring in the client? Repeated frightening thoughts and dreams Avoidance of locales similar to where the assault took place Insomnia and reduced concentration Depression and feelings of guilt and numbness

Insomnia and reduced concentration Clients who have been sexually assaulted often experience posttraumatic stress disorder (PTSD) related to the sexual assault. One symptom of PTSD is hyperarousal, which may include sleep disorders and difficulty concentrating. Victims may re-experience the trauma with frightening thoughts and dreams. Avoidance behaviors may lead the client to stay away from places that remind him or her of the assault. Numbness, guilt, and depression may occur, but they are not symptoms of hyperarousal. Test-Taking Tip: Start by reading each of the answer options carefully. Usually at least one of them will be clearly wrong. Eliminate this one from consideration. Now you have reduced the number of response choices by one and improved the odds. Continue to analyze the options. If you can eliminate one more choice in a four-option question, you have reduced the odds to 50/50. While you are eliminating the wrong choices, recall often occurs. One of the options may serve as a trigger that causes you to remember what a few seconds ago had seemed completely forgotten. p. 355

A client is prescribed clonazepam. Which documented change in behavior would suggest that the treatment is successful? Less anxiety Normal appetite Improved sleep pattern Reduced auditory hallucinations

Less anxiety Clonazepam is in the class of drugs known as benzodiazepines, which are the most commonly used antianxiety agents. Reporting less anxiety is a desired outcome of this therapy. This drug would not affect the client's appetite, sleep pattern, or auditory hallucinations. p. 45

The client begins to sob uncontrollably and his or her speech becomes so incoherent that the nurse can no longer gather any information. Upon what will the nurse's immediate interventions focus? Securing hospital admission Contacting a family member or close friend Lowering the client's anxiety level from severe to moderate Assisting the client to identify new effective coping strategies

Lowering the client's anxiety level from severe to moderate Individuals with severe anxiety are not able to collaborate on problem solving. The nurse must assist the client to lower anxiety from severe to moderate or lower. Securing hospital administration, contacting a family member, and identifying new coping strategies are secondary to the goal of lowering the client's anxiety. pp. 329-330

A new client is diagnosed with generalized anxiety disorder. It is most important for the nurse to assess this client for which additional problem? Conduct disorder Alcohol use disorder Major depressive disorder Obsessive-compulsive disorder

Major depressive disorder Clinicians and researchers have shown clearly that anxiety disorders frequently co-occur with other psychiatric problems. Several studies suggest that other major depressive disorder commonly coexists with generalized anxiety or panic disorder. Although conduct disorder, alcohol use disorder, and obsessive-compulsive disorder are possibilities, the most likely comorbid problem is depression. p. 150

Which therapeutic intervention can the nurse implement independently to help a client experiencing mild anxiety regain control? Modeling Thought stopping Response prevention Systematic desensitization

Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently by the nurse. Thought stopping, response prevention, and systematic desensitization require agreement of the treatment team. p. 133

Selective inattention is first noted when an individual experiences which level of anxiety? Mild Moderate Severe Panic

Moderate Selective inattention is noted in moderate anxiety. The individual's perceptual field is reduced and the he or she is not able to see the entire picture of events. Selective inattention is not a feature of mild, severe, or panic level anxiety. p. 132

A nurse is assessing an adult client with posttraumatic stress disorder (PTSD)? Which symptom should the nurse expect to find? Mood alterations Undisturbed sleep Talking about memories Unchanged concentration levels

Mood alterations Posttraumatic stress disorder usually follows a traumatic or stressful event and is characterized by reexperiencing, avoidance, hypervigilance, and alterations in mood. Mood alterations like chronic depression are a feature of posttraumatic stress disorder. Clients with PTSD have difficulty sleeping or are troubled by dreams of past events. Clients with PTSD often avoid talking about memories related to the past traumatic event and may have difficulty concentrating. p. 123

A nurse plans the care for an adult diagnosed with a tumor in the brain's frontal lobe. The nurse should focus initial interventions on the client's anticipated problems with which functions? Motor function and judgment Sensory and calculation abilities Interpretation of visual stimuli Hearing and emotional expression

Motor function and judgment The premotor cortex is responsible for the coordinated movement of multiple muscles and the somatic association cortex integrates motor commands. The somatic association cortex is the area of the brain responsible for coordinating learned motor skills. Cognition, memory, and analytical functions are largely functions of a third region of the frontal lobe, known as the prefrontal cortex. Damage to this area of the frontal lobe may cause changes in decision-making and judgment. The parietal lobe controls sensory and calculation abilities. The occipital lobe controls interpretation of visual stimuli. The temporal lobe controls hearing and expression of emotions. p. 37

During the process of conduction, a specialized chemical is transported between two neurons at which location?

Neurotransmitters are chemicals released from the axon terminal at the presynaptic neuron on excitation. This neurotransmitter then diffuses across a space, or synapse, to an adjacent postsynaptic neuron, where it attaches to receptors on the neuron's surface. p. 39

A teenager changes study habits to earn better grades after initially failing a test. What is the most likely cause of this behavioral change? Altruism Idealization Normal anxiety Acting-out behavior

Normal anxiety Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Altruism involves addressing stressors by meeting the needs of others. Idealization involves attributing exaggerated positive qualities to others. Acting-out behavior is a destructive coping style of lashing out at others. p. 131

A young adult applying for a job is mildly tense but eager to begin the interview. What is does this experience represent? Denial Compensation Normal anxiety Selective inattention

Normal anxiety Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Denial involves ignoring unpleasant realities. Compensation involves adopting opposite behaviors or emotions to deal with unpleasant ones. Selective inattention involves a narrowing of one's perceptual field. p. 131

A 4-year-old client, who survived a severe car accident that resulted in the mother's death, is withdrawn, not sleeping, having nightmares, and acting out the car accident over and over again when playing. The father reports the client says repeatedly, "It's my fault because I'm bad." These behaviors support which diagnosis? Adjustment disorder Dissociative identity disorder Posttraumatic stress disorder (PTSD) Acute stress disorder (ASD)

PTSD in preschool children may manifest as repetitive play that includes aspects of the traumatic event, social withdrawal, and negative emotions such as fear, guilt, anger, horror, sadness, shame, or confusion. Children may blame themselves for the traumatic event and manifest persistent negative thoughts about themselves. Unlike PTSD, adjustment disorder may be diagnosed immediately or within 3 months of exposure. Responses to the stressful event may include combinations of depression, anxiety, and conduct disturbances. Dissociative identity disorder includes the presence of "alters" or other personalities that take over in times of stress. As compared with PTSD, which occurs a month after the trauma, ASD occurs from 3 days to one month after exposure to a highly traumatic event. Individuals with ASD experience three or more dissociative symptoms either during or after the traumatic event, including a sense of numbing, detachment, or absence of emotional responsiveness; a reduction in awareness of surroundings; derealization; depersonalization; or dissociative amnesia. p. 124

A client is running from chair to chair in the solarium. The client is wide-eyed and keeps repeating, "They are coming! They are coming!" The client neither follows staff direction nor responds to verbal efforts to calm him or her. The nurse assesses the client's anxiety at which level? Mild Moderate Severe Panic

Panic Panic-level anxiety results in markedly disorganized, disturbed behavior, including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety. Mild, moderate, and severe levels of anxiety typically do not include such extreme behavior. p. 132

Inability to leave one's home in order to avoid severe anxiety suggests which anxiety disorder? Panic attacks with agoraphobia Obsessive-compulsive disorder Posttraumatic stress response Generalized anxiety disorder

Panic attacks with agoraphobia Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. Symptoms of obsessive-compulsive disorder include intrusive thoughts and/or ritualistic behaviors. Posttraumatic stress response occurs after an individual experiences or witnesses severe trauma. Generalized anxiety disorder is a chronic disorder marked by excessive and constant worrying. p. 138-139

What type of anxiety may be associated with delusional thinking? Acute anxiety Severe anxiety Chronic anxiety Panic level anxiety

Panic level anxiety Panic level anxiety is the most extreme level and results in markedly disturbed thinking, which may include delusions. Acute anxiety, severe anxiety, and chronic anxiety typically do not involve delusional thinking. p. 132

Upon assessing a client who has experienced a stroke, the nurse finds that there is loss of sensation and proprioception in the left upper and lower limbs. The client has also lost the ability to distinguish between left and right side. What part of the cerebrum could potentially have a lesion? Frontal lobe Parietal lobe Temporal lobe Occipital lobe

Parietal lobe Sensory perception, proprioception, and the ability to distinguish between right and left are the functions of the parietal lobe of the cerebral cortex. The frontal lobe of the cerebrum is responsible for voluntary motor ability of the body. The functions of the temporal lobe include language comprehension and storing sounds in memory (language, speech). The occipital lobe functions to interpret visual images, visual association, and visual memories. p. 36

The health care provider is working with a client suspected of having obsessive compulsive disorder. The provider says, "We want to do an imaging study that will tell us which parts of your brain are particularly active." From this comment, what test will the nurse expect the provider to order? Computed tomography (CT) scan Positron emission tomography (PET) scan Ventriculogram Electroencephalogram (EEG)

Positron emission tomography (PET) scan A PET scan detects brain activity. CT scans, ventriculograms, and electroencephalograms are limited to visualization of structures. p. 37

Care planning for the rape victim is facilitated if the nurse understands that rape-trauma syndrome is actually a variant of what disorder? Posttraumatic stress disorder Maturational crisis disorder A dissociative disorder Generalized anxiety disorder

Posttraumatic stress disorder Rape-trauma syndrome is a variant of posttraumatic stress disorder. Such trauma is not maturational in nature because it is not associated with a developmental stage. Dissociative disorders and generalized anxiety disorder are not usual post-assault outcomes. p. 354

The plan of care for a client who uses elaborate washing rituals specifies that response prevention is to be applied. Which scenario is an example of response prevention? Withholding reassurance from staff Having the client repeatedly touch dirty objects Telling the client to relax whenever tension mounts Preventing the client from washing hands after touching a dirty object

Preventing the client from washing hands after touching a dirty object. Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without health care provider approval. Not allowing the client to wash hands after touching a perceived "dirty" object is an example of response prevention. Not allowing reassurance, repeatedly touching "dirty" objects, , and telling the client to relax are not examples of response prevention. p. 145

Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike the following week. The client replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident in the adult's response? Displacement Rationalization Passive aggression Reaction formation

Rationalization The correct answer, rationalization, refers to justifying an action to satisfy the teller and the listener, which the client does by using hiking shoes as an excuse to mask the real reason for not going. Displacement is the transfer of emotions about a particular person, object, or situation to one that is nonthreatening. Passive aggression is the indirect and unassertive expression of aggression toward others. Reaction formation involves keeping unacceptable feelings or behaviors out of one's awareness by developing the opposite behavior or emotion. p. 135

A primary health care provider instructs a nurse to document cognitive-behavioral therapy as part of the care plan for a client with social phobia. What intervention does the nurse know is appropriate for the client during the cognitive-behavior therapy? Support the client's beliefs. Re-evaluate the client's situation. Give an opinion on client's thoughts. Calm the client through isolation from peers.

Re-evaluate the client's situation Cognitive behavioral therapy helps clients learn to control negative feelings. The nurse should re-evaluate the situation realistically and develop a positive insight in the client by replacing the negative thoughts. The nurse should not support the client's negative beliefs. The nurse should not give his or her own opinion on the client's thoughts, because doing so may make the client feel rejected. The nurse should not isolate the client from peers, because doing so could cause withdrawal and aggression in the client. p. 144

A mental health nurse plans care for four clients, each diagnosed with a different condition: reactive attachment disorder, disinhibited social engagement disorder, adjustment disorder, and acute stress disorder. What commonly shared feature will the nurse's interventions target in clients with these disorders? Feelings of guilt Self-care deficits Reactions to trauma Impaired social skills

Reactions to trauma The common feature of these disorders is exposure to trauma. Disorders included under the trauma umbrella include posttraumatic stress disorder, reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, and adjustment disorder. Feelings of guilt, self-care deficits, and impaired social skills represent problems that may or may not be present for clients diagnosed with these disorders. p. 411

What is a short-term effect of stress controlled by the hypothalamus-pituitary-adrenal cortex (HYPAC)? Fluid gain Hypoglycemia Reduced inflammation Muscular tension

Reduced inflammation In response to stress in the short-term, the HYPAC reduces inflammation, reduces fluid, and elevates blood sugar. Muscular tension is controlled by the sympathetic-adrenal medulla. p. 122

A nurse adds this outcome to the plan of care: "Within one week, the client will stay awake for an entire group session." Which part of the nervous system is related most to this outcome? Amygdala Hippocampus Temporal lobe Reticular activating system (RAS)

Reticular activating system Through projections of the reticular activating system (RAS), the brainstem regulates the entire cycle of sleep and wakefulness and the ability of the cerebrum to carry out conscious mental activity. The amygdala and hippocampus are involved in emotions, learning, memory, and basic drives. The temporal lobe is involved in language comprehension and memory storage. p. 35

Which behavior is demonstrated by a client who engages in splitting with dichotomous thinking? Unconsciously represses undesirable aspects of self Places responsibility for behavior outside the self Sees things as divided into "all good" or "all bad" Demonstrates a lack of personal boundaries

Sees things as divided into "all good" or "all bad" Splitting demonstrates the failure to integrate the positive and negative into a cohesive whole. An individual is not seen as a person with good and bad traits, but rather as all good or all bad. Unconsciously repressing undesirable aspects of self, placing responsibility for behavior outside the self, or demonstrating a lack of personal boundaries are not behaviors considered part of splitting. p. 170

Based on current understanding of brain physiology, which of the following neurotransmitters should the nurse expect to see targeted with the medication prescribed for the treatment of depression? Dopamine Gamma-amino butyric acid (GABA) Serotonin Histamine

Serotonin Antidepressant medication targets serotonin and norepinephrine. Dopamine is implicated in schizophrenia (increase) and Parkinson disease (decrease). GABA is implicated in anxiety disorders. Acetylcholine is implicated in Alzheimer disease, Huntington disease, and Parkinson disease. Histamine is associated with allergic reactions. p. 42

The nurse caring for a client experiencing a panic attack expects the health care provider to prescribe an immediate dose of which type of medication? Anticholinergic medication Standard antipsychotic medication Tricyclic antidepressant medication Short-acting benzodiazepine medication

Short-acting benzodiazepine medication A short-acting benzodiazepine is the only type of medication listed that would lessen the patient's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety. Standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects. Tricyclic antidepressants have very little antianxiety effect and have a slow onset of action. p. 148

What is the most likely potential problem for a client diagnosed with severe obsessive-compulsive disorder? Sleep disturbance Excessive socialization Command hallucinations Altered state of consciousness

Sleep disturbance Clients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with sleep. Excessive socialization, command hallucinations, and altered states of consciousness are not typically associated with obsessive-compulsive disorder. p. 140

What term is used to identify the inability to view both positive and negative aspects of others as part of a whole? Devaluation Splitting Impulsiveness Social ineffectiveness

Splitting Splitting is the inability to integrate both the positive and the negative qualities of an individual into a whole. The individual using this defense tends to think in extremes. Devaluation, impulsiveness, and social ineffectiveness do not accurately identify the behavior described. p. 170

A client attempted suicide 3 days ago. When the nurse asks about the related events, the client says, "I don't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the client used? Repression Suppression Rationalization Intellectualization

Suppression Defenses against anxiety can be adaptive or maladaptive. Suppression is a conscious, deliberate effort to avoid painful and anxiety-producing memories. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. In this scenario, the client is aware of the memory. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. Intellectualization is a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion. p. 134

A nurse is planning interventions for a veteran who is reporting difficulty sleeping. When considering the client's history, which data is most relevant to the development of posttraumatic stress disorder (PTSD)? Family history of depression Quit smoking tobacco 2 months ago Regularly smoked marijuana as a teenager Sustained a concussion a month ago

Sustained a concussion a month ago A concussion can result in traumatic brain injury (TBI). Recent TBI is the strongest predictor of PTSD. A family history of depression is a risk factor for possible depression that can be diagnosed in some cases of PTSD but it is not a strong predictor of the disorder. The remaining options are not relevant to the diagnosis of PTSD. p. 125

What is the defining characteristic of acute stress disorder that distinguishes it from posttraumatic stress disorder (PTSD)? Occurs after a traumatic event Symptoms resolve within 1 month Sleep is restless with nightmares Irritability caused by basic work and family issues

Symptoms resolve within 1 month The defining difference between acute stress disorder and PTSD is that symptoms of acute stress disorder resolve within 1 month. A traumatic event, restless sleep, and irritabilities are common to both conditions. pp. 126-127

When a client is prescribed lorazepam 1 mg orally four times a day for 1 week for generalized anxiety disorder, what should the nurse do? Question the health care provider's prescription regarding the high dose. Explain the long-term nature of benzodiazepine therapy to the client. Teach the client to limit caffeine intake. Tell the client to expect mild insomnia.

Teach the client to limit caffeine intake. Caffeine is an antagonist of antianxiety medication. The nurse should instruct the client to limit caffeine intake. The dose is not excessive. Benzodiazepines are typically taken short-term. Mild insomnia is not a typical side effect of lorazepam. p. 149

A client who has experienced a traumatic brain injury is demonstrating abnormally fluctuating emotions. The client's history and symptoms suggest injury to which lobe of the cerebral cortex? Frontal Temporal Occipital Parietal

Temporal The temporal lobe connects to the limbic system to allow expression of emotions. Any injury to the temporal lobe would result in abnormally fluctuating emotions. This lobe is also responsible for language comprehension. The frontal lobe is chiefly responsible for initiating voluntary activities. The occipital lobe interprets visual images and stores visual memories. The parietal lobe is chiefly concerned with the perception of sensations. p. 36

Which of the identified areas on the graphic of the brain is responsible for regulating skeletal muscle coordination?

The cerebellum is involved primarily in the regulation of skeletal muscle coordination and contraction and the maintenance of equilibrium. It plays a crucial role in coordinating contractions so that movement is accomplished in a smooth and directed manner. Muscle coordination is not associated directly with the midbrain, pons, or medulla. The midbrain is involved with pupillary reflex and eye movement. The pons is the major processing station in auditory pathways. The medulla contains reflex centers that control balance, heart rate, and respiration. p. 37

A student nurse observes that a client compulsively looks at his or her reflection in the mirror. Based on the client's behavior, what is the most likely diagnosis the student nurse will expect the health care provider to make? The client has panic disorder. The client has hoarding disorder. The client has body dysmorphic disorder. The client has obsessive-compulsive disorder.

The client has body dysmorphic disorder. Body dysmorphic disorder is characterized by a preoccupation with an imagined defective body part. Client with body dysmorphic disorder often pay excessive attention to body parts that they imagine to be defective. As a result, they may compulsively look at themselves in mirrors. Clients with panic disorder may have an unusual fear of future events. In hoarding disorder, the client accumulates and collects materials for future use. Obsessive-compulsive disorder is marked by performing repeated activities or rituals. p. 141

A client is taking medication that acts by blocking reuptake of both serotonin and norepinephrine. Which client action suggests that the treatment is successful? The client reports feeling more hopeful. The client exercises a sore shoulder. The client is able to write his or her telephone number. The client goes to his or her room to "calm down."

The client reports feeling more hopeful Depression is thought to be at least in part caused by lowered levels of serotonin and norepinephrine. Increasing the amount of these transmitters in the brain by blocking reuptake may result in mood elevation, indicated by more hopeful feelings. Blocking serotonin and norepinephrine would not have an effect on a client's muscle soreness or memory. Blocking these chemicals is a treatment for depression, which is not characterized by a need to calm oneself. p. 44

A client asks "What's wrong with my brain that causes me to have such a problem with aggression?" The nurse's response is based on what knowledge? The prevailing theory is that diminishment of stress hormones causes anger and aggression. No abnormalities of the brain have been identified that correlate with anger and aggression. The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. Personality type plays a much greater part in anger and aggression than physical factors.

The limbic system, the prefrontal cortex, and neurotransmitters have been implicated in playing a part in aggression. The limbic system, the prefrontal cortex, and neurotransmitters have all been implicated by research as playing a part in anger and aggression. It is untrue that diminishment of stress hormones causes anger and aggression, no abnormalities of the brain have been identified that correlate with anger and aggression, and personality type plays a much greater part in anger and aggression than physical factors. p. 376

A client diagnosed with obsessive-compulsive disorder takes several hours to maintain hygiene. What appropriate method does the nurse apply to help the client in maintaining hygiene? The nurse gives a wide variety of clothing options to the client. The nurse gives continuous directions to the client. The nurse discusses with the client his or her feelings about self-care. The nurse dresses the client.

The nurse discusses with the client his or her feelings about self-care. Clients diagnosed with obsessive-compulsive disorder spend several hours maintaining hygiene. The nurse should talk with the client regarding self-care and encourage the client to express his or her feelings and thoughts about self-care to help reduce the compulsive behavior. Limiting the choice of clothing helps the client to select clothes quickly. The nurse gives simple directions to the client to enhance self-hygiene. The nurse should not dress the client but can assist the client in dressing. The nurse should encourage the client to perform the task independently. p. 140

What is one purpose of the psychosocial assessment? To identify stressors and coping mechanisms To evaluate current cognitive processes To differentiate physical- and somatic-based symptoms To monitor severity of depression

To identify stressors and coping mechanisms Identification of stressors and coping mechanisms occurs during the psychosocial assessment. Evaluating current cognitive processes is the main purpose of the mental status evaluation (MSE). Thorough physical and psychological health evaluations will differentiate physical- and somatic-based symptoms. A number of standardized rating scales are used to evaluate and monitor the severity of depression. p. 80

What term is used to identify a syndrome that occurs after stopping the long-term use of a drug? Amnesia Tolerance Enabling Withdrawal

Withdrawal Withdrawal is a condition marked by physical and psychological symptoms that occur when a drug that has been taken for a long time is stopped or drastically reduced in dosage. Amnesia refers to impaired memory recall. Tolerance is the need to take larger amounts of a substance to achieve the same effects. Enabling is codependent behavior by friends and family of individuals with substance abuse disorders. p. 300