Mental Health Final

voyerism

"peeping tom". repetitive urge to observe unsuspecting persons who are naked, undressing or engaging in sexual relations (males before age 15; lack of social skills)

At the admission interview, the father of a 4yo boy with ADHD says to the nurse, "I know that my wife or I must have caused this disease." What is the nurse's best response? 1. "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder." 2. "What do you think you might have done that could have led you to causing this disorder to develop in your son?" 3. "Many parents feel this way, but I doubt there's anything that you did that caused ADHD to develop in your child." 4. "Let's not focus on the cause but rather on what needs to be done to help you son get better. I know that you and your wife are very interested in helping him to improve his behavior."

1. "ADHD is more common within families, but there is no evidence that problems with parenting cause this disorder."

The nurse meets with the mother of a child diagnosed with ADHD. The mother states, "I feel so guilty that he has this disease, like I did something wrong. I feel like I need to be with him constantly in order for him to get better. But still sometimes I feel like I'm going to lose control and hurt him." The nurse should suggest which intervention to the mother? 1. Arranging for respite care to watch her child and give herself a regular break 2. Taking a job to allow herself to feel some success because her child will not ever improve 3. Arranging to have coffee with friends daily as a way to begin a support group 4. Considering foster care if she feels that she cannot handle her child's problems

1. Arranging for respite care to watch her child and give herself a regular break

A client who is admitted to the adult unit of a mental health care facility with depression tells the nurse that he has pedophilia. What should the nurse do? 1. Be aware of personal opinions and views. 2. Recognize that because the client is depressed, the client will not be able to discuss pedophilia. 3. Ensure that the client is never alone with other clients on the unit. 4. Refer the client to group therapy.

1. Be aware of personal opinions and views.

A parent of a child diagnosed with ADHD is talking to the nurse about her son's condition. The parent states the methylphenidate controls his symptoms but is causing him to loose weight. He is difficult to wake and get ready for school unless he gets the medication as soon as he wakes up. He does not eat breakfast and very little lunch. He eats an average dinner. He has lost 3 lb in 2 weeks. Which action should the nurse suggest first? 1. Eat a breakfast bar, banana, and milk at the bedside every am at the same time he takes his medication 2. Monitor weight closely for a month since he will likely stop loosing weight when school ends in 2 weeks 3. Suggest a change of medication to a non-stimulant drug that will treat without causing appetite decrease 4. Suggest a supplement such as high protein or other food to increase his caloric intake

1. Eat a breakfast bar, banana, and milk at the bedside every am at the same time he takes his medication to ensure intake before symptoms of medication set in

The nurse manager of a psychiatric unit notices that one of the nurses commonly avoids a 75yo client's company. Which factor should the nurse manger identify as being the most likely cause of the nurse's discomfort with older clients? 1. Fears and conflicts about aging 2. Dislike of physical contact with older people 3. A desire to be surrounded by beauty and youth 4. Recent experiences with her mother's older adult friends

1. Fears and conflicts about aging

The nurse is managing the care for a client in a disaster shelter who broke a femur and has lost her family home in a hurricane. What measures should the nurse take? Select all that apply. 1. Supervise the care provided to the client during crisis 2. Obtain a prescription for an anti psychotic medications for the client 3. Act as a client advocate for the client in crisis. 4. Discuss with the interdisciplinary team available community resources for the client 5. Obtain accurate identification including name, age, contact info, and names of relatives

1. Supervise the care provided to the client during crisis 3. Act as a client advocate for the client in crisis. 4. Discuss with the interdisciplinary team available community resources for the client 5. Obtain accurate identification including name, age, contact info, and names of relatives

Despite education and role play practice of restraint procedures, a staff member is injured when actually restraining a client. When helping the uninjured staff deal with the incident, the nurse should address which factor? 1. The emotional responses may be similar to those of other crime victims 2. The member is likely to resign after experiencing such an injury 3 Legal action against the client will take time and energy 4. The member must debrief with the assaultive client before returning.

1. The emotional responses may be similar to those of other crime victims

A child is being seen at the clinic for ADHD assessment. What symptoms would the nurse expect to find? SATA 1. excessive climbing and running 2. excessive fidgeting 3. pouting behaviors 4. cannot wait to take turns 5. easily distracted

1. excessive climbing and running 2. excessive fidgeting 4. cannot wait to take turns 5. easily distracted

A school age client is diagnosed with conduct disorder. After admission, the nurse identifies his problematic behaviors as cruelty to animals, stealing, truancy, aggression with peers, lying, and explosive angry outbursts resulting in destruction of property. The nurse is now talking with the client about his behavioral contract, which should include which components. 1. taking prescribed medications 2. acceptable methods for expressing anger 3. consequences for unacceptable behaviors 4. rules for interacting with staff and other clients 5. personal possessions allowed on the unit

1. taking prescribed medications 2. acceptable methods for expressing anger 3. consequences for unacceptable behaviors 4. rules for interacting with staff and other clients

An older adult client is admitted and diagnosed with delirium. Later in the day, he tries to get out of the locked unit. He yells, "Unlock the door. I've got to go see my doctor. I just can't miss my monthly Friday appointment." Which of the following responses by the nurse is the most appropriate? 1. "Please come away from the door. I'll show you to your room." 2. "It's 5 o'clock Tuesday and you're in the hospital. I'm Pat, a nurse." 3. "The door is locked to keep you from getting lost." 4. "I want you to come eat your lunch before you go to your appointment."

2. "It's 5 o'clock Tuesday and you're in the hospital. I'm Pat, a nurse."

The mother of an adolescent client who is diagnosed with oppositional defiant disorder tells the nurse that she has read extensively on the disorder and does not believe it is correct for her daughter. Which response by the nurse is appropriate? 1. "'It sounds like you're very interested in your daughter. Let's focus on what is best for her." 2. "Tell me what you've found in your reading that's leading you to that conclusion." 3. "Your health care provider has had many years of education and experience, so you can believe he is right." 4. "That doesn't matter now because we just need to help her get better."

2. "Tell me what you've found in your reading that's leading you to that conclusion."

When communicating with a client who speaks a different language, which best practice should the nurse implement? 1. Speak loudly and slowly. 2. Arrange for an interpreter to translate. 3. Speak to the client and family together. 4. Stand close to the client and speak loudly.

2. Arrange for an interpreter to translate.

The nurse is leading a group session for parents of children diagnosed with oppositional defiant disorder. The nurse should give which recommendation for discipline? 1. Avoid limiting the child's use of the television and computer for punishment. 2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration. 3. Use primarily positive reinforcement for good behavior while ignoring any demonstrated bad behavior. 4. Use time out as the primary means of punishment for the child regardless of what the child has done.

2. Be consistent with discipline while assisting with ways for the child to more positively express anger and frustration.

A nurse calls the unit manager to report that her purse has been stolen from the locked break room. The nurse says she thinks she knows which of the staff stole the purse. Which actions by the nurse manager would be appropriate? Select all that apply. 1. Confront the person the nurse suspects 2. Call hospital security to initiate an investigation 3. Ask the nurse to document all the facts related to the incident 4. Alert nursing admin that a staff's purse has been stolen 5. Ask other staff to report any suspicious activity they may have observed.

2. Call hospital security to initiate an investigation 3. Ask the nurse to document all the facts related to the incident 4. Alert nursing admin that a staff's purse has been stolen 5. Ask other staff to report any suspicious activity they may have observed.

After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time and she feels better able to cope with the needs of her husband and children. How should the nurse begin the discussion with the client? 1. Tell the client this is a bad decision that she will regret in the future 2. Find out more about the client's rationale for her decision to stop treatment. 3. Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later. 4. Remind the client of her duty to protect her children by continuing treatment.

2. Find out more information

What should be charted by the nurse when the client has an involuntary commitment or formal admission status? 1. Nothing should be charted. The forms are in the chart. No need to duplicate. 2. The client's receipt of information about status and rights should be charted. 3. The client's willingness to cooperate with seclusion should be charted. 4. The name of the Health care provider officially signing the certificates should be charted.

2. The client's receipt of information about status and rights should be charted.

A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, "He did not really mean to hurt me, but I hate for the kids to see this. I am so worried about them." What is the most crucial information for the nurse to determine? 1. Type and extend of abuse occurring in the family 2. Potential of immediate danger to the client and children 3. Resources available to the client 4. Whether the client wants to be separated from her husband

2. always assess safety first

A nurse plans care for an older adult client with cognitive impairment who is still living at home. Which action should the nurse identify as a priority for safety in planning care for this client? 1. Having 2 people accompany the client whenever the client is up and about 2. ensuring the removal of objects in the client's path that may cause him to trip 3. putting the client's favorite belongings in a safe place so that he will not lose them 4. giving the client his medications in liquid form to make certain that he swallows them

2. ensuring the removal of objects in the client's path that may cause him to trip

As an angry client becomes more agitated while talking about problems, the nurse decides to ask the staff assistance in taking control of the situation when the client demonstrates which behavior? 1. swearing about a spouse's behaviors when discussing marital problems 2. picking up a pool cue stick and telling the nurse to get out of the way 3. making a fist and pounding loudly on the table 4. coming out of the room instead of staying in time out

2. picking up a pool cue stick and telling the nurse to get out of the way

A couple informs the nurse that they have been having "intimacy problems". What is the most appropriate response by the nurse? 1. "I can refer you to a therapist." 2. "I need to obtain your admission history first." 3. "I am available to hear your concerns." 4. "Let me refer you to a marriage counselor."

3. "I am available to hear your concerns."

The nurse observes a client in a group who is reminiscing about his past. Which effect should the nurse expect reminiscing to have on the client's functioning in the hospital? 1. Increase the client's confusion and disorientation 2. Cause the client to become sad 3. Decrease the client's feelings of isolation and loneliness 4. Keep the client from participating in therapeutic activities

3. Decrease the client's feelings of isolation and loneliness

When caring for the client diagnosed with delirium, the nurse should investigate which condition as the most important? 1. Cancer of any kind 2. Impaired hearing 3. Prescription drug intoxication 4. Heart Failure

3. Prescription drug intoxication

What is a realistic short term goal to be accomplished in 2 to 3 days for a client with delirium? 1. Explain the experience of having delirium 2. Resume a normal sleep wake cycle 3. Regain orientation to time and place 4. Establish normal bowel and bladder function

3. Regain orientation to time and place

Which observation by the nurse should suggest that a 15 month old toddler has been abused? 1. The child appears happy when personnel work with him. 2. The child plays alongside others contentedly. 3. The child is underdeveloped for his age. 4. The child sucks his thumb.

3. The child is underdeveloped for his age

A client is being discharged before complete stabilization of symptoms. When developing a discharge plan for this client, the nurse should ensure that the client will have which factor in place? 1. more medical consultations after discharge 2. monthly outpatient visits 3. many coordinated services 4. a caring and supportive family

3. many coordinated services

A client was experiencing marital discord with a spouse of 4 years. When the spouse walked out, the client became angry and began to throw things and break dishes. A friend talked the client into seeking help at the local mental health center. Which of these questions should the nurse ask initially to begin assess this client's immediate problem? 1. "Do you feel in control of yourself at this time?" 2. "What did you do to cause your spouse to leave?" 3. "In hindsight, how might you have manged this situation differently?" 4. "What led you to come in for help today?"

4. "What led you to come in for help today?"

The nurse is planning care for a group of clients. Which client should the nurse identify as needing the most assistance in accepting being ill? 1. An 8yo boy who alternatively cries for his mother and is angry with the nurse about being hospitalized after a bike accident 2. A 32yo woman diagnosed with depression related to lupus who discusses her medications adverse effects with the nurse 3. A 45yo man who just suffered a severe MI and talks to the nurse about concerns regarding resuming physical activity 4. A 60yo woman diagnosed with COPD who refuses to wear an oxygen mask even though poor oxygenation makes her confused

4. A 60 yo woman diagnosed with COPD who refuses to wear an oxygen mask even though poor oxygenation makes her confused

The parent of a school age child tells the nurse that "For most of the year, my husband was unemployed and I worked a second job. Twice I spanked my son repeatedly when he refused to obey. It hasn't happened again. Our family is back to normal." After assessing the family, the nurse decides the child is still at risk for abuse. Which observation best supports this conclusion? 1. The parents say they are taking away privileges when their son refuses to obey. 2. The child has talked about family activities with the nurse. 3. The parents are less negative toward the nurse. 4. The client wears long-sleeved shirts and long pants, even in warm weather.

4. Avoidance and hiding anything implies there is something to hide

An older adult experiences short term memory problems and occasional disorientation a few week's after her husband's death. She also is not sleeping, has urinary frequency and burning, and the woman's health care provider to discuss the client's situation and background, assess, and give recommendations. The nurse concludes that the client most likely has which problem? 1. Onset of Alzheimers 2. Trouble adjusting to living alone without her husband 3. Delayed grieving related to Alzheimers 4. Delirium and a UTI

4. Delirium and a UTI

The nurse is planning care for a client admitted for vascular dementia. Which action is most appropriate in assisting the client with activities of daily living? 1. Perform activities for the client during hospitalization 2. Document all activities the nurse expects the client to complete during the shift. 3. Inform the client that if morning care is not completed by 0830 hours, the UAP will complete it. 4. Encourage the client to complete as many activities as possible, and provide ample time to complete them.

4. Encourage the client to complete as many activities as possible, and provide ample time to complete them.

When planning the care for a client who is being abused, which measure is most important to include? 1. Being compassionate and empathetic 2. Teaching the client about abuse and the cycle of violence 3. Explaining to the client about their personal and legal rights 4. Helping the client develop a safety plan

4. Safety

Based on a client's history of violence toward others and inability to cope with anger, what should the nurse use as the most important indicator of goal achievement before discharge? 1. Acknowledgment of the client's angry feelings 2. Ability to describe situations that provoke angry feelings 3. Development of a list of how anger has been handled in the past 4. Verbalization of feelings in an appropriate manner

4. Verbalization of feelings in an appropriate manner

adventitious crisis

A major natural or man-made disaster or a crime of violence

nuclear family

A married couple and their unmarried children living together.

maturational crisis

A normal state in growth and development in which a specific maturational task must be learned but old coping mechanisms are no longer adequate or acceptable.

power of attorney for health care

A person designated by the patient to make health care decisions for the patient if the patient becomes unable to make his or her own decisions.

A patient in good health and without any major health needs says, "I want to try some techniques to improve my mental and physical well-being but I'm overwhelmed by all the suggestions on the Internet." Which techniques would be appropriate for the nurse to suggest? (Select all that apply.) a. Yoga b. Exercise c. Meditation d. Aromatherapy e. Acupuncture f. Spinal manipulation

A, B, C, D

A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions

A. Taking over

A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

C. Extended family living arrangements are common in some cultures.

A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged.

C. The boundaries are enmeshed.

What would a nurse expect to find in an assessment of a healthy family? A. Change is viewed as detrimental to the family. B. There is a passive response to most stressors. C. The structure is flexible enough to adapt to crises. D. Minimum influence is being exerted on the environment.

C. The structure is flexible enough to adapt to crises.

CRISIS

CRISIS

CULTURE

CULTURE

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

D. The mother is using double-bind communication.

symptoms of ADHD

Difficulty concentrating, sitting still, paying attention, staying organized, following instructions, remembering details, and/or controlling impulses. low frustration tolerance, temper outbursts, labile moods, poor school performance, peer rejection, and low self esteem

psychosocial assessment of older adult

Do they have support? Have you built rapport? Are they feeling isolated? Self-care (activity? feeling isolated?)?

Also called "flashers", _______ is characterized by recurrence of intense sexual urges and arousing fantasies involving exposure of ones genitals to an unsuspecting stranger

Exhibitionism

situational crisis

External sources such as a job change, motor vehicle crash, death, or severe illness provoke situational crises.

FAMILY

FAMILY

What to do if we expect someone is experiencing crisis

FIRST assess patient's potential for suicide then assess (1) the patient's perception of the precipitating event, (2) the patient's situational supports, (3) the patient's personal coping skills

Recurrent, intense sexual urges and fantasies involving touching and rubbing against a non-consenting person (likely attempted in a public place such as a crowded subway or train station where the perpetrator cannot be caught)

Frotteurism

IMPULSE CONTROL

IMPULSE CONTROL

INTEGRATIVE HEALTH

INTEGRATIVE HEALTH

Clinical picture of delirium

Inability to direct, focus, sustain and shift attention an abrupt onset clinical features fluctuate with periods of lucidity disorganised thinking and poor executive functioning Others: Disoriented to time and place, anxiety, agitation, poor memory, delusional thinking

NEURO FOR CHILDREN

NEURO FOR CHILDREN

NEUROCOGNITIVE

NEUROCOGNITIVE

Needs of Older Adult

Needs of Older Adult

difference between conduct disorder and ODD

ODD may become conduct disorder in later years conduct disorder may be a precursor to antisocial personality disorder

cohabitating family

One or more children living with a biological or adoptive parent and that parent's cohabitating partner

unmarried biological or adoptive family

One or more children who live with two parents who are not married to each other and are biological or adoptive parents to all children in the family

When collaborating with the health care provider to develop the plan of care for a child diagnosed with ADHD, the treatment plan will likely include which treatments? 1. Anti-anxiety medications such as buspirone and homeschooling 2. Antidepressant medications such as imipramine and family therapy 3. Anti-convulsant medications such as carbamazepine and monthly blood levels 4. Psychostimulant medications such as methylphenidate and behavior modification

Psycho-stimulant medications such as methylphenidate and behavior modification

SEXUAL DYSFUNCTION

SEXUAL DYSFUNCTION

An older client is seen in the clinic for a physical examination. Laboratory studies reveal that the hemoglobin and hematocrit levels are low, indicating the need for further diagnostic studies and a blood transfusion. The client is a Jehovah's Witness and refuses to have a blood transfusion. The nurse should take which most appropriate action?

Support the client's decision not to receive a blood transfusion.

VIOLENCE AND ABUSE

VIOLENCE AND ABUSE

Also called "peeping Toms", _______ is characterized by months of recurrent sexual urges and fantasies involving the act of observing an unsuspecting person...

Voyeurism

crisis

a major disturbance caused by a stressful event or threat, which disrupts homeostasis

Oppositional Defiant Disorder (ODD)

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months and exhibited during interaction with at least one individual who is not a sibling

Conduct Disorder

a persistent pattern of behavior marked by violation of the basic rights of others or major age-appropriate social norms or rules the behavior is usually abnormally aggressive and can frequently lead to destruction of property or physical injury

The nurse notes that the client's grandmother is looked to for input whenever questions arise about the client's care choices. Which cultural specific will guide the nurse's plan of care? a. Communication b. Social organization c. Environmental control d. Biologic variations

b. Social organization

The charge nurse of a unit tries, as a rule, to admit Hispanic clients to a room at the end of the hall so that "the noise from the family will not disturb others." This nurse is exhibiting a. Racism b. Prejudice c. Discrimination d. Sexism

c. Discrimination

blended family

child(ren) living with one biological/adoptive parent and that parent's spouse

conduct disorder child onset vs adolescent

childhood onset has worse prognosis and is more common in males Adolescent onset is equally common in both genders

single-parent family

children living with a single adult

extended family

children living with at least one biological/adoptive parent and at least one related non-parent adult

It is important for the nurse to understand the structure of the client's family so that he/she a. Can address the various family members correctly b. Can tailor visiting hours to the family's needs c. Can avoid embarrassing moments during client interventions d.Can develop a holistic plan that includes the whole family

d.Can develop a holistic plan that includes the whole family

techniques for interviewing: ask about often overlooked problems such as... (DDDIFL)

difficulty sleeping depression dizziness incontinence falling loss of energy

Factors that may contribute to female orgasmic disorder

fears of pregnancy rejection loss of control hostility toward or from men cultural/societal restrictions

apraxia

inability to perform particular purposive actions, as a result of brain damage. may need repeated instructions and directions to perform the simplest tasks

agnosia

inability to recognize familiar objects or people

aphasia

inability to speak

whats ADHD?

inappropriate degree of inattention, impulsiveness, and hyperactivity, present in two different settings

Side effects of Stimulants for ADHD

insomnia, appetite suppression, headache, abdominal pain, and lethargy

Exhibitionism

intentional display of the genitals in a public place

most cases of anorgasmia are ___ rather than acquired

lifelong

Clinical picture of dementia (alzheimers)

memory loss that interferes with one's ADLs progressive deterioration of cognitive abilities including problem solving and new learning, emotional changes such as anxiety, mood lability, and depression neurological changes that produce hallucinations and delusions

2 most common meds for ADHD

methylphenidate and mixed amphetamine salts

"other" family

one or more children living with related or unrelated adults who are not biological or adoptive parents. This includes children living with grandparents and foster families

techniques for interviewing: timing

pace that allows client to formulate answers avoid interrupting by allowing a pause in conversation

agism

prejudice or discrimination on the basis of a person's age

female orgasmic disorder

recurrent delay in, or absence of, orgasm after a normal sexual excitement phase

frotteuristic disorder

rubbing or touching a nonconsenting person often in a busy public place

techniques for interviewing: a request such as "___________________" often provides important information

tell me about how you spend your days

pharmacological safety for the older adult

what medications are they taking and do they understand their effects?

techniques for interviewing: use ________________ questions

yes or no

children are most likely to be abused at what ages

younger than 4 adolescents are abused at least as often as children, but rates are commonly underestimated