Mental Health Midterm II

A 72-year-old client diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When the healthcare provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact?

The client is at risk for falls

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon?

The client may be at risk for self harm

When the partner of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information?

The rate of bipolar disorder is higher in relatives of people with bipolar disorder.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement?

"Depression is seen in people of all ages, from childhood to old age."

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful?

"I can be successful if I do all the things required to learn the job."

A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression?

"I still feel bad about my sister dying of cancer. I should have done more for her!"

A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement?

"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away."

Which statement would best show acceptance of a depressed, mute client?

"I would like to sit with you for 15 minutes now and again this afternoon."

A 17-year-old client confides to the nurse that they have been thinking of ways to kill a peer. What response should the nurse give when the client states, "you have to keep it a secret because its confidential information"?

"Issues of this kind have to be shared with the treatment team and your parents."

Which criterion is NOT essential when the nurse plans nursing interventions designed to meet a specific goal?

Economical

The nurse is planning care for a 14-year-old. The nurse demonstrates an understanding of the developmental task appropriate for this client by providing which experience?

Encouraging them to talk about their school plans to help achieve identity

What is the first-line drug used to treat mania?

Lithium Carbonate

The nurse is working with a client experiencing depression stemming from low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially what is the nurse's priority?

Making the client feel physically and emotionally safe

Role-playing is associated with which type of psychotherapy?

Modeling

Selective inattention is first noted when experiencing which level of anxiety?

Moderate

Beck's cognitive theory suggests that the etiology of depression is related to what factor?

Negative processing of information

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior?

No pleasure from previously enjoyed activities

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all that apply.)

Obesity Insulin Resistance

The mental status examination aids in the collection of what type of data?

Objective

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching?

Onset of action is from 1 to 3 weeks or longer.

Delusionary thinking is a characteristic of which form of anxiety?

Panic level anxiety

The relaxation response calls upon the initiation of what process?

Parasympathetic activation

Jacob, a college student whose friend recently committed suicide, rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism?

Perception

What three structural components comprise a nursing diagnosis?

Problem, probable cause, supporting data

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term?

Psychomotor agitation

When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior?

Rapid-cycling

What are the physiologic responses associated with successful guided imagery? Select all that apply.

Reduction of obsessive thoughts reduction in anxiety improved sleep patterns

The client's priority nursing diagnosis has been established as risk for self-directed violence: suicide related to multiple losses. What is the priority outcome for this client?

Refrain from attempting suicide.

Which nursing intervention demonstrates the theory behind operant conditioning?

Rewarding the client with a token for avoiding an argument with another client. operant conditioning utilizes positive reinforcement.

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment?

Risk for injury/suicide

Which client problem would be most suited to the use of interpersonal therapy?

Dysfunctional grieving

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response?

Learned helplessness

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year?

Life-Changing Event Questionnaire

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response?

"Let's look at what you just said that you can 'never do anything right.'"

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question?

"Stressors are events that happen that threaten your current functioning and require you to adapt."

Which response should the nurse provide a client who asks, "Why you need to conduct an assessment interview"?

"We will be able to form a relationship together where we can discuss the current problems and come up with goals and a plan for treatment."

A cognitive therapist would help a client restructure the thought "I am stupid!" to which statement?

"What I did was stupid."

The nurse best assesses the client's spiritual life by asking which question?

"What role does religion play in your life?"

A 26-year-old client is brought to the emergency room by a friend. The client is unable to give any coherent history. Which response should the nurse provide when the client's friend offers to provide information regarding the client?

"Yes, I will be happy to get any information and history that you can provide."

A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4).

1. Risk for injury 2. Self-care deficit, bathing, and hygiene 3. Knowledge deficient 4. Nonadherence

Which client behavior illustrates eustress?

A bride is planning for her wedding.

How does Harry Stack Sullivan's Interpersonal Theory view anxiety?

A painful emotion arising from social insecurity.

Which room placement would be best for a client experiencing a manic episode?

A single room near the nurses' station

The nurse is conducting an admission interview with a client who was raped 2 weeks ago. When asked about the rape, the client becomes very anxious and upset and begins to sob. What should be the nurse's response to the client's reaction?

Acknowledge that the topic of the rape is upsetting and reassure the client that it can be discussed at another time when she feels more comfortable.

What is a desired outcome for the maintenance phase of treatment for a manic client?

Adhere to follow-up medical appointments.

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder?

Adult separation anxiety disorder

According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory?

All memories

A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact?

Amitriptyline, which is a TCA is lethal in overdose

Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority?

Assessing the client for strengths upon which a nurse-client relationship can be based

A nurse is about to interview an older client whose glasses and hearing aid were placed in the bedside drawer for safe keeping. Before beginning the interview, which nursing intervention that will best facilitate data collection?

Assist the client in putting on glasses and hearing aid.

Dysthymia cannot be diagnosed unless it has existed for what period of time?

At least 2 years

What is the premise underlying behavioral therapy?

Behavior is learned and can be modified.

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex?

Blood glucose levels

The nurse providing anticipatory operant conditioning guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by which intervention?

Ignoring the tantrum and giving attention when the child acts appropriately

The nurse is caring for a client on day 1 post-surgical procedure. The client becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the client's actions?

Call for staff help and assess the client's vital signs.

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics?

Colorful and inappropriate

What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period?

Cyclothymia

Which medication is FDA approved for treatment of anxiety in children?

Duloxetine

A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the client and the family to recognize possible signs of impending mania?

Decreased Sleep

Freud believed that individuals cope with anxiety by implementing which mechanism?

Defense mechanisms

What statement about the comorbidity of depression is accurate?

Depression is commonly seen in individuals with medical disorders.

Which of the following describe the symptoms of the manic phase of bipolar disorder? (Select all that apply.)

Distractibility Excess energy Racing thoughts Purposeless movements Pressured speech

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior?

Distracting the client by suggesting, "It's time to work on your art project."

The nurse is providing teaching to a preoperative client just before surgery. The client is becoming more and more anxious and begins to report dizziness and heart pounding. The client also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make?

Do not attempt any further teaching at this time.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. What information should the nurse provide the client regarding this practice?

Explain the high possibility of an adverse reaction.

What is the major distinction between fear and anxiety?

Fear is a response to a specific danger; anxiety is a response to an unknown danger.

The first stage of the general adaptation syndrome (GAS) can be characterized by which response?

Fight or flight

Which side effects of lithium can be expected at therapeutic levels?

Fine hand tremor and polyuria

A client prescribed a monoamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, what can the client safely eat?

Fruit and cottage cheese plate

Which behavior would be characteristic of a client during a manic episode?

Going rapidly from one activity to another

A 31-year-old client admitted with acute mania tells the staff and the other clients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior?

Grandiosity

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior?

Grandiosity

Which approach to reducing client stress is most effective for children experiencing postoperative pain?

Guided imagery

Consider both Sullivan's term security operations and Freud's term defense mechanisms. Which statement suggests that the client's specialized treatment goal has been successfully met?

I'm experiencing much less anxiety about school now

Which nursing diagnosis for a psychiatric client is correctly structured and worded?

Imbalanced nutrition: less than body requirements related to poor self-concept as evidenced by reporting "I'm not worthy of eating"

A nurse expresses an exclusive belief in the biological model for mental illness when stating "it's the only one I really believe." What conclusion should be drawn from this statement?

In believing only in the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

What principle forms the basis of nursing outcome planning?

Individuals have the right to outcomes that is reflective of their abilities.

What would a client experience during a progressive relaxation session?

Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed

Which tool can the novice nurse might refer to when writing nursing outcomes?

International Classification for Nursing Practice (ICNP)

The nurse is caring for an adult client who experienced severe physical abuse from the age of 2 through 12. What information should the nurse provide the client concerning the function of the "id" and the ability to function as an adult?

It is the source of one's survival instincts.

A nurse is providing care to a 28-year-old client diagnosed with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, the nurse should identify which client symptom as having priority?

Lack of Sleep

A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept?

Schema, which is a unique assumption we make about ourself.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic?

Self-deprecating ideation

Which theorist is associated with behavioral therapy?

Skinner

A 43-year-old client being seen in the mental health clinic states, "I have always been a practicing Jew, but in the past few months I am questioning everything. I just don't know if I believe in it anymore." Which of the following nursing diagnoses best describes the client's comment?

Spiritual Distress

What is the major reason for the hospitalization of a depressed client?

Suicidal Ideation

Which of the following is true of the relationship between bipolar disorder and suicide?

Suicide is a serious risk those diagnosed with bipolar disorder commit suicide.

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client?

Talking with friends and attending a loss support group

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention?

Waiting quietly for the client to reply

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L?

Withhold medication and notify the physician.

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention?

Writing in a diary

A client diagnosed with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes this technique?

biofeedback

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique?

cognitive reframing

What is the primary source for data collection during a psychiatric nursing assessment?

client's own words and actions

What stress-reduction technique should a nurse teach an individual experiencing severe performance anxiety?

deep breathing

Meditation is successful in promoting stress reduction because it brings about which outcome?

quiets the sympathetic nervous system

When a hyperactive manic client expresses the intent to strike another client, what is the initial nursing intervention?

set verbal limits

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form?

social support

When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication?

take with meals

What factor exerts the greatest influence on the degree to which various life events upset a specific individual?

the individuals perception of the event