Mental Health Final Questions Videbeck update

A nurse is preparing to gather a health history of a client. Which questions can elicit disclosure if a client has been abused? Select all that apply.

1. "When there are arguments at home, have you ever been hurt or afraid?" 2. "It looks like someone has hurt you. Tell me about it." 3. "Some other women I have cared for have described problems like yours. If this is happening to you, can we talk about it."

A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply.

1. A 6-year-old is being seen for the 5th time for a urinary tract infection 2. A baby with contrecoup injuries to the brain 3. A 3-month-old with a fractured femur

In violent families, which environment may be the most dangerous place for victims?

Home

Natural environmental phobias

fear of storms, water, heights, or other natural phenomena

fear

feeling afraid or threatened by a clearly identifiable, external stimulus that represents danger to the person

depersonalization

feelings of being disconnected from himself or herself; the client feels detached from his or her behavior

phases of therapeutic relationship

orientation working resolution or termination *in real life, these are not clear cut, they overlap and interlock.

parent surrogate

when a client acts like a child, or when the nurse has to perform baths or feedings, the nurse may be tempted to assume the parental role. - may begin to sound authoritative. this makes client act more like a child - relationship falls from adult-adult to child-adult. - nurse must be clear and firm and set limits. the nurse can still nurture client while establishing boundaries. -

A nurse is providing education to the care provider of a cognitively impaired client who is prescribed a cholinesterase inhibitor. Which information about medication side effects should the nurse be sure to include?

Gastrointestinal (GI) symptoms

The nurse is working with the family of a client who is newly diagnosed with Alzheimer's type dementia. Which suggestion would be effective for assisting the family members in daily orienting of their family member when the client returns home?

Use daily newspapers, calendars, and a set routine.

Which type of hallucination is most commonly seen in clients diagnosed with delirium?

Visual

The nurse understands that numerous comorbidities can contribute to the development of dementia. Which client may be at risk for dementia?

A 49-year-old client whose human immunodeficiency virus (HIV) has progressed to acquired immunodeficiency syndrome (AIDS)

Depot Injection

A TIME RELEASED form of intramuscular medication for maintenance therapy Will LAST LONGER Use DEEP muscles to inject

SORL1

A gene that may be a factor in late onselt Alzehimer's diseaes

Parkinson's disease is thought to be caused by which neural change?

A loss of neurons at the basal ganglia

A nurse is assessing a client diagnosed with Alzheimer's disease. As part of the assessment, the nurse asks the client to identify common objects. The nurse is assessing for what?

Agnosia

When assessing a client with dementia, the nurse notes that the client is having difficulty identifying common items, such as a ball or book. The nurse interprets this finding as what?

Agnosia

The nurse documents that a client diagnosed with dementia of the Alzheimer's type is exhibiting agnosia when the client is observed being unable to ...

identify a picture of a car.

Sublimation

- Substituting a socially acceptable for an impulse that is unacceptable - Person who has quit smoking sucks on hard candy when the urge to smoke arises

Approximately what percentage of women rape victims are raped by someone they know?

65%

What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply.

Criticizing Ridiculing Threatening a victim's dog

2nd Generation Antipsychotics BLOCK what 2 neurotransmitters?

D2 + Serotonin

A client has posttraumatic stress disorder (PTSD) following a disaster that resulted in mass casualties. What question should the nurse prioritize when exploring the physical dimensions of this client's PTSD?

How would you describe the quality and quantity of your sleep since the incident?

The peak age of onset for social phobia

Is middle adolescence; it sometimes emerges in a person who was shy as a child.

A nurse is conducting an inservice presentation for a group of newly hired mental health nurses. Which would the nurse most likely include when describing conversion disorder (functional neurologic symptom disorder)?

Laboratory and diagnostic test results are usually negative.

After educating a group of students on attention deficit hyperactivity disorder (ADHD), the instructor determines that additional education is required when the group identifies which as a typical characteristic?

Language difficulty

Which medication is the most effective treatment for attention deficit hyperactivity disorder (ADHD)?

Methylphenidate

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

N-methyl-D-aspartate (NMDA) receptor antagonist

A man 20 years of age arrives at the emergency department by ambulance. He is unconscious, with slow respirations and pinpoint pupils. There are "tracks" visible on his arms. The friend who came with him reports that the client had just "shot up" heroin when he became unconscious. Which medication would the nurse most likely expect to administer?

Naloxone Naloxone, an opioid antagonist, is given to reverse respiratory depression, sedation, and hypertension. Naltrexone is used to treat alcohol dependence. Bupropion and varenicline are used to promote smoking cessation. (less)

Which is a typical characteristic of parents of clients diagnosed with anorexia nervosa?

Overprotective of their children

Recovery

Phase of reorganization (behavioral response to grief)

Orthodox Jewish Americans

Relative to stay with dying person so soul does not leave body while person is alone, leaving body alone after death is disrespectful, cover body with sheet, Eyes closed, body covered and untouched until Rabbi, family, Jewish undertaker can begin rites. Organ donation permitted, autopsy not permitted, burial with in 24 hours unless delayed by the Sabbath. Shiva 7 day period begins on funeral day, time for mourners to reflect on change that has occurred.

Which type of intervention may be helpful for children who are bullies?

Social skills training

The majority of perpetrators of elder abuse include which population?

Spouse in the caregiver role

Which is a disturbance of the normal fluency and time patterning of speech?

Stuttering

What action by a 6-year-old child would most strongly suggest a diagnosis of disinhibited social engagement disorder?

The child gives adults enthusiastic hugs immediately after meeting them

A nurse observes that a client who has posttraumatic stress disorder (PTSD) is startled even by small noises. What is this behavior indicative of?

The client is hypervigilant.

The diagnosis of delirium is supported when the nurse notes which in the client?

The is convinced that the client sees "hundreds" of bugs and is not always oriented to time and place

positive reframing

a cognitive-behavioral technique involving turning negative messages into positive ones

A client diagnosed with depression is being treated with phenelzine (Nardil). The nurse should teach the client to avoid which of the following foods? a. rice b. chicken c. aged- cheese d. oranges

c. Aged cheese Hypertensivecrisis is the most serious effect and is life-threatening when a client prescribed a MAOI ingests tyramine-containing foods, such as aged cheese.

Which of the following is an anticonvulsant used as a mood stabilizer? a. Bupropion (Wellbutrin) b. Phenelzine (Nardil) c. Divalproex (Depakote) d. Venlafaxine (Effexor)

c. Divalproex (Depakote) Depakote is an anticonvulsant that may be used as a mood stabilizer. Effexor, Wellbutrin and Nardil are antidepressants

which medication classification has been effective in stabilizing moods in people with bipolar disorder? a. antianxiety b. antibiotic c. anticonvulsants d. anticoagulants

c. anticonvulsants several anticonvulsants traditionally used to treat seizure disorders have proved helpful in stabilizing the moods of the people with bipolar illness

OCULOGYRIC

eyes rolled back in a locked position Acute dystonia symptom

what are beliefs?

ideas that one holds to be true. -some have objective evidence to substantiate them. - some are irrational and may persist despite these beliefs having no supportive evidence.

panic anxiety

intense anxiety, may be a response to a life-threatening situation

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

"His diagnosis is primarily based on the rapid onset of his change in consciousness." The key diagnostic indicator for delirium is impaired consciousness, which is usually sudden in onset. Although infection may be an underlying cause, and other cognitive changes may occur such as problems with memory, orientation, and language, impaired consciousness developing over a short period is key. (less)

Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads the nurse to believe the client is experiencing dissociative symptoms?

"I describe my feelings like I'm having an out-of-body experience."

A client is receiving methadone maintenance therapy. After teaching the client about this treatment, the nurse determines that the education was successful when the client states which of the following?

"I should eat small frequent meals if I get nauseated." A client receiving methadone maintenance therapy may experience nausea. Therefore, the client should eat small, frequent meals to treat the nausea and loss of appetite, and should take the drug with food and lie quietly to minimize the nausea. Alcohol should be avoided. Constipation may occur, necessitating the use of a mild laxative. (less)

Which statement, made by a nurse who experienced sexual abuse as as a child, demonstrates being best prepared to work with sexual abuse and trauma survivors?

"I've been supported by health care professionals and now I want to support other survivors."

A nursing instructor teaching about sexual assault identifies a need for further instruction when one of the students makes which statement?

"It is not considered rape if it occurs with same-sex couples."

A client has entered treatment for alcohol dependency at his wife insistence. The client's wife has threatened to leave the marriage unless the client seeks treatment. The client admits that he drinks every day, but that his drinking is well in control. The nurse recognizes his comments as denial. What is the best response by the nurse?

"Jim, what negative consequences have resulted from your drinking?" To confront denial, the nurse points to the evidence of severe dysfunction that inevitably appears in the substance abuser's life. Job losses, financial problems, possible estrangement from family and friends, and legal problems are common, and the nurse can respectfully but firmly remind the client that many of these problems are a result of alcohol or drug abuse. (less)

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal?

"My spouse always seems so irritated now, which isn't like my spouse."

A nurse works in a psychiatric clinic. During a counseling session, the nurse finds that the client who has posttraumatic stress disorder (PTSD) is unable to identify the intensity of the client's emotions. The client states that extreme emotions appear out of nowhere and with no warning. What suggestion should the nurse provide to help the client get in touch with the client's emotions?

"Use a journal or a log to write down your feelings."

A client diagnosed with borderline personality disorder tells the nurse that she "frequently spaces out." Which response by the nurse would be most appropriate?

"What's happening around you when this occurs?" To determine a pattern for the client's coping skills, it is important to ask the client what is happening in the environment when dissociation occurs. In addition, this is the only question that is open ended; therefore, it will elicit more information than a closed-ended question would. (less)

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

"You'll be expected to attend group therapy each day." Rules and explanations must be brief, clear, and leave little room for misinterpretation. A client with antisocial personality disorder tends to disregard rules and authority and be socially irresponsible. The words "You'll be expected to attend..." are concise and concrete and convey precisely what behavior is expected. The other options leave open the interpretation that attendance is suggested but not mandatory. (less)

Prolixin

- IM or SC - First generation antipsychotic - Neuroleptic Malignant Syndrome!!! -

Ego Defense Mechanisms

- Methods of attempting to protect the self and cope with basic drives or emotionally painful thoughts, feelings or events - Compensation, conversion, denial, displacement, dissociation, fixation, identification, intellectualization, introjection, projection, rationalization, reaction formation, regression, reporession, resistance + sublimation

Worden's Tasks of Grieving

1) Accept reality of loss 2) Work through pain of grief 3) Adjust to changed environment due to loss 4) Emotionally relocate loss and move on

A nurse is using limit setting with a child hospitalized for a psychiatric disorder. Which statement made by the nurse would reflect appropriate limit setting? Select all that apply.

1. "Swearing is not allowed here on the unit." 2. "You will lose television privileges for 24 hours if you ignore a unit rule." 3. "When you feel like swearing come and talk to me."

A nurse is assessing risk for trauma and stress-related disorders for a child. Which areas are important for the nurse to ask about? Select all that apply.

1. Incarceration of a parent 2. Childhood physical abuse 3. Unexpected death of a family member 4. Childhood exposure to mother experiencing violence

When presenting a discussion of posttraumatic stress disorder (PTSD) to a group of emergency department nurses, the psychiatric-mental health nurse provides examples of traumatic events that may precede PTSD. Which example would the nurse most likely include? Select all that apply.

1. Personal assault by a family member 2. Military combat mission where there were casualties 3. Surviving an EF 4 tornado

What percentage of women can expect to be a victim of an ongoing unwanted pursuit from stalking?

12-32%

Assessment of an 8-year-old client reveals communication difficulties and an inability to manage age-appropriate tasks. The child undergoes standardized testing. An intelligent quotient (IQ) of which would support a diagnosis of intellectual disability?

65

Below average intellectual functioning is initially diagnosed when an intelligence quotient (IQ) is below which level?

70

When describing intellectual disability to a group of parents, a nurse would identify which intelligent quotient (or less) as the usual threshold?

70

A nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what?

70% women and 30% men

A client can expect symptoms of alcohol withdrawal to begin how many hours after the last drink?

8 Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake.

Chlordiazepoxide (Librium)

A Benzodiazepine used to treat Anxiety

Complicated Grieving

A grieving response outside the norm: void of emotion, grieves for prolonged periods, has expressions of grief that seem disproportionate to the event

A client is considered to have an ultrahigh risk for the development of schizophrenia when the assessment process identifies ...

A sibling who experiences visual hallucinations Researchers have recently identified three patient groups considered to be at "ultrahigh risk" for the development of schizophrenia. One of these is a family history of psychosis, which would include a sibling who experiences visual hallucinations. (less)

The nurse assesses a 6-year-old child for posttraumatic stress disorder (PTSD). The caregiver explains that the child witnessed the mother being stabbed by a neighbor. Which is a behavior consistent with the child's diagnosis?

A two-month history of angry outbursts with minor provocation

Which assessment finding can help the nurse differentiate a child experiencing child neglect rather than child abuse?

A young child is admitted to the hospital with hypothermia because the child is inadequately

Interventions for a client with panic disorder would include A) encouraging the client to verbalize feelings. B) helping the client to avoid panic-producing situations. C) reminding the client to practice relaxation when anxiety level is low. D) teaching the client reframing techniques. E) teaching relaxation exercises to the client. F) telling the client to ignore any anxious feelings.

A) encouraging the client to verbalize feelings. C) reminding the client to practice relaxation when anxiety level is low. D) teaching the client reframing techniques. E) teaching relaxation exercises to the client.

Clozaril

Agranulocytosis risk (WBC <3500mm) Need baseline WBC count before administration

Propranolol (Inderal)

An Alpha-adrenergic agonist used to treat Anxiety, panic disorder & GAD

A nurse is caring for an older adult client who has been taking an antipsychotic medication for 1 week. The nurse notifies the physician when he observes that the client has muscle rigidity that resembles Parkinson's disease. Which agent would the nurse expect the physician to prescribe?

Anticholinergic Unless the client develops akathisia, the physician will likely order an anticholinergic medication such as benztropine (Cogentin) to increase the acetylcholine. An anxiolytic, anticholinergic, or beta-blocker would not be used. (less)

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders?

Antidepressants

Which medication classification is used in the treatment of tic disorders?

Antipsychotics

A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as what?

Aphasia

For various reasons, the mentally L client may have difficulty understanding and processing vague and abstract communication. Which of the following isn't an accurate depiction of a concrete question? A. They are easy to understand B. they require rephrasing unclear questions C. There is no need for interpretation D. They elicit more accurate responses.

B. Concrete questions do not require rephrasing of unclear questions

When noted in an assessment of a child, the nurse should suspect child abuse if which common physical findings signaling abuse are present?

Bruises, burns, lacerations, missing teeth, and skeletal injuries

Which phone is acceptable distance between a speaker in the audience? A. Intimate B. personal C. Public D. Social

C. Public zone - 12 25 feet

A client has been on Haldol for 5 years when she is admitted to the inpatient unit for a recent exacerbation of her schizophrenic symptoms. Upon assessment, she has akathisia, dystonia, a stiff gait, and rigid posture. When considering interventions for the client's symptoms, which of the following would be most appropriate?

Consult with the psychiatrist and suggest that she be placed on an anticholinergic drug. EPSs generally are treated by reducing the dose of the medication, trying a different medication, or adding a medication that reduces or eliminates side effects. Medications that reduce or eliminate EPSs are dopamine releasers, such as amantadine (Symmetrel), or anticholinergic drugs, such as trihexyphenidyl (Artane), benztropine (Cogentin), biperiden (Akineton), procyclidine (Kemadrin), and ethopropazine (Parsidol). (less)

Individuals with anorexia nervosa concentrate on which body cue?

Controlling food intake

Behavioral theorists view anxiety as being learned through experiences.

Conversely, people can change or "unlearn" behaviors through new experiences. Behaviorists believe that people can modify maladaptive behaviors without gaining insight into their causes.

Which characteristic differentiates conversion disorder from malingering disorder?

Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms.

Which term describes the use of socially unacceptable words, which are frequently obscene?

Coprolalia

Neurotransmitters associated with anxiety disorders

Current etiologic theories and studies of anxiety disorders have shown a familial incidence and have implicated the neurotransmitters GABA, norepinephrine, and serotonin.

A female client states that she has been receiving numerous text and phone messages from a co-worker. Which type of harrassment should be documented in the nurse's notes?

Cyberstalking

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

A client with amnestic disorder is being evaluated for dementia. Which of the following is a diagnostic characteristic of amnestic disorder?

History and physical examination indicative of memory impairment Diagnostic characteristics of amnestic disorder include memory impairment not solely limited to periods of delirium, history and physical examination indicative of medical condition underlying the memory impairment, demonstration of significant problems with social or occupational functioning, and memory significantly decreased from usual level. (less)

Treatment for anxiety disorders

Involves medication (anxiolytics, SSRI and tricyclic antidepressants, and clonidine and propranolol) and therapy.

Which is an inattentive behavior seen in attention deficit hyperactivity disorder (ADHD)?

Missing details

Most common anxiety disorder

Panic Disorder

Which of the following statements accurately reflects the prognosis for a client with a personality disorder?

Prognosis varies based on the degree of functional impairment and the client's motivation to change. At one time, the prognosis for all personality disorders was considered grim, because the general consensus was that these conditions were untreatable. Because people continue to grow and change throughout life, however, current views emphasize that personality disorders are treatable. Prognosis varies widely, based on the degree of functional impairment and the client's motivation to change. (less)

Which type of abuse includes name calling and belittling?

Psychological abuse

Which statement requires additional education regarding the truth about rape?

Rape is a crime of passion.

A nurse is working on developing a safety plan with a client who is a survivor of violence. Which would the nurse address first?

Recognizing the signs of danger

Which is not a risk factor for child sexual abuse?

The child is aged 10 years or younger.

After teaching a group of nursing students about somatic symptom disorder, the instructor determines that additional education is needed when the students identify which as true?

The client usually thinks anxiety is behind the symptoms.

The nurse is working with a 17-year-old client with a complex and dysfunctional family background. What aspect of this client's history should the nurse identify as the most significant risk factor for posttraumatic stress disorder (PTSD)?

The client was sexually abused by the mother's boyfriend at a young age

Major goals for the nursing care of clients with dementia should include which of the following?

The client will be safe; be physiologically stable; have infrequent episodes of agitation. Safety is always the nurse's first priority; patients with dementia often cannot meet their basic physical needs; and agitation is a common emotional response to confusion and disorientation. (less)

A nurse is studying the medical chart of a client with delirium. The nurse finds that the client was given haloperidol. What would be the most likely reason for administering this drug to the client?

To decrease agitation

A nurse is caring for a child with attention deficit hyperactivity disorder. The nurse asks the child to draw pictures of the child and family members. What is the most likely rationale for this intervention?

To help the child self-express

A nurse working in a psychiatric unit is counseling a rape survivor. How can the nurse use cognitive processing therapy for the client?

Use structured sessions to focus on examining beliefs that interfere with daily life.

Insecure attachment

Usually forms during childhood, especially if child has learned fear and helplessness

An appropriate goal for a client newly admitted to the unit for alcohol withdrawal is what?

Verbalize feeling safe and comfortable. The client should verbalize feeling safe and comfortable. The other answer choices are goals for longer-term treatment—i.e., after the detoxification process has been successfully completed. (less)

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan?

Vigilant monitoring for potential indications of self-harm

spirituality

a client's beliefs about life, health, illness, death, and one's relationship to the universe; involves the essence of a person's being and his or her beliefs about the meaning of life and the purpose for living

flooding

a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object (either a picture or the actual object) until it no longer produces anxiety

anxiety disorders

a group of conditions that share a key feature of excessive anxiety, with ensuing behavioral, emotional, cognitive, and physiologic responses

mild anxiety

a sensation that something is different and warrants special attention

Traumatic stressors can cause...

a short, acute stress reaction or, if unresolved, may occur later as PTSD

decatastrophizing

a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen

anxiety

a vague feeling of dread or apprehension; it is a response to external or internal stimuli that can have behavioral, emotional, cognitive, and physical symptoms

which type of therapy involves increasing the frequency of the client's positively reinforcing interactions with the environment and to decrease negative interactions? a. interpersonal therapy b. behavior therapy c. cognitive therapy d. electroconvulsive therapy

a. Interpersonal therapy Interpersonal therapy focuses on difficulties in relationships, such as grief reactions, role disputes and role transitions.Interpersonal therapy helps the person to find ways to accomplish establishing relationships and trusting behaviors. Cognitive therapy focuses on how the person thinks about the selfm others and the future and interprets his or her experiences. Behavior therapy seeks to increase the frequency of the client's positively reinforcing interactions with the environment and to decrease negative interaactions. ECT is used to treat depression in select groups.

Attachment behaviors

affectional bonds with significant other

when completing discharge medication education for the client he asks how long it would take before the effects of his prescribed SSRI could be felt. the nurse states that it will likely take? a. 1 to 2 days b. 3 to 4 weeks c. 2 to 3 weeks d. 5 to 7 days

c. 2 to 3 weeks most antidepressant medications do not become effective or reach a therapeutic level for at least 2 or 3 weeks

When assessing a client immediately following ECT, the nurse expects which of the following? a. Numbness and tingling in the extremities b. Long term memory impairment c. confusion d. full of energy

c. confusion After ECT treatment, the client may be mildly confused or briefly disoriented. He or she is very tired and often has a headache. The client will have some short term memory impairment. Numbness and tingling in the extremities is not an expected symptom.

A middle-aged client with young children has been the victim of intimate partner violence (IPV). When providing initial care to this family, the nurse should:

carefully assess the children for signs of trauma.

derealization

client senses that events are not real, when, in fact, they are

Stacey is a 51 year old woman who has been severely depressed and has been contemplating suicide. While she feels like she has no other way out, she also wishes someone would help her . What is this known as? a. rescue syndrome b. determination c. vacillation d ambiivalence

d. ambivalence clients considering suicide are frequently ambivalent about their ideas their ideas. Shneidman defines ambivalence as " the commonm internal attitude toward suicide: to feel that one has to do it, and at the same time to yearn (even to plan) for recue and intervention. " Nurses target assessment and intervention efforts toward the part of suicidal clients that does not want to die.

Which characteristics is most common among suicidal clients? a. remorse b. anger c. psychosis d. ambivalence

d. ambivalence suicide involves ambivalence. many fatal accidents may be impulsive suicides. it is impossible to know, for example, whether the person who drove into a telephone pole did this intentionally.

a nurse is preparing a presentation for a local community group about suicide. when describing the age group most at risk, which of the following would the nurse include? a. teenagers b middle aged males c. females in their mid 20s d individuals over age 65

d. individuals over 65 people older than 65 have the highest suicide rates (25%) of any age group

working phase of therapeutic relationship

divided into two sub phases; problem identification and exploitation. *problem identification- client identifies the issues or concerns causing problems. *exploitation- nurse guides the client to examine feelings and responses and to develop better coping skills and a more positive self image. -trust developed between nurse and client at this point allows them to examine the problems and to work on them within the security of the relationship. - client has to believe that the nurse will not turn away or be upset with them. - clients will test the nurse to see how they will react - nurse must be non-judgmental and refrain from giving advice. allow the client to analyze the situation.

Why is it important to recognize the verbal and nonverbal communication content of various stages of grieving?

it can help nurses to select interventions that meet the client's psychological and physical needs.

social relationship

primarily initiated for the purpose of friendship, socialization, companionship, or accomplishment of a task. -advice is often given -roles may shift during social interactions. -outcomes are rarely assessed. -must be limited in nurse client relationship to make sure goals are accomplished.

OPISTHOTONUS

tightness in the entire body with the head back + arched neck Acute dystonia symptom

A nurse is assessing a client diagnosed with schizophrenia. When documenting the findings, which of the following would the nurse identify as a positive symptom? Select all that apply.

• Delusions • Hallucinations Correct Positive symptoms reflect an excess or distortion of normal functions, including delusions and hallucinations. Negative symptoms reflect a lessening (or complete loss) of normal functions, such as restriction or flattening in the range and intensity of emotion (diminished emotional expression); reduced fluency and productivity of thought and speech (alogia); withdrawal and inability to initiate and persist in goal-directed activity (avolition); and inability to experience pleasure (anhedonia). (less)

People who are impulse-driven and have difficulty delaying gratification frequently participate in which of the following behaviors? Select all that apply.

• Gambling • Shopping beyond their means • Binge eating • Abusing alcohol Impulsivity is a characteristic of people with borderline personality disorder (BPD). They have difficulty delaying gratification and often act "in the moment." Gambling, spending money irresponsibly, binge eating, engaging in unsafe sex, and abusing substances are typical. (less)

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response?

"Acute stress disorder is a possibility, which might develop into PTSD."

A client asks the nurse, "What is Alcoholics Anonymous all about?" Which is the best response by the nurse?

"It is a self-help group for which the norm is sobriety." Alcoholics Anonymous (AA) was founded in the 1930s by alcoholics. This self-help group developed the 12-step program model for recovery, which is based on the philosophy that total abstinence is essential and that alcoholics need the help and support of others to maintain sobriety. Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed. Groups that advocate strong punishment describes organizations such as Mothers Against Drunk Driving. (less)

The nurse is assessing a client who has received a tentative diagnosis of delirium. The nurse is explaining to the family about the major cause of the client's condition. Which statement by the nurse would be most appropriate?

"The client's diagnosis is primarily based on the rapid onset of the change in consciousness."

Tardive Dyskinesia (TD)

- A syndrome of PERMANENT involuntary movements caused by ANTIPSYCHOTIC meds - SYMPTOMS: involuntary movements of the tonge, facial + neck muslces, uper + lower extremities, tongue thrusting, lip smacking, blinking, grimacing + other excessive unnecessary facial movements are characteristic - After it has developed, TD is IRREVRESABLE - Antipsychotic medications can mask the symptoms of TD - Mostly caused by long term use of conventional antipsychotic drugs - 20-30% of patients on long term treatment develop symptoms of TD - The pathophysiology is still unclear, and no effective treatment has been approved for general use - Clinical trials report success in treating with Levetiracetam

Cultural Considerations

- African Americans respond more RAPIDLY to antipsychotics + tricyclic antidepressants than do whites + have a greater risk for developing side effects - Asians metabolize antipsychotics + tricyclic antidepressants more SLOWLY than do whites + therefore requiire lower dosages to achieve the same effects - Hispanics require LOWER dosages of antidepressants than do whites

Computerized Tomography (CT)

- Also called "CAT scan" - A precise X-ray takes CROSS SECTIONAL images layer by layer - Can visualize the brains soft tissues

Glutamate

- An EXCITATORY amino acid - At HIGH LEVELS can have neuroTOXIC effects - Implicated in brain damae caused by stroke, hypoglycemia, Huntington's or Alzheimer's

Agranulocytosis

- Deficiency of agranulocytes in blood - Leads vulnerable to infection - Side effect of antipsychotics - Potentially fatal

Epinephrine

- EXCITATORY - Also known as ADRENALINE - Has limited distribution in the brain - Controls "fight or flight" response in the peripheral nervous system

Regression

- Moving back to a previous developmental stage to feel safe or have needs met - Five year old asks for a bottle when new baby brother is fed

Geodon

- Neuroleptic Malignant Syndrome risk - Contraindicated in patients with history of HEART ISSUES - 2nd generation antipsychotic

Transference

- Occurs when the client displaces onto the therapist attitudes and feelings that the client originally experienced in other relationships - Automatic and unconscious in the theraputic relationship

Limitations of Brain Imaging Technologies

- Radioactive substances in PET + SPECT limit the number of times a person can undergo the tests - Equipment is expensive - Some cannot tolerate these procedures due to claustrophobia - Researchers are finding that many of the changes in disorders such as schizophrenia re at the molecular and chemical levels and cannot be detected with current imaging techniques

Substitution

- Replacing the desired gratification with one that is more redily available - Woman who would like to have her own cildren opens a day care center

Stimulants

- Treats ADHD and narcolepsy

Dimensions of Grieving

-Cognitive responses: -Questioning, trying to make sense of loss -Attempting to keep lost one present -Emotional responses (anger, sadness, anxiety) -Spiritual responses -Behavioral responses -Physiologic responses

Kubler-Ross's five stages of grieving

-Denial -Anger -Bargaining -Depression -Acceptance (Table 10.1 in book)

Bowlby's phases of grieving

-Numbness, denial of loss -Emotional yearning for lost loved one; protest over permanence of loss -Cognitive disorganization, emotional despair; difficulty functioning -Reorganization, reintegration

Horowitz's four stages of loss and adaptation

-Outcry -Denial and intrusion -Working through -Completion

Maslow's hierarchy.

-Physiologic loss -Safety loss -Loss of security and sense of belonging -Loss of self-esteem -Loss related to self-actualization

Engel's five stages of grieving

-Shock and disbelief -Developing awareness -Restitution -Resolution of loss -Recovery

when creating a johari window

-first step is for the nurse to appraise his or her own qualities by creating a list of them. -second step is to find out others perceptions by interviewing them and asking them to identify qualities, both positive and negative -third step is to compare list and assign qualities to the appropriate quadrant

Freud's 5 Stages of Psychosocial Development

1.) Oral (birth - 18 months) 2.) Anal (18- 36 months) 3.) Phallic/Oedipal (3 - 5 years) 4.) Latency (5 - 11 years) 5.) Genital (11 - 13 years)

6 Psychosocial Theories

1.) Psychoanalytic 2.) Developmental 3.) Interpersonal 4.) Humanistic 5.) Behavioral 6.) Existential

Piaget's 4 Stages of Cognitive Development

1.) Sensorimotor: birth to 2 years 2.) Preoperational: 2 - 6 years 3.) Concrete operations: 6 - 12 years 4.) Formal operations 12 - 15 years

3 Studies Conducted ot Investigate the Genetic Basis of Mental Illness

1.) TWIN STUDIES: Used to compare rates of certain mental illnesses or traits in monozygotic (identical) twins, who have identical genetic makeup 2.) ADOPTION STUDIES: Used to determine a trait among biologic versus adoptive family members 3.) FAMILY STUDIES: Used to compare whether a trait is more common among first degree relatives (parents, siblings and children) than among more distant relatives or the general population

Fluoxetine (Prozac)

A SSRI antidepressant used to treat Panic disorder & GAD

A nurse has been asked to identify children with attention deficit hyperactivity disorder (ADHD) in a school. Which children should the nurse identify as having ADHD? Select all that apply.

A child who makes excessive noise by tapping the desk A child who does not follow instructions in class

Which of the following is considered the etiology of personality disorders?

A combination of psychosocial and biologic variables A combination of psychosocial and biologic factors is believed to be responsible for the formation of personality itself and personality disorders.

Generalized Anxiety Disorder (GAD)

A person with GAD worries excessively and feels highly anxious at least 50% of the time for 6 months or more. Unable to control this focus on worry, the person has three or more symptoms.

ONLY 3rd Generation ANTIPSYCHOTIC

Abilify

Nurses at an urban emergency department seek to develop a plan to help women involved in abusive relationships. Which component is critical to the success of the plan?

Access to community resources for referral

Neurotransmitter that is EXCITATORY + INHIBATORY

Acetylcholene

Which is not considered a characteristic of violent families?

Adequate support systems

A student nurse asks the mental health nurse about when somatic symptom disorder (SSD) usually begins. The nurse responds by saying that the first symptoms often appear during which time?

Adolescence

Clients from which continent or country may have symptoms of somatization disorder that include the nondelusional sensation of worms in the head or ants under the skin?

Africa

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as what?

Agnosia

A client is diagnosed with Alzheimer's disease. While assessing the client, the nurse notes that the client has trouble identifying objects such as a key and spoon. The nurse would document this as which of the following?

Agnosia Deficits typically assessed in clients with Alzheimer's disease include: aphasia (alterations in language ability), apraxia (impaired ability to execute motor activities despite intact motor functioning), agnosia (failure to recognize or identify objects despite intact sensory function), or a disturbance of executive functioning (ability to think abstractly, plan, initiate, sequence, monitor, and stop complex behavior). (less)

A mental health client has been prescribed clozapine (Clozaril) for the treatment of schizophrenia. The nurse should be alert to which of the following potentially life-threatening adverse effects of this medication?

Agranulocytosis Agranulocytosis is a life-threatening adverse effect of Clozaril. WBC counts should be monitored frequently due to extremely low levels of white blood cells. Weight gain occurs with certain antipsychotics. Palpitations and hemorrhage are not generally associated with antipsychotics. (less)

The nurse is caring for a client with dementia. The client's brain images show atrophy of cerebral neurons and enlargement of the third and fourth ventricles. What is the cause of dementia in this client?

Alzheimer's disease

Stimulants: MECHANISM OF ACTION

Amphetamines + methylphenidate are often termed INDIRECTLY ACTING AMINES because they act by causing the release of the neurotransmitters (norepinephrine, dopamine + serotonin) from presynaptic nerve terminal as opposed to having direct agonist effects on the postsynaptic receptors. They also BLOCK the reuptake f these neurotransmitters

What is the primary sign of delirium?

An altered level of consciousness

What is the primary sign of delirium?

An altered level of consciousness The primary sign of delirium is an altered level of consciousness that is seldom stable and usually fluctuates throughout the day. All other options are not the primary sign of delirium. (less)

Loss related to self-actualization

An external or internal crisis that blocks or inhibits striving toward fulfillment may threaten personal goals and individual potential. A person who wanted to go to college, write books, and teach at a university reaches a point in life when it becomes evident that those plans will never materialize. Or a person loses hope that he or she will find a mate and have children. These are losses that the person will grieve.

GABA

An inhibitory neurotransmitter. functions as the body's natural antianxiety agent by reducing cell excitability.

The parent of an 8-year-old client was concerned that the child may have an intellectual disability. The parent reports that the child has difficulty communicating. Which finding would confirm a diagnosis of intellectual disability?

An intelligence quotient (IQ) of 70 or below

Koro

An intense anxiety reaction, or a man's profound fear that his penis will retract into the abdomen and he will then die.

Avoidant, dependent, and obsessive-compulsive personality disorders are characterized by which of the following?

Anxious or fearful behaviors Clients with Cluster C personality disorders—which include avoidant personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder—are often anxious, tense, and fearful. (less)

A client with dementia is having difficulty finding the words that the client wants to use. When the client could not remember the name of the client's shoes, he referred to them as, "the things you put on your feet." What is the name for this condition?

Aphasia

A client diagnosed with Alzheimer's disease has an alteration in language ability. This alteration would be documented as which of the following?

Aphasia Aphasia is an alteration in language ability. Agnosia is the failure to recognize or identify objects despite intact sensory function. Apraxia is impairment in the ability to execute motor activities despite intact motor functioning. Akinesia is impaired muscle movement that may occur in Parkinson's disease. (less)

Which term is used to describe the inability to execute motor functioning, despite intact motor abilities?

Apraxia

Automatisms

Are automatic, unconscious mannerisms. Examples include tapping fingers, jingling keys, or twisting hair. Automatisms are geared toward anxiety relief and increase in frequency and intensity with the client's anxiety level.

The mental health nurse recognizes that genetic intolerance of alcohol has been documented among which ethnic group?

Asians Asians have a genetic intolerance to alcohol even when consumed in small amounts. Such an intolerance has not been identified in those of African, Italian, or German descent.

A client with a diagnosis of posttraumatic stress disorder (PTSD) has been brought to the emergency department (ED) by concerned family members, who state that the client is experiencing a "nervous breakdown." The ED nurse should prioritize what aspect of care during the initial care of the client?

Assessing the client's risk for self-harm and ensuring safety

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment?

Assessing the quantity and quality of the client's sleep

When assuming the management of the care of a delusional client, which of the following should be the nurse's priority intervention?

Assure the client that he or she is safe in this milieu Assuring the client that he or she is in a safe environment is the first step in the establishment of a therapeutic relationship that is vital to successful psychiatric treatment.

After teaching a group of nursing students about pharmacotherapy and attention deficit hyperactivity disorder (ADHD), the instructor determines that the education was successful when they identify which agent as the first line choice?

Atomoxetine

Get the stuff from him - is an example of which type of message? A. Clear B. abstract C. Direct D. Concrete

B. abstract

A client he was verbally expressing angry feelings while smiling is exhibiting which type of facial expression? A. Emotionless B. confusing C. Expressive D. Impassive

B. confusing

It is the nurses responsibility to establish a therapeutic relationship with the client. Which of the following isn't excepting body position for therapeutic communication? A. Legs crossed B. hands of the side of the body C. Lack of eye intact D. Arms folded against The chest

B. hands of the side of the body

Which communication technique involves expressing uncertainty about the reality of the clients perception? A. Restating B. voicing doubt C. Reflecting D. Silent

B. voicing doubt

Which of the following medications is used to control the extrapyramidal effects associated with antipsychotic medications?

Benzotropine (Cogentin) Cogentin is an anticholinergic drug used to relieve drug-induced extrapyramidal adverse effects, such as muscle weakness, involuntary muscle movement, pseudoparkinsonism, and tardive dyskinesia. (less)

Which statement regarding posttraumatic stress disorder (PTSD) and children is accurate?

Best practices demonstrate that adolescents who have PTSD are at increased risk of drug

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?

Binge eating disorder

Which of the following groups of theories is believed currently to explain the etiology of schizophrenia?

Biologic Schizophrenia is thought to have multiple etiologies. The overwhelming body of scientific evidence suggests that schizophrenia is a brain disease. Computed tomography scanning and magnetic resonance imaging have shown frequent enlargement of the lateral cerebral ventricles in people with schizophrenia. (less)

A client with anorexia nervosa self-describes as "a whale." However, the nurse's assessment reveals that the client is 5 feet 8 inches tall and weighs only 90 pounds. The nurse identifies this as reflecting what?

Body image disturbance

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?

Bradycardia

When working with children with neurodevelopmental disorders, which would be appropriate?

Building on the child's strength

A 17-year-old client with a long-standing diagnosis of bulimia nervosa has been admitted to the emergency department after collapsing in a mall. The care team that admits the client to the hospital should prioritize which assessment?

Cardiac assessment and measurement of electrolyte levels

A nurse makes a home visit to a family caring for a client with Alzheimer's disease. The client's wife tells the nurse that she hasn't been out of the house for more than 2 weeks because her sister has been unable to help care for the client. Which nursing diagnosis would the nurse identify as the priority?

Caregiver Role Strain related to social isolation Although family coping, activity intolerance, and powerlessness may be issues, the priority nursing diagnosis is Caregiver Role Strain related to social isolation, as evidenced by the wife's statement of not being out of the house for 2 weeks. The nurse should assist the client's wife in obtaining respite care if it is available. (less)

African American grieving considerations

Catholic and Episcopalian services- hymns, poetry, eulogy. Baptist and Holiness- singing speaking in tongues, liturgical dancing. Viewed in church, buried in cemetery. Mourning- prayers, black clothing, decreased social activities- few weeks to several years.

Filipino Americans

Catholic, black clothing, armbands, place wreaths on casket, drape black cloth on home of deceased, announcements in newspaper.

A personality disorder is defined as a collection of traits that do which of the following?

Cause behavioral dysfunction and inner distress A personality disorder can be defined as a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder also can be considered a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness. (less)

One of the biosocial theories of the etiology of borderline personality disorder involves the role of an invalidating environment, a social situation that negates private emotional responses and communication. The most severe form of invalidation occurs in which of the following situations?

Child sexual abuse The most severe form of invalidation occurs in situations of child sexual abuse. Often, the abusing adult has told the child that this is a "special secret" between them. The child experiences feelings of fear, pain, and sadness, yet this trusted adult continuously dismisses the child's true feelings and tells the child what he or she should feel. Divorce, marriage, and death of a family member are not the most severe forms of invalidation. (less)

The nurse is legally obligated to report suspected child abuse to local authorities. Which information is essential?

Child's name, location, age, and suspected perpetrator

A nurse is assessing a client with borderline personality disorder. During the assessment the nurse notes that the client is using projective identification. Which of the following would support this interpretation?

Client attributes own feelings falsely to others. Clients falsely attributing to others their own unacceptable feelings, impulses, or thoughts is termed projective identification. Lacking a definitive sense of self reflects issues with separation-individuation. Misinterpreting environmental stimuli reflects cognitive schema. The inability to control emotional reactions in social situations reflects emotional dysregulation. (less)

A nurse is developing a plan of care for a client diagnosed with delusional disorder. Which of the following would the nurse need to keep in mind?

Clients with delusional disorder typically have problems with medication adherence. By the time a client with a diagnosis of delusional disorder is seen in a psychiatric setting, he or she has generally had the delusion for a long time. It is deeply ingrained and many times unshakable even with psychopharmacologic intervention. These clients rarely comply with medication regimens. Male clients who have the erotomanic subtype are likely to require special care because they are more likely than other clients to act on their delusions (for example, by continued attempts to contact the loved object or stalking). (less)

Dialectical behavior therapy (DBT) combines behavior therapy with which of the following types of therapy?

Cognitive DBT combines cognitive and behavior therapy strategies. Clinicians partner with clients and focus on the many interconnected behaviors.

The nurse is providing care to a client with somatic symptom disorder (SSD). Which would the nurse expect to be included in the client's plan of care?

Cognitive behavior therapy

A nurse is caring for a client with acute stress disorder. The main goal of therapy for this client is prevention of the progression of this condition to posttraumatic stress disorder (PTSD). Which therapy would the client most likely be referred for?

Cognitive behavioral therapy

A nurse is developing a plan of care for a client newly diagnosed with bulimia nervosa. Which would the nurse expect to implement in conjunction with pharmacologic therapy?

Cognitive behavioral therapy

A 27-year-old has been brought to the emergency department by emergency medical services following a violent sexual assault that took place in the parking garage of the client's building. Which task would fall most clearly within the scope of practice of a forensic nurse?

Collecting specimens from the client for use as evidence

A nurse is assessing a child who had an episode of passing feces in the classroom. The child has no other disabilities. The nurse concludes that the child had intentional encopresis. Which other condition is the child likely to have?

Conduct disorder

An 80-year-old is brought to the clinic by his wife. He has a history of peripheral vascular disease and Type 2 diabetes. The wife states that he hasn't seemed himself for the preceding few days, noting that he has been lethargic and mildly confused at times and has been incontinent of urine. She reports that his blood glucose levels have been elevated. The nurse considers which of the following as the most likely explanation for the client's change in mental status?

Delirium related to underlying medical problem Any disturbance in any organ or system that affects the brain can disrupt metabolism and neurotransmission, leading to a decline in cognition and function. Infections, fluid and electrolyte imbalances, and drugs are the most frequent causes of delirium. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults. (less)

Which is the most commonly identified issue preventing people from leaving an abusive relationship?

Dependency

A nurse is caring for a client with posttraumatic stress disorder (PTSD). On reassessing the client, the nurse finds that the client shows signs of another psychiatric disorder as well. Signs of which psychiatric disorders would the nurse likely see in this client? Select all that apply.

Depression Anxiety disorder

Which would be most important for a nurse to do when caring for a client with somatic symptom disorder?

Develop a sound, positive nurse-client relationship

Nurses who work in a pediatric psychiatric-mental health facility should do what?

Develop self-awareness of issues that remind them of their own childhood and adolescence.

The nurse working with pediatric clients knows the importance of checking for developmental delays, which not only slow the child's progress but also are often associated with what?

Development of poor self-esteem

A nurse is assessing an 8-year-old child. The child is unable to dress the self and is not able to manipulate toys, such as building blocks. The child stutters while talking. The child does not have impaired motor coordination. What is the most likely diagnosis of the child?

Developmental coordination disorder

Which of the following is an example of a benzodiazepine?

Diazepam .Diazepam is classified as a benzodiazepine, one of the most commonly used medications. Naltrexone is a narcotic antagonist used in the treatment of alcohol or narcotic dependence. Haloperidol is an antipsychotic drug used in the treatment of hallucinations. Disulfiram is used in the treatment of alcohol abuse. (less)

Changes that are found during the mental status examination of a client diagnosed with delirium include what?

Difficulty focusing

A psychiatric-mental health nurse working in the community is planning an educational program for fifth- and sixth-grade teachers. Which would the nurse include?

Discussion of strategies the teachers can use to counteract the role media plays in encouraging eating disorders

The way in which personality disorders are different from personality traits is best described as follows:

Disorders cause impairment in social and occupational functioning, whereas traits do not. Personality disorder is a collection of personality traits that have become fixed and rigid to the point that the person experiences inner distress and behavioral dysfunction. A personality disorder is a lifelong pattern of behavior that affects many areas of the person's life, causes problems, and is not produced by another disorder or illness (less)

The nurse is caring for a 10-year-old client who was sexually abused at 7 years old. The nurse knows that children who are sexually abused are at increased risk for which condition?

Dissociative disorders

A client in a psychiatric clinic has a history of two distinct personality states. The client is also unable to remember important personal information. What is the client likely to be suffering from?

Dissociative identity disorder

A group of nursing students is reviewing the various theories related to the etiology of schizophrenia. The students demonstrate understanding of the information when they identify which neurotransmitter as being responsible for hallucinations and delusions?

Dopamine Although research is demonstrating that schizophrenia does not result from dysregulation of a single neurotransmitter or biogenic amine (such as serotonin, norepinephrine, or dopamine), positive symptoms of schizophrenia, specifically hallucinations and delusions, are thought to be caused by dopamine hyperactivity in the mesolimbic tract. Researchers are also hypothesizing a role for GABA but have yet to identify any specific information. (less)

The ingestion of mood-altering substances stimulates which neurotransmitter pathway in the limbic system to produce a "high" that is a pleasant experience?

Dopamine The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience. (less)

A client diagnosed with schizoid personality disorder is described by family members as which of the following?

Eccentric and a loner A client diagnosed with schizoid personality disorder is described by family members as being eccentric and a loner, not dramatic and emotional, nervous and fearful, or tired and sad. (less)

Which aspect of managing a child with attention deficit hyperactivity disorder (ADHD) may often be overlooked in the treatment plan?

Effects on siblings

5 Types of Psychotropic Drugs

Either ENHANCE or INHIBIT neurotransmitters. antipsychotics antidepressants mood stabilizers anxiolytics stimulants

A mental health nurse is interviewing a child for suspected abuse. The parent states that the child is having disciplinary problems at school and stutters when approached. From the listed behavioral indicators, the nurse would suspect which type of abuse?

Emotional

The nurse is educating the spouse of a client with a somatic symptom disorder about how to best help the client. Which strategy should the nurse suggest?

Empathize about physical discomfort but encourage independence.

A group of at-risk teenagers have successfully completed an outdoor training program in which they had to collaborate and conquer a number of challenges. The nurse should identify what likely outcome of this program?

Enhanced resilience for the participants

Physiologic Loss

Examples include amputation of a limb, a mastectomy or hysterectomy, or loss of mobility

Phobias

Excessive anxiety about being in public or open places (agoraphobia), a specific object, or social situations.

When assessing a client diagnosed with hypochondriasis, the most serious risk factor to be identified for this client is what?

Extensive use of over-the-counter medications

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support?

Facilitate the client's participation in a support group

A group of nursing students is reviewing information about somatic symptom and related mental health disorders. The students demonstrate understanding of the information when they identify which disorder as involving physical or psychological symptoms (or both) fabricated to assume the sick role?

Factitious disorder

In which disorder is the individual motivated solely by the desire to become a health care client?

Factitious disorder

When lecturing about dissociative disorders to a group of nursing students, a nurse states that an essential feature of these disorders involves what?

Failure to integrate identity, memory, and consciousness

A nurse is preparing a presentation for a senior center about elder abuse. When describing individuals associated with abusing older adults, which group would the nurse most likely identify? Select all that apply.

Family member Adults Children Spouses

A client broke down in tears when speaking with the nurse, stating, "You have no idea what it's like to be responsible for finding Osama bin Laden. Every day I have to stay one step ahead of the Al Qaida operatives that he's sent after me." In light of the client's statement, which of the following nursing diagnoses should the nurse prioritize?

Fear related to persecutory delusions The client is expressing fear and anxiety resulting from a perceived threat. He is confused about his role and/or identity. There is no evidence of labile affect, despite the client having grandiose delusions. The primary concern for the client is fear. Defensive coping is not in evidence, and impaired social interactions are secondary to the client's immediate fear. (less)

Which is the hallmark of beginning mild dementia?

Forgetfulness

Which of the following is the hallmark of beginning mild dementia?

Forgetfulness The hallmark of the initiation of mild dementia is forgetfulness. Memory impairment is the prominent early sign of dementia.

Drugs with SHORT Half-Live (2-4 hours) need to be given ____________________.

Frequently

A nurse is studying the brain images of children with attention deficit hyperactivity disorder (ADHD). In these images, the nurse would find abnormalities related to which area of the brain?

Frontal lobe

Exacerbation of anorexia nervosa results from the client's effort to do what?

Gain control of one part of life

The parents of a toddler are distraught that the toddler has been diagnosed with autism spectrum disorder. When providing care for the child and the parents, the nurse understands that autism spectrum disorder is thought to be caused by what?

Genetic factors

After teaching a group of nursing students about intellectual disability, the instructor determines that the teaching was successful when the students identify which as the most common etiology?

Genetic syndromes

Nurses working with rape trauma victims need to be aware of their own attitudes about rape and sexual assault. Which rationale best explains why?

Giving back the survivor as much control as possible is important.

1st Generation ANTIPSYCHOTICS (conventional)

Haldol Loxitane Thorazine Prolixin Trilafon Mellaril Stelazine Inapsine Loxitane Moban Navane

Ecstasy is an example of which type of substance?

Hallucinogen

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

Heart rate and rhythm

When a client is working toward the prevention of an alcohol abuse relapse, the nurse is acting in a therapeutic role when doing which of the following?

Helping the client identify positive coping mechanisms When a client is working toward the prevention of an alcohol abuse relapse, the nurse is most therapeutic when helping the client identify positive coping mechanisms.

Assertiveness training

Helps the person take more control over life situations. These techniques help the person negotiate interpersonal situations and foster self-assurance. They involve using "I" statements to identify feelings and to communicate concerns or needs to others. Examples include "I feel angry when you turn your back while I'm talking," "I want to have 5 minutes of your time for an uninterrupted conversation about something important," and "I would like to have about 30 minutes in the evening to relax without interruption."

Which characteristic would a nurse least likely see in an abused individual?

High self-esteem

A nurse is preparing a presentation for a group of staff nurses about neurocognitive disorders. When describing vascular neuorocognitive disorder, the nurse would identify which as posing the greatest risk for this disorder?

Hypertension

Which mental health disorder is characterized by a fear of developing a serious illness based on a misinterpretation of body sensation?

Hypochondriasis

Which is the primary treatment for delirium?

Identify and treat any causal or contributing medical conditions

An adult male client with a history of PTSD is brought to the emergency department (ED). The client was startled by a dog while out for a walk and kicked it. He was calm and apologetic when he presented to the triage nurse. Which is a priority nursing intervention?

Identify risks for self-harm and aggression

A client who has been having difficulty functioning in daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects what?

Illness anxiety disorder

During a client interview, the nurse determines that the client has a fear of developing a serious illness based on a misinterpretation of body sensation. The nurse identifies this as being characteristic of what?

Illness anxiety disorder

A nurse is reviewing the plan of care for a client with anorexia nervosa and notes a behavioral plan for increasing weight. The nurse correlates this intervention with which nursing diagnosis?

Imbalanced nutrition: less than body requirements

Cognitive disorders are characterized by what?

Impaired attention, memory, and abstract thinking

Cognitive disorders are characterized by which of the following?

Impaired attention, memory, and abstract thinking Cognitive mental disorders are characterized by a disruption of or deficit in cognitive function, which encompasses orientation, attention, memory, vocabulary, calculation ability, and abstract thinking. (less)

When describing the major difference between somatic symptom disorder and factitious disorders, which would the nurse include?

In somatic symptom disorder, clients are not consciously aware that needs are being met through physical complaints.

Guatemalan Amaericans

Include marimba band in funeral procession and services, lighting candles, and blessing deceased during wake in home.

Cognitive-behavioral techniques used to treat clients with anxiety disorders

Include positive reframing, decatastrophizing, thought stopping, and distraction.

Positive symptoms seen in schizophrenia are believed to be a result of which of the following types of neurological dysfunction?

Increased amount of dopamine Positive (or productive) symptoms reflect an increased amount of dopamine affecting the cortical areas of the brain. Negative symptoms reflect an inadequate amount of dopamine, cerebral atrophy, and organic functional changes in the brain. (less)

After teaching a group of nursing students about different personality disorders, the instructor determines that the education was successful when the students identify which of the following as characteristic of schizotypal personality disorder?

Increased eccentricity Individuals with schizotypal personality disorder are dramatically. These individuals are perceived as strikingly odd or strange in appearance and behavior, even to laypersons. They may have unusual mannerisms, an unkempt manner of dress that does not quite "fit together," and inattention to usual social conventions (e.g., avoiding eye contact, wearing clothes that are stained or ill-fitting, and being unable to join in the give-and-take banter of coworkers). (less)

A nurse is working with a client who is anticipating the possibility of leaving an abusive relationship. In helping the client make the decision to leave or to stay in the abusive situation, which would be most important for the nurse to do?

Inform the client that if leaving the abusive situation, there is a possibility the partner will attempt to fatally injure the client.

Disulfiram (Antabuse): MECHANISM OF ACTION

Inhibits the enzyme aldehyde dehydrogenase, which is involved in the metabolism of the ethanol. Acetaldehyde levels are then increased from 5-10 times HIGHER than normal, resulting int eh disulfiram-alcohol reaction

Which of the following is the central focus of persecutory delusions?

Injustice that must be remedied by legal action The focus of persecutory delusions is often on some injustice that must be remedied by legal action. Clients often see satisfaction by repeatedly appealing to courts and other government agencies. The central theme of somatic delusions involves bodily functioning or sensations. The central theme of the jealous subtype is the unfaithfulness or infidelity of a spouse or lover. Clients representing with grandiose delusions are convinced they have a great, unrecognized talent or have made an important discovery. (less)

A child with attention deficit hyperactivity disorder (ADHD) has been prescribed dextroamphetamine. For what effects should the nurse tell the parents to monitor the child? Select all that apply.

Insomnia Weight loss Appetite suppression

Which are forms of psychological abuse? Select all that apply.

Insulting Humiliating Destroying another's property

A client was admitted to an inpatient unit with a diagnosis of dementia. A nursing assessment and interview of the client would include what?

Intellectual ability, health history, and self-care ability

A client comes to the mental health clinic and reports feeling depressed for the last 3 months. The client also admits to having thoughts of suicide. When the nurse inquires about the client's relationships, the client tells the nurse that the client's spouse constantly belittles the client, telling the client often that the client is "stupid and fat." Which problem should the nurse assess for further?

Intimate partner violence

Mild anxiety...

Is an asset to the client and requires no direct intervention. People with mild anxiety can learn and solve problems and are even eager for information.

Which of the following is the best description of the term substance use disorders, according to the American Psychiatric Association?

Is an umbrella term for substance abuse and substance dependence Substance use disorders, as defined by the American Psychiatric Association, is an umbrella term for substance abuse and substance dependence.

Substance/medication-induced anxiety disorder

Is anxiety directly caused by drug abuse, a medication, or exposure to a toxin. Symptoms include prominent anxiety, panic attacks, phobias, obsessions, or compulsions.

Susto

Is diagnosed in some Hispanics (Peruvians, Bolivians, Colombians, and Central and South American Indians) during cases of high anxiety, sadness, agitation, weight loss, weakness, and heart rate changes. The symptoms are believed to occur because supernatural spirits or bad air from dangerous places and cemeteries invades the body.

Black Box Warning

Issued by the FDA when a drug is found to have serous or life threatening side effects, even if such side effects are rare

Delirium can be differentiated from many other cognitive disorders in which way?

It has a rapid onset and is highly treatable if diagnosed quickly.

Grieving/Bereavement

It involves not only the content, (what a person thinks, says, and feels) but also the process (how a person thinks, says and feels). All people grieve when they experience life's changes and losses

A client's family member asks the nurse, "What is a conversion disorder?" Which is the best response by the nurse?

It involves unexplained, usually sudden, deficits in sensory or motor function.

Which statement incorrectly identifies a positive aspects regarding methadone for heroin addiction?

It is available in IV form. Methadone is safer because it is legal, controlled by a physician, and available in tablet form. It is not available in IV form.

Jean has early Alzheimer's disease. When asked about her family history, she relates that she has two children who are both grown and who visit her around the holidays each year. The nurse subsequently discovers that Jean has one child who is currently assigned overseas and has not been home for 2 years. Which of the following would best describe Jean's behavior?

Jean is confabulating, most likely to cover for her memory deficit. Jean may have some difficulty recalling events or knowledge that she formerly knew to be fact. Because of the inability to recall recent events, she may be confabulating, or filling in memory gaps with fabricated or imagined data. (less)

The client with dementia often cannot clearly communicate physical needs. Which intervention should the nurse teach the caregiver to address common physical problems?

Keep a record of bowel movements.

A nurse is interviewing a client who is suffering from posttraumatic stress disorder (PTSD). Which intervention would help the nurse ensure the client's comfort during the interview?

Keep environmental noises to a minimum.

A nurse is talking with a client 57 years of age who has been a heavy drinker for many years. The client is being treated for alcoholism, and this is her second week as an inpatient on the psychiatric unit. It is 5 a.m., and the client has been having difficulty sleeping. The client is an orthopedic nurse, and although she is clothed in a hospital-issued gown and robe, she is wearing a stethoscope around her neck that the nurse recognizes as belonging to one of the staff nurses. When the nurse asks her why she is wearing the stethoscope and where she got it, the client gives her a long and involved reply that describes how her nursing supervisor came to visit and gave it to her to wear "so she'd remember to get well." The nurse suspects that the client may be experiencing which of the following?

Korsakoff's amnesis syndrome Korsakoff's amnesic syndrome, also known as psychosis, is associated with alcoholism and involves the heart and the vascular and nervous systems, but the primary problem is acquiring new information and retrieving memories. Symptoms include amnesia, confabulation, (i.e., telling a plausible but imagined scenario to compensate for memory loss), attention deficit, disorientation, and vision impairment. Wernicke's encephalopathy, a degenerative brain disorder caused by thiamine deficiency, is characterized by vision impairment, ataxia, hypotension, confusion, and coma. Delirium tremens is an acute withdrawal syndrome characterized by autonomic hyperarousal, disorientation, hallucinations, and tremors. Malignant hyperthermia is characterized by a sharp increase in body temperature leading to muscle breakdown, kidney and cardiovascular failure, and death. (less)

2nd Generation ANTIPSYCHOTICS (atypical)

Latuda Geodon Clozaril Clozapine Seroquel Risperdal Zyprexa Invega Fanapt Saphris

Drugs with LONG Half-Live (21-24 hours) need to be given ____________________.

Less frequently

An adolescent client says the client has become bored with the video game that has been used as a reward for positive behavior. Which is the most effective intervention for this client?

Let the client choose another reward that would be more fun.

Which of the following medications is used to prevent alcohol withdrawal symptoms?

Lorazepam (Ativan) Safe withdrawal usually is accomplished with the administration of benzodiazepines, such as Ativan, Librium, or Valium, to suppress the withdrawal symptoms.

Safety Loss

Loss of a safe environment is evident in domestic violence, child abuse, or public violence. a person's home should be a safe haven with trust that family members will provide protection, not harm or or be violent

Characteristics of susceptibility

Low self esteem, low trust in others, a previous psychiatric disorder, previous suicide threats or attempts, absent or unhelpful family members

The most significant risk factors for alcoholism include all of the following except ...

Low socioeconomic status The most significant risk factors for alcoholism are having an alcoholic parent, genetic vulnerability, and growing up in an alcoholic home.

A nurse is caring for a young adult in the mental health clinic. The client tells the nurse that the client was physically neglected as a child. The nurse should assess the client for symptoms of what?

Major depression

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action?

Make efforts to demonstrate empathy to the client

Which occurs when an individual intentionally produces illness symptoms to avoid work?

Malingering

The nurse should consider which as a possible indicator of child neglect?

Malnourishment unrelated to illness

Which best describes the concept of somatization?

Manifestation of physical symptoms from psychological distress

After teaching a group of nursing students about drugs used to treat Alzheimer's disease, the instructor determines that additional teaching is needed when the group identifies which as a N-methyl-D-aspartic acid (NMDA) receptor antagonist?

Memantine

Which of the following is the most consistent and dramatic cognitive impairment seen in dementia?

Memory The most dramatic and consistent cognitive impairment is memory. The mental status assessment can be difficult for clients with dementia because cognitive disturbance is the clinical hallmark of dementia. Deficits in visuospatial tasks that require sensory and motor coordination develop early, drawing is abnormal, and the ability to write may change. Language is progressively impaired. Judgment, reasoning, and the ability to solve problems or make decisions are also impaired later in the disorder, closer to the time of placement in a nursing home. (less)

Mood Stabilizing Drugs: SIDE EFFECTS

Mild nausea, diarrhea, anorexia, fine hand tremor, polydipsia, polyuria, a metallic taste in the mouth, fatigue, lethargy, weight gain, acne, drowsiness, muscle weakness, lack of coordination, renal failure, coma + death

A client with a medical diagnosis of dementia of Alzheimer's type has been increasingly agitated in recent days. As a result, the nurse has identified the nursing diagnosis of "risk for injury related to agitation and confusion" and an outcome of "the client will remain free from injury." What intervention should the nurse use in order to facilitate this outcome?

Monitor amount of environmental stimulation and adjust as needed.

A combat veteran with posttraumatic stress disorder has been admitted to the psychiatric unit after consuming a large number of antidepressants and drinking half a quart of whiskey 2 days earlier. What aspect of care should the nurse prioritize?

Monitoring the client for suicidal ideation

Treatment of Generalized Anxiety Disorder

More people with this chronic disorder are seen by family physicians than by psychiatrists. The quality of life is diminished greatly in older adults with GAD. Buspirone (BuSpar) and SSRI or SNRI antidepressants are the most effective treatments

While reviewing the medical record of a client with moderate dementia of the Alzheimer type, a nurse notes that the client has been receiving memantine. The nurse identifies this drug as which type?

NMDA receptor antagonist Memantine is classified as an NMDA receptor antagonist that has been shown to improve cognition and activities of daily living in clients with moderate to severe symptoms of dementia. Risperidone, olanzapine, and quetiapine are examples of atypical antipsychotics. Galantamine, donepezil, rivastigmine, and tacrine are cholinesterase inhibitors. Clonazepam, alprazolam, and lorazepam are examples of benzodiazepines. (less)

Which personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy?

Narcissistic Narcissistic personality disorder is characterized by a pervasive pattern of grandiosity, need for admiration, and a lack of empathy. Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. Obsessive-compulsive personality disorder is characterized by a preoccupation with orderliness, perfectionism, and control. (less)

A nurse is implementing a brief intervention with a client who is abusing alcohol. The nurse most likely would be involved with which of the following?

Negotiating a conversation with the client to reduce use Brief intervention involves a negotiated conversation between the nurse and the client that is designed to reduce the substance use. Asking the client questions about substance use refers to screening. Pointing out inconsistencies reflects confrontation. Helping the client change his or her way of thinking reflects a cognitive approach. (less)

An 8-month-old infant has been brought to the emergency department unresponsive by the infant's teenage parent and the care team suspects shaken baby syndrome. When providing care for this infant, the nurse should prioritize which assessment?

Neurological assessment

The nurse obtains a psychosocial history from a client who may have psychological factors affecting the medical condition. Which should the nurse recognize as pertinent to this diagnosis?

No physiologic cause has been found for the client's symptoms.

A nurse is preparing an in-service program about schizophrenia for a group of psychiatric-mental health nurses. Which of the following would the nurse include as a major reason for relapse?

Nonadherence to prescribed medications Although a lack of family or social support, accessibility to community resources, and stigmatization are factors that can contribute to relapse, one of the major reasons for relapse is failure to follow the medication regimen. (less)

A nurse is preparing to interview a client who has a delusional disorder. Which of the following would the nurse expect?

Normal behavior The nurse plans for the interview and expects that the client will act in a normal manner. Generally, clients diagnosed with a delusional disorder have psychosocial functioning that is not markedly impaired. They show few, if any, psychological deficits, and those that do occur are generally related directly to the delusion. General behavior and emotional responses are not odd or bizarre. Cognition is not impaired, and motor symptoms are not evident. (less)

When the nurse is not informed of developmental and cultural issues related to the client's background, which of the following may be expected?

Normal patterns of behavior may be labeled as deviant, immoral, or insane. If the nurse does not remain culturally sensitive, it is possible that symptoms or behaviors that are observed might be misinterpreted as deviant or immoral. Client behavior is always based upon client history and cultural background; understanding of behavior cannot be obtained simply from conventional wisdom. (less)

A client has been prescribed quetiapine (Seroquel) for delusional disorder. In teaching the client about this medication, the nurse must be certain to include which of the following information?

One of the common side effects is dry mouth. Dry mouth is a common, sometimes bothersome, side effect. Quetiapine does not cause breast milk production. Dizziness may occur due to orthostatic hypotension but will decrease as the body becomes accustomed to the medication. It is not an emergency. Quetiapine can cause changes in blood sugar but will not induce sugar cravings. (less)

The nurse is counseling a family whose child has autism. When describing this condition, which would the nurse most likely include?

Onset before child is 2.5 years old

A nurse is assessing a child with attention deficit hyperactivity disorder. Which assessment finding is the nurse likely to see in this child? Select all that apply.

Overactivity Impulsiveness

Symptoms of a panic attack

Palpitations, sweating, tremors, shortness of breath, a sense of suffocation, chest pain, nausea, abdominal distress, dizziness, paresthesias, and vasomotor lability. The person has a fight, flight, or freeze response.

Which of the following is likely the etiologic basis of the compulsive patterns seen in people with obsessive-compulsive personality disorder (OCPD)?

Parental overcontrol The basis of the compulsive patterns seen in OCPD is parental overcontrol and overprotection that is consistently restrictive and sets distinct limits on the child's behavior. Lack of nurturing is not implicated in this disorder, nor is substance use within the family. Clients diagnosed with paranoid personality disorder may have been hyperactive as a child. (less)

A nurse is observing a client diagnosed with borderline personality disorder on the inpatient unit. Which of the following would the nurse most likely note?

Participating in relationships in which the client has control Individuals with borderline personality disorder restrict their relationships to ones in which they feel control. They distance themselves from groups when feeling anxiety (which is most of the time) and rarely use their support systems. They are reluctant to share their feelings. To meet their interpersonal needs, they idealize others and establish intense relationships that violate interpersonal boundaries of others, leading to rejection. (less)

A nurse who provides care in a large, urban emergency department has worked with numerous victims of various forms of abuse as well as those who are abusers. The nurse recognizes that persons who commit abuse are most likely what?

Past victims of abuse themselves

A client has experienced a gradual flattening of affect, confusion, and withdrawal and has been diagnosed with Alzheimer's disease. The nurse assesses which additional characteristics of this disorder?

Personality change, wandering, and inability to perform purposeful movements

A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse has this reluctance?

Physical restraints may increase the client's agitation.

A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse this reluctance?

Physical restraints may increase the client's agitation. The use of physical restraints are usually a last resort for clients with dementia, as restraint use may increase any fears or thoughts of being threatened. The nurse may need to use physical restraints if the patient is pulling at intravenous lines or catheters. Physical restraints do not commonly cause injury to the client or lead to fatality. (less)

General adaptation syndrome

Physiologic aspects of stress

A older adult client develops delirium secondary to an infection. Which would be the most likely cause?

Pneumonia

Which is an infection-related cause of delirium?

Pneumonia

In clients who do not completely recover from being victimized by rape, which mental illness is most likely to develop?

Post-traumatic distress syndrome

When educating the public concerning marijuana use, the nurse should emphasize that heavy and regular use of marijuana is likely to result in which of the following problems?

Psychological dependence with an increased risk for self-harm Cannabis (marijuana) use leads to psychological dependence, thereby retarding personality growth and adjustment to adulthood. Users of large amounts may experience suicidal ideation or have delusions of invulnerability, causing them to take risks. (less)

Which provides the most acceptable example of neglect according to the definition of the term?

Rejecting a 3-year-old who is crying and seeking affection after the child stumbles and falls

A nurse's aide has rung the call light for assistance while providing a client's twice-weekly bath because the client became agitated and aggressive while being undressed. Knowing that the client has a diagnosis of Alzheimer's disease and is prone to agitation, which measure may help in preventing this client's agitation?

Reminding the client multiple times that he or she will be soon having a bath

The nurse is assessing a client who is diagnosed with delirium. Which presenting sign in the client indicates to the nurse that the client may may have a diagnosis of dementia?

Remote memory loss Impaired memory may be present in both delirium and dementia. However, remote memory loss and forgetting the names of adult children, their occupations, or even their own names occurs in the later stages of dementia. Irrelevant speech, visual hallucinations, and impaired consciousness are signs of delirium. In dementia, speech is normal at the initial stages and then progresses to aphasia. Hallucinations are less common in dementia. Consciousness is usually not impaired in client with dementia. (less)

A client is diagnosed with somatic symptom disorder. Which would the nurse expect to assess as the major clinical finding?

Report of symptoms with no demonstrable pathology on testing or examination

When health care professionals detect signs of elder abuse in clients, the law requires them to take which action?

Report the abuse to the state authorities.

During an interview, a 6-year-old child tells a nurse that the child is often left alone at home by the child's parents. Which action should the nurse take?

Report the child's information to the child protection agency.

During the nurse's assessment of a new client on a medical unit, the client confides in the nurse that the client's spouse often "slaps me around" after the client has been drinking. What action should the nurse take in response to this statement?

Report the client's statement promptly to the appropriate authorities.

When assessing a client with somatic symptom disorder, which would the nurse most likely note?

Reports of physical symptoms do not have a demonstrable organic basis to fully account for them

Which of the following nursing diagnoses would be the priority for the client experiencing acute delirium?

Risk for Injury related to confusion and cognitive deficits The plan of care must be deliberately designed to meet the client's unique needs, with safety always being the nurse's highest priority. Risk for injury is a NANDA diagnosis and the etiology of confusion and cognitive deficits are factors that can be modified through nursing care. (less)

A client with PTSD is brought to the nurse in a primary care setting with lower back pain after falling from a ladder. The client became aggressive with their partner before agreeing to come to the setting. The nurse smells alcohol on the person's breath and the client does not make eye contact or expand openly to assessment questions. Which are priority nursing assessments? Select all that apply.

Risk for self-injury Risk for aggression Risk for substance abuse

Hispanic americans

Roman Catholic- pray for soul of deceased during novena (9 day devotion), rosary (devotional prayer), mourning (luto) wearing black/ black and white while behaving in subdued manner. Respect for deceased includes not watching TV, going to movies, listening to radio, or attending social events. Flowers and crosses to decorate grave

Which type of rapist derives erotic gratification from the victim's suffering?

Sadistic rapist

In the care of a client with somatic symptom disorder, the nurse should anticipate that drug treatment will prioritize which class in order to treat the disorder?

Selective serotonin reuptake inhibitors (SSRIs)

Medications have been tried for somatic symptom disorder. Which drugs have been shown to be effective in some cases?

Selective serotonin reuptake inhibitors (SSRIs)

A client has been diagnosed with bulimia. Which cognitive behavioral technique would be useful for the client?

Self-monitoring

An adolescent client has been diagnosed with anorexia nervosa. Which intervention should be included in the client's plan of care?

Set up a strict eating plan for the client

A 3-year-old who has been seen in the emergency department for various fall-related injuries is being treated for apparent blindness in the left eye as a result of retinal hemorrhage. The nurse should suspect that which form of child abuse is part of the cause of the child's condition?

Shaken baby syndrome

A client who is abusing substances is to undergo brief intervention. The nurse understands that this technique is most effective for a client who exhibits which of the following?

Short history of drug use Brief intervention is most successful when working with individuals who are experiencing few problems with their drug use, have low levels of dependence, have a short history of drug use, and have stable backgrounds. (less)

Which can be identified as a hallmark symptom of dementia?

Short-term memory loss

A nurse is caring for a client who has a diagnosis of posttraumatic stress disorder (PTSD) and has been referred for care. During the client interview, what statement by the client should the nurse prioritize for follow-up?

Sometimes I feel like I can't even cope unless I've had a few drinks to calm my nerves.

Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency?

Stalking

For clients who purge, what is the most important goal?

Stop the behavior

A 55-year-old man was admitted to the psychiatric unit after an incident in a department store in which he accused a sales clerk of following him around the store and stealing his keys. He was subdued by the police after destroying a window display because voices had told him that it was evil. As the nurse approached the client, he says, "You're all out to get me, and you're one of them. They're Rostoputians and grog babies here." This demonstrates what?

Suspiciousness and neologisms The client is demonstrating suspiciousness ("you're all out to get me") and neologisms (use of the words "Rostoputians and grog babies"). Loose associations and flight of ideas occur when the client talks about many topics in rapid sequence, but they are not connected with each other. Illusions are when the client sees something that is not there; echolalia is the repetition of words (or words that sound similar) said by someone else. (less)

A nurse is caring for a client who has been receiving treatment for schizophrenia with chlorpromazine for the past year. It would be essential for the nurse to monitor the client for which of the following?

Tardive dyskinesia Tardive dyskinesia is late-appearing, abnormal involuntary movements. Therefore, it is essential that the nurse monitor the client for tardive dyskinesia at this time. Weight gain (not weight loss) and new onset of diabetes (hyperglycemia) are possible side effects of an antipsychotic. Torticollis, a dystonic reaction, would occur early in antipsychotic drug treatment. (less)

A client has been taking neuroleptic medications for many years as a treatment for schizophrenia. The client is exhibiting tongue protrusion, facial grimacing, and excessive blinking. These manifestations are characteristic of which extrapyramidal side effects (EPS).

Tardive dyskinesia Unusual movements of the tongue, neck, and arms suggest tardive dyskinesia, an adverse reaction to neuroleptic medication. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. Neuroleptic malignant syndrome causes rigidity, fever, hypertension, and diaphoresis. Akathisia causes restlessness, anxiety, and jitteriness. (less)

A 7-year-old client experiences tics, which have become increasingly frequent in recent months. How should the nurse educate the client's teacher to respond to the tics?

Teach the client's classmates that the tics are not something that the client can control.

Which feature would most likely predispose an adult to engage in family violence?

The adult was physically abused as a child

The nurse's suspicion that a child has been sexually abused is supported by what assessment data? Select all that apply.

The anal area is bruised The child reports "itching down there" The vulva appears edematous The urinalysis reports a bacterial infection

A college student who was the victim of an attempted sexual assault has sought care due to anxiety that is affecting every aspect of the client's life. Which characteristic of the client's situation and the client's anxiety would suggest a diagnosis of posttraumatic stress disorder (PTSD) rather than acute stress disorder?

The attack took place several months ago, and the client's anxiety has been continuous.

The psychiatric nurse recognizes that a male rape victim is less likely to report the crime due to which reason?

The belief that his masculinity will be in question

A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply.

The child avoids eye contact. The child does not relate to parents. The child becomes upset with minor changes in routine.

Loss of Security and a Sense of Belonging

The loss of a loved one affects the need to love and the feeling of being loved. loss accompanies changes in relationships, such as birth, marriage, divorce, illness, and death' as the meaning of a relationship changes, a person may lose roles within a family or group.

A nurse was placed in charge of the pediatric care unit. Over a period of time it was discovered that most of the children on the unit experienced sudden cardiac arrest. Although the nurse went to great lengths to revive the children, most of these children died. On further investigation, it was found that the nurse had been injecting high doses of digoxin drug in the children, which caused the cardiac arrest. The nurse was arrested and found guilty. What would have been the most likely cause of the nurse's behavior?

The nurse might have Munchausen's syndrome by proxy.

A client has developed posttraumatic stress disorder (PTSD) after a violent sexual assault committed by a close family member. When planning this client's care, the nurse should follow what guideline?

The nurse should avoid touching the client during interactions unless necessary

A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?

The nurse wants to prevent increasing the client's confusion. The nurse understands that too many visitors or more than one person speaking at once may increase the client's confusion. The nurse should also explain to the visitors, that they should speak quietly with the client, one at a time. This may help prevent the client from becoming overstimulated.Talking with many friends at a time doesn't pose a physical danger to the client. While it is ideal for the client to demonstrate proper orientation, it is not the reason the nurse monitors the client's response to visitors. Talking to one person at a time does not help the client maintain an adequate balance of activity and rest. (less)

What assessments would the nurse need to make during the initial visit with Susan?

The nurse would do a thorough psychosocial assessment, as well as assess Susan's functional abilities and impairment, Susan's perception of her situation, willingness to accept treatment, her safety, and coping skills.

Which would not increase the likelihood that an older adult will incur physical abuse?

The older adult is independent with activities of daily living.

The nurse preparing an educational program on dementia should include which information?

The onset of symptoms of dementia is gradual

The nurse preparing an educational program on dementia should include which of the following information?

The onset of symptoms of dementia is gradual Dementia refers to a syndrome of global or diffuse brain dysfunction characterized by a gradual, progressive, chronic deterioration of intellectual function.

Conscious

The perceptons, thoughts + eotions that exist in the person's awareness, such as being aware of happy feelings or thinking about a loved one

Social phobia also know as social anxiety disorder

The person becomes severely anxious to the point of panic or incapacitation when confronting situations involving people. Examples include making a speech, attending a social engagement alone, interacting with the opposite sex or with strangers, and making complaints. The fear is rooted in low self-esteem and concern about others' judgments. The person fears looking socially inept, appearing anxious, or doing something embarrassing such as burping or spilling food. Other social phobias include fear of eating in public, using public bathrooms, writing in public, or becoming the center of attention.

Anxiety has positive and negative side effects. What are they?

The positive effects produce growth and adaptive change. The negative effects produce poor self-esteem, fear, inhibition, and anxiety disorders (in addition to other disorders).

Unconscious

The realm of thoughts and feelings that motivate a person even though he or she is totally unaware of them - Includes most defense mechanisms and some instinctual drives or motivations

What is the major clinical finding in somatic symptom disorder?

The report of symptoms with no demonstrable pathology on testing or examination

Antidepressents: MECHANISM OF ACTION

Their major interaction is with the monoamine neurotransmitter systems in the brain, particularly norepinephrine + serotonin

Rando's "six Rs"

These are tasks inherent to grieving and they include: 1) Recognize: understanding the loss, that it HAS happened 2) React: Emotional response to loss, feeling the feelings. 3) Recollect and re-experience: Memories are reviewed and relived 4) Relinquish: Accepting that the world has changed (as a result of the loss), and that there is no turning back. 5) Readjust: return to daily life 6) reinvest: accepting changes that have occurred, re-entering the world, forming new relationships and committments

Attachment Behaviors (Bowlby)

These attachment behaviors are crucial to the development of a sense of security and survival: 1. forming a bond (most intense; i.e. falling in love) 2. maintaining a bond (i.e. loving someone--this is a source of security) 3. disrupting a bond (i.e. divorce; person responds with anxiety, protest, anger) 4. renewing an attachment (resolving conflict/renewing relationship--this is a source of joy)

Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?

They are at increased risk for being abused.

A client with chronic alcoholism has been found to have Korsakoff's psychosis. This irreversible complication is characterized by what?

Thiamine, or vitamin B1, deficiency Korsakoff's psychosis is associated with a deficiency in thiamine, or vitamin B1.

The treatment plan for which of the following clients would most likely include a family treatment approach?

Those with dependent personality disorders Clients with borderline, dependent, histrionic, and avoidant personality disorders may benefit from family treatment approaches.

A nurse is caring for a client with delirium. The nurse assesses the client's activities of daily living (ADLs) on a daily basis. What is the most likely reason for assessing these so frequently? Choose the best answer.

To assess for fluctuation in the client's capabilities Clients with organic diseases like delirium tend to have fluctuations in their ability to carry out activities of daily living. Thus, the nurse should assess these daily. Although the nurse should encourage the client to make decisions about treatment amd assist the client in establishing a daily routine, these actions do not require daily assessment. Assess the prognosis of the client after therapy also is not required daily. (less)

A nurse is studying the medical chart of a client with delirium. The nurse finds that the client was given haloperidol. What would be the most likely reason for administering this drug to the client?

To decrease agitation Haloperidol is usually given to clients with delirium when they become extremely aggressive. The main purpose of the drug is to reduce agitation, not to sedate the client. Haloperidol does not improve the client's appetite. The nurse should provide adequate nutritious food and fluid intake to improve the health of the client. Benzodiazepines are used instead of haloperidol if delirium is induced by alcohol withdrawal. (less)

The nurse is planning care for a client with a somatic symptom illness. What should the nurse's goals be while formulating the plan to treat the client? Select all that apply.

To help the client express emotions freely, To help the client cope with interpersonal conflicts and To help the client identify the cause of the physical illness

A client is admitted to the hospital with posttraumatic stress disorder (PTSD). When approaching the client for the first time, the nurse speaks softly and gently, in a nonthreatening manner. What is the most appropriate reason for this behavior of the nurse?

To prevent the risk of triggering fears in the client

A client drinks 24 oz of vodka every day, having gradually increased to this level over the past 2 to 3 years. The client continues to maintain a job and functions well in activities of daily living, relationships, and other aspects of social life. Which of the following terms should the nurse use to describe this drinking behavior?

Tolerance Tolerance is characterized by a need for more of a substance to achieve the same effects from it. Abuse describes maladaptive behaviors related to alcohol or other substances. Withdrawal is a set of symptoms that occur when a patient is not ingesting a substance used regularly. Intoxication is the level of alcohol in the bloodstream and impairing behavior. (less)

When a client repeatedly vocalizes an obscene phrase and imitates the motions of a staff member, the nurse documents that the client is most likely exhibiting symptoms of what disorder?

Tourette's syndrome

Positive reframing

Turning negative messages into positive messages. The therapist teaches the person to create positive messages for use during panic episodes. For example, instead of thinking, "My heart is pounding. I think I'm going to die!" the client thinks, "I can stand this. This is just anxiety. It will go away." The client can write down these messages and keep them readily accessible such as in an address book, a calendar, or a wallet.

Torticollis

Twisted head + neck Acute dystonia symptom

A nurse is giving a talk about child abuse to a local community group. When discussing risk factors for child abusers, which would the nurse identify as the most likely profile of the perpetrator of fatal child abuse?

Unemployed young woman who dropped out of high school

Nurses who work with children should be on alert for which physical signs of child abuse?

Unexplained cuts, bruises, burns, and scars

Which are nursing actions that support active listening? Select all that apply.

Use appropriate vocabulary Use reflective comments

Which three elements are necessary to legally define rape of a male, female, or mixed gendered person?

Use of force; vaginal, oral, or anal penetration; nonconsent of victim

Which type of hallucination most commonly occurs in clients diagnosed with dementia?

Visual Visual, rather than auditory, hallucinations are the most common in those with dementia. Auditory, gustatory, and olfactory hallucinations are not the most common type seen in people with dementia. (less)

Clients receiving clozapine (Clozaril) must get white blood cell counts drawn every ...

Week for the first 6 months Clients taking this antipsychotic must have weekly white blood cell counts for the first 6 months of clozapine therapy and every 2 weeks thereafter.

Which is most often the criterion for determining the effectiveness of treatment in the client diagnosed with anorexia nervosa?

Weight gain

A female adult client is admitted to the emergency department for intoxication with alcohol. She has an unsteady gait, myopathy, and neuropathy, and cannot remember past or recent events. When treated with thiamine, the client's symptoms greatly improve. Which of the following conditions was the client likely experiencing?

Wernicke-Korsakoff syndrome. Wernicke-Korsakoff syndrome is the coexistence of Wernicke's encephalopathy and Korsakoff's psychosis. Wernicke's encephalopathy is characterized by ataxia, nystagmus, ophthalmoplegia, and mental status changes. Korsakoff's psychosis involves gait disturbances, short-term memory loss, disorientation, delirium, confabulation, and neuropathy. (less)

Off-Label Use

When a drug will prove effective for a disease that differs form the one involved in original testing + FDA approval

Anxiety disorders are diagnosed...

When anxiety no longer functions as a signal of danger or a motivation for needed change, but becomes chronic and permeates major portions of the person's life, resulting in maladaptive behaviors and emotional disability.

Ambivalent attachment

When at least one partner is unclear about how the couple loves or does not love each other. Ex woman pressured to have abortion feels ambivalence about her unborn child

a client with mania is exhibiting signs of manic episode manifested by an elevated mood. which of the following would the nurse expect to assess? a. feelings of being on top of the world b. lack of restraint with feelings c. overvalued sense of self importance d indiscriminate enthusiasm for interactions

a. feelings of being on top of the world an elevated mood can be expressed as euphoria (exaggerated feelings of well being) or elation (feeling "high" , "ecstatic" "on top of the world" or up in the clouds".

The nurse knows that the most dangerous time period following a previous suicide attempt is which of the following? a. first 3 months b. first 6 months c. first 9 months d. first year

a.First 3 months

empathy

ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client - nurse must develop this skill - nurse must be able to put hi or herself into the patients shoes. - listen and sensing the importance of the situation to the client, the nurse can imagine the clients feelings about the experience, - gift of self from client and nurse when empathy occurs -

what are values?

abstract standards that give a person a sense of right and wrong and establish a code of conduct for living.

Muslim Americans

adhere to five steps of the burial procedure, including washing, dressing, and positioning of the body. The first step is traditional washing of the body by a Muslim of the same gender.

A psychiatric-mental health nurse is teaching the family members of a client about strategies for engaging with their family member who has recently been diagnosed with posttraumatic stress disorder (PTSD). The nurse should encourage the client's family to:

anticipate that the client is likely to be irritable and withdrawn at times.

therapeutic use of self

as the nurse begins to understand themselves, they can use aspects of his or her personality, values, experiences, feelings, etc to establish relationships with clients. - nurses use themselves as a therapeutic tool to establish relationships with clients and to help clients grow change and heal. -nurses must clearly understand themselves to promote their clients growth and to avoid limiting clients choices to those nurses values.

orientation phase

begins when the nurse and client meet and ends when the client begins to identify problems to examine. -nurse establishes roles, purpose of meeting, and parameters of subsequent meetings, identifies the clients problems, clarifies expectations. - before meeting patient, nurse reads background info, becomes familiar with medications, gathers necessary paperwork, and arranges for a quiet, private and comfortable setting. -time for self assessment. - nurse must examine preconceptions about the client and ensure thst he or she can put them aside and get to know the real person. - nurse must come to each client without preconceptions or prejudices. -begins to build trust with the client. -nurses responsibility to est. a therapeutic environment that fosters trust and understanding. -introduce self. and degree of education. - listen closely to the clients history, perceptions and misconceptions.

systematic desensitization

behavioral technique used to help overcome irrational fears and anxiety associated with a phobia

Attentive presence

being with the client and focusing intently on communicating with and understanding him or her

When facilitating change in the behavior of a client diagnosed with a personality disorder, the nurse knows which intervention will have the greatest impact on success?

collaborating with the client when establishing treatment goals Because clients with personality disorders need to feel in control, it is important to involve them in formulating their care plan. The nurse asks what the client would like to accomplish in concrete terms, such as minimizing problems at work, or getting along with others. Clients are more likely to engage in the therapeutic process if they believe they have something to gain. When planning interventions with a client who has a personality disorder, it is important to recognize that the person has disturbed values that do not reflect the views held by the general population. Because of these disturbances, the nurse needs to collaborate with the client regarding the goals that are identified during treatment. The remaining options although appropriate will not be attainable if the client does not recognize the interventions as being useful and personally applicable. (less)

panic disorder

composed of discrete episodes of panic attacks, that is, 15 to 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort

Complicated Grief: risk factors

death of child, spouse, parent; sudden, untimely deaths, multiple deaths, suicide, murder, or manslaughter

selective mutismis

diagnosed in children when they fail to speak in social situations even though they are able to speak. They may speak freely at home with parents, but fail to interact at school or with extended family. Lack of speech interferes with social communication and school performance. There is a high level of social anxiety in these situations.

teacher

during working phase, nurse may teach the client new methods of coping and solving problems, - inherent in most aspects of client care. - instruct about medication regimen - to be a good teacher, nurse must feel confident about the knowledge he or she has and must know the limitations of that knowledge base. - nurse must be honest about what info he or she can provide. - nurse should be knowledgeable about resources that are available to the client.

Chronic stress that is repressed can cause...

eating disorders, such as anorexia nervosa and bulimia

sympathy

feelings of concern or compassion on shows for another -by expressing sympathy, the nurse may project his or her concerns onto the client thus inhibiting the clients expression of feelings. -often shifts the emphasis to the nurses feelings.

therapeutic relationship

focuses on the needs, experiences, feelings and ideas of the client only. - nurse and client agree about the areas to work on and evaluate the outcomes. -nurse uses communication skills, personal strengths, and understanding of human behavior to interact with client, - parameters are clear - focus is the clients needs. nurse should not be concerned about whether or not the client likes him or her.

Other types of specific phobias

for example, fear of getting lost while driving if not able to make all right (and no left) turns to get to one's destination.

When analyzing the behaviors of a client who meets the criteria for antisocial personality disorder, the nurse recognizes that which nursing diagnoses would be pertinent to the client's care?

ineffective coping Nursing diagnoses commonly used when working with these clients include ineffective coping, ineffective role performance, risk for other-directed violence. The client with antisocial personality disorder is impulsive, manipulative, and dishonest. Clients with this disorder are frequently involved in illegal matters. Self-mutilation and disturbed identity are more appropriate for clients with borderline personality disorder. Social isolation would apply more readily to Cluster A disorders. (less)

The nurse assesses a client who comes to the emergency room for vaginal bleeding and swelling. The client reports she had sexual intercourse with her boyfriend the previous night and states, "It was consensual, but sometimes he is rough." The client begins to cry and looks away. What should the nurse suspect?

intimate partner violence

non verbal techniques that create an atmosphere of presence

leaning toward client maintaining eye contact being relaxed having arms resting at sides having an interested but neutral attitude.

what must a nurse do before she can begin to understand others?

must first know herself or himself.

trust

nurse client relationship requires trust -trust builds when the client is confident in the nurse and when the nurses presence conveys integrity and reliability. -builds when client believes nurse will be consistent in their words and actions and can be relied on. -show caring, interest, understanding, honesty, consistency, keep promises, and listen to the client. congruence occurs when words and actions match.

nurse client contract

nurse must outline the responsibilities of the nurse and client. -both should agree on these responsibilities - informal or formal contract

A nurse is seeing a 3-year-old child who is brought to a pediatric clinic by the mother with concerns about toilet training. The nurse notes the child has multiple bruises of various ages on the arms, trunk, and legs. The nurse should suspect:

physical abuse.

Stress that is ignored or suppressed can cause...

physical symptoms with no actual organic disease, called somatic symptom disorders. Stress can also exacerbate the symptoms of many medical illnesses, such as hypertension and ulcerative colitis.

Haitian Americans

practice vodun (voodoo) or "root medicine"- practice of calling on a group of spirits with whom one periodically makes peace during specific events in life, including death of a loved one

caregiver

primary caregiving role in mental health setting is implementation of the therapeutic relationship to build trust, explore feelings, assist the client in problem solving and help the client meet psychosocial needs. -nurse must consider the relationship boundaries and parameters that have been established.

what is self awareness?

process of developing an understanding of ones own values beliefs thoughts feelings attitudes motivations prejudices strengths and limitations and how these qualities affect others. - allows the nurse to observe, pay attention to and understand the subtle responses and reactions of clients when interacting with them.

stress

the wear and tear that life causes on the body

what does ongoig self awareness allow the nurse to accept?

values, attitudes and beliefs of others that may differ from his or her own.

Which of the following are negative symptoms associated with schizophrenia? Select all that apply.

• Ambivalence • Avolition • Anhedonia Explanation: Negative symptoms of schizophrenia include ambivalence, avolition, and anhedonia. Positive symptoms of schizophrenia include delusions and hallucinations.

The nurse working with clients who have borderline personality disorder (BPD) understands that they need help to both recognize genuine respect from others as well as reciprocate that respect for others. How can the nurse model self-respect? Select all that apply.

• Be assertive. • Clearly communicate expectations. • Observe personal limits. The nurse in the therapeutic relationship models self-respect by observing personal limits, being assertive, and clearly communicating expectations.

When assessing a client with borderline personality disorder, which of the following behaviors would the nurse expect to find? Select all that apply.

• Repeated, frequent crisis episodes • Self-directed anger • Learned helplessness • Deceptive competence Behavior patterns associated with BPD include: emotional vulnerability (high sensitivity to negative emotional stimuli), self-invalidation (self-directed anger and no personal awareness), active passivity (learned helplessness), unrelenting crises (repeated, stressful, negative environmental events/roadblocks), inhibited grieving, and apparent competence (appearing more competent than person actually is). (less)

When describing the etiology of pyromania to group of nurses, which neurotransmitter would the nurse identify as being linked to this disorder. Select all that apply.

• Serotonin • Norepinephrine Early research demonstrated low serotonin and norepinephrine levels associated with arson. No other neurtotransmitters have been linked to this disorder.

The nurse is assessing the orientation of a client who belongs to the religious group Jehovah's Witnesses. Which question should the nurse ask this client? Select all that apply.

• Where is your residence located? • What is your mother's name? • Where is your workplace located? Explanation: People from different cultural backgrounds may not be familiar with the information requested to assess memory. People belonging to the Jehovah's Witnesses religious group do not celebrate birthdays, thus they may have difficulty stating their date of birth and the nurse may mistake the failure to know such information for impaired orientation. Questions about the location of the client's residence or workplace and about the client's mother's name can be asked this client while assessing for orientation. (less)

The nurse is conducting a mental health assessment of a client who has been experiencing low mood, anxiety and loss of pleasure for the past month. The client tells the nurse he comes from a "really big family." Despite this, the client tells the nurse he continues to feel alone. Select the nurse's best response.

" You can have lots of people in your social network and still feel isolated."

A mental health nurse presenting an educational program on rape for high school students responds to the statement, "Women cry rape often times just to get even with the guy," by offering which answer?

"Actually, fewer than 2% of all reported rapes are found to be false."

The geriatrician has prescribed an 80-year-old female client donepezil (Aricept) in order to treat her dementia, Alzheimer's type. Which of the following teaching points should the nurse provide to the client's husband about her new medication?

"Aricept won't cure your wife's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease." Cholinesterase inhibitors such as donepezil (Aricept) cannot cure DAT, but they can slow the progression of the disease and can stabilize symptoms. The drug does not directly affect sleep patterns. (less)

The parents of a 2-year-old child complain to the nurse that their child is always dismantling toys, scribbling on the walls, and running all around the place and that it is very difficult to control the child's behavior. What is the most appropriate response from the nurse?

"At this child's age, these behaviors are expected."

A nurse tells the child and caregiver that the nurse will interview each of them separately. The caregiver questions why this needs to occur. What is the nurse's best response?

"Both interviews provide unique and meaningful information."

A nurse receives a referral from a health care provider to assess a male client for posttraumatic stress disorder (PTSD). The client is a military veteran and been deployed on a military assignment. He is currently working as a civilian doing security work. The client is at risk of job loss because they avoid patrolling areas that are reminders of past trauma. When forced to complete these aspects of surveillance work, the client displays hyperarousal including mild aggression. Which question by the nurse is fundamental for the assessment?

"Describe your sleep habits over the past few months"

When conducting a social history with a client diagnosed with a borderline personality disorder (BPD), which of the following is the most relevant question the nurse should ask?

"Do you always practice safe sex?" BPD results in impulsive behavior and often sexual promiscuity; therefore, the most relevant question the psychiatric nurse can ask is whether the client always practices safe sex.

The mental health nurse assesses for the most common mental health disorder found in children when asking which question?

"Do you ever get scolded at school for not sitting still?

Which assessment question should the nurse ask of a client suspected of being ostracized by a school bully?

"Do you feel like a part of a group in school?"

The nurse can assess potential victims of domestic violence by asking which question?

"Has a past or current partner ever caused you to be afraid?"

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence?

"I don't know what else I can do to keep him from getting angry at me."

A client with paranoid personality disorder is admitted to a psychiatric facility. Which statement by the nurse would best establish rapport and encourage the client to confide in the nurse?

"I get upset once in a while, too." Sharing a benign, nonthreatening, personal fact or feeling helps the nurse establish rapport and encourages the client to confide in the nurse. The nurse cannot know how the client feels. Telling the client otherwise would justify the suspicions of a paranoid client; furthermore, the client relies on the nurse to interpret reality. (less)

A nurse is presenting to a church group a program about domestic violence. During the presentation, a member of the audience asks the nurse to explain what "intergenerational transmission of violence" means because the person has seen that phrase used in the media. Which response by the nurse would be most appropriate?

"People who grow up in violent home situations tend to be involved in domestic violence situations as an adult."

A 43 year old female client is observed walking and dancing around unit dressed in red high heels and provocative style of dress. The client is seen sitting on the lap of a male client on the unit, and they are laughing. Which of the following is the most therapeutic nursing intervention?

"I need for you to get off his lap, this behavior is not appropriate." Clients with have a long-standing pattern of excessive emotionality and attention-seeking behaviors. A matter-of-fact approach to limit-setting and boundaries effectively limits the manipulative and attention-seeking behaviors. (less)

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse?

"I realize this must be very difficult for you but try to remember I'm not your enemy."

A client is prescribed disulfiram as part of his alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate?

"It can help to prevent you from drinking." Disulfiram is not a treatment or cure for alcoholism, but it can be used as adjunct therapy to help deter some individuals from drinking while using other treatment modalities to teach new skills on coping with altering abuse behaviors. Disulfiram plus even small amounts of alcohol produces adverse effects. Disulfiram does not affect withdrawal symptoms and does not eliminate alcohol from the body. (less)

A nurse is working with a client who is a survivor of rape. The client asks the nurse, "It's been 6 months since it happened. Why can't I get back into doing the things I did before?" What is the nurse's best response?

"It can take at least a year or more to get back to where you were before."

An emergency department nurse is assessing a client with traumatic injuries. To assess whether or not the client's injuries have resulted from abuse, which question would be most appropriate for the nurse to ask the client?

"It looks like someone has hurt you. Tell me about it."

The nurse is conducting a health promotion class on drug awareness with a group of junior high school students. Which of the following teaching points should the nurse include in this session?

"Marijuana use can result in psychological dependence, which can have a very negative effect on your life." Although marijuana is not considered to be physically addictive and no withdrawal criteria have been established, it may lead to psychological dependence, thereby retarding personality growth and adjustment to adulthood. (less)

The adult children of a woman with narcissistic personality disorder meet with the therapist as part of their mother's treatment. The nurse is aware which of the following statements by the daughter is consistent with behavior typically associated with this personality disorder?

"My mother never really seemed to see me as a person with my own thoughts and problems." Clients with narcissistic personality disorder have a lifelong pattern of self-centeredness, self-absorption, inability to empathize with others, grandiosity, and extreme desire for the admiration of others. They feel that they are unusually special and often exaggerate their accomplishments to appear more important than they actually are. As sensitive as they are to the opinions of others, they are particularly insensitive to the needs or feelings of others and lack empathy. (less)

A nurse is assessing a survivor of intimate partner violence. During the interview, the nurse determines that the survivor's partner is using power and control over the client through coercion and threats. Which client statement would lead the nurse to suspect this?

"My partner tells me that he or she will tell child services I'm a bad parent."

A client asks the nurse to go to lunch with her one day next week after she is discharged. Which statement is the most therapeutic response?

"My role here is to help you recover. Let's talk about what else you can be doing after discharge." Clients with borderline personality disorder may display negative behaviors that can interfere with therapy. The nurse will have to confront clients about their behaviors and set appropriate limits. (less)

A mental health nurse is working with a client with antisocial personality disorder. The nurse has just reviewed the unit rule of one cigarette per break. While telling him about the unit rules, he asks, "Well, if I have not done anything bad all day, can I have two cigarettes instead of one?" The most therapeutic nursing response would be which of the following?

"No, only one cigarette is allowed per break time." The client is trying to manipulate the nurse in order to gratify his immediate need for a cigarette. In responding to manipulative behavior, the most therapeutic intervention is to maintain the limits that have been set and not to change the rules or make concessions for the client. The correct answer is the only option that is clear and assertive and maintains the rules. (less)

The nurse is working with a client who has been experiencing nightmares, hyperarousal and negative thoughts following a bomb threat at the client's workplace. The nurse's colleague states, "It turned out to be just a threat, not a bombing, so technically she can't have posttraumatic stress disorder (PTSD)." What is the nurse's best response?

"PTSD is a real possibility, even though the bombing never actually took place."

A nurse is assessing a 7-year-old child in a school. The nurse suspects that the child has an insecure relationship with the parents. Which statement said by the child would have led the nurse to this conclusion?

"Please don't tell my mom anything we've talked about."

A woman with borderline personality disorder has been admitted to the inpatient unit because she has been engaging in wrist cutting. The client's sister is visiting, and she asks the nurse to explain why the client sometimes does this to herself. Which response by the nurse would be most appropriate?

"Sometimes the self-injurious behavior is undertaken to relieve stress." Clients with borderline personality disorder are impulsive and may respond to stress by harming themselves. Self-harm is an effort to self-soothe by activating endogenous endorphins to provide comfort. The behavior is not sedating or calming, and it is not used to prevent delusional thinking or mood swings. (less)

A child with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate. The parent reports that the child is having trouble sleeping. When assessing this report, which question would be most appropriate for the nurse to ask?

"When does the child take the last dose of medication?"

The client is 16 years old with an identical twin just diagnosed with anorexia nervosa. The client tells the nurse the client is concerned that the client may also develop the disorder. Which response by the nurse is the most appropriate?

"While eating disorders have shown a genetic link, other factors also play a role in its development."

A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client?

"You have the right to be safe and respected."

The nurse is seeing a Chinese client who reports chronic pain that radiates to the lower back. The client reports the pain has been unresolved with analgesia, physical therapy and therapeutic massage. The client's diagnostic imaging reports are all unremarkable. Which statement by the nurse would be the most supportive response to this client?

"You must be so frustrated with this unexplained pain. Do you have other stresses in your life too?

results of johari window

*if quad 1 is the longest, indicates the nurse is open to others; smaller quad 1 means that the nurse shares little about themselves with others * if 1 and 3 are both small, the person demonstrates little insight. any change in one quadrant is reflected by changes in other quadrants - goal is to work toward moving qualities from 2, 3, and 4 into quadrant 1. doing so indicates that the nurse is gaining self knowledge and awareness.

Difference between CONVENTIONAL (1st) + ATYPICAL (2nd) Antipschotics

- 1st are injectable - BOTH block dopamine, the difference is in how - 1st: Strong blockers - 2nd: Weak blockers + also block SERATONIN

Metabolic Syndrome

- A cluster of conditions that increase the risk for heart disease, diabetes + stroke Includes AT LEAST 3 of the following to be DIAGNOSED: - Obesity - Increased blood pressure - High blood sugar level - High cholesterol

Neuroleptic Malignant Syndrome (NMS)

- A potentially FATAL idiosyncratic reaction to an ANTIPSYCHOTIC - Rigidiy; high fever; unstable blood pressure, diaphoresis; pallor; delirium; elevated levels of enzymes, particularily reatine phosphokinase - Confusion, MUTENESS, fluctuate from agitation to stupor - High dosages of high potency drugs increase the risk - Often occurs in the first 2 weeks of therapy or an increase in dosage - Dehydration, poor nutrition + concurrent medical illness all increase risk - DISCONTINUE meds immediately + treat dehydration + hyperthermia until stabilization

Antianxiety Drugs (Anxiolytics): SIDE EFFECTS

- A tendency to cause physical dependence - Significant discontinuation symptoms occur when the drug is stopped; they often resemble the original symptoms for which the client sought treatment - Psychological dependence is common - Drowsiness, sedation, poor coordination, impaired memory, clouded sensorium - Clients often develop a tolerance

Introjection

- Accepting another person's attitudes, beliefs and values as one's own - Person who dislikes guns becomes an avid hunter, just like a best friend

Reaction formation

- Acting the opposite of what one thinks or feels - Woman who never wanted to have children becomes a supermom

Akathisia

- An intense need to move about - They client appears restless or anxious, agitated and often with a rigid posture - Often leads clients to stop taking their antipsychotics - Can be treated by a change in antipsychotic medication or by the addition of an oral agent such as a beta blocker, anticholinergic or benzodiazepine

Antianxiety Drugs (Anxiolytics): MECHANISM OF ACTION

- Benzodiazepins mediate the actions of the amino acid GABA, the major inhibitory neurotrasmitter in the brain. Because GABA receptor channels selectively admit the anion chloride into neurons, activation of GABA receptors hyperpolarizes neurons + thus is inhibitory. Benzodiazepines produce their effects by binding to a specific side on the GABA receptor. - Buspirone is belevied to exert its anxiolytic effect by acting as a parital agonist at serotinin recptors, which decreases serotonin turnover

Supppression

- Conscious exclusion of unaccceptable thoughts and feelings from conscious awareness - Student decides not to think about a parent's illness to study for a test

Side Effects of MAOIs

- Daytime sedation, insomnia, weight gain, dry mouth, orthostatic hypotention, sexual dysfunction - Potential for a LIFE THREATENING hypertensive crisis if the client ingests food that contains tyramine or takes sympathomimetic drugs - The enzyme MAP is necessary to break down the tyramine in certain foods, so its inhibition with MAOIs results in increased serum tyramine levels, causing severe hypertension, hyperpyrexia, tachycardia, diaphoresis, tremulousness + cardiac dysrhythmias - Drugs that may cause FATAL interactions include: SSRIs, certain cyclic compounds, buspirone (BuSpar), dextromethorphan + opiate derivatives such as meperidine - Studies currently under way to determine wheather a selegiline transdermal patch would be effective in treating depression without the risks of dietary tyramine and orally ingested MAOIs

Dissociation

- Dealing wiht emotional conflict by a temporary alteration in consciousness or identity - Amnesia that prevents recall of yesterday's auto accident - Adult remembers nothing of childhood sexual abuse

Pseudoparkinsonism

- Drug induced parkinsonism - Often referred to by the generic label of EPS - Symptoms resemble those of Parkinson's disease + include a stiff, stooped posture; mask like faces; decreased arm swing; a shuffling, small gait; ratchet like movements of joints; drooling; tremor; bradycardia; coarse PILL ROLLING movements of the thumb + fingers while at rest - Treated by changing to an antipsychotic medication that has a lower incidence of EPS or by adding an oral anticholinergic or amantadine, which is a dopamine agonist that increases transmission of dopaine blocked by the antipsychotic drug

Antipsychotic Drugs: SIDE EFFECTS

- EXTRAPYRAMIDAL SIDE EFFECTS: Serious neurologic symptoms are the major side effects of antipsychotic drugs. - Acute dystonia - Pseudoparkinsonism - Akathisia -Neuroleptic Malignant Syndrome (NMS) - Tardive Dyskinesia (TD) - Anticholinergic Side Effects - Increased blood prolactin levels (which may cause breast tenderness + enlargement) - Diminshed libido - Menstrual irregularities - Increased risk for breast cancer - May contribute to weight gain - Metabolic syndrome

Repression

- Excluding emotionally painful or anxiety provoking thoughts and feelings from conscious awareness - Woman has no memory of the mugging she suffered yesterday

Rationalization

- Excusing own behavior to aboid guilt, responsibility, conflict, anxiety or loss of self-respect - Student blames failure on teacher being mean

Undoing

- Exhibiting acceptable behavior to make up for or negate unacceptable behavior - Person who cheats on a spouse brings the spouse a bouquet of roses

Conversion

- Expression of an emotional conflict though the development of a PHYSICAL symptom, usually sensorimoter in nature - A teenager forbidden to see x rate movies is tempted to do so by friends + develops blindness and the teenager is unconcerned about the loss of sight

Psychoanalytic Theory

- Founded by Freud - Psychoanalytic theory supports the notion that all human behavior is caused and can be explained (deterinistic theory). - Personality composed of Id, Ego + Superego - Behavior motivated by subconscious thoughts + feelings

Side Effects of SSRI

- Have fewer side effects compared with cyclic compounds - Enhanced serotining transmission can lead to several common side effects such as anxiety, agitaion, akathisia, headache, nausea, insomnia, weight gain + sexual dysfunction

Side Effects of Cyclic Antidepressants

- Have more side effects than do SSRIs - Side effects vary depending on the drug - Block cholinergic receptors, resulting in anticholinergic effects such as dry mouth, constipation, urinary hesitancy or retention, dry nasal passages + blurred near vision

Fixation

- Immobilization of a portion of the personality resulting from unsuccessuful completion of tasks in the develpmental stage - Never learning to delay gratification - Lack of a clear sense of identity as an adult

Acute Dystonia

- Includes acute muscular rigidity, cramping, stiff + thick tonge with difficulty swallowing - Laryngospasm + respiratory difficulties are possible - Spasms or stiffness can occur in muslce groups to produce TORTICOLLIS (twisted head + neck), OPISTHOTONUS (tightness in the entire body with the head back + arched neck) or OCULOGYRIC CRISIS (eyes rolled back in a locked position) - Can be painful + frightening for the client - Most likely to occur in the FIRST WEEK of treatment with antipsychotics, clients younger than 40 years, in males + in those receiving high-potency drugs such as haloperidol + thiothixene - Immediate treatment with anticholinergic drugs, such as intramuscular benztropine mesylate (Cogentin) or intramuscular or IV diphenhydramine (Benadryl), usually brings rapid relief

Superego

- Is the part of a person's nature that reflects moral and ethical concepts, values, parental and social expectations; therefore it is in direct OPPOSITION to the id

Disulfiram (Antabuse)

- It is a sensitizing agent that causes an adverse reaction when mixed with alcohol in the body - This agent's only use is as a DETERRENT to drinking alcohol in persons seeking treatment for alcoholism - 5-10 min after a person taking disulfiram ingests alcohol, symptoms begin to appear: facial and body flushing from baodilation, a throbbing headache, sweating, dry mouth, nausea, vomiting, dizziness + weakness

Mood Stabilizing Drugs: MECHANISM OF ACTION

- Its mechanism of action is poorly understood - Lithium normalizes the reuptake of certain neurotransmitters such as serotonin, norepinephrine, acetylcholine + dopamine - It reduces the release of norepinephrine through competition with calcium + produces its effects intracellularly rather than within neuronal synapses - It acts DIRECTLY on G proteins + certain enzyme subsystems such as cyclic adenosine monophosphates + phosphatidylinositol - The mechanism of action of anticonvulsants may be due to a KINDILING PROCESS

Zyprexa

- METABOLIC SYNDROME risk - oral - 2nd generation antipsychotic

Identification

- Modeling actions and opinions of influential others while searching for identity or aspiring to reach a personal, social or occupational goal - Nursing student becomes a critical care nurse because this is the specialty of an instructor she admires

Countertransference

- Occurs when the therapist displaces onto the client attitudes or feelings from his or her past

Anticholinergic Side Effects

- Often occur with the use of antipsychotics and include orthostatic hypotension, dry mouth, constipation, urinary hesitance or retention, blurred near vision, dry eyes, photophobia, nasal congestion + decreased memory - Usually decrease within 3-4 weeks but do not entirely remit

Seroquel

- Orthostatic hypertension risk - Antipsychotic

Cogentin

- Orthostatic hypertention risk - Anti chlorengic drugs - Treats dystonia + parkinsons disease

Compensation

- Overachievement in one area to offset real or perceived deficiencies in another area - Napoleon complex: diminutive man becoming emperor - Nurse with low self esteem working double shifts so her supervisor will like her

Id

- Part of one's nature that reflects basic or innate desires such as pleasure seeking behavior, aggression and sexual impulses - Seeks instant gratification, causes impulsive unthinking behavior and has no regard for rules of social convention

Antidepressents + its 4 goups

- Primarily used in the treatment of major depressive illness, anxiety disorders, bipolar disorder + psychotic depression - Off label uses include treatment of chronic pain, migraines, peripherial + diabetic neuropathies, sleep apnea, dermatologic disorder, panic disorders + eating disorders 4 Groups: 1.) Ticyclics 2.) SSRIs 3.) MAOIs 4.) Atypicals

Intellectualization

- Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions - Person shows no emotional expression when discussing serious car accident

Extrapyramidal Side Effects (EPSs)

- Serious neurologic symptoms are the major side effects of antipsychotic drugs. - Include: acute dystonia, pseudoparkinsonism + akathisia - Blockade of D2 receptors in the midbrain is responsible for EPSs

Ego

- The balancing or mediating force between the id and the superego - Represents mature + adaptive behavior that allows a person to function successfully in the world - Freud believed that anxiety resulted from the ego's attempts o balance the impulsive instincts of the id with the stringent rules of the superego

Subconscious

- Those in the PRECONSCIOUS or UNCONSCIOUS level of awareness - Freud believed that much of what we do and say is motivated by our subconscious

Projection

- Unconscious blaming of an unacceptable inclinations or thoughts of an external object - Man who has though about same gender sexual relationship, but never had one, beats a man who is gay

Antianxiety Drugs (Anxiolytics)

- Used to treat anxiety, insomnia, OCD, depression, PTSD, alchohol withdraw - Among the most widely prescribed drugs - Benzodiazepines are the most effective in relieving anxiety and are the most frequently prescribed

Mood Stabilizing Drugs

- Used to treat bipolar disorder - Stabilizes the client's mood, preventing or minimizing the highs + lows that characterize bipolar illness - Treat acute symptoms of mania - Lithium is the most established - Some anticonvulsant drugs are effective mood stabalizers

Displacemnt

- Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings - Person who is mad at the boss yells at his or her spouse

positive regard

- nurse who appreciates the client as worthy human being can respect the client regardless of their behavior. unconditional nonjudgemental attitude. implies respect. -call the client by name, spending time with client, and listening and responding openly are measures by which the nurse conveys respect and positive regard to client - considering the clients ideas and preferences when planning care

Which individual is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? Select all that apply.

1. A client who has quit the client's job so that the client no longer has to go to the client's old office where the client was attacked and robbed 2. A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect 3. A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device 4. A client who is unable to relax without first barricading the client's home after a violent home invasion and assault

Types of anxiety disorders

1. Agoraphobia 2. Panic disorder 3. Specific phobia 4. Social anxiety disorder (social phobia) 5. Generalized anxiety disorder (GAD)

Three categories of phobias

1. Agoraphobia (discussed earlier in text) 2. Specific phobia, which is an irrational fear of an object or a situation 3. Social anxiety or phobia, which is anxiety provoked by certain social or performance situations

During an interview, a client reveals to the nurse, "I was sexually abused as a child." Based on this information, which finding would the nurse most likely anticipate being revealed during the assessment? Select all that apply.

1. Client has difficulty establishing interpersonal relationships 2. Client has a history of substance abuse 3. Client has difficulty establishing a mutually satisfying sexual relationship 4. Client engages in self-harming behaviors

Treatment for Panic disorder

1. Cognitive-behavioral techniques 2. deep breathing and relaxation 3. medications such as benzodiazepines, SSRI antidepressants, tricyclic antidepressants, and antihypertensives such as clonidine (Catapres) and propranolol (Inderal).

Tips for managing stress

1. Keep a positive attitude and believe in yourself. 2. Accept there are events you cannot control. 3. Communicate assertively with others: talk about your feelings to others, and express your feelings through laughing, crying, and so forth. 4. Learn to relax. 5. Exercise regularly. 6. Eat well-balanced meals. 7. Limit intake of caffeine and alcohol. 8. Get enough rest and sleep. 9. Set realistic goals and expectations, and find an activity that is personally meaningful. 10. Learn stress management techniques, such as relaxation, guided imagery, and meditation; practice them as part of your daily routine.

A client is diagnosed with posttraumatic stress disorder (PTSD). The client is a survivor of a bomb blast. Which symptoms of PTSD is the nurse likely to find in the client? Select all that apply.

1. Reexperiencing the trauma through dreams 2. Feeling detached from others 3. Showing irritability and outbursts of anger 4. Losing a sense of control over one's life

A nurse is developing the plan of care for a 6-year-old child diagnosed with attention deficit hyperactive disorder (ADHD). The nurse identifies interventions to address which behavior issues? Select all that apply.

1. Refusal to acknowledge others' right to select group activities 2. Thoughtless habit of not waiting for a turn 3. Frequent acting out during class "quiet time" 4. Temper tantrums when asked to clean up the child's room

The nurse is planning to give health-related education to adolescents with posttraumatic stress disorder (PTSD). What topics should the nurse discuss specifically for these clients? Select all that apply.

1. Set small, specific, achievable goals 2. Have a healthy, balanced diet 3. Abuse of alcohol and drugs can cause ill effects

A psychiatric-mental health nurse is assessing a client who has been referred for care following a violent assault. Which finding would the nurse most likely document as reflecting the diagnostic criteria for posttraumatic stress disorder (PTSD)? Select all that apply.

1. The client describes oneself as being constantly "on edge." 2. The client states, "All I can think about these days is the attack." 3. The client states "completely avoiding the neighborhood where the attack occurred."

The nurse is aware that fewer than half of rapes and sexual assaults are reported. Which are some of the reasons people do not report being sexually assaulted? Select all that apply.

1. The client is embarrassed of the assault. 2. They have a fear of being blamed for the incident. 3. The perpetrator may use coercion or threats to control the victim.

After a series of admissions to the emergency department over the past several months, an 80-year-old client's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which aspect of the client's situation may contribute to elder abuse? Select all that apply.

1. The client is physically dependent on the client's son since losing mobility. 2. The client has no income or savings of the client's own. 3. The client's son describes the client as "needy, helpless, and pathetic."

The nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) several months ago. During a comprehensive follow-up assessment, what areas should the nurse assess? Select all that apply.

1. The client's use of alcohol or other drugs 2. Characteristics of the client's sleep 3. The effect of the client's PTSD on the family

The nurse is planning a community education session on elder abuse awareness. Which points should the nurse be sure to include? (Select all that apply.)

1. Withholding money for necessities is a form of abuse 2. Not helping you get medical attention you need is a form of abuse 3. It is abuse if you feel forced to have sex 4. It is abuse if your caregiver holds your arm too tight

A nurse is teaching a client about how traumatic events affect a person. Which examples are included in the teaching plan? Select all that apply.

1. Witnessing a fatal shooting 2. Being trapped inside a capsized boat 3. Receiving word of a terrorist attack in a nearby community

When the school nurse is assessing an adolescent who reports troubling sleeping, which characteristics of the client indicate there may be violence in the home? (Select all that apply.)

1. the client's father monitors contact with friends 2. has a family history of alcohol abuse 3. must go straight home after school each day

Erikson's 8 Stages of Psychosocial Development

1.) Trust vs. Mistrust 2.) Automony vs. shame 3.) Initiative vs. guilt 4.) Industry vs. inferiority 5.) Identity vs. role confusion 6.) Intamacy vs. isolation 7.) Generative vs. stagnation 8.) Ego integrity vs. despair

3 Critical components in assessment

1.Adequate perception regarding the loss: a. What does the client think and feel about the loss? b. How is the loss going to affect the client's life? c. What information does the nurse need to clarify or share with the client? 2. Adequate support while grieving for the loss 3. Adequate coping behaviors during the process.

A nurse is working with a client, and family of the client, who has a diagnosis of Alzheimer's disease. The nurse explains to the client and family that the average course of the disease is how many years?

10 Alzheimer's disease is a progressive brain disorder that has a gradual onset but causes an increasing decline in functioning, including loss of speech, loss of motor function, and profound personality and behavioral changes such as paranoia, delusions, hallucinations, inattention to hygiene, and belligerence. It is evidenced by atrophy of cerebral neurons, senile plaque deposits, and enlargement of the third and fourth ventricles of the brain. Risk for Alzheimer's disease increases with age, and average duration from onset of symptoms to death is 8 to 10 years. (less)

In accordance to the sociocultural theory, the nurse identifies the client most at risk of alcoholism is the

18-year-old homesick college freshman An 18-year-old homesick college freshman has several of the factors identified by the sociocultural theory: stressors, availability, no supervision, and peer pressure. Thus, the nurse identifies this client at most risk for alcoholism. (less)

four quadrants of Johari's window

1; open/public- self qualities one knows about oneself and others also know 2; blind/unaware- self qualities known only to others 3; hidden/private- self qualities known only to oneself 4; unknown- an empty quadrant to symbolize qualities as yet undiscovered by oneself or others

Alprazolam (Xanax)

A Benzodiazepine used to treat Anxiety, panic disorder, social phobia, agoraphobia

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)?

A middle-aged woman with a history of anxiety who suffered a random physical assault

High-pitched, rapid delivery of a message often indicates which of the following? A. Anxiety B. reminiscing C. Depression D. Confusion

A. Anxiety

The nurses standing 4 feet away, conversing with a client. Which zone is a distance that is more comfortable between family and friends who are talking? A. Personal 8 - 36 inches B. public 12 to 25 feet C. Social 4 to 12 feet D. Intimate 0 to 18 inches

A. Personal 8 to 36 inches

A client diagnosed with schizophrenia is hallucinating. With communication technique me the nurse used to redirect the client, A. Presenting reality B. seeking information C. Redirecting D. Making observations

A. Presenting reality

The nurse indicated interest in and acceptance of the client by all the following behaviors except A. Sitting behind a desk B. slightly leaning towards the client C. Maintaining a nonthreatening I contact D. Facing the client

A. Sitting behind a desk does not indicate interest and acceptance

The nearest places her arm around the shoulder of a distressed client. Which type of touch according to Knapp is used in greeting such as a handshake? A. Social - polite B. Love - intimacy C. Functional - professional D. Friendship - warm

A. Social - polite

Which of the following would be the least optimal in terms of an environment for therapeutic communication for a client who has difficulty maintaining boundaries? A. The clients room B. A conference room C. In interview room D. The end of the hall

A. The clients room is the least optimal environment

1st Generation Antipsychotics BLOCK what neurotransmitters?

ALL 4 Dopamine

A client diagnosed with schizophrenia has been prescribed clozapine (Clozaril). Which of the following is a potentially fatal side effect of this medication?

Agranulocytosis Agranulocytosis is manifested by a failure of the bone marrow to produce adequate white blood cells. Neuroleptic malignant syndrome is a life-threatening reaction to neuroleptic medication that requires immediate treatment. Tardive dyskinesia causes involuntary movements of the tongue, mouth, facial muscles, and arm and leg muscles. Dystonia is characterized by cramps and rigidity of the tongue, face, neck, and back muscles. (less)

The nurse is interviewing a client with a history of violence. He boasts that he "put a kid in a wheelchair" once when he was younger and has maimed others. He states, "Who cares? Life's tough." Violence and insensitivity are associated with which of the following personality disorders?

Antisocial personality disorder Those with antisocial personality disorder display aggressive, irresponsible behavior that often leads to conflicts with society and subsequent involvement in the criminal justice system. People with this disorder commonly display behaviors such as fighting, lying, stealing, abusing children and spouses, abusing substances, and participating in confidence schemes. These people, while often superficially charming, lack genuine warmth. (less)

Loss of Self-Esteem

Any change in how a person is valued at work or in relationships or by himself or herself can threaten self-esteem. It may be an actual change or the person's perception of a change in value. death of a loved one, a broken relationship, loss of a job , and retirement are example of change that represent loss and can result in a threat to self-esteem.

A client who has a diagnosis of borderline personality disorder and lives at home with her parents. She has been in the psychiatric unit for 2 weeks and is scheduled to be discharged tomorrow. Which of the following would be most therapeutic when Cheryl's parents come in to discuss discharge plans?

Ask the parents to keep a written schedule of activities for each day for the client When providing family and client education upon discharge, it is important for the nurse to ask the parents to keep a written schedule of daily activities for the client in order to keep a fixed routine with the aim of preventing chronic boredom and emptiness that is often associated with borderline personality disorder. (less)

The family members of a military veteran are distraught that he has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse's most appropriate action?

Assess the client for signs and symptoms associated with post-traumatic stress disorder

The best goal for a client learning a relaxation technique is that the client will A) confront the source of anxiety directly. B) experience anxiety without feeling overwhelmed. C) report no episodes of anxiety. D) suppress anxious feelings.

B) experience anxiety without feeling overwhelmed.

Which of the following is a term used to describe unclear patterns of words that often contain figures of speech that are difficult to interpret? A. Cue B. abstract messages C. Concrete Messages D. Metaphor

B. Abstract messages

But the nurse and the client use cues as a type of communication technique. When the client uses cues to communicate, the nurse must further investigate their meaning. Which type of cue is being used when the client states, "nothing can help me"? A. Clear B. Covert C. Overt D. Intentional

B. Covert

Which question should be avoided because it may be preconceived as criticism by the client? A. Where? B. why? C. How? D. what?

B. WHY?

A nurse is preparing to document information obtained from a client diagnosed with a delusional disorder who is experiencing somatic delusions. Which of the following would the nurse most likely document?

Body complaints Somatic delusions involve bodily functions or sensations, with clients believing that they have physical ailments. Clients with delusional disorder show few, if any, psychological deficits. These clients characteristically have average or marginally low intelligence. Mental status generally is not affected. Thinking, orientation, affect, attention, memory, perception, and personality are generally intact. (less)

A nurse is working with the family of a client who has been diagnosed with antisocial personality disorder. Which of the following would be most important for the nurse to focus on when teaching the family about this disorder?

Boundary setting Family members of clients with antisocial personality disorder usually need help in establishing boundaries. Because there is a long-term pattern of interaction in which family members feel responsible for the client's antisocial behavior, these patterns need to be interrupted. Anger management and self-responsibility are appropriate for the client, not the family. Medication therapy is usually not prescribed unless the client has another disorder. (less)

Which is a cardiac complication of an eating disorder?

Bradycardia

An adolescent client tells a nurse that he or she occasionally "sniffs airplane glue." When discussing the effects of long-term use of inhalants, which of the following would the nurse most likely include?

Brain damage and cognitive abnormalities Long-term inhalant use is linked to widespread brain damage and cognitive abnormalities that can range from mild impairment to severe dementia. Tremors, central nervous system arousal, and cardiac changes are not associated with long-term inhalant use. Intoxication can lead to cardiac arrest. (less)

When attempting to preserve evidence from a possible rape with no report of oral sex, the female victim should be instructed that which self-care activities are permitted?

Brushing her teeth

Japanese Americans

Buddhist-life passage, bathe deceased with warm water, dress in white kimono after purification rites. 2 days family and friends visit, bring gifts, offer money, pray, burn incense

Vietnamese americans

Buddhists-bathe deceased, dress deceased in black clothes, put rice in mouth, place money with deceased to buy a drink as the spirit moves to afterlife, body displayed in home before burial, music is played when friends enter to warn deceased of arrival

Which of the following would be the best intervention for a client having a panic attack? A) Involve the client in a physical activity. B) Offer a distraction such as music. C) Remain with the client. D) Teach the client a relaxation technique.

C) Remain with the client.

1. The nurse observes a client who is becoming increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. His speech is high-pitched and random; he seems preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as A) Mild B) Moderate C) Severe D) Panic

C) Severe

A client with GAD states, "I have learned that the best thing I can do is to forget my worries." How would the nurse evaluate this statement? A) The client is developing insight. B) The client's coping skills have improved. C) The client needs encouragement to verbalize feelings. D) The client's treatment has been successful.

C) The client needs encouragement to verbalize feelings.

When working with a client with moderate anxiety, the nurse would expect to see A) inability to complete tasks. B) failure to respond to redirection. C) increased automatisms or gestures. D) narrowed perceptual field. E) selective attention. F) inability to connect thoughts independently.

C) increased automatisms or gestures. D) narrowed perceptual field. E) selective attention. F) inability to connect thoughts independently.

The nurses standing 4 feet away from the client with her arms crossed. At what space is the therapeutic communication interaction most comfortable within most cultural situations? A. 12 to 25 feet B. 18 inches to 36 inches C. 3 to 6 feet D. 0 to 18 inches

C. 3 to 6 feet away from the client. Hispanic, Mediterranean, East Indian, Asian, in Middle Eastern are more comfortable with less than 4 to 12 feet of space between them while talking

Which of the following includes the circumstances or parts that clarify the meaning of the content of the message? A. Process B. proxemics C. Context D. Congruence

C. Context

Which verbal cue refers to accents on words or phrases that highlight the subject or give insight on the topic? A. Intensity B. pitch C. Emphasis D. Tone

C. Emphasis

When the nurse states, "tell me more about that," The nurse is utilizing which communication technique? A. Formulating a plan of action B. accepting C. Exploring D. Focusing

C. Exploring

Which communication technique involves giving encouragement to the client, enabling continuance of the conversation? A. Focusing B. excepting C. General leads D. Exploring

C. General leads gives encouragement to continue

Nancy is the nurse caring for a young mother who states that she is unhappy with her husband because he spends too much time with his friends during football season. When Nancy Stacy she agrees with the client that she is "right" and her assumption that her husband is inappropriately inattentive, which non-therapeutic communication technique is this an example of? A. Voicing doubt B. summarizing C. Giving approval D. Silent

C. Giving approval

A client who is schizophrenic is catatonic and has a mask like face. Which of the following facial expressions is being exhibited? A. Incongruent B. confusing C. Impassive D. Espresso

C. Impassive

According to Peplau, which of the following would not be considered a goal of therapeutic communication? A. Guiding the client in problem solving B. active listening C. Self exploration of feelings by the nurse D. Establishing repport

C. Self exploration of feelings by the nurse

Effective assessment involves observing all dimensions of human response, which includes:

COGNITIVE: What the person is thinking EMOTIONAL: What the person is feeling SPIRITUAL: What the person's values and beliefs are BEHAVIORAL: how the person is acting PHYSIOLOGIC: What is happening to the person's body

Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder?

Client fears criticism from others, including staff. Symptoms suggesting an avoidant personality disorder include fear of rejection, avoidance of relationships, and censorship of expression of thoughts and feelings because of fear of a negative reaction. Borderline personality disorder presents with unstable interpersonal relationships, labile affect, and complaints of emptiness. Clients with histrionic personality disorder are overly dramatic, manipulative, and attention-seeking. Clients with schizoid personality disorder are indifferent to and lack concern for interpersonal contacts. (less)

Which of the following statements best reflects schizoaffective disorder?

Clients are often misdiagnosed as having schizophrenia. Mental health providers find schizoaffective (SAD) difficult to conceptualize, diagnose, and treat because of the variable clinical course. Clients are often misdiagnosed as having schizophrenia. To be diagnosed with SAD, a client must have an uninterrupted period of illness when there is a major depressive, manic, or mixed episode along with two of the following symptoms of schizophrenia: delusions, hallucinations, disorganized speech, disorganized or catatonic behavior, or negative symptoms (e.g., diminished emotional expression, alogia, or avolition). In addition, the positive symptoms (delusions or hallucinations) must be present without the mood symptoms at some time during this period (for at least 2 weeks). (less)

Which is a significant obstacle in providing psychiatric care for clients who have somatic symptom illnesses?

Clients are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented.

When describing somatic symptom disorder to a group of nurses, which would the nurse include as a significant obstacle in providing psychiatric care for clients with that disorder?

Clients are often unrecognized because clients seek out multiple care providers and care is often fragmented.

risk factors for vulnerability

Death of spouse/child/parent, sudden unexpected death, multiple deaths, death by suicide or murder

For clients with bulimia, nursing interventions are often directed toward improving self-concept and regaining control. Which would be included in the primary interventions?

Cognitive-behavioral therapy (CBT) including self-monitoring

Correlation between defense mechanisms and anxiety disorders.

Defense mechanisms are intrapsychic distortions that a person uses to feel more in control. It is believed that these defense mechanisms are overused when a person develops an anxiety disorder.

Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiologic dependence? A) Benzodiazepines B) Tricyclics C) Monoamine oxidase inhibitors D) Selective serotonin reuptake inhibitors

D) Selective serotonin reuptake inhibitors

When assessing a client with anxiety, the nurse's questions should be A) avoided until the anxiety is gone. B) open ended. C) postponed until the client volunteers information. D) specific and direct.

D) specific and direct.

A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client's A) motivation for treatment. B) family and social support. C) use of coping mechanisms. D) use of alcohol.

D) use of alcohol.

Which therapeutic communication technique is being utilized when the nurse asks the client, "is there something you'd like to talk about?" A. Excepting B. focusing C. Exploring D. Broad opening

D. Broad opening - allows the client to take the initiative and introducing the topic

Which of the following terms is used to describe a phase that describes an object or situation by comparing it to something else familiar? A. Cliché B. proverb C. Overt Cue D. Metaphor

D. Metaphor

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care?

Deficient fluid volume related to refusal to drink

A client who has used IV heroin every day for the past 10 years says, "I don't have a drug problem. I can quit whenever I want." Which of the following defense mechanisms is being used by the client?

Denial The client who says he can quit a heroin addiction whenever he wants is utilizing the defense mechanism of denial.

A client was admitted to the eating disorder unit with bulimia. When the nurse assesses for a history of complications of this disorder, which are expected?

Dental erosion and chronic edema

The client is a 29-year-old woman who is having a great deal of difficulty with her new job. She has been unable to make decisions on her own and feels overwhelmed when she needs to begin a new project. She often relies on one of her co-workers to help her with her decisions and projects. Which of the following would describe the client correctly?

Dependent personality Clients with dependent personality have a pervasive and excessive need to be taken care of, leading to submissive and clinging behavior and fears of separation. In addition, they need so much approval from others that they have tremendous difficulty making independent decisions or starting projects. In effect, they do not trust their own judgment and often believe that others have better ideas. (less)

A nurse is caring for several hospitalized clients with anorexia nervosa. The nurse would be especially alert for which if noted in the clients' histories?

Depression

A nurse is reviewing the medical history of a client diagnosed with somatic symptom disorder. Which would the nurse expect to find as a comorbid condition?

Depression

The nurse is caring for a client with somatic symptom disorder. When assessing this client, the nurse would be especially alert for symptoms of what?

Depression

A nurse is caring for a client with posttraumatic stress disorder (PTSD). During the assessment interview, the nurse finds that the normally calm client at times becomes very aggressive and uses abusive language. When in the aggressive state, the client fails to recognize personal information. What is this behavior indicative of?

Dissociative identity disorder

Psychosocail Theoris

Each theory suggests how normal development occurs based on the theorist's beliefs, assumptions and view of the world

What term is used to describe the speech pattern being used when the client imitates or repeats what the nurse is saying?

Echolalia Echolalia is the client's imitation or repetition of what the nurse says. Neologisms are words invented by the client. Clang associations are ideas that are related to one another based on sound or rhyming rather than meaning. A word salad is a combination of jumbled words and phrases that are disconnected or incoherent and make no sense to the listener. (less)

EcholaliaA nurse is caring for a client in an inpatient mental health setting. The nurse notices that when the client is conversing with other clients, he repeats what they are saying word for word. The nurse interprets this finding and documents it as which of the following?

Echolalia The nurse should document the client's speech pattern as echolalia, or parrot-like and inappropriate repetition of another's words. Echopraxia refers to an involuntary imitation of another person's movements or gestures. Neologisms are made-up words that have no common meaning and are not recognized. Tangentiality is a disorganized thinking pattern in which the topic of conversation changes to an entirely different topic; the change is a logical progression but causes a permanent detour from the original focus. (less)

A nurse is assessing a child diagnosed with autism spectrum disorder. When assessing the child's communication, which of the following would the nurse expect to find? Select all that apply.

Echolalia Delayed language skills

The family members of a client with posttraumatic stress disorder (PTSD) state that they are "constantly walking on eggshells" because the client reacts so strongly to stressors that seem inconsequential to them. What is the nurse's best response?

Educate the family about the client's hyperarousal

The nurse is assessing a client admitted for drug and alcohol abuse. Which data from the assessment will increase the nurse's suspicion that the client may experience withdrawal symptoms?

Elevated vital signs and nervousness Earliest signs of withdrawal include irritability and impatient behavior. A coarse tremor of hand, tongue, and eyelids may follow, as may nausea and vomiting, general malaise or weakness, autonomic nervous system hyperactivity (e.g., increased blood pressure and pulse), headache, paroxysmal sweats, anxiety, a depressed or irritable mood, and orthostatic hypotension. Sleep disturbances, insomnia, nightmares, or hallucinations also may occur during withdrawal. (less)

A nurse is preparing a teaching plan for a client with antisocial disorder. Which of the following would the nurse most likely employ to promote successful education?

Engaging the client in a discussion to direct the topic to the client. Client education efforts have to be creative and thought provoking. In teaching a person with ASPD, a direct approach is best, but the nurse must avoid "lecturing," which the client will resent. In teaching the client about positive health care practices, impulse control, and anger management, the best approach is to engage the client in a discussion about the issue and then direct the topic to the major educational points. These clients often take great delight in arguing or showing how the rules of life do not apply to them. A sense of humor is important, as are clear teaching goals and avoiding being sidetracked. (less)

A 33-year-old client has been treated for a periorbital hematoma and a broken nose that the client suffered when the client's spouse struck the client. The client does not know where the spouse currently is, and the client is scheduled for discharge. What action should the care team prioritize in this client's care?

Ensuring that the client goes to a safe place

When interviewing an abused child, the nurse must first complete what?

Establish a safe environment

A client diagnosed with anorexia nervosa is being treated in an outpatient setting in the community. Which activity would be the priority?

Establishing a therapeutic relationship

The nurse is preparing to perform the initial interview of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What action should the nurse prioritize during this interaction?

Establishing therapeutic rapport with the client

The nurse in charge of an inpatient psychiatric unit finds herself frustrated and angry with a client who has borderline personality disorder. Which of the following steps should the nurse take?

Examine her own feelings to discover the source of her anger. Working with clients who have personality disorders is difficult. For this reason, nurses may find it helpful to discuss their emotional reactions to clients who have personality disorders with knowledgeable and trusted nurse colleagues. Doing so can facilitate nurses working through negative countertransferences, resulting in their tolerating and accepting feelings of irritation and anger as natural reactions to clients with personality disorders. This realization can increase the nurse's own self-awareness and sense of emotional control. (less)

Working with Anxious Clients

First and foremost, the nurse must assess the person's anxiety level because that determines what interventions are likely to be effective.

The nurse is assessing a child with autism spectrum disorder. After reading the medical history, the nurse finds that the child engages in stereotypical motor behavior. Which observation of the child made by the nurse might be indicative of stereotypical motor behavior?

Flapping hands repeatedly

A client informs the nurse that while on vacation at a theme park, the sound of fireworks triggered an intense reminder of a house fire experienced as a child. The client describes experiencing the smells from the fire, choking sensations, burning eyes and images of the flames destroying the insides of his home. Which symptom is experienced by the client?

Flashback

During a client interview, a client states that "God has sent me a special message. I'm the only one who can carry out his plan." The nurse interprets this statement as suggesting which type of delusion?

Grandiose Grandiose delusions focus the belief that the person has a great, unrecognized talent or has made an important discovery. The delusion may be religious in nature, such as a special message from a deity. With mixed delusions, no one delusional theme predominates. Somatic delusions involve bodily functions or senstations. Erotomanic delusions are characterized by the belief that the person is loved intensely by a loved object who is usually married, of a higher socioeconomic status or otherwise unattainable. (less)

A child is taking methylphenidate for treatment of attention deficit hyperactivity disorder (ADHD). Which side effect much be monitored in this child?

Growth delays

A nurse is caring for a client who uses phencyclidine (PCP). PCP is classified as which type of substance?

Hallucinogen PCP is classified as a hallucinogen. Heroin and morphine are considered opioids. Examples of inhalants are aerosols and adhesives. Cannabis is also known as marijuana.

The client is an 84-year-old suffering from delirium. The client has been in a nursing home for the past 2 years but recently is becoming combative and has become a threat to staff. Which medication would the client most likely receive for these symptoms?

Haloperidol

Clients with a somatization disorder typically do what?

Have a history of going to many different providers without satisfaction

Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by which of the following situations?

Having several clients complain that their pain medication is not working Suspicion that a nursing professional is impaired by a substance abuse problem is most supported by having several clients complain that their pain medication is not working.

Which is a metabolic cause of delirium?

Hypoglycemia

Which of the following is a metabolic cause of delirium?

Hypoglycemia Hypoglycemia is a metabolic cause of delirium. Meningitis and encephalitis are infection-related causes. Alcohol intoxication is a drug related cause of delirium.

Which area of the brain has been associated with the symptoms of eating disorders?

Hypothalamus

A client diagnosed with delusional disorder is experiencing persecutory delusions involving the belief that someone is putting poison in his food. When developing the client's plan of care, which nursing diagnosis would be most likely?

Imbalanced Nutrition, Less than Body Requirements Imbalanced Nutrition, Less Than Body Requirements would be most likely for a client who is fearful that his food is being poisoned. As a result, the client would not be obtaining adequate nutrition. Disturbed sensory perception (tactile) would be appropriate if the client was experiencing a somatic delusion involving insects crawling on the skin. Refusal of medication or inability to adhere to the prescribed medication therapy would suggest a nursing diagnosis of Ineffective Therapeutic Regimen Management. Although the client's ability to perform his role may be impacted by his delusion, more information would be needed to support this nursing diagnosis. (less)

Decatastrophizing

Involves the therapist's use of questions to more realistically appraise the situation. The therapist may ask, "What is the worst thing that could happen? Is that likely? Could you survive that? Is that as bad as you imagine?" The client uses thought-stopping and distraction techniques to jolt himself or herself from focusing on negative thoughts. Splashing the face with cold water, snapping a rubber band worn on the wrist, or shouting are all techniques that can break the cycle of negative thoughts.

Anxiety disorder due to another medical condition

Is diagnosed when the prominent symptoms of anxiety are judged to result directly from a physiologic condition. The person may have panic attacks, generalized anxiety, or obsessions or compulsions. Medical conditions causing this disorder can include endocrine dysfunction, chronic obstructive pulmonary disease, congestive heart failure, and neurologic conditions.

Separation anxiety disorder

Is excessive anxiety concerning separation from home or from persons, parents, or caregivers to whom the client is attached. It occurs when it is no longer developmentally appropriate and before 18 years of age.

The four levels of anxiety are

Mild anxiety (helps people learn, grow, and change) Moderate anxiety (increases focus on the alarm; learning is still possible) Severe anxiety (greatly decreases cognitive function, increases preparation for physical responses, and increases space needs) Panic (fight, flight, or freeze response; no learning is possible; the person is attempting to free himself or herself from the discomfort of this high stage of anxiety). "Fight, flight, or freeze"

A client attends an outpatient mental health clinic accompanied by his wife for an assessment. The client's wife reports the client is easily irritated if the home is not maintained in a specific order and when he is unable to complete his "to do" list on time. The client has a serious and formal demeanor. Which of the following personality disorders best describes this client?

Obsessive-compulsive personality disorder Perfectionism, rigidity, controlling behavior, and extreme orderliness characterize people with obsessive-compulsive personality disorder. Their rigid perfectionism often results in indecisiveness, preoccupation with detail, and an insistence that others do things their way. Resisting authority and insisting that they and they alone are right are common behavioral patterns. Hoarding worthless objects, displaying stinginess, working excessively, showing stubbornness, and moralizing also occur to a high degree in people with this disorder. (less)

Exhaustion stage

Occurs when the person has responded negatively to anxiety and stress: body stores are depleted, or the emotional components are not resolved, resulting in continual arousal of the physiologic responses and little reserve capacity.

Which would not be considered a risk factor for being a victim of elder abuse?

Older than 65 years

Treatment for Phobias

One behavioral therapy often used to treat phobias is systematic (serial) desensitization, in which the therapist progressively exposes the client to the threatening object in a safe setting until the client's anxiety decreases. During each exposure, the complexity and intensity of exposure gradually increase, but the client's anxiety decreases. The reduced anxiety serves as a positive reinforcement until the anxiety is ultimately eliminated.

Dependent attachment

One partner relies on the other to provide for his or her needs without necessarily meeting the partners needs

A client is a 25-year-old man who has a long history of being suspicious of his friends and wife. He persistently accuses his wife of being unfaithful. He accuses his friends of making statements that are insulting to his character. Which of the following is the most accurate description of the client's personality?

Paranoid People with paranoid personality disorder are suspicious and quick to take offense. They usually cannot acknowledge their negative feelings toward others and project these negative feelings on them. They may have few friends, look for hidden meaning in innocent remarks, be litigious and guarded, or bear grudges for imagined insults or slights. Marital or sexual difficulties are common and often involve issues related to fidelity. (less)

Which assumption made the principles of cognitive behavioral therapies (CBT) is demonstrated by the quote, "For there is nothing either good or bad but thinking makes it so."

People are disturbed not by an event but by the perception of that event. Thoughts have a powerful effect on emotion and behavior. By changing dysfunctional thinking, a person can alter their emotional reaction to a situation and reinterpret the meaning of an event. By thinking a "thing" is "bad" we make it bad is one of the operations tenets of cognitive behavioral therapy (CBT). (less)

Which is an inaccurate statement regarding malingering?

People who malinger usually do not stop the physical symptoms when given a reward.

While being assessed, a client with schizophrenia states, "Everywhere I turn, the government is watching me because I know too much. They are afraid that I might go public with the information about all those conspiracies." The nurse interprets this statement as indicating which type of delusion?

Persecutory Persecutory delusions involve the belief that one is being watched, ridiculed, harmed, or plotted against. Grandiose delusions involved the belief that one has exceptional powers, wealth, skill, influence, or destiny. Nihilistic delusions involve the belief that one is dead or a calamity is impending. Somatic delusions involve beliefs about abnormalities in bodily functions or structures. (less)

The nurse is teaching a client's parents about managing the child's tic disorder. The nurse explains that it is extremely important for the child to get plenty of rest. What is the primary reason for the nurse to provide this education? Choose the best answer.

Physical stress and fatigue can increase symptoms in tic disorder.

A client with borderline personality disorder has been admitted to the inpatient unit after she was found in her parents' bedroom, burning her arm with an iron. This injury required a brief stay in the hospital's burn unit prior to transfer to your psychiatric unit. Which of the following is highest nursing care priority for this client during the first 24 hours of her admission?

Protection from self mutilation Clients with borderline personality disorder become intensely and inappropriately angry if they believe others are ignoring them and consequently may impulsively try to harm or mutilate themselves. (less)

A client with a diagnosis of schizophrenia has a history of auditory and visual hallucinations. Which of the following interventions is most likely to minimize the client's hallucinations?

Provide frequent contact and communication with the client To prevent or minimize hallucinations, the nurse should help present and maintain reality by frequent contact and communication with the client. Limiting sleep or modifying the timing of medication administration is not likely to prevent or lessen hallucinations. (less)

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?

Provide the client with a feeling of responsibility and control over the client's behavior

A client with posttraumatic stress disorder (PTSD) has been prescribed lorazepam 1 mg SL q6h PRN. What assessment finding indicates that treatment is having the desired effect?

Reduced anxiety

The nurse understands the importance of developing rapport with family members before the evaluation when caring for children with psychiatric disorders. The main reason for doing this is what?

Reducing anxiety

A male client age 52 years who has a history of alcohol dependence is admitted to a detoxification unit. He has tremors, he is anxious, his pulse has risen from 98 to 110 beats/min, his blood pressure has risen from 140/88 to 152/100 mm Hg, and his temperature is 0.6º above normal. He is slightly diaphoretic. Which nursing diagnosis would be the priority?

Risk for Injury The client is experiencing alcohol withdrawal, and protecting him from injury is the priority at this time. Although the client may be coping ineffectively or denying his alcoholism, his physical safety is a top priority. There is no indication to suggest that the client's thought processes are disturbed. (less)

A nurse is reviewing the medical record of a client diagnosed with antisocial personality disorder. The nurse notes that the client has had numerous episodes involving irritability, aggressiveness, and impulsivity, and has exhibited callousness toward others. Based on this information, which nursing diagnosis would the nurse most likely identify as a priority?

Risk for Other-Directed Violence Although they can be interpersonally charming, these clients can become verbally and physically abusive if their expectations are not met. Protection of other clients and staff from manipulative and sometimes abusive behavior is a priority. Thus, a nursing diagnosis of Risk for Other-Directed Violence would be a priority. Clients with antisocial personality disorder are less likely to engage in self-injury or self-violence; rather, they are more likely to strike out at those who are perceived to be interfering with their immediate gratification. Risk for Suicide would be a priority if the client was also experiencing depression. (less)

Which of the following would be a priority nursing diagnosis for a client diagnosed with borderline personality disorder (BPD)?

Risk for Self-Mutilation One of the first diagnoses to consider with this client population is Risk for Self-Mutilation, because protection of the client from self-injury is always a priority. The other diagnoses may be appropriate for the client, but Risk for Self-Mutilation would be the priority. (less)

A client is diagnosed with dementia that has progressed significantly. Which would be the priority for this client?

Safety

The client is 79 years old and has been diagnosed with dementia. Continuing assessment reveals that the client's condition is progressing significantly. Which would be the priority when providing care?

Safety

Which is a priority nursing intervention when child abuse or neglect is suspected?

Safety

The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what?

Same frequency as in heterosexual couples

A nurse is caring for a client diagnosed with schizophreniform disorder. The nurse demonstrates understanding of this disorder, identifying that the client is at risk for developing which of the following?

Schizophrenia About one-third of the individuals with schizophreniform disorder recover with the other two-thirds developing schizophrenia. Schizophreniform disorder is not associated with the development of personality disorder, major depression, or substance abuse . (less)

A 20-year-old son of a client who was diagnosed with schizophrenia at the age of 25 is concerned that he may also develop the disorder. Which of the following statements regarding schizophrenia and genetics is true?

Schizophrenia has shown a strong genetic contribution. Many studies strongly suggest a genetic contribution. Relatives of people with schizophrenia have a higher incidence of the disorder than found in the general population. First-degree relatives (i.e., parents, siblings, children) of clients with schizophrenia are at greater risk for the illness than are second-degree relatives (e.g., grandparents, grandchildren, aunts, uncles, half-siblings). Schizophrenia is 13% more likely to develop in children with one parent who has schizophrenia than in those with unaffected parents; when both parents have schizophrenia, a child has a 46% risk for the illness. (less)

A client with which psychiatric disorder is at high risk for suicide? a. schizophrenia b. personality disorders c. anxiety disorders d. eating disorders

a. Schizophrenia

A child with an existing diagnosis of attention deficit hyperactivity disorder shows signs and symptoms of depression. Which would most likely be prescribed?

Selective serotonin and norepinephrine reuptake inhibitor (SSNRI)

The nurse is admitting a client with histrionic personality disorder to the inpatient unit. The nurse would anticipate that this client may exhibit which behavior?

Self-dramatization The client with histrionic personality disorder uses self-dramatization and emotional exaggeration to draw attention to self. The antisocial personality tends to be manipulative. Paranoid personality disorder causes the client to be suspicious and distrust others. In obsessive-compulsive personality disorder, the client's perfectionism interferes with task completion. (less)

A client in the emergency department has self-inflicted wounds on both arms. Assessment reveals that the client was diagnosed with borderline personality disorder 6 months ago, for which she has been receiving outpatient treatment. The client tells the nurse that she recently found out her therapist is moving and will not longer be able to work with her. What is the highest priority nursing diagnosis for this client?

Self-mutilation Although all the above are problems for this patient, the highest priority nursing diagnosis is self-mutilation. If left untreated, self-mutilation can lead to suicide attempts.

Following a long history of multiple visits to community clinics and emergency departments, a client has been diagnosed with hypochondriasis. During this current visit to the emergency department, the client has just been informed that diagnostic testing and assessment reveal no severe illness. Despite this, the client persists in verbalizing physical complaints. How should the nurse respond to this?

Set limits with the client about the complaints.

A client on an inpatient psychiatric unit has features of borderline personality disorder: She is frequently angry, has an unstable sense of herself, and is highly impulsive. She can be verbally abusive to staff, who feel manipulated by her behaviors. Which of the following interventions does the nurse determine as a priority?

Setting limits The nurse introduces the use of limit setting when clients engage in manipulative, acting-out, dependent, or similar inappropriate behaviors.

In a toddler, which injury is most likely the result of child abuse?

Several small, circular burns on the child's back

Somatic symptom illness disorders are characterized by what?

Severe physical symptoms that cannot be explained by any organic or physical pathology

An older adult client has been attending a local day program for the elderly. The nurse who facilitates the program notices the client has multiple bruises on the arms, has scrapes to the hands and face, and is socially withdrawn. A referral to the client's family physician confirms the client has genital herpes. Which type of elder abuse should the nurse suspect?

Sexual abuse

To promote recovery, which of the following would be most important for a nurse to keep in mind when establishing a nurse-client relationship with a client who has schizophrenia?

Short, time-limited interactions are best for a client experiencing psychosis. Engaging a client with schizophrenia takes time, and short, time-limited interactions are best for a client who is experiencing psychosis. Consistency in interactions and follow-through helps to establish trust. Relationships should be built on the recovery paradigm that focuses on individualizing treatment and care that is person centered and allows for self-direction. Clients with schizophrenia are often reluctant to engage in any relationship. (less)

The nurse receives a report that a 75-year-old client recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse "Audrey", the name of the client's daughter. The nurse interprets this behavior as which of the following?

Signs of delirium Delirium is a syndrome characterized by a rapid onset of cognitive dysfunction and disruption in consciousness. Growing rates of delirium mirror the increasing older adult population and are expected to continue to rise. Delirium is the most common psychiatric syndrome in general hospitals, occurring in up to 50% of elderly inpatients. It is associated with significantly increased morbidity and mortality both during and after hospitalization. (less)

Keisha is a 42-year-old married woman with two children, ages 16 and 18. She is also caring for her mother, who is in the late stages of Alzheimer's disease. The nurse would want to assess Keisha for which of the following?

Signs of stress Nurses must assess family members, especially caregivers, for signs of stress or burnout. Although this issue might not be pertinent during early stages of dementia, it becomes paramount as clients progressively degenerate and demands for physical care mount. (less)

A nurse who started recovering from alcohol abuse 3 months earlier is ready to return to work. When speaking with her therapist, she states she is nervous about how her co-workers will respond to her now that "they all know I'm a drunk." Which of the following diagnoses best targets the problem implicit in the nurse's remarks?

Situational low self-esteem related to medical condition Each client enters recovery with a different personality and psychosocial history. In most cases, however, the client's self-esteem may be low because he or she can no longer hide from the devastation caused by substance abuse and related behaviors. Guilt, shame, embarrassment, and despair are common feelings in the early stages of recovery. (less)

The nurse is performing a physical health assessment of a client who has been diagnosed with posttraumatic stress disorder (PTSD). What aspect of this assessment should the nurse prioritize?

Sleep assessment

Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. The client watched the client's spouse burn to death from the helicopter. The client continues to have nightmares and is fearful that the client will die in a fire. An appropriate nursing diagnosis for the client is what?

Sleep pattern disturbance related to recurrent nightmares

A client is diagnosed with dementia related to Parkinson's disease. While at a doctor's visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to do which of the following?

Slow deterioration of memory and function Compelling evidence shows that drugs that inhibit ACh destruction or increase cholinergic activity can slow deterioration of memory and function. Cholinesterase inhibitors increase availability of ACh by interfering with the enzyme that breaks it down. These centrally acting drugs help elevate the level of ACh by decreasing the binding sites of acetylcholinesterase, which lengthens the potential for cholineregic activity. (less)

When performing a spiritual assessment on a child, the nurse and child discuss church attendance and practices that are most important to the child. Which domain is the nurse addressing when doing this assessment?

Social

A client complains of severe low back pain that began shortly after the death of the client's mother 2 years ago. No physical cause has been found to account for the pain. The client has been largely responsible for the care of four younger siblings because the client's father spends much of the week out of town on work-related business. Based on the client's symptoms, which nursing diagnosis is most appropriate for the client at this time?

Somatic complaints due to anxiety related to life stressors

Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which defense mechanism?

Somatization

When clients diagnosed with borderline personality disorder (BPD) see nurses as either all good or all bad, the client is using which primitive defense?

Splitting Because clients with BPD view the world in absolutes, nurses and other treatment team members are alternately categorized as all good or all bad. This primitive defense is called splitting, and it presents clinicians with a challenge to work openly with each other, as well as the client, until the issue can be resolved through team meetings and clinical supervision. This is not an example of defending, invalidating, or projective identification. (less)

Which of the following occurs when a client tends to adore and idealize other people even after a brief acquaintance but then quickly leaves them if these others do not meet the client's expectations in some way?

Splitting Splitting occurs in this situation. Thought stopping is a technique to alter the process of negative or self-critical thought patterns such as, "I'm dumb, I'm stupid." Decatastrophizing is a technique that involves learning to assess situations realistically rather than always assuming a catastrophe will happen. In positive self-talk, the client reframes negative thoughts into positive ones. (less)

A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect?

Stalking

A police officer was diagnosed with posttraumatic stress disorder after attending to a violent crime scene. What aspect of the client's current health status would most likely warrant inpatient treatment?

The client alluded to "ending this misery" in a conversation with a colleague

Alarm reaction stage

Stress stimulates the body to send messages from the hypothalamus to the glands (such as the adrenal gland, to send out adrenaline and norepinephrine for fuel) and organs (such as the liver, to reconvert glycogen stores to glucose for food) to prepare for potential defense needs.

A nursing student is aware that which accounts for more deaths, illnesses, and disabilities across the life span than any other preventable condition?

Substance abuse disorders

The parents of a child with attention deficit hyperactivity disorder (ADHD) bring the child for a follow-up visit. During the visit, they tell the nurse that the child receives the first dose of methylphenidate at about 7:30 a.m. every morning before leaving for school. The teacher and school nurse have noticed a return in the child's overactivity and distractibility just before lunch. The child's second dose is scheduled for about 12 p.m. Which might the nurse suggest as a possible solution to control the child's symptoms a bit more effectively?

Switch to a longer-acting preparation.

The psychiatric-mental health nurse is providing care for a child who has been diagnosed with disinhibited social engagement disorder. What intervention best addresses the characteristics of this disorder?

Teaching the child how to interact appropriately with strangers

An obese client is admitted to the facility for abusing amphetamines in an attempt to lose weight. Which nursing intervention is appropriate for this client?

Teaching the client alternative ways to lose weight

A client with posttraumatic stress disorder (PTSD) is having a flashback experience of a traumatic event. The client asks the nurse if the client can hold the nurse's hand. What should the nurse interpret from this behavior?

The client benefits from supportive touch.

Resistance stage

The digestive system reduces function to shunt blood to areas needed for defense. The lungs take in more air, and the heart beats faster and harder so it can circulate this highly oxygenated and highly nourished blood to the muscles to defend the body by fight, flight, or freeze behaviors. If the person adapts to the stress, the body responses relax, and the gland, organ, and systemic responses abate.

The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing which of the following?

Telling other clients that he "was a dairy farmer" when he actually ran a small grocery store Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit, such as a client telling others that he "was a dairy farmer" when he actually ran a small grocery store. Evidence of perseveration is a client telling the staff repeatedly that "my name is George and I'm hungry." Sundown syndrome can be described as a client pacing nervously and resisting the staff's request to "get ready for bed." Concrete thinking is described when the client asks where the cats are when told it's "raining cats and dogs." (less)

A nurse is working with a child undergoing behavioral modification therapy for attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation?

The child cannot sit through meals.

The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this?

The child continuously repeats socially unacceptable words.

The nurse's assessment of a child from a dysfunctional family background suggests that the child lacks resilience. What outcome should the nurse identify after performing appropriate interventions?

The child demonstrates that the child is empowered to solve life problems

The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding?

The child has difficulty forming complete sentences.

A nurse is caring for a child with attention deficit hyperactivity disorder (ADHD). The child is given medication and behavioral modification therapy to treat the condition. Which outcome achieved within 3 days would indicate successful therapy?

The child is able to complete assignments or tasks with assistance.

The nurse is assessing a 6-year-old child who witnessed the murder of the child's parents. The nurse suspects that the child has developed posttraumatic stress disorder (PTSD). Which specific behavioral manifestation leads the nurse to interpret this?

The child is easily startled and hyper-vigilant.

A nurse is speaking to the peers of a child with attention deficit hyperactivity disorder (ADHD). The nurse finds that these children do not like the child and do not want to include the child during play. What are the likely reasons for the children feeling this way? Select all that apply.

The child is not cooperative while playing. The child constantly interrupts while playing. The child doesn't follow the rules of the game.

A nurse is assessing a child with attention deficit hyperactivity disorder (ADHD). For every question asked by the nurse, the child answers, "I don't know." What is the most likely reason for the child to respond in this way?

The child is not paying attention to the nurse's questions.

The nurse is teaching the parents of a child with involuntary enuresis about methods to manage the condition. Which intervention does the nurse recommend to the parents?

The child should use pads with a warning bell.

The pediatric nurse is caring for a child who comes from an abusive background and who has been diagnosed with reactive attachment disorder. What behavior should the nurse anticipate when planning this child's care?

The child will be reluctant to engage with the nurse

When anxiety becomes severe...

The client can no longer pay attention or take in information. The nurse's goal must be to lower the person's anxiety level to moderate or mild before proceeding with anything else. It is also essential to remain with the person because anxiety is likely to worsen if he or she is left alone. Talking to the client in a low, calm, and soothing voice can help. Helping the person to take deep even breaths can help lower anxiety.

Which of the following assessment findings in a client who is suspected of having a delusional disorder would be suggestive of a diagnosis of schizophrenia?

The client experiences frequent and sustained hallucinations. The presence of prominent and sustained hallucinations is suggestive of schizophrenia rather than delusional disorder. Nonbizarre delusions are associated with delusional disorder, and people with either diagnosis lack insight. Response to therapy does not differentiate between the two diagnoses. (less)

Adaptive Denial

The client gradually adjusts to the reality of the loss; can help the client let go of previous (before the loss) perceptions while creating new ways of thinking about himself or herself, others, and the world.

Which of the following factors would contraindicate the use of disulfiram (Antabuse) in the treatment of a client who has an alcohol use disorder?

The client had six drinks a few hours ago. Disulfiram (Antabuse) may not be administered to a client who is acutely intoxicated. A family history of alcoholism, marijuana use, and binge drinking do not preclude the use of the drug. (less)

A nurse is performing a follow-up assessment of a client who had been treated for posttraumatic stress disorder (PTSD) a year ago. The client tells the nurse that the client is not able to maintain relationships and that the relationships last for a very short time. What is the most likely reason for this problem?

The client has issues with developing trust.

A client suffered a gunshot injury in a robbery and subsequently developed posttraumatic stress disorder (PTSD). What aspect of the client's current condition was confirm that the client is experiencing hyperarousal?

The client is easily startled by sudden noises

A client who has been admitted for an appendectomy states, "I'm really afraid of the surgery because my mother died when she was admitted for an emergency surgery." When preparing to work with the client concerning this anxiety about the surgery, the nurse recognizes what?

The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger.

A client with a diagnosis of posttraumatic stress disorder (PTSD) tells the nurse, "When things get really bad, it sometimes feels like I'm not even in my body, like I'm floating around and watching myself." How should the nurse best interpret this client's statement?

The client is likely experiencing derealization as a result of PTSD

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation?

The client is often "staring into space" and has no idea how much time has passed

A client with posttraumatic stress disorder (PTSD) is treated with exposure therapy. What change is most likely expected in the client after receiving this therapy?

The client may be able to control thoughts and feelings about the event.

The nurse asks a client to pretend he is brushing his teeth. The client is unable to perform the action. Upon examination, the nurse finds that the client possesses intact motor abilities. What can this problem be documented as?

The client may have apraxia. Impaired ability to execute motor functions despite having intact motor abilities is referred to as apraxia. In this case, the client knows how to and has the physical abiltiy to brush his teeth, but is unable to demonstrate the action upon request. Thus the client has apraxia. The inability to recognize or name objects or sounds heard is referred to as agnosia. Aphasia is the deterioration of language function. Disturbed executive function is the inability to carry out complex motor activities. Using a toothbrush is not a complex activity. (less)

A nurse is assessing a victim of rape with a diagnosis of posttraumatic stress disorder (PTSD). The client is trying to recall and express the trauma. The nurse finds that, at times, the client is unable to remember certain facts associated with the trauma. What would the nurse interpret from this finding?

The client may have repressed memories.

A nurse is caring for a client with dissociative disorder. The nurse tells the client, "Hello, I'm Robin, your nurse. It is 9 o'clock in the morning now. You are in room number 303. My name is Robin, I'm your nurse." What is the most appropriate reason for the nurse to repeat this statement?

The client may need to be reoriented.

A client with posttraumatic stress disorder (PTSD) has been referred for employment. Why might the nurse fear that the client will not be capable of sustaining the job long term?

The client may not be able to get along with coworkers

The client's diagnosis of schizoaffective disorder is supported when the nurse documents which of the following?

The client reports "hearing voices" for the last three months The client's diagnosis of schizoaffective disorder is supported when the nurse documents that the client reports "hearing voices" for the last three months. The documentation is objective and includes a direct quote from the actual client. What is being documented is consistent with the criteria for schizoaffective disorder. (less)

The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation?

The client reports large gaps in memory of the traumatic event

A 6-year-old client who has been diagnosed with autism spectrum disorder would be expected to display which behavior?

The client spends time alone and shows little interest in making friends.

The nurse is reviewing the health record of a client who developed posttraumatic stress disorder (PTSD) following a spouse's cardiac arrest and death. The health record states that the client experienced derealization during the traumatic event. What assessment finding would substantiate this statement?

The client states that the client cannot remember what happened during and immediately after the event

The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)?

The client states that the client is often "awake for hours and hours each night."

A client with a delusional disorder has been undergoing individual psychotherapy. The therapy would be deemed ultimately successful when the client meets which of the following outcomes?

The client will differentiate between reality and fantasy. The ultimate goal of all forms of treatment for clients with delusional disorders is to foster the ability to distinguish between fantasy and reality. Promoting healthy coping, anxiety awareness, and healthy relationships are therapeutic outcomes, but the priority in treatment is the delusional thinking itself. (less)

A 59-year-old has just been diagnosed with early-stage dementia. The client is experiencing mild forgetfulness but can function normally. The client lives with a spouse and adult child, who is a single parent of two. When planning care for this family, which of the goals should the nurse identify as a priority?

The client will discuss emotional response to diagnosis.

A client who is being treated for posttraumatic stress disorder tells the nurse, "Sometimes it's like I can't feel anything—not happiness, not sadness, not fear. Nothing." How should the nurse best interpret the client's statement?

The client's emotional numbing is a protective mechanism

A client with somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which would be most important for a nurse to keep in mind?

The client's experience of pain is real.

The nurse-therapist is conducting a group therapy session in which one of the participants is a male adult who has been diagnosed with narcissistic personality disorder. The nurse recognizes the significance of childhood experiences in the etiology of personality disorders, which for this client may have included what pattern?

The client's mother catered to his every need and the client used temper tantrums to successfully get his way. Narcissistic personality disorder is characterized by an exaggerated sense of self-importance. It is plausible that a client's high degree of control and entitlement early in life may have contributed to or exacerbated such tendencies. The other patterns of interaction would not tend to promote entitlement or a grandiose self-view. (less)

A parent brings a teenage child, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse the absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer.

The client's symptoms disappeared after getting the medical note.

The nurse is assessing a client who was sexually assaulted several months ago and who has subsequently developed posttraumatic stress disorder (PTSD). The nurse observes that the client's nonverbals are closed and the client is reluctant to engage with the nurse. How should the nurse best interpret this client's behavior?

The client's trauma likely has an impact on the client's ability to trust

A client with opioid addiction is prescribed methadone maintenance therapy. When explaining this treatment to the client, which of the following would the nurse need to keep in mind?

The drug helps to satisfy the craving for the opioid. .Methadone maintenance is the treatment of people with opioid addiction with a daily, stabilized dose of methadone. Methadone is used because of its long half-life of 15 to 30 hours. Methadone is a potent opioid and is physiologically addicting, but it satisfies the opioid craving without producing the subjective high of heroin. (less)

Which statement about the etiology of somatic symptom disorder is accurate?

The exact etiology is unknown.

The nurse is teaching basic physical exercises and meditation techniques to a client recently diagnosed with conversion disorder. What outcome does the nurse expect from teaching the client these exercises? Choose the best answer.

The exercises may help the client manage stress underlying the disorder

Autonomic nervous system responses to fear and anxiety generate...

The involuntary activities of the body that are involved in self-preservation. Sympathetic nerve fibers "charge up" the vital signs at any hint of danger to prepare the body's defenses.

In moderate anxiety...

The nurse must be certain that the client is following what the nurse is saying. The client's attention can wander. Speaking in short, simple, and easy-to-understand sentences is effective.

During panic-level anxiety...

The person's safety is the primary concern. He or she cannot perceive potential harm and may have no capacity for rational thought. The nurse must keep talking to the person in a comforting manner, even though the client cannot process what the nurse is saying. Going to a small, quiet, and nonstimulating environment may help to reduce anxiety. The nurse can reassure the person that this is anxiety, that it will pass, and that he or she is in a safe place. The nurse should remain with the client until the panic recedes. Panic-level anxiety is not sustained indefinitely, but can last from 5 to 30 minutes.

A nurse is careful to provide a quiet, comfortable, safe environment when conducting an assessment interview. What is the reason this is particularly important when working with a client believed to be exhibiting characteristics of a personality disorder?

This disorder produces defensive, guarded, and impulsive behavior that is easily provoked into anger when the client feels threatened. Personality disorders are diagnosed when there is impairment of personality functioning and personality traits that are maladaptive. Individuals have identity problems such as egocentrism or being self-centered, and their sense of self-esteem comes from gaining power or pleasure that is often at the expense of others. Their behavior often fails to conform to cultural, social, or legal norms, and they are motivated by personal gratification. Individuals with these disorders are often withdrawn, defensive, guarded, and impulsive, and may demonstrate an escalation of anger or make hostile or threatening comments. The remaining options are specific to certain types of personality disorders. (less)

Which of the following is a technique used to help the client with borderline personality disorder (BPD) gain control over self critical thoughts?

Thought stopping Thought stopping is a practice that may help the patient control the a technique to alter the process of negative or self critical thought patterns such as "I'm dumb, I'm stupid, I can't do anything right." (less)

Preconscious

Thoughts and emotions are not currently in the person's awareness but he or she can recall them with some effort such an adult remembering what he or she did, thought or felt as a child

Which is an inaccurate picture of the cycle of abuse that occurs over time?

Violent episodes are less frequent

Assessment of genetic predisposition supports asking a client who is exhibiting symptoms of a delusional disorder which of the following?

Whether any family members have been diagnosed with schizophrenia Some studies have found that delusional disorders are more common among relatives of individuals with schizophrenia than would be expected by chance, thus, asking whether any family members have been diagnosed with schizophrenia could be helpful. (less)

Limit setting is most appropriate in which patient population? a. manic b. depressed c. anxious d. suicidal

a. manic Most of the time , anxious,depressed and suicidal clients do not test the limits of the caregiver.

a client with bipolar disorder is experiencing acute mania. the client is unable to sit still, moving from place to place. medication therapy has been prescribed but not yet initiated. which of the following would the nurse include in the plan of care to meet the client's physical needs? a. providing high energy snacks b. increasing environmental stimuli c. instituting a sleep hygiene program d. encouraging frequent rest periods

a. providing high energy snacks for the client experiencing acute mania, the nurse would provide snacks and high energy foods, because it is highly likely that the client is unable to sit long enough to eat. sleep hygiene is a priority but may not be realistic until medications take effect. because of client's activity level, frequent rest period would be unlikely. limiting stimuli would be helpful in decreasing agitation

a client comes to the emergency department complaining of a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and his pulse is racing. The client states that he is being treated for depression with MAOI. Which question by the nurse would be the most important to ask at this time? a. what have you had to eat or drink today? b. do you use any herbal remedies c. are you having any chest pain d. when did you last have blood drawn to check your drug level?

a. what have you had to eat or drink today? the client is exhibiting signs of a hypertensive crisis, which can occur when a client is receiving MAOI therapy and ingests food or other substances that contain tyramine

inappropriate boundaries

all staff members are at risk for allowing relationship to expand into an inappropriate relationship. - self awareness is important - if the nurse is intouch with their feelings and aware of their influence over others, then the nurse can maintain the boundaries. - do not try to be friends with the client. do act empathetic and warmly to client though.

termination phase of therapeutic relationship

also called resolution phase - final stage -begins when the problems are resolved. - ends when the relationship is ended - nurse and client usually have feelings about ending the relationship, especially the client. - clients can try to bring up old unsolved issues to try to not terminate the relationship. nurse must overlook this and tell client it is normal - dont agree to see outside of the therapeutic relationship.

Acculturation

altering cultural values or behaviors as a way to adapt to another culture

phobia

an illogical, intense, and persistent fear of a specific object or social situation that causes extreme distress and interferes with normal functioning

severe anxiety

an increased level of anxiety when more primitive survival skills take over, defensive responses ensue, and cognitive skills decrease significantly; person with severe anxiety has trouble thinking and reasoning

A young adult client female is assessed after being raped. The client reports being tied up and beaten while the perpetrator forced sexual intercourse. She recalls the perpetrator saying, "I will make you pay." What most accurately describes this category of rapist?

anger retaliation

Because of the lag period before montime that the moamine oxidase inhibitors (MAOIs) are effective, adequate wash out periods of which time frame are recommended between the time that MAOI is discontinued and another class of antidepressants is started? a. 1 week b. 5 weeks c. 4 weeks d. 2 weeks

b. 5 weeks because of the lag period, adequate washout periods of 5 to 6 weeks are recommended between the time the MAOI is discontinued and another another class of the antidepressant is started.

a nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment finding would support this suspicion? select all that apply a. headache b. blurred vision c. warm dry skin d orthostatic hypotension e agitated delirium

b. blurred vision c. warm dry skin e. agitated delirium anticholinergic effects are prominent and include dry mucous membranes, warm dry skin blurred vision decreased bowel motility and urinary retention. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. orthostatic hypotension and headache are side effects of MAOIs

a nurse is preparing an education plan for the family of a client who has been diagnosed with bipolar disorder. After teaching them about potential indicators for relapse the nurse determines that the education was effective when the family identifies which of the following as suggesting mania? select all that apply a. reading several books at once b. talking faster than usual c. being hungry all the time d. sleeping more than usual e. avoiding people

b. talking faster than usual c. being hungry all the time a reading several books at once indicators of possible mania include reading several books or newspapers at once talking faster than usual feeling irritable and being hungry all the time. avoiding people and sleeping more than usual would suggest depression

avoidance behavior

behavior designed to avoid unpleasant consequences or potentially threatening situations

A nurse is caring for a client that does not want to participate in group therapy. Which behavior is supportive of a diagnosis of dependent personality disorder?

believes he or she is incapable of functioning independently Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which leads to submissive and clinging behavior and fears of separation. These behaviors are designed to elicit care taking from others. The dependent person must rely on others to make decisions and assume responsibility of major areas of life. Low self-esteem and exaggeration are seen in avoidant personality disorder. Attention seeking is seen in narcissistic personality disorder. (less)

panic attack

between 15 and 30 minutes of rapid, intense, escalating anxiety in which the person experiences great emotional fear as well as physiologic discomfort

An intoxicated client was admitted for trauma treatment last night at 2:00 AM (0200). When should the nurse expect to be alert for withdrawal symptoms?

between 8:00 and 10:00 AM (0800 and 1000) today (6 to 8 hours after drinking stopped) Symptoms of withdrawal usually begin 4 to 12 hours after cessation or marked reduction of alcohol intake. Symptoms include coarse hand tremors, sweating, elevated pulse and blood pressure, insomnia, anxiety, and nausea or vomiting. Severe or untreated withdrawal may progress to transient hallucinations, seizures, or delirium (called delirium tremens (DTs)). Alcohol withdrawal usually peaks on the second day and is over in about 5 days. (less)

defense mechanisms

cognitive distortions that a person uses unconsciously to maintain a sense of being in control of a situation, to lessen discomfort, and to deal with stress; also called ego defense mechanisms

when teaching a group of new mental health nurses about major differences between bipolar i and bipolar ii , which of the following would be most appropriate for the nurse to include? a. unlike bipolar ii, bipolar i disorder involves no symptoms of mania but only depression b. both disorders are the same , except the risk for suicide is greater with bipolar i c. bipolar ii is more often recognized than bipolar i d. the mania symptoms of bipolar ii have little effect on functioning

d the mania symptoms of bipolar ii disorder have little effect on functioning with bipolar i, at least one manic episode or mixed episode and a depressive episode have to occur. bipolar ii is not as easily recognized as bipolar i because of the symptoms are less dramatic.

A 42-year-old woman with major depression is in an inpatient psychiatric hospital. She has been taking phenelzine (Nardil), a monoamine oxidase inhibitor (MAOI), for her depression. The therapist writes an order to discontinue the phenelzine and begin fluoxetine (prozac). which of the following actions be the nurse are indicated? a. begine educating the client about food restrictions when taking fluoxetine b. note in the medication administration record to check the client's bood pressure for the first two days after starting fluoxetine. c. begin educating the cclient about selective serotonin reuptake inhibitors d. call the therapist to discuss the need for a washout preiod before starting fluoxetine.

d. call the therapist to discuss the need for a washout period before starting fluoxetine if the client is switching from an MAOI to fluxetinem the provider should allow a washout period of at least five weeks (half-life of MAIO) . Conversely, if a client is switching from fluoxetine to an MAOI, providers should allow a"washout" period of at least two weeks (half life of fluoxetine) before beginning the MAOI.

a client is hospitalized on a psychiatric unit secondary to a suicide attempt. He has been diagnosed with depression and is consistently depressed. when assessing the client, which of the following would alert the nurse that the client's suicidal risk has worsened? a. he is lethargic, remaining isolated from other clients b. he tells the nurse that he feels more depressed than ever c. his energy level and degree of depression remain the same d.he says he feels better as he interacts more with other clients

d. he says he feels better as he interacts more with other clients during the depths of depression, clients may not have the energy to complete a suicide. as a clients begin to feel better and have increased energy, they may be at a greater risk for suicide. if a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. the nurse may misinterpret the mood improvement as a positive moce toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety

a client with bipolar disorder is experiencing a major depressive episode. which of the following would the nurse expect to assess? select all that apply a. widespread shopping sprees b. difficult concentrating c. flight of ideas d. obsessive rumination e. hypersomnia

d. obsessive rumination e. hypersomnia b difficult concentrating during major depressive episode, client would exhibit obsessive rumination, insomnia or hypersomnia, diminished ability to concentrate, or indecisiveness. Flight of ideas and engaging in widespread shopping woud characterize mania

a client has been diagnosed with major depression and placed on Elavil. which of the following is a side effect of amitriptyline (Elavil)? a. weight loss b. diarrhea c. excessive salivation d. orthostatic hypotention

d. orthostatic hypotension side effects of Elavil include orthostatic hypotension, constipation, weight gain and dry mouth.

when assessing risk of suicide, which of following are important assessment component? select all apply a degree of hapelessness b previous attempt c lethality of method d seriousness of suicidal ideation e unemplyment

d. seriousness of suicidal ideation a degree of hopelessness b previous attempt c lethality of method assessing for suicide risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disordersm previous attempt, suicide planning and implementation, and availability and lethality of the suicide method

in a therapy session, a client with a diagnosis of major depression admits to the nurse therapist " i actually went out driving on the interstate this morning and had every intention of getting up to speed plowing right into the overpass by my exitm maybe tomorrow." The nurse would recognize the clients statement as what? a. suicidal gesture b suicidal ideation c. suicidal threat d. suicidal intent

d. suicidal intent the specificity and concreteness of the client's plan indicates suicidal intent. Suicidal ideations, threats and gestures are typically more vague and less rooted in time and place

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting

what is one of the most important skills a nurse can develop?

establish therapeutic relationships with clients

A client has been referred for care because the client's primary care provider suspects that the client has posttraumatic stress disorder (PTSD) following a motor vehicle accident. When working with this client, the psychiatric-mental health nurse should begin by:

establishing therapeutic rapport with the client.

A client has been taking haloperidol (Haldol) for five years when she is admitted to the inpatient unit for relapse of symptoms of schizophrenia. Upon assessment, the client demonstrates akathisia, dystonia, a stiff gait, and rigid posture. The nurse correctly identifies these symptoms are indicative of which of the following?

extrapyramidal side effects Extrapyramidal side effects (EPSs) include severe restlessness; muscle spasms or contractions; chronic motor problems such as tardive dyskinesia; and the pseudoparkinsonian symptoms of rigidity, masklike faces, and stiff gait. (less)

Animal phobia

fear of animals or insects (usually a specific type; often this fear develops in childhood and can continue through adulthood in both men and women; cats and dogs are the most common phobic objects)

Situational phobias

fear of being in a specific situation such as on a bridge or in a tunnel, elevator, small room, hospital, or airplane

agoraphobia

fear of being outside; from the Greek fear of the marketplace

Blood-injection phobias

fear of seeing one's own or others' blood, traumatic injury, or an invasive medical procedure such as an injection

When reviewing the documented history of an adult client with anorexia nervosa, what is the nurse most likely to find? (Select all that apply.)

food restriction began at age 15 depression at age 16 lasting one month reported believing that friends were "jealous" of her body

what are attitudes?

general feelings or a frame of reference which a person organizes knowledge about the world. - color how we look at and view things in the world. - a positive mental attitude occurs when a person chooses to put a positive spin on an experience, comment or a judgement. - a negative attitude colors how one views the world or other people. -nurse should reevaluate and readjust beliefs and attitudes periodically as he or she gains experience and wisdom.

disenfranchised grief

grief over a loss that is not or cannot be mourned publicly or supported locally

Delirium can be differentiated from many other cognitive disorders in which of the following ways?

has a rapid onset and is highly treatable if diagnosed quickly. Delirium often is caused by an acute disruption of brain homeostasis. When the cause of that disruption is eliminated or subsides, the cognitive deficits usually resolve within a few days or sometimes weeks. Dementia, in contrast, results from primary brain pathology that usually is irreversible, chronic, progressive, and less amenable to treatment. (less)

the nurse must not

let feelings of empathy turn into sympathy for the client - the nurse who feels sorry for the client often tries to compensate by trying to please him or her. - clients often test the nurse to see how much the nurse is willing to do. - nurse needs to reassess their professional behavior and refocus on the clients needs and goals.

specific task of the working phase

maintaining the relationship gathering more data exploring perceptions of reality developing positive coping mechanisms promoting a positive self concept encouraging verbalization of feelings facilitating behavior change working through resistance evaluating progress and redefining goals as appropriate providing new opportunities for the client to practice new behaviors promoting independence.

Native Americans

medicine man helps deceased regain spiritual equilibrium, ceremonies of baptism for the spirit wards off depression. Death state of unconditional love where spirit remains present and comforts tribe and encourages movement toward life purpose. Belief in happy afterlife (land of spirits); proper mourning essential for soul of deceased and protection of community. End of mourning designated with a ceremony at burial grounds with blanket covering grave. Dinner, singing, speechmaking, and contributing money

A client had been withdrawn in his room for three days, not eating or sleeping, prior to his admission to the inpatient unit. Upon interview, the client demonstrates difficulty answering questions, appears to have no facial expressions, and cannot follow simple instructions. This cluster of symptoms can be described as which of the following?

negative symptoms. Common negative symptoms of schizophrenia include alogia, affective blunting, avolition, anhedonia, and attentional impairment.

The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse?

neglect

acceptance

nurse who does not become upset or responds negatively to clients outburst, anger or acting out conveys acceptance to the client - avoiding judgements of the person no matter what the behavior is. - this doesnt mean acceptance of inappropriate behavior. - nurse must set boundaries for behavior in the nurse client relationship.

Johari window

one way of learning more about oneself. creates a word portrait of a person in four areas and indicates how well that person knows himself or herself and communicates with others.

What is the initial intervention the nurse should implement when helping a client diagnosed with dementia deal with paranoid delusions?

observe the client in order to identify the triggers for the delusions Clients with dementia may believe that their physical safety is jeopardized; they may feel threatened or suspicious and paranoid. These feelings can lead to agitated or erratic behavior that compromises safety. Avoiding direct confrontation of the client's fears is important. Clients with dementia may struggle with fears and suspicion throughout their illness. Triggers of suspicion include strangers, changes in the daily routine, or impaired memory. The nurse must discover and address these environmental triggers rather than confront the paranoid ideas. (less)

therapeutic relationship is crucial to the success

of interventions with clients requiring psychiatric care because the therapeutic relationship and the communication within it serves as the underpinning for treatment and success.

A school health nurse is seeing an 11-year-old child who is refusing to attend school for the past 3 weeks. On assessment, the child describes a recent school experience where the child has been deliberately isolated from social groups. The child tells the nurse this began after an argument with their "best friend." The child is describing:

ostracism

A nurse is caring for a client with delirium who is experiencing illusions. What environmental conditions should the nurse arrange for this client?

provide a well-lit room without glare or shadows and limit noise Clients with delirium have difficulty paying attention, are easily distracted and disoriented, and may have sensory disturbances such as illusions, misinterpretations, or hallucinations. A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a client with cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations. (less)

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia?

provides interaction with those with similar concerns Attending a support group regularly also means that caregivers have time with people who understand the many demands of caring for a family member with dementia. While the other options suggest accurate results, none are the greatest benefit such a support group experience can provide. (less)

A client is brought to the emergency department stating, "I'm scared because the FBI is now tapping my home phone, and I can hear them talking between my two telephones during the night." The client's eyes dart around the room while the nurse is trying to interview him, and he is tapping his fingers on the table. The nursing priority with this client is which of the following?

reassure John that he is in a safe place where he will be helped. Safety needs are paramount. The person with schizophrenia is likely to be anxious and fearful around others due to disordered thought processes. Therefore the nurse builds a trusting relationship and assumes responsibility for the client's well-being by reassuring him of his safety and security. (less)

Bereavement

refers to the process by which a person experiences the grief.

grieving

refers to the process by which a person experiences the grief.

Heritability

refers to the proportion of a disorder that can be attributed to genetic factors:

Grief

refers to the subjective emotions and affect that are a normal response to the experience of loss.

nonacceptance and avoidance

relationship can be jeopardized if the nurse finds the clients behavior unacceptable or distractful and allows those feelings to show by avoiding the client or making verbal responses or facial expressions of annoyance or turning away from client. - nurse needs to be aware of clients background and behavior before beginning relationship - if the nurse believes there will be a conflict, the nurse should request another client. - it is nurses responsibility to treat each client with acceptance and positive regard regardless of the clients history.

confidentiality

respecting the clients rights to keep private any information about his or her mental and physical health and related care - allowing only those dealing with the clients care to have access to the info that the client divulges. -client can determine which family members can be included in their care if they are of age. - boundaries must be clear to the client. - for a child, parent or guardian is allowed access to info and can make treatment decisions

self disclosure

revealing personal info to clients. - some self disclosure can improve rapport between nurse and client - can use to convey support educate clients and demonstrate that a clients anxiety is normal. -may help the client feel more comfortable and more willing to share thoughts and feelings or help gain insight into his or her situation.

Behavior and characteristics of individuals with personality disorders are best described with which of the following?

rigid and inflexible. The behavior of clients with personality disorders is enduring and inflexible and pervades a wide range of personal and social contexts.

Which of the following can be identified as a hallmark symptom of dementia?

short-term memory loss. As a broad diagnosis, dementia includes conditions in which short-term memory loss is a hallmark. The deterioration of memory is so great that it prevents clients from functioning at previous levels of social and occupational performance and seriously deters them from learning new information. (less)

Difference between side effects + adverse effects?

side effects: MILD adverse effects: Can be FATAL

types of relationships

social intimate therapeutic

homeostasis

state of equilibrium or balance

Chinese Americans

strict norms for announcing the death, preparing the body, arranging the funeral and burial, and mourning after burial. Burning incense, reading scripture assist spirit in afterlife journey. Buddhists meditate before a shrine. Place bowls of food on table for spirit for 1 year.

Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night?

take a nap mid afternoon and before dinner Clients with dementia often experience disturbed sleep-wake cycles; they nap during the day and wander at night. This behavior can contribute to the nighttime activity. The other options are not likely to affect sleep cycles. (less)

roles of the nurse in therapeutic relationship

teacher caregiver advocate parent surrogate

therapeutic roles of the nurse

teacher caregiver advocate parent surrogate

assertiveness training

techniques using statements to identify feelings and communicate needs and concerns to others; helps the person negotiate interpersonal situations, fosters self-assurance, and ultimately assists the person to take more control over life situations

Which child has the greatest risk for being the target of bullying at school?

the child who wears hearing aids

moderate anxiety

the disturbing feeling that something is definitely wrong; the person becomes nervous or agitated

secondary gain

the internal or personal benefits received from others because one is sick, such as attention from family members, comfort measures, and being excused from usual responsibilities or tasks

Mourning

the outward expression of grief. Rituals of mourning include having a wake, sitting Shiva, holding religious ceremonies, and arranging funerals.

primary gain

the relief of anxiety achieved by performing the specific anxiety-driven behavior; the direct external benefits that being sick provides, such as relief of anxiety, conflict, or distress

nurse client contract should include

time place and length of sessions when sessions will terminate who will be involved in the treatment plan client responsibilities nurses responsibilities

A client is admitted with the diagnosis of possible schizophrenia and to rule out (R/O) organic pathology. Based on this information, what treatment will the nurse expect for this client?

to be scheduled for a computerized tomography (CT) of the brain The CT will reveal structural changes in the brain that might be responsible for symptoms of psychosis (e.g., abscess, tumor). Psychological testing may be performed but will be less definitive in ruling out organic pathology. Immunological studies are not indicated. The DST is related to depression. (less)

components of therapeutic relationship

trust genuine interest acceptance positive regard self awareness therapeutic use of self

The nurse is assessing a client who has recently received a diagnosis of posttraumatic stress disorder. When conducting this assessment, the nurse should:

try to identify any strengths or skills that can be applied during recovery.

intimate relationship

two peple who are emotionally committed ti each other. both parties are concerned about having their individual needs met and helping each other to meet needs - may include sexual or emotional intimacy as well as sharing of mutual goals. -evaluation may be ongoing or not. - has no place in the nurse client interaction.

Which of the following statements characterizes the major difference between the typical and atypical antipsychotics medications?

typical antipsychotics most often relieve positive symptoms but do not have a significant impact on negative symptoms. Traditional antipsychotics treat the positive symptoms of schizophrenia (ie, hallucinations and delusions). Atypical antipsychotics relieve both the positive and negative symptoms (eg, apathy, avolition, social withdrawal) of schizophrenia, and are less likely to cause distressing EPSs typically seen with traditional antipsychotics. (less)

Symptoms of Generalized Anxiety Disorder

uneasiness, irritability, muscle tension, fatigue, difficulty thinking, and sleep alterations.

Anticipatory grieving

when people are facing an imminent loff begin to grapple with the very real possibility of the loss or death in the near future

genuine interest

when the nurse is comfortable with her or himself, aware of their strengths and limitations and clearly focused, the client perceives a genuine person showing genuine interest. - nurse should be open and honest and display congruent behavior. nurse must be very selective about personal examples - self disclosure examples are most helpful to client when they represent common day to day experiences.

Clients with borderline personality disorder commonly exhibit which of the following symptoms? Select all that apply.

• Fear of abandonment • History of unstable, insecure attachments • Constant need for reassurance People with borderline personality disorder have an extreme fear of abandonment and a history of unstable and insecure relationships. They constantly seek reassurance and acceptance from others. (less)

After reviewing the different types of personality disorders, a group of nursing students demonstrates understanding when they identify which of the following as being associated with emotional volatility? Select all that apply.

• Histrionic • Narcissistic Personality disorders characterized by emotionally volatility include histrionic and narcissistic personality disorders. Avoidant, dependent and obsessive -compulsive personality disorders are characterized by anxiety and fear.

When reviewing the history of a client with antisocial personality disorder, which of the following would the nurse expect to find? Select all that apply.

• Lack of remorse for actions • Episodes involving scams for personal gain • Repeated incidents involving assaults A client with antisocial personality disorder shows a pervasive pattern of disregard for and violation of the rights of others. History may reveal repeated incidents of physical fights or assaults demonstrating irritability and aggressiveness, repeated failure to sustain consistent work behavior or honor financial obligations, lack of remorse for actions, conning others for personal profit or pleasure, and impulsivity or failing to plan ahead. (less)

A client has vascular neurocognitive disorder. When teaching the family about the cause of this disorder, which would the nurse expect to integrate into the explanation?

Blood flow in the vessels to the brain are blocked.

The geriatrician has prescribed an 80-year-old client donepezil in order to treat the client's dementia, Alzheimer's type. Which teaching points should the nurse provide to the client's spouse about the new medication?

"Donepezil won't cure your spouse's dementia of Alzheimer's type, but it has the potential to slow down the progression of the disease."

A 73-year-old client has been brought to the emergency department by the client's adult children due to abrupt and uncharacteristic changes in behavior, including impairments of memory and judgment. The subsequent history and diagnostic testing have resulted in a diagnosis of delirium. Which teaching point about the client's diagnosis should the nurse provide to the family?

"If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning."

An 80-year-old client with Alzheimer's disease is prescribed donepezil. Which teaching points should the nurse provide to the client's spouse about the new medication?

"The drug won't cure the client's Alzheimer's, but it has the potential to slow down the progression of the disease."

A client diagnosed with Alzheimer's disease says, "I'm so afraid. Where am I? Where is my family?" How should the nurse respond?

"You are in the hospital and you're safe here. Your family will return at 10 o'clock, which is 1 hour from now."

Magnetic Resonance Imaging (MRI)

- A type of body scan, an energy field is created with a huge magnet and radio waves - The energy field is converted to a visual image or scan - Produces MORE detail + contrast than a CT - Can show the size + thickness of brain structures

Neurotransmitters

- Chemical substances manufactured in the neuron that aid in the transmission of information throughout the body - They either excite or stimulate an action in the cells (excitatory) or inhibit or stop an action (inhibitory). - Fit into specific receptor cells embedded in the membrane of the dendrite - After they are released into the synapse + relay the message to the receptor cells, they are either retransported back from the synapse to the axon to be stored for later use (reuptake) or metabolized + inactivated by enzymes, primarily monoamine oxidase (MAO).

Dophamine

- EXCITATORY - A neurotransmitter located primarily in the brain stem, has been found to be involved in the control of COMPLEX MOVEMENTS, motivation, cognition, and regulation of emotional responses - It is generally excititory + is synthesized from tyrosine, a dietary amino acid schizophrenia + parkinson's disease - Antipsychotic medications work by BLOCKING dophamine receptors + reducing dopamine activity - Receptors classified into subcatagories (D1, D2, D3, D4 + D5) - Receptors D2, D3 + D4 have been associated with mental illness

Norepinephrine

- EXCITATORY - Also known as noradrenaline - The MOST prevalent neurotransmitter in the nervous system, is located primarily in the brain stem - Plays a role in changes in attention, learning, memory, SLEEP / WAKEFULNESS + mood regulation - EXCESS has been implicated in anxiety disorders - DEFICITS may contribute to memory loss, social withdraw + depression

Acetylcholine

- EXCITATORY OR INHIBITORY - A neuotransmitter found in the brain, spinal cord + peripheral nervous system, particularly at the neuromuscular junction of skeletal muscle - Can be excitatory orinhibitory - Synthesized from dietary chloine found in red meant + vegetables - Affects the sleep-wake cycle - People with Alzheimer's diseased have DECREASED acetylcholine-secreting neurons - People with Myasthenia Gravis have REDUCED acetylcholine

Psychoimmunology

- Examines the effect of psychosocial stresors on the body's immune system - A compromised immune system could contribute to the development of a variety of illness, particularly in populations already genetically at risk - So far, efforts to link a specific stressor with a specific diseaes hav ebeen unsuccessful

Antipsychotic Drugs

- Formally known as NEUROLEPTICS - Used to treat the symptoms of psychosis - Work by BLOCKING dopamine receptors

Gamma-Aminobutyric Acid

- GABA - Major INHIBITORY neurotrasmitter - Modulates other neurotransmitters - Benzodiazepines (treat anxiety + induce sleep) INCREASE GABA function

Serotonin

- INHIBITORY - A neurotransmitter found ONLY in the brain - Derived from tryptophan, a dietary amino acid - Function is mostly INHIBITORY - Involved in the control of food intake, sleep and wakefulness, temperature regulation, pain control, sexual behavior and regulation of emotions - Plays an important role in anxiety and mood disorders and schizophrenia - Can contribute to the delusions, hallucinations and withdrawn behavior seen in schizophrenia

Cerebellum

- Located below the cerebrum + is the center for the coordination of movements and postural adjustments - Receives + integrates information from all areas of the body

Postinjection Delirium/Sedation Syndrome

- Sedation, confusion, disorientation, agitation+ cognitive impairment that can progress to ataxia, convulsions, weakness + hypertension (which can later lead to cardiac arrest) - Monitor for when giving injections - SERIOUS

Potency

- The AMMOUNT of drug needed to achieve that maximal effect - Lower potency drugs require higher dosages to achieve efficacy, wheras high potency drug achieve efficacy at lower dosages

Half-life

- The time it takes for HALF of the drug to be removed from the bloodstream - Drugs with a shorter half life may need to be given three or four times a day but drugs with a longer half life may be given once a day

Psychoparmacology

- The use of medications to treat mental illness - Directly affect the central nervous system + therefore behavior, perceptions, thinking + emotions

Positron Emission Tomography (PET) + Single Photon Emission Computed Tomography (SPECT)

- Used to examine the FUNCTION of the brain - Radioacvtive substance are injected into the blood; the flow of those substances are injected into he blood; the flow of those substances in the brain is monitored as the client performs cognitive activities as instructed by the operator - Both mostly used for RESEARCH

Antipsychotic Drugs: MECHANISM OF ACTION

- Work by BLOCKING dopamine receptors - D2, D3 + D4 receptors linked with mental illness

7 Principles That Guide Pharmacologic Treatment

1.) A med is selected based on its effect on the client's target symptoms. The med is evaluated by its ability to diminish or eliminate the target symptoms 2.) Many must be given in adequate dosages for a period of time before their full effect is realized 3.) The dosage of med is often adjusted to the lowest effective dosage for the client 4.) As a rule, older adults require lower dosages of meds than younger clients to experience therapeutic effect in older adults. 5.) Psychotropic meds often are decreased dradually (tapering) rather than abruptly. This is because of potential problems with REBOUND recurrence of the original symptoms or WITHDRAW. 6.) Follow up care is essential to ensure compliance with the medication regimen, to make needed adjustments in dosage + to manage side effects 7.) Compliance with the medication regimen often is enhanced when the regimen is as simple as possible in terms of both the number of meds + doses a day

3 Neurobiologic Causes of Mental Illness

1.) Genetics + Heredity 2.) Stress + the Immune Response (Psychoimmunology) 3.) Infection as a Possible Cause

When conducting a nursing assessment of a client experiencing moderate cognitive dysfunction, the nurse can best prepare for an effective interview by ensuring what?

Asking a family member to be present during the assessment

An 80-year-old is brought to the clinic by the client's spouse. The client has a history of peripheral vascular disease and type 2 diabetes. The spouse states that the client hasn't seemed to be normal for the preceding few days, noting that the client has been lethargic and mildly confused at times and has been incontinent of urine. The spouse reports that the client's blood glucose levels have been elevated. The nurse considers which as the most likely explanation for the client's change in mental status?

Delirium related to underlying medical problem

A client with Alzheimer's disease in the intensive treatment unit repeatedly tries to go into other clients' rooms to nap during the day. The most appropriate nursing intervention for this client is what?

Escorting the client to the client's room for napping

A client with amnestic disorder is being evaluated for dementia. Which is a diagnostic characteristic of amnestic disorder?

History and physical examination indicative of memory impairment

Which is the priority when caring for a client with delirium?

Identifying the cause

A nurse is caring for a client with delirium. The client sees a thermometer on the nurse's table and shouts, "Don't stab me!" and cowers. Which feature of delirium is this client exhibiting?

Illusion

Which is the priority intervention for a client diagnosed with delirium?

Maintenance of safety

A client is exhibiting signs of mild delirium such as occasional confusion about why the client is in the hospital and what day of the week it is. When developing a care plan, the nurse identifies several strategies to improve the client's cognitive function. Which intervention will be helpful to the client?

Make up a daily calendar with the date and the times of scheduled activities.

A client with Alzheimer's disease has a nursing diagnosis of risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's care plan to prevent injury?

Remove hazards from the environment.

Which nursing diagnosis would be the priority for the client experiencing acute delirium?

Risk for injury related to confusion and cognitive deficits

Which would be the priority goal for a client with dementia?

Safety

The nurse receives a report that a 75-year-old client is recovering from surgery. During the shift, the nurse notes that the client is forgetful and restless. Several times, the client calls the nurse the name of the client's daughter. The nurse interprets this behavior as what?

Signs of delirium

The client is 42 years old, married, and has two children, ages 16 and 18. The client is also caring for the client's parent, who is in the late stages of Alzheimer's disease. The nurse would want to assess the client for what?

Signs of stress

A client is diagnosed with dementia related to Parkinson's disease. While at a doctor's visit, a cholinesterase inhibitor is prescribed for the client. The nurse knows that this type of medication would be prescribed for the client to do what?

Slow deterioration of memory and function

The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed doing what?

Telling other clients that the client "was a dairy farmer" when the client actually ran a small grocery store

Efficacy

The MAXIMAL therapeutic EFFECT that a drug can achieve

The client has early Alzheimer's disease. When asked about family history, the client relates that the client has two children who are both grown and who visit the client around the holidays each year. The nurse subsequently discovers that the client has one child who is currently assigned overseas and who has not been home for 2 years. Which would best describe the client's behavior?

The client is confabulating, most likely to cover for memory deficit.

An 82-year-old client with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which outcome should the nurse prioritize?

The client will remain free from injury.

A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?

The nurse wants to prevent increasing the client's confusion.

A nurse is caring for a client with delirium. The nurse assesses the client's activities of daily living on a daily basis. What is the most likely reason for assessing these so frequently?

To assess for fluctuation in the client's capabilities

What is the greatest benefit support groups provide to the caregivers of clients diagnosed with dementia?

provides interaction with those with similar concerns

A client was admitted to the intensive care unit after a motor vehicle accident. The client sustained a right parietal injury, resulting in an acute confusional state or delirium. The client reports that there are "bugs crawling around" on the arms. The nurse understands this as:

tactile hallucinations from delirium.

Which client behavior should the nurse attempt to change when managing a client's tendency to wander and pace at night?

take a nap mid afternoon and before dinner

The nurse should consider the intervention referred to as "going along with" when managing the care of which client?

the older widower who is worried about his wife not being able to visit because of the snow