Mental Health

A family brings a parent to the physician's office to discuss the parent's decline in cognitive status. The family states that the parent is forgetful and needs reminders to be able to live alone. Following assessment, which stage of Alzheimer disease does the nurse anticipate?

Mild cognitive impairment

The nurse is teaching the family of clients with Alzheimer disease about the disease process. The nurse is using a picture of the brain and highlighting which structures?

Neurofibrillary tangles and amyloid plaques

A patient with major depression has been placed on phenelzine. The nurse is instructing on dietary practices. Which food selection would be omitted from the diet?

Spinach and feta salad

A client with bipolar disorder has a Bathing/Hygiene Self-Care Deficit related to decreased attention and concentration. Which of the following nursing interventions would address this problem?

Spread uncompleted hygiene tasks throughout remainder of the day.

The client asks the nurse if there is a diagnostic test that confirms the diagnosis of Alzheimer disease. Which response by the nurse identifies how the diagnosis is confirmed?

"Alzheimer disease is confirmed by validating mental decline and ruling out other diseases."

A 25-year-old woman tells the nurse that she has been worried and tearful lately because of pressures at work. She states, "My boyfriend tells me that it's 'stress' and 'anxiety,' but doesn't everyone have that? What is anxiety anyway?" Which of the following responses gives the best information about the nature of anxiety?

"Anxiety is a sense of psychological distress."

A client has gained 100 lb over the past 20 years, and wants to lose weight. What strategy will greatly contribute to this client's success?

A sensible weight loss regimen prescribed by a dietitian

What does desensitization refer to?

A systematic way to replace a panic response with a relaxation response.

One approach to establish adequate eating patterns for a client with anorexia is to assume a positive expectation of the client. Which is the best statement by the nurse?

"I will sit here quietly with you while you eat."

The geriatrician has begun an 80-year-old female client on donepezil (Aricept) in order to treat her dementia of Alzheimer's type (DAT). 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."

The parents are struggling with the idea their child has anorexia and comment that the child "often eats large quantities of food." Which statement by the nurse best supports the diagnosis?

"Cycles of self-starvation, binging, purging, and exercising are common."

A client who attempted suicide 5 years ago is brought to the emergency department (ED) by a friend. The client states, "I just don't feel like living anymore. No one would care if I lived or died." What question should the nurse ask next?

"Do you have a plan for suicide at this time?"

The nurse is caring for a client who is concerned about having the beginning symptoms of Alzheimer disease. Which question is helpful in determining risk factors?

"Do you have any family with Alzheimer disease?"

The nurse is providing education via phone to a client who called stating that the newly prescribed imipramine (Tofranil) is not working as depression is still a problem. Which question is most important to ask first?

"How long have you been taking the medication?"

At 1 am, the client with mania rushes to the nurses' station and demands that the psychiatrist come to the unit now to write an order for a pass to go home. Which response by the nurse would be the most therapeutic?

"I can't call the psychiatrist now, but you and I can talk about your request for a pass."

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which comment indicates that the client may be suffering from anorexia nervosa?

"I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls."

A client diagnosed with panic disorder with agoraphobia is talking with the nurse about the progress made in treatment. Which statement indicates a positive client response?

"I went to the mall with my friend last Saturday."

One week ago, the client was prescribed Buspirone (Buspar) for anxiety. The client phones the office and reports the medication has not eliminated the symptoms. Which is the best response by the nurse?

"It may take up to 4 weeks for full therapeutic response."

A client with mania is demonstrating hypersexual behavior: blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which of the following interventions is indicated at this time?

"Let's go to the conference room and talk for a while."

A client has recently lost her spouse and has been experiencing depression as a result. Which of the following statements from the nurse about the client's condition is most accurate?

"Usually, the kind of depression you are experiencing resolves with time."

A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young woman who has been diagnosed with anorexia nervosa. Which of the following assessment questions is most therapeutic?

"What do you think about how much you weigh right now?"

A client with schizophrenia is reluctant to take his prescribed oral medication. The most therapeutic response by the nurse to this refusal is:

"What is it about the medicine that you don't like?"

The family of a client with Alzheimer's dementia who is admitted to a psychiatric unit awaiting placement to a long-term care facility indicates to the nurse an understanding of the prognosis when they state:

"What supports are available for the long term?"

According to the National Institute of Aging, how many stages are typical of the progression of Alzheimer's disease?

3

An employee left work suddenly due to experiencing palpitations, a smothering sensation, and light-headedness. This individual was due to meet with a supervisor for an important meeting later in the day. This person is most likely experiencing:

A panic attack

Which factor should the nurse be most concerned about when caring for a client taking an antianxiety medication?

Abrupt withdrawal

The nurse is relating medication classifications for Alzheimer type dementia to the path physiology of the disease process. Which neurotransmitter do most the medications on the market currently impact?

Acetylcholine

A client is scheduled for magnetic resonance imaging (MRI) of the head and neck. Which action by the nurse would be most helpful in calming the anxious client?

Allow the client to express fears and concerns.

Which of the following is the result of progressive deterioration of the brain?

Alzheimer's disease

The nurse is differentiating between anorexia and bulimia. What clinical manifestation would correlate with anorexia?

Amenorrhea

During the initial interview, a schizophrenic client states to the nurse, "I don't enjoy things anymore. I used to love to read mystery books, but even that isn't enjoyable now." The nurse correctly identifies the client is experiencing which of the following conditions?

Anhedonia

A client is being seen in the health clinic. During the nursing assessment, the client states that she has amenorrhea for the last 6 months. She weighs 80 pounds and is 5'2" tall. She states that she usually eats salads so that she does not gain weight. The nurse suspects that the client most likely has:

Anorexia nervosa

Which medication classification is given to counteract extrapyramidal symptoms (EPS)?

Anticholinergics

Implementation of the nursing treatment plan for the client with bulimia may include which of the following?

Increasing coping skills for anxiety

What is another name for the drug classification known as minor tranquilizers?

Anxiolytics

The nurse is caring for an 18-year-old gymnast who has been admitted for investigation of seizures. She weighs 50 kg. For two meals, the nurse observes that she eats a very small amount of salad and skim milk. What approach would you take?

Ask her about her appetite, reasons for her low intake and her usual eating patterns.

The nurse is caring for a patient who is taking amitriptyline for depression. What nursing intervention would be most appropriate if this patient developed orthostatic hypotension?

Ask the patient to sit on the side of the bed for 1 minute before getting up

Which of the following nursing diagnoses would be of highest priority for a client diagnosed with advanced Alzheimer disease?

Aspiration Risk

A 40-year-old man has been prescribed fluoxetine. The client states he has not continued the prescribed therapy even though his depression improved. What assessment is most important for the nurse to make?

Assess for sexual dysfunction

It is important for a nurse not to argue about the validity of a schizophrenic client's delusions or try and convince him or her that they are wrong because clients may:

Become more fixated on their delusions.

The nurse understands that a client with an eating disorder will eat outside the range of normal. Which is the primary reason that eating disorders remain underreported?

Behaviors are kept secret.

A college student has been referred to the college clinic for evaluation for anorexia nervosa. The nursing assessment to substantiate this disorder should include what?

Body weight significantly below ideal for her height and age

An adolescent client is being admitted to the psychiatric unit for treatment of an eating disorder. Her admission interview reveals a history of recurrent episodes of binge eating and self-induced vomiting. The nurse recognizes these as symptoms of what disease?

Bulimia nervosa

Which nursing action is most helpful in managing the positive symptoms of schizophrenia?

Medication administration

When teaching a client with generalized anxiety disorder, the nurse instructs the client to avoid which of the following?

Caffeine

To elevate mood for a client with depression, the nurse should recommend high intake of:

Carbohydrates

A nurse is caring for a newly admitted client to the emergency department. The nurse obtains the following vital signs: temperature,101.6°F;pulse rate,92 beats/minute; respiratory rate,28 breaths/minute; and blood pressure, 160/100 mmHg. The client appears disheveled and disoriented. Upon physical assessment, the nurse notes restlessness and muscle spasms with rigidity. Which documented finding in the health history is evaluated as a potential causative factor?

Changing from one psychotherapeutic to another

The nurse is caring for several clients with various eating disorders as follows: Client A = Male client, 50 years old, BMI of 30 Client B = Male client, 15 years old, BMI of 14 Client C = Female client, 28 years old, BMI of 27 Client D = Female client, 60 years old, BMI of 17 Based only on these findings, which of these clients is most at risk for bulimia nervosa?

Client C

Which of the following is a true statement regarding anorexia nervosa?

Clients consume 600-900 calories/daily

Which type of therapy assists the clients to alter their irrational thinking?

Cognitive Therapy

A teenager is being seen in the outpatient clinic after a fainting episode at home. The client's body mass index (BMI) is 16, and she reports no menses for the past 3 months. Which additional assessment finding would the nurse anticipate?

Complaint of temperature intolerance

The nurse is working in a long-term care facility and has been caring for a client for several years. During the morning shift, the client's family appears at the nurse's station stating that their family member has forgotten the family's last visit and has confused their names, even after correcting. The nurse looks at the preceding shift documentation and notes that the staff states that the client is acting odd. Which would be the nurse's first action?

Complete a thorough head-to-toe assessment.

A client spends hours stacking and unstacking towels. She is repeatedly checking to make sure that the towels are in order of color. This behavior is identified as a:

Compulsion

A nurse is caring for a client who will undergo electroconvulsive therapy (ECT) for treatment of depression. When assessing a client immediately following ECT, the nurse expects which of the following?

Confusion

The nurse is preparing a teaching plan for a client diagnosed with bulimia nervosa. Which of the following would be included in the teaching plan?

Consume no more than 2000 to 3000 calories/day.

Clients with a social phobia would most likely fear which situation?

Meeting strangers

The nurse is assessing an older adult client and notes that the client has lost 15 pounds in the last three months. Diagnostic tests do not reveal any physiologic problem. The nurse is aware that weight loss in an older adult is indicative of which psychosocial problem?

Depression

How would a health care provider define a diagnosis of depression?

Eliminate other possible conditions.

Which instructions should a nurse provide a client who depends on lithium to control bipolar disorder?

Emphasize the importance of maintaining adequate salt intake.

What mood disorder has alternating sad and elated mood, resembling bipolar disorder, but less extreme mood shifts?

Cyclothymia

The drug haloperidol, used with schizophrenia, exerts its actions by blocking postsynaptic dopamine receptors. The older client must be monitored while on haloperidol because of the potential for:

Dehydration and aspiration.

The nurse is calling a report to the emergency department from a long-term care facility. The nurse states that the client abruptly experienced a change in mentation including disorientation and confusion. Vital signs are: temperature, 102.2°F; pulse rate, 88 beats/minute; respiratory rate, 24 breaths/minute; and blood pressure, 152/70 mm Hg. Lungs are clear. Which potential diagnosis would the emergency department physician place in the initial documentation?

Delirium

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

Dental erosion and swollen parotid glands.

Severe levels of anxiety result in what?

Distorted sensory awareness

Which type of therapy involves shifting the client's attention and energy to a more neutral topic?

Distraction

A nurse is counseling a client diagnosed with depression. When asked questions, the client responds with words of self-blame and self-pity. Applying the monoamine hypothesis, the nurse suspects which chemical is elevated?

Dopamine

A teenager who is attending a clinic for eating disorders has shown improvement in weight, but the laboratory values remain poor. Which of the following behaviors would the nurse identify as the likely cause of this finding?

Drinking water before weighing

A client diagnosed with schizophrenia is constantly repeating what others say. The nurse would document these symptoms as which of the following?

Echolalia

A client with bulimia and a history of purging by vomiting is hospitalized for further observation because she is at risk for which of the following?

Electrolyte imbalances and cardiac dysrhythmias

A client with panic disorder is experiencing difficulty sleeping and is up at the nurses' station late at night. What will best help the client achieve healthy sleeping patterns?

Encourage the use of relaxation exercises or techniques.

Binge eating in anorexia nervosa is usually followed by purging. A mental health nurse knows that purging is defined as what?

Evacuation of the digestive tract by self-induced vomiting or excessive use of laxatives and diuretics

A client with bulimia nervosa tells a nurse she was doing well until last week, when she had a fight with her father. Which nursing intervention would be most helpful?

Examining the relationship between feelings and eating

The nurse is obtaining a history from a 68-year-old client reporting memory loss. The nurse is obtaining general data about the client's condition and then asks specifically if the client and family can remember the first symptoms of memory loss. Which report by family members is typical of Alzheimer progression?

Family members cannot remember exactly when; small things have occurred over time.

A client has been diagnosed with posttraumatic stress disorder (PTSD). Which of the following statements best describe hallmark symptoms associated with PTSD:

Flashbacks, recurring dreams, and numbness

Anticonvulsants enhance which neurotransmitter in clients diagnosed with bipolar disorder?

GABA

Clients with anorexia nervosa become totally absorbed in their quest for weight loss and thinness. This exacerbation of anorexia nervosa results from the client's effort to:

Gain control of one part of her life

At the encouragement of her husband, a client has sought care because of the overwhelming anxiety she experiences surrounding her young children's safety. The client admits that she will not normally let her children leave her sight for fear that they will be abducted, abused or injured and that she lives with a constant, underlying anxiety for their safety. The nurse would recognize that this client experiences:

Generalized anxiety.

An elderly client with primary degenerative dementia is slow in following simple directions and indecisive selecting clothes to be worn for the day. What is the best approach to take?

Give her the opportunity to select from two outfits; cue her to follow-through on instructions.

Which of the following interventions would be appropriate for a client with anorexia nervosa?

Having the client in view of staff for 90 minutes after each meal

The nurse is caring for a client who is receiving valproic acid. What clinical manifestation should the nurse periodically monitor for?

Hepatotoxicity

Which referral for assistance at home with ADLs would be most appropriate for the nurse to recommend with the client prior to the Alzheimer's dementia stage of decline?

Home health aide

Administering an MAOI with food containing tyramine may develop a potentially fatal condition known as which of the following?

Hypertensive crisis

A client is telling the nurse that an actress is sending secret love notes to him. The nurse would be correct in suspecting that the client is experiencing

Ideas of reference

Which type of therapy is facilitated by a bond that develops between the therapist and the client?

Interpersonal psychotherapy

The nurse is caring for a client diagnosed with delirium. What does the nurse know to be true of delirium?

It is a sudden, transient state

A nurse is caring for a client with dementia. What measure should the nurse take when assisting the client with nutrition and hydration?

Keep reminding the client to chew and swallow

A client with major depression is having a disturbed sleep pattern. Which nursing intervention will help the client to get maximum sleep during the night?

Keep the client busy during the day.

Which of the following is an example of sub acute symptoms that may be observed in the older adult who may be depressed?

Lack of energy

Which of the following is an outcome of the drug memantine (Namenda) in clients with advanced stages of Alzheimer disease?

Lessens symptoms

Which psychotropic medication is administered based on an individualized dosage according to blood levels of the drug?

Lithium.

Clients with eating disorders are generally not aware of how much or how little they are eating because of their altered perception of their body's size and shape. What intervention by the nurse can assist these clients in recognizing what they are actually eating?

Maintain a strict intake and output log.

The nurse is providing community education regarding Alzheimer disease. Which client scenario is best for the client with progressing Alzheimer symptoms?

Maintain the client in the home and bring assistance to the care provider.

The mental health nurse knows that limit setting is most appropriate in which client population?

Manic

Eating disorders affect approximately 30 million people of all ages and genders in the United States. All are considered eating disorders except:

Obesity

A nurse who works in an outpatient mental health facility understands that imbalances of serotonin and/or dopamine levels are linked to eating disorders. Which behavior problem is most likely to be associated with the fear of becoming fat?

Obsessive-compulsive disorder

The nurse is talking to a client with an eating disorder who has received a prescription for naltrexone/bupropion. The nurse is aware that this medication will cause which type of medications to lose their effectiveness?

Opioids

An older adult client is admitted to the medical division after a fall. At home he is taking amitriptyline 25 mg three times per day. What adverse effect could be related to the patient's fall?

Orthostatic hypotension

A teenage client is brought to the ED with a fractured left hip. The client is 5'4" tall and weighs 82 lbs, and reports dieting to fit into a prom dress. What likely caused the fracture?

Osteopenia

A client with mania is in the dining room at lunchtime and is observed taking food from other clients' trays. The nurse's intervention should be based on which rationale?

Other clients need to be protected from the intrusive behavior.

The client recounts to the nurse an instance of jumping onto the hood of a car to avoid an approaching dog, and reports feeling embarrassed by this reaction. The client discloses suffering from a severe dog bite in childhood. The nurse classifies this symptom as which of the following?

Phobic disorder

soldier has been back from Iraq for two weeks. He is being seen in the outpatient mental health clinic due to complaints of inability to sleep, nightmares, and flashbacks. The nurse would expect the client to be diagnosed with which of the following?

Posttraumatic stress disorder

A teenage client has been diagnosed with anorexia nervosa. What is a complication of anorexia nervosa?

Premature osteoporosis

What is a nurse's role in providing home care for a client with Alzheimer's disease?

Provide emotional and physical support.

When planning care for a client newly diagnosed with Alzheimer's disease, the nurse should focus on:

Providing a safe, structured environment

Which of the following is a nurse's role in providing nutritional support to clients in their final stages of Alzheimer's disease?

Providing gastrostomy tube feedings

During the assessment of a client with mood disorder, the nurse observes that the client experiences hallucinations and delusions. Which of the following forms of depressive disorders does the client experience?

Psychotic depression

A client has been diagnosed with bulimia nervosa. The nurse knows an important assessment finding does not include which component?

Pulmonary embolism

The nurse is caring for an adolescent client who is 20% below ideal body weight as a result of restricting food intake. The nurse will give the most attention to which client assessment?

Pulse

While caring for an older adult client, the nurse notices the client is exhibiting increased episodes of forgetfulness, restlessness, and increased anxiety. Which assessment data is most significant for this client?

Recent loss of spouse

The nurse is assessing a client with early signs of dementia. The nurse asks the client what he ate for breakfast that morning. The purpose of this question is to determine which of the following?

Recent memory

A client with bipolar disorder is having a disturbed thought process. Which nursing intervention can help the client to be oriented and accurately perceive circumstances surrounding admission?

Reduce distracting stimuli.

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

Repetitive thoughts and recurring impulses

A client is admitted with a diagnosis of paranoid schizophrenia. The student nurse asks the charge nurse about the approach to take with the client, who has been exhibiting hostility and isolation. Which approach would be the most appropriate direction from the charge nurse?

Respect the client's need for personal space and avoid physical contact.

A client arrives at the psychiatric unit exhibiting extreme agitation, disorientation, and incoherence of speech with frantic and aimless physical activity and grandiose delusions. Which of the following concerns takes highest priority in planning your nursing interventions?

Risk for injury.

A client with depression is admitted to the hospital following a suicide attempt. Which nursing diagnosis would be most appropriate at this time?

Risk for self-directed violence related to depression

Which type of antidepressants is rarely fatal in overdose?

SSRIs

The nurse is caring for a client who states he is not feeling very well. When asking the client for specific symptoms, the client is vague with details but does state feeling better when the sun is shining. With this information, the nurse would document which disorder as a possibility?

Seasonal affective disorder

Increases in which neurotransmitter contribute to restrictive eating?

Serotonin

A client with mania hospitalized on a general unit constantly belittles other clients and is demanding special favors from the nurses. The most appropriate nursing intervention is:

Set limits with specific and consistent consequences for belittling or demanding behavior.

During an initial interview at a clinic, a young female client states that there is nothing wrong with her. Which of the following would indicate to the nurse that this client might have anorexia nervosa?

Severe weight loss due to self-imposed dieting

Sharon is admitted for an appendectomy. As the nurse enters the room to prep Sharon for surgery, she is breathing rapidly, sweating, restless, and anxious. The nurse's most therapeutic intervention at this time would be to:

Speak to Sharon with simple, short directions in a soothing voice, and do not ask her to make choices about positioning or comfort.

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which of the following nursing interventions would be most appropriate?

Stay with the client, emphasizing that he is safe and that you will remain with him.

Which of the following is a symptom of neuroleptic malignant syndrome that the nurse needs to report to a physician?

Tachycardia

A client is taking a traditional antipsychotic medication and is exhibiting grimacing and lip smacking. The nurse would document this side effect as which of the following?

Tardive dyskinesia

A nurse stops at the scene of an accident and attempts to assist a client who is lying in an overturned vehicle. When the nurse crawls into the vehicle, the client starts screaming "incoming, incoming!" and is violently thrashing and attempting to kick the nurse. Which is the best interpretation by the nurse?

The accident has triggered a flashback.

A client is experiencing psychotic depression. Which of the following findings would the nurse understand as distinguishing this mood disorder from others?

The client experiences hallucinations and delusions.

The nurse is discharging four clients from the behavioral health unit. Which client would be the best candidate for long-term inpatient care?

The client with suspicion and anger

For a client with anxiety disorder who is taking antianxiety medication, why should the nurse instruct the client to avoid stimulating drugs such as nonprescription diet pills?

They stimulate the sympathetic nervous system.

The nurse has been working with a client who has difficulty controlling mood. The client continues to experience anger outbursts, which makes it difficult to maintain employment. When explaining this dysfunction to the client's family members, which area of the brain does the nurse identify as being the site for mood generation?

The limbic system

Which of the following is the primary reason for monitoring food and fluid intake and toilet patterns of a client with mental disabilities?

To identify problems

Why is it important for the nurse to redirect a schizophrenic client's focus to what is real in the "here and now" when a client dwells on delusions?

To interrupt the client's delusional thinking

An independent older client has developed influenza. Three days into the illness the client became disoriented and confused, and didn't recognize family members. What action would the physician likely take?

Treat the underlying condition.

A client with a medical diagnosis of dementia of Alzheimer's type (DAT) 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?

Use the least restrictive devices if necessary.

Understanding the definition of eating disorders is important in communicating facts while managing these conditions. Which is not an eating disorder?

obesity

A client has been demonstrating progressing symptoms of Alzheimer's disease. The client's spouse has been the primary caregiver with minimal help from the family. The client sleeps only two hours a night and spends a significant amount of the remaining 22 hours a day wandering the house checking to see if the doors are locked. What is an activity that could be offered to the client to distract from wandering?

viewing old photographs

A client has signs and symptoms consistent with major depression. The primary care practitioner orders laboratory and diagnostic tests as well as performs a full health history and physical examination to rule out other problems that may be causing the client's symptoms. What are other possible underlying problems that the nurse would expect could be identified as related to the client's symptoms? Select all that apply.

• Brain tumor • Alcohol or sedative abuse • Chronic hypoxia

A group of students is reviewing information about social phobia in preparation for an oral class presentation on this topic. Which of the following would the students expect to include when describing a person with this condition? Select all that apply.

• Fear that others will judge them negatively • Demonstrate a distorted view of their own capabilities • Exaggerate personal flaws

When assessing for anorexia nervosa, the nurse would anticipate finding which of the following characteristics? Select all that apply.

• Good academics • Teenage girl

A client has been diagnosed with major depression. Which of the following affective manifestations would the nurse expect the client to display? Select all that apply.

• Looking gloomy • Showing decreased initiative • Being insensitive to others' feelings

Schizophrenia is now characterized as a psychobiologic disease because of recent findings in brain and neurotransmitter chemistry. What are two psychobiologic explanations for schizophrenia?

• Many neurotransmitter imbalances are involved in schizophrenia. • Schizophrenia is known to have a familial or genetic component.

A client with obsessive-compulsive disorder describes all doorknobs as being contaminated with a variety of viruses. He cleans each knob three times with paper towels before use. Such behavior allows the client to:

• Temporarily reduce anxiety

A client who reports moderate to severe anxiety requires intervention. Which technique suggested by the nurse would be helpful in assisting this client in the management of anxiety? Select all that apply.

• Visualize a relaxing place. • Listen to music.