nurs 203 midterm prep u questions

Maintaining a therapeutic environment and promoting growth through role modeling are components of which basic level function? a) Milieu therapy b) Counseling c) Health teaching d) Case management

a) Milieu therapy A basic level function is milieu therapy, which is the maintenance of the therapeutic environment. Counseling involves interventions and communication. Health teaching is a basic level function, as is case management.

Which intervention is appropriate for a psychiatric-mental health nurse at the basic level of practice? a) Promoting symptom management b) Managing psychotropic medications c) Conducting family therapy d) Interpreting laboratory tests

a) Promoting symptom management

During the mid-20th century, the focus of treatment centered on treating neurotransmitter dysfunction in the brain. As a result hospital stays were shortened due to the introduction of which? a) Psychopharmacology b) Insulin shock therapy c) Psychosurgery d) Hydrotherapy

a) Psychopharmacology

Which mental health service is an advanced-level function? a) Psychotherapy b) Milieu therapy c) Counseling d) Self-care activities

a) Psychotherapy Psychotherapy is an advanced-level function. Milieu therapy, counseling, and self-care activities are basic level functions.

Which statement by the nurse demonstrates an understanding of the role automatisms have in a panic attack? a) "The client taps her fingers very rapidly when she is feeling anxious." b) "I discourage her finger tapping since it serves to increase her anxiety level." c) "She knows that if she taps her fingers she will be able to lessen her anxiety." d) "I can tell that the more she taps, the less anxiety she is actually feeling."

a) "The client taps her fingers very rapidly when she is feeling anxious." Automatisms are automatic, unconscious mannerisms associated with anxiety. 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. None of the remaining options accurately state the fact that the tapping identifies the level of anxiety a client is experiencing but does not manage or less the emotion.

Which is a result of deinstitutionalization? a) A "revolving door" of repetitive hospital admissions b) An increase in available community resources c) The improvement of the ability of people diagnosed with mental illness to achieve independence d) An improvement in community-based programs' ability to get funding

a) A "revolving door" of repetitive hospital admissions One result of deinstitutionalization is the "revolving door" of repetitive hospital admission without adequate community follow-up. There are decreased community resources, and the majority of those who are mentally ill are unable to achieve independence.

In the 1970s, state mental hospitals came under increasing scrutiny and many were closed. What was the end result of this trend? a) A lack of suitable housing for persons with mental illness b) Higher employment rates among previously institutionalized people c) Increased numbers of for-profit institutions for the mentally ill d) Increased numbers of training programs for the mentally ill

a) A lack of suitable housing for persons with mental illness

Chlorpromazine is a drug in which classification? a) Antipsychotic b) Antimanic c) Antianxiety d) Antidepressant

a) Antipsychotic

A client spends hours stacking and unstacking towels. The client is repeatedly checking to make sure that the towels are in order of color. What term is used to identify this behavior? a) Compulsion b) Phobia c) Obsession d) Derealization

a) Compulsion Compulsions are ritualistic or repetitive behaviors or mental acts that a person carries out continuously in an attempt to neutralize anxiety. A phobia is an illogical, intense, persistent fear of a specific object or a social situation that causes extreme distress and interferes with normal functioning. An obsession is a recurrent, persistent, intrusive, and unwanted thought, image, or impulse that causes marked anxiety and interference with interpersonal, social, or occupational function. Derealization is sensing that things are not real.

When describing the historical aspects of psychiatric-mental health care, the nurse addresses the changes in thought about the cause of mental illness from 0 to 1000 CE. Which cause would the nurse most likely identify as the belief during this period? a) Demonic control b) Personal failure c) Physical illness d) Contaminated environments

a) Demonic control

In early Christian times, what was thought to cause mental illness? a) Demonic control b) Personal failure c) Sin d) Contaminated environments

a) Demonic control During early Christian times (1-1000), primitive beliefs and superstitions were strong. All diseases were blamed on demons and the mentally ill were viewed as possessed, or under demonic control.

When assessing an elderly client who has newly been diagnosed with an anxiety disorder, the mental health nurse's priority is to carry out which task? a) Determine the client's risk for self-harm or harm to others b) Obtain a thorough history, focusing on the client's physiologic functioning c) Assess for physical conditions that may affect anxiety d) Determine the effects that culture has had on the client's anxiety issues

a) Determine the client's risk for self-harm or harm to others The first step in the assessment process is to identify the client's level of anxiety and to determine whether a threat of self-harm or harm to others exists. In any situation where the client history is not known, the nursing priority is safety.

How can a nurse best assure the management of personal long-term self-reflection that is associated with professional interaction with clients? a) Engage in regular discussions with a formal clinical supervisor b) Keep a journal that focuses on personal feelings c) Communicate with peers working in similar client environments d) Regularly reflect from the client's point of view

a) Engage in regular discussions with a formal clinical supervisor While all the options present interventions to foster self-reflection, the nurse should engage in formal clinical supervision. Even experienced clinicians have a supervisor with whom they discuss personal feelings and challenging client situations to gain insight and new approaches. The other options are more focused on less formal, more self-directed reflection activities.

When providing care to a client, the psychiatric-mental health nurse is implementing the therapeutic use of self. The nurse is applying the concepts based on the work of which individual? a) Hildegard Peplau b) Florence Nightingale c) Dorothea Dix d) Sigmund Freud

a) Hildegard Peplau

Which provides the best definition for mental illness? a) Inability to function in a manner that manages both external and internal stressors effectively b) Existence of cognitive dysfunction resulting in a lack of autonomy c) Manifestation of altered sensory perceptions d) Result of genetic or environmental alterations resulting in mental dysfunction

a) Inability to function in a manner that manages both external and internal stressors effectively

Which is a true statement regarding Medicaid? a) It covers individuals and families with low incomes. b) It covers people 65 years of age and older. c) It covers people with permanent kidney failure. d) It covers people with certain disabilities.

a) It covers individuals and families with low incomes.

Which is an inaccurate depiction of self-awareness? a) It involves changing one's values or beliefs. b) The nurse gains recognition of his or her feelings and beliefs. c) There is an understanding that a nurse's belief may conflict with the client's. d) It involves self-reflection.

a) It involves changing one's values or beliefs.

Relaxation techniques help clients with anxiety disorders because they can promote what? a) Reduction of autonomic arousal b) Increase in sympathetic stimulation c) Release of cortisol d) Increase in the metabolic rate

a) Reduction of autonomic arousal Regularly inducing the relaxation response reduces the general level of autonomic arousal in anxious clients. It lowers blood pressure, heart rate, metabolic rate, and oxygen demands. This physiologic effect may result from effects on the production of cortisol, a hormone the body releases in response to stress. Cortisol is helpful during the fight-or-flight response, but its prolonged presence in chronically anxious or stressed clients can inhibit the immune system and have other deleterious effects on the body.

Which should be included in a teaching plan for a client prescribed a benzodiazepine? a) Rise slowly from a lying or sitting position b) Maintain a fluid restriction c) Consume caffeine in moderation d) Stop taking drug if sedation develops

a) Rise slowly from a lying or sitting position Clients taking a benzodiazepine should rise slowly from a lying or sitting position. The client should drink adequate fluids, avoid caffeine, and not stop taking the drug abruptly.

Which is a criterion for mental health? a) Satisfaction with personal relationships and self b) Absence of mental health disorders c) Absence of sadness or anger d) No observable demonstration of deviant behavior

a) Satisfaction with personal relationships and self People in a state of emotional, physical, and social well-being fulfill life responsibilities, function effectively in daily life, and are satisfied with their interpersonal relationships and themselves. None of the remaining options fully satisfy the criteria for a healthy mental status.

Which condition involves a persistent, irrational fear attached to an object or situation that objectively does not pose a significant danger? a) Specific phobia b) Posttraumatic stress disorder c) Obsessive-compulsive disorder d) Generalized anxiety disorder

a) Specific phobia Specific phobia is a disorder marked by persistent fear of clearly discernible, circumscribed objects or situations, which often leads to avoidance behaviors. Posttraumatic stress disorder can occur following exposure to an actual or threatened traumatic event such as death, serious injury, or sexual violence. In obsessive-compulsive disorder, affected clients have both obsessions and compulsions and believe that they have no control over them, which results in devastating consequences for the individuals. Generally speaking, clients with generalized anxiety disorder feel frustrated, disgusted with life, demoralized, and hopeless. They may state that they cannot remember a time that they did not feel anxious. They experience a sense of ill-being and uneasiness and a fear of imminent disaster.

Which is necessary as a defining feature in mental illness? a) The individual must have difficulties in functioning that cause distress and/or impairment of some type. b) The individual must need medications in order for the diagnosis to be of psychiatric origin. c) The individual must acknowledge that he or she is having difficulties in functioning. d) The individual must have physiological symptoms that match with behaviors that are impaired.

a) The individual must have difficulties in functioning that cause distress and/or impairment of some type.

Which is the greatest barrier to an individual's ability to obtain the most effective and safest psychiatric medication? a) These medications are often not covered by the managed care system because they are expensive. b) These medications are not available because they are in such great demand. c) These medications are paid for by all insurance companies, but clients do not like to take psychotropics. d) The side effects of newer medications are often too severe for clients to consider taking them.

a) These medications are often not covered by the managed care system because they are expensive.

During the moral treatment period, clients were routinely placed into which environment? a) asylums b) community mental health centers c) psychosocial rehabilitation centers d) group homes

a) asylums In the moral treatment period (1790-1900), moral treatment and the use of kindness, compassion, and a pleasant environment was adopted. Clients were routinely removed from their communities and placed in asylums, which was thought to be best for their safety and comfort. Community mental health centers, by and large, ignored the legions of people with serious mental illnesses and instead focused on the treatment of those with alcoholism and drug addiction. Clients were not placed in psychosocial rehabilitation centers or group homes during the moral treatment period.

A nurse is seeing a client who is having severe to panic level anxiety after a physical assault months previously. The client tells the nurse, "When the panic starts I feel like I am watching myself through a window." The nurse can most accurately describe this experience as: a) depersonalization. b) derealization. c) decatastrophizing. d) demonstrating automatisms.

a) depersonalization. Depersonalization is a feeling that the client may describe as being disconnected from herself, such as watching oneself. This is common when individuals experience panic levels of anxiety. Derealization refers to the sensation that things are not real or surreal during panic levels of anxiety. Decatastrophizing refers to a treatment approach used by therapists in which the client is asked questions in order to urge the client to develop a more realistic appraisal of the situation causing the anxiety. Automatisms are automatic, unconscious mannerisms that are geared toward relief of anxiety and increase in intensity and frequency with a rise in the client's anxiety level.

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. a. " You can have lots of people in your social network and still feel isolated." b. "It sounds like you have a level III sized social network." c. "It is important to reach out to people in your social network to tell them you are sad." d. "Social networks can be overwhelming so it is better to be isolated."

a. " You can have lots of people in your social network and still feel isolated." The best response by the nurse is one in which the client's concerns about being isolated are validated. Not all interpersonal interactions within a network are supportive. A person can have a large, complex social network but little social support. it is important to remind the client of this and assist the client in identifying alternative forms of social support. It is ineffective and irrelevant to identify which social network category the client is within. Telling the client to reach out to people in the social network assumes the client has positive interpersonal relationships with the people in the network. The nurse must explore the quality of these relationships prior to encouraging the client to reach out. It is not better to be isolated when one is experiencing the symptoms of depression. Social support enhances health outcomes and reduces mortality by helping members make needed behavior changes and buffering stressful life events.

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? a. "Acute stress disorder is a possibility, which might develop into PTSD." b. "If the client doesn't receive treatment right away, the client might not recover from the PTSD." c. "It's more likely that the client is experiencing anxiety, which will likely decrease with time." d. "Actually, she won't meet the diagnostic criteria for PTSD until 3 months after the attack."

a. "Acute stress disorder is a possibility, which might develop into PTSD." A diagnosis of PTSD requires 1 month of symptoms. Acute stress disorder exists closer to the traumatic event and may develop into PTSD if not resolved. Anxiety is not necessarily self-limiting.

On observing a client diagnosed with posttraumatic stress disorder (PTSD), the nurse suspects that the client is dissociating. What questions should the nurse ask the client to confirm the suspicion? Select all that apply. a. "Can you see me?" b. "Are you able to hear me?" c. "Have you been taking drugs recently?" d. "How many hours do you sleep a day?" e. "Are you woken up by nightmares?"

a. "Can you see me?" b. "Are you able to hear me?" Since the nurse suspects that the client is dissociating, the nurse should ask questions regarding how aware the client is of his or her reality. Questions that state whether the client can see or hear reflect the client's ability to be associated with reality. Because the nurse suspects that the client is unaware of reality, questions regarding drug history, hours of sleep, and sleep disturbances should not be asked. The client may not be in an appropriate state to answer these questions.

The nurse is seeing a male client who is experiencing anxiety and having difficulty managing anger. The client tells the nurse he received an email last week in which a co-worker was insulting and dismissive. The client states he had difficulty sleeping after receiving the email. Select the nurse's best response. a. "Is there any other way in which can you interpret what the co-worker said in the email?" b. "Have you always had a bad relationship with this co-worker?" c. "Would you be interested in learning some assertive communication skills?" d. "Have you considered using a sleep medication to help initiate sleep during stressful times?"

a. "Is there any other way in which can you interpret what the co-worker said in the email?" Assisting clients to develop appropriate problem-solving strategies based on personal strengths and previous experiences is important in understanding and coping with stressful situations. Attempting to help the client interpret the email in a different way may encourage the client to manage emotions by seeing the situation differently. This, in turn, can help the client re-establish a normal sleep pattern. By using the alternate response options, the client is not challenged the see the situation differently, thus, leading the client to respond to stressful situations with the same maladaptive coping which leads to changes in health behaviors.

The nurse is providing counseling to a client who has been experiencing anxiety and sleep disturbance. While providing education to the client, in which way can the nurse best describe allostatic load? a. "It is the wear and tear on your body from having stress over a long period of time." b. "It is when you feel back to yourself again after you have experienced stress." c. "It describes the alarm reaction stage when you have a traumatic event." d. "It is an intense but short lived response involving your brain and body"

a. "It is the wear and tear on your body from having stress over a long period of time." Allostatic load refers to is an ongoing physiological reaction to events resulting in "wear and tear" on the body and negatively impacts health and well-being. The adaptive physiological changes that occur during acute stress become maladaptive when prolonged and contribute to the risk for illness. Homeostasis is the body's tendency to resist physiological change and hold bodily functions relatively consistent, well-coordinated, and usually stable, A return to one's norm after a stressful event is the most accurate description of homeostasis. In general adaptation syndrome, an alarm reaction is the first stage of a process in which the brain and body seek to achieve homestasis. Acute stress is an intense biopsychosocial reaction to a threatening event that is time-limited (usually less than a month) but can occur repeatedly. It can lead to physiologic overload, which in turn can have a negative impact on a person's health.

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? a. Assessing the quantity and quality of the client's sleep b. Assessing the client's communication skills c. Assessing the quality of the client's support network d. Assessing the client's vital signs

a. Assessing the quantity and quality of the client's sleep Intrusion almost always takes a toll on the client's sleep. Communication and social support are only peripherally related to episodes of intrusion. Intrusion will certainly affect the client's vital signs, but these changes are unlikely to be as problematic as sleep difficulties.

The advanced practice psychiatric mental health registered nurse is leading a support group for adolescents who have recently experienced disruptions in their life. What participant most warrants further assessment for posttraumatic stress disorder? a. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother b. An adolescent who often redirects the conversation to the subject of the adolescent's sister's death c. An adolescent who began smoking in the weeks after discovering a dead body in a park d. An adolescent who states "I've lost my soulmate" after the death of a boyfriend or girlfriend in an accident

a. An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother Adolescents with PTSD may act out by engaging in disruptive behavior. The adolescent redirecting discussion to the dead sister and the adolescent who lost a relationship because of death from an accident are expressing uncomplicated grief. The adolescent who began smoking requires intervention but is not necessarily experiencing PTSD.

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? a. Assess the client for signs and symptoms associated with post-traumatic stress disorder b. Educate the family about the usual emotional responses to returning home from military service c. Organize a family meeting where family members can tell the client how they feel d. Educate the family about the relationship between hyperarousal and emotional distance

a. Assess the client for signs and symptoms associated with post-traumatic stress disorder It is highly plausible that the client has post-traumatic stress disorder, given the high incidence and prevalence among veterans. Assessment should precede any interventions such as family meetings or education sessions.

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? a. Assessing the client's risk for self-harm and ensuring safety b. Developing therapeutic rapport with the client and family c. Assessing the client's current drug regimen and allergy status d. Identifying the client's coping ability and functional status

a. Assessing the client's risk for self-harm and ensuring safety In an emergency context, the assessment of suicidality and the risk for self-harm is a priority. The nurse should perform each of the other listed actions, but measures to ensure the client's safety are paramount.

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? a. Enhanced resilience for the participants b. Decreased risk for personality disorders c. Decreased risk for somatic symptom disorders d. Hyperarousal and enhanced coping for participants

a. Enhanced resilience for the participants Facing and conquering challenges increases self-worth, self-efficacy, and resilience. This type of activity is unlikely to have a direct effect on participants' risks of somatic symptom disorders or personality disorders, which have complex etiologies. Participants' coping is likely to be enhanced, but hyperarousal is associated with poor coping and low resilience.

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? a. Establishing therapeutic rapport with the client b. Educating the client about basic coping strategies c. Reassuring the client that recovery will occur d. Eliciting the details of the traumatic event

a. Establishing therapeutic rapport with the client Establishing the therapeutic relationship with the client is foundational to all other aspects of care. Teaching coping strategies would be premature. The nurse must avoid false reassurance. It is useful for the nurse to know details of the trauma, but these may come up after rapport is established.

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? a. Facilitate the client's participation in a support group b. Provide the client with educational resources that promote the client's self-worth c. Facilitate a meeting between the client and the client's family members d. Encourage the client to make new friends

a. Facilitate the client's participation in a support group A support group can be a valuable source of social support. If the client states that the client is estranged from the client's family, it would be inappropriate for the nurse to independently broach this barrier. Making new friends is difficult for a client experiencing PTSD. Educational resources can be valuable but are not a substitute for social support.

A nurse is helping a male client recognize the impact of stressful events on his health. Using the Recent Life Changes Questionnaire, the client learns that the most stressful life change is which type? a. His mother was just diagnosed with cancer b. He is experiencing sexual dysfunction c. He fractured his ankle recently d. He recently moved from one house to another

a. His mother was just diagnosed with cancer According to the Recent Life Changes Questionnaire, a change in the health status of a family member has a life stress value of 52. This is following by sex difficulties which has a life stress value of 49, then personal injury or illness which has a life stress value of 42 and finally a change in residence is given a life change value of 33.

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? a. Make efforts to demonstrate empathy to the client b. Facilitate cognitive restructuring therapy c. Arrange for the client to receive cognitive processing therapy d. Avoid communicating with the client until the client initiates

a. Make efforts to demonstrate empathy to the client Exhibiting empathy often helps to build therapeutic rapport, especially with a client who is reluctant to engage with the nurse. Cognitive behavioral therapy would not be an initial action. It is unrealistic and ineffective for the nurse to avoid communication with the client.

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? a. Monitoring the client for suicidal ideation b. Developing a therapeutic relationship with the client c. Mobilizing the client's social support network d. Affirming the client's self-worth and self-concept

a. Monitoring the client for suicidal ideation It is imperative to establish a therapeutic relationship with clients and to enlist their social support network. However, the client's risk of suicide is a priority because of the immediate safety implications. Affirming the client is important, but safety is a priority.

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. a. Personal assault by a family member b. Military combat mission where there were casualties c. Surviving an EF 4 tornado d. Falling off a playground swing e. Urinary incontinence due to a prolapsed bladder

a. Personal assault by a family member b. Military combat mission where there were casualties c. Surviving an EF 4 tornado Examples of traumatic events are violent personal assault, rape, military combat, natural disasters, terrorist attacks, being taken hostage, incarceration as a prisoner of war, torture, an automobile accident, or being diagnosed with a life-threatening illness. Falling off a swing is not necessarily a trauma, but a typical accident common to many children. Prolapsed bladder is not a traumatic event and can be easily corrected with various surgical procedures.

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? a. Teaching the child how to interact appropriately with strangers b. Teaching the child how to set boundaries in familial relationships c. Role modeling conflict management with the child d. Teaching the child how to manage disruptive thoughts of trauma

a. Teaching the child how to interact appropriately with strangers Disinhibited social engagement disorder is characterized by being overly familiar with strangers. The disorder is not primarily associated with family boundaries, disruptive thoughts, or the management of conflict.

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? a. The client alluded to "ending this misery" in a conversation with a colleague b. The client has twice attempted a return to work, without success c. The client's care provider has increased the dose of paroxetine twice in 2 months d. The client admits that the client often lashes out verbally at the client's spouse and children

a. The client alluded to "ending this misery" in a conversation with a colleague All of the listed data are clinically significant. However, an allusion to suicide may warrant inpatient treatment for the client's safety.

The nurse is seeing a client who recently received a letter of denial of admission to a college. The client reports having difficulty sleeping and concentrating on work. The nurse recognizes that the significance of not getting into college is influenced by which factor? Select all that apply. a. The client is Hispanic. b. The client lives at home with her parents. c. The client incorporates religious values daily. d. The client works at a coffee shop. e. The client is physically active

a. The client is Hispanic. b. The client lives at home with her parents. c. The client incorporates religious values daily. Although people respond to stressful events in different ways, cultural, ethnic, family, and religious values shape the significance of an event, such as a car accident. Employment role and physical activity have not been found as major factors contributing to how significant the event is believed to be because this is largely based on influences that shape people psychosocially.

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? a. The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger. b. The client has "signal anxiety," which is always the first symptom of anxiety. c. The client has "trait anxiety," and this reflects the client's anger toward the client's mother's surgeon. d. The client is expressing "free-floating anxiety" and needs to have medication in order to bring it under control.

a. The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger. Fear is different from anxiety. It is the body's physiologic and emotional response to a known or recognized danger. Signal anxiety is a response to an anticipated event, but it is not always the first symptom of anxiety. Trait anxiety is a component of personality that has been present over a long period and is measurable by observing the person's physiologic, emotional, and cognitive behaviors. Free-floating anxiety is anxiety that is always present and accompanied by a feeling of dread.

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation? a. The client is often "staring into space" and has no idea how much time has passed b. The client states that usual coping mechanisms are ineffective c. The client states that the client's mood is "alright" when appearing to be in some distress d. The client experiences awakenings during the night and is unable to fall asleep again

a. The client is often "staring into space" and has no idea how much time has passed "Spacing out" is an example of dissociation (depersonalization). It is not uncommon for the client with PTSD to experience failure of coping skills, sleep disturbances, and reluctance to acknowledge moods, but these are not evidences of dissociation.

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? a. The client reports large gaps in memory of the traumatic event b. The client reports crying at unpredictable times c. The client states that the client has been neglecting business in recent weeks d. The client's family members describe the client as irritable and agitated

a. The client reports large gaps in memory of the traumatic event Amnesia about traumatic events is characteristic of dissociation. Emotional lability, apathy, and agitation are not unusual in a client dealing with PTSD, but these do not directly indicate the presence of dissociation.

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? a. The client states that the client cannot remember what happened during and immediately after the event b. The client reports that the client cannot drive down the street where the event occurred c. The client reports that the client has become "obsessed" with monitoring the client's own heart rate and blood pressure d. The client states that the client no longer has any hope for the future

a. The client states that the client cannot remember what happened during and immediately after the event Derealization is a sense of unreality surrounding a traumatic event, often resulting in an absence of memories. Avoidance, hopelessness, and obsessive behaviors are evidence of trauma, but these do not demonstrate derealization.

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? a. The client's emotional numbing is a protective mechanism b. The client's depersonalization is an ominous sign c. The client has unrealistic expectations of his level of emotional functioning d. The client would likely benefit from anxiolytic medications

a. The client's emotional numbing is a protective mechanism Emotional numbing is the result of seeking to avoid stress-inducing situations. Anxiolytics are unlikely to alleviate emotional numbing. Emotional numbing is not synonymous with depersonalization. Emotional numbing is an objectively recognized phenomenon, not simply the result of the client having unrealistic expectations.

A nurse is preparing a plan of care for a client with anxiety. Which would the nurse likely include? Select all that apply. a. Using appropriate coping skill b. Identifying treatment modalities c. Involving family for support, if appropriate d. Providing supportive feedback e. Using restraint when panic develops

a. Using appropriate coping skill b. Identifying treatment modalities c. Involving family for support, if appropriate d. Providing supportive feedback Appropriate measures to include in the plan of care for a client with anxiety include: introducing appropriate coping skills, identifying alternate treatment modalities, involving family and support persons when appropriate, and providing feedback that is supportive to the client. Restraint is always a last resort.

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for: a. a visit with the therapist to the place where the explosion occurred. b. a critical examination of the ways the client's PTSD has affected the client's life. c. a family meeting where each member will describe the effects of the client's PTSD. d. a visit to a support group created for victims of the tragedy.

a. a visit with the therapist to the place where the explosion occurred. Exposure therapy may involve a visit to the place where a traumatic event occurred. Reflection, family meetings, and support groups may be components of the client's broader treatment plan, but they are not exposure therapy.

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: a. establishing therapeutic rapport with the client. b. gently encouraging the client to talk about the incident. c. eliciting the objective facts about the incident. d. reassuring the client that the client is having an expected response to such an incident.

a. establishing therapeutic rapport with the client. Therapeutic rapport is absolutely foundational to all other interactions between the client and the nurse. As such, it must precede the details of assessment. The nurse must be careful not to provide false reassurance, and any reassurance that is given must exist in a context of rapport.

The nurse is working with a client who has the tendency to "tend and befriend." The nurse identifies this is characteristic of: a. the female response to stress. b. an aggressive response to stress. c. the male response to stress. d. a response using denial of emotions.

a. the female response to stress. Whereas males are more likely to respond to stress with a fight or flight response, females have less aggressive responses; they "tend and befriend." To "tend and befriend" is a less aggressive response to stress. This response seeks to acknowledge the emotion rather than deny its existence.

The nurse is assessing a client who has recently received a diagnosis of posttraumatic stress disorder. When conducting this assessment, the nurse should: a. try to identify any strengths or skills that can be applied during recovery. b. prioritize psychological findings over physical findings. c. corroborate the client's statements with a trusted friend or family member. d. reassure the client that the client will eventually have a full recovery.

a. try to identify any strengths or skills that can be applied during recovery. During assessment, it is important to note any strengths that can be integrated into the client's care. Psychological findings do not always take priority over physical findings and it is unnecessary to confirm everything that the client says with another individual. The nurse must avoid false reassurance; full recovery is never guaranteed.

A client who experienced serious and repeated traumas has been diagnosed with dissociative identity disorder after being rescued from an abuser. Before caring for this client, the nurse should be prepared for: a. wide variations in the personality that the client exhibits. b. states of catatonia alternating with mania. c. hostility and possibly violence. d. childlike intellectual development and problem-solving skills.

a. wide variations in the personality that the client exhibits. Dissociative identity disorder is characterized by the presence of more than one distinct personality or identity state. Clients are not typically catatonic or manic and there is no notable risk for violence. Intellectual development is not affected.

A nurse is providing community education about the prevention of mental illness. In response to the question, "What does it mean to be mentally healthy?" which is the nurse's best response? a) "Mental health is difficult to define and depends on cultural norms." b) "Mental health is marked by productivity, fulfilling relationships, and adaptability." c) "Mental health is the absence of mental illness." d) "Mental health is defined as behavior accepted as normal by the major cultural group."

b) "Mental health is marked by productivity, fulfilling relationships, and adaptability."

Which individual has experienced the consequences of deinstitutionalization? a) A man who was denied inpatient psychiatric treatment by his health maintenance organization (HMO) b) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure c) A man who has been unable to obtain health insurance but who receives Medicare benefits d) A woman who has been the frequent object of stigma due to her history of psychiatric illness

b) A woman who was transferred from a psychiatric hospital to the community because of the hospital's impending closure The process of deinstitutionalization involves moving chronically mentally ill clients from state psychiatric hospitals back to their homes or to community-supervised facilities.

A young parent tells the nurse, "I can't stop smoking. That is what I do to make myself feel better." What is the term used to describe this behavior? a) Defense mechanism b) Coping mechanism c) Caregiver burden d) Crisis

b) Coping mechanism Mild anxiety is often managed without conscious thought by coping mechanisms, which are behaviors used to decrease stress and anxiety. There are many typical behaviors used as coping mechanisms, including smoking.

A client comes in for a therapy session and begins to have a panic attack. The therapist asks the client to relax in the chair and then gently asks the client to imagine the client in a very safe and calm place. This technique, often useful in anxiety disorders, is called what? a) Cognitive therapy b) Deep breathing c) Desensitization d) Problem-solving

b) Deep breathing Helping the client focus on deep breathing can decrease the hyperarousal involved in panic attacks. It is also an opportunity for the therapist to teach the client self-help and adaptive coping mechanisms for panic attacks.

Which is a difference between counseling and psychotherapy? a) Psychotherapy is reserved for clients who have a documented history of failing to respond to counseling. b) Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role. c) Transference and countertransference are significant obstacles in psychotherapy that can be avoided in a counseling mode. d) Counseling may be used in the care of acutely psychotic clients, but psychotherapy is contraindicated.

b) Generalist psychiatric nurses may perform counseling interventions, but psychotherapy is an advanced practice role.

The nurse is assessing a client and finds two enlarged supraclavicular lymph nodes. The nurse asks the client how long these enlarged nodes have been there. The client states, "I can't remember. A long time I think. Do I have cancer?" The nurse is aware that that body responds to stress. Which is an immediate physiologic response to stress the nurse would expect to see in this client? a) Vasodilation of peripheral blood vessels b) Increased blood pressure c) Decrease in blood glucose levels d) Pupil constriction

b) Increased blood pressure An initial response to stress, as seen by the fight-or-flight response, is an increase in the client's heart rate and blood pressure. Vasoconstriction leads to the increase in blood pressure. Blood glucose levels increase, supplying more readily available energy, and pupils dilate.

An adolescent client reveals that she is about to take a math test from her tutor. Nursing assessment reveals mild anxiety. The nurse explains that this level of anxiety does what? a) Will interfere with her cognitive abilities b) Is conducive to concentration and problem solving c) May be transferred to her tutor and result in test anxiety d) Is pathologic and warrants postponing the test

b) Is conducive to concentration and problem solving Mild anxiety is often helpful to individuals and can assist in maintaining concentration and problem-solving abilities. Moderate to severe anxiety can begin to inhibit an individual's coping because these levels create physiologic responses (such as tachycardia and sweating) and psychological responses (such as loss of concentration and inability to focus) that may prevent the person from functioning adequately, interfere with cognitive abilities, and become pathologic if not treated adequately.

A nurse is conducting a review class for a group of psychiatric-mental health nurses about the changes in psychiatric care that have occurred through the years related to legislation and policy initiatives. The nurse determines that the teaching was successful when the group identifies that supporters of the Community Mental Health Centers Construction Act (1963) believed that institutionalization was contributing to what? a) Financial problems b) Mental Illness c) Overpopulation d) Abuse of psychopharmacology

b) Mental Illness The supporters of the 1963 legislation believed the exact opposite of what Dorothea Dix believed during the previous century. That is, instead of viewing an institution as a peaceful asylum, institutionalization was viewed as contributing to illness. Financial problems declined with deinstitutionalization as federal legislation was passed to provide an income for disabled persons allowing people with severe and persistent mental illness to be more independent financially. Overpopulation was prevented by commitment laws in the early 1970s, making it more difficult to commit people which further decreased the state hospital populations. Medication abuse was not associated with institutionalization

Which is a clinical activity of only the advanced practice registered nurse? a) Milieu therapy b) Psychotherapy c) Crisis intervention d) Triage

b) Psychotherapy

What nursing action demonstrates the intended impact of the American Nurses Association (ANA) standards of care on mental health nursing care? a) Using the standards to determine if a nurse's action is considered criminally negligent. b) Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. c) Using the standards as a guide to identify advanced level nursing functions. d) Citing the standards as a guide for determining the delegation of care.

b) Referring to the standards to determine if a particularly prescribed treatment falls within the scope of a nurse's practice. The American Nurses Association (ANA) develops standards of care as authoritative statements by professional organizations that describe the responsibilities for which nurses are accountable, thus identifying the nurse's scope of practice. They are not legally binding unless they are incorporated into the state nurse practice act or state board rules and regulations. When legal problems or lawsuits arise, these professional standards are used to determine safe and acceptable practice and to assess the quality of care in the court of law. Neither identifying advanced level functions or safety delegation principles are directly associated with the ANAs nursing standards.

When a parent observes the parent's young child heading toward a busy road the parent becomes stressed, feeling the parent's heart pounding, breathing heavily, and hands becoming wet with perspiration. Which physiological system is activated with the parent's "fight or flight" reaction to this danger? a) Parasympathetic nervous system b) Sympathetic nervous system c) Motherly response system d) Central nervous system

b) Sympathetic nervous system The sympathetic nervous system activates the fight or flight response quickly as a survival response that results in an increased heart and respiratory rate, moist hands and feet, and dilated pupils. The parasympathetic system is most active in nonstressful events. The motherly instinct is not a proven physiological system.

The nurse is assessing a client with anxiety. Which behavior might indicate that the client has moderate anxiety? a) The client is focused in an activity. b) The client is nervous and agitated. c) The client has impaired cognitive skills. d) The client is unable to communicate verbally.

b) The client is nervous and agitated. A client who is moderately anxious has a disturbing feeling that something is wrong. This causes nervousness and agitation. Increased concentration and attention is seen in clients having mild anxiety. Cognitive skills are impaired in clients who have severe anxiety. Inability to communicate verbally indicates that the client is panicking.

A nurse is caring for a client who has panic attack. The nurse takes the client in a small, isolated room. How would this intervention benefit the client? Choose the best answer. a) The client would return to rational thought. b) The client would have an enhanced sense of security. c) The client would be able to demonstrate relaxation techniques. d) The client would be able to understand what the nurse is saying.

b) The client would have an enhanced sense of security. A client with panic-level anxiety should be taken to a small, isolated room. This is to reduce any external stimuli that could escalate anxiety. Taking the client to a small room would make the client feel more protected and secured. A client experiencing a panic attack may lose rational thought; however, this intervention would not directly improve thought processes. The client would not be able to demonstrate relaxation techniques in a panic laden state. This intervention would not enhance the client's ability to understand what the nurse is saying.

One of the primary reforms accomplished by Dorothea Lynde Dix was the ... a) establishment of "commitment" laws in state legislatures. b) establishment or enlargement of state hospitals. c) use of music to treat mentally ill clients. d) use of exercise therapy to treat mentally ill clients.

b) establishment or enlargement of state hospitals. One of the primary reforms accomplished by Dorothea Lynde Dix was the establishment or enlargement of state hospitals to treat the mentally ill. She also was instrumental in the establishment of mental hospitals in England, Canada, and Europe in the 19th century.

Which statement made by a client diagnosed with posttraumatic stress disorder (PTSD) leads the nurse to believe the client is experiencing dissociative symptoms? a. "It's like I'm having flashbacks every time I fall asleep." b. "I describe my feelings like I'm having an out-of-body experience." c. "Loud noises always make me a little jittery now." d. "I feel guilty that I survived the attack and my friend didn't."

b. "I describe my feelings like I'm having an out-of-body experience." Dissociation is a disruption in the normally occurring linkages among subjective awareness, feelings, thoughts, behavior, and memories. A person who dissociates is making himself or herself "disappear." That is, the person has the feeling of leaving his or her body and observing what happens to him or her from a distance and being detached from others. During trauma, dissociation enables a person to observe the event while experiencing no or only limited pain and to protect himself or herself from awareness of the full impact of the traumatic event. Flashbacks are common with PTSD; loud noises associated with the trauma cause flashbacks. Guilt is common for survivors.

Which statement regarding posttraumatic stress disorder (PTSD) and children is accurate? a. The risk of developing PTSD following leukemia treatment is about the same as all children of the same age. b. Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse. c. In a family unit where one child is diagnosed with cancer, all the children in the household are at increased risk for developing PTSD. d. Children who were abused during childhood are more likely to be diagnosed with obsessive-compulsive disorder rather than PTSD.

b. Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse. For adolescents, PTSD has been associated with an increased risk of drug use. Childhood cancer survivors have been found to have four times the risk of developing PTSD as their siblings. In another study of childhood cancer survivors, nearly 16% had PTSD. Similarly, high rates of PTSD have been reported among clients with alcohol and drug dependence who experienced childhood abuse.

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. a. Mania b. Depression c. Schizophrenia d. Anxiety disorder e. Obsessive-compulsive disorder

b. Depression d. Anxiety disorder Clients with PTSD are likely to develop depression and anxiety disorder. Associated symptoms should be identified and treated accordingly. Clients with PTSD are less likely to have mania, schizophrenia, and obsessive-compulsive disorder along with it.

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? a. Dissociative amnesia b. Dissociative identity disorder c. Derealization disorder d. Acute stress disorder

b. Dissociative identity disorder Dissociative identity disorder is one of the dissociative disorders characterized by disruption of the integrated functions of consciousness, memory, identity, or environmental perception. In dissociative identity disorder, the client may assume two or more distinct identities that recurrently take control of the client's behavior. The client may also be unable to remember important personal information that is of a stressful nature. Dissociative amnesia is characterized by a fugue experience in which the client moves to a new geographical location, with no memory of past events. Derealization disorder is characterized by a feeling of being detached from one's mental processes or body. Acute stress response occurs in response to a stressful event and is characterized by reexperiencing, hyperarousal, and avoidance.

When a client is experiencing panic, which is the priority intervention? a. Give the client medication immediately. b. Move the client to a quiet environment. c. Offer the client therapy to calm down. d. Physically restrain the client.

b. Move the client to a quiet environment. Decreasing external stimuli will help lower the client's anxiety level. The client's safety is priority. Anxious behavior can be escalated by external stimuli. In a large area, the client can feel lost and panicked, but a smaller room can enhance a sense of security. Medicating the client would be inappropriate. Restraint should only be used as a last resort. Therapy can be appropriate once the client's anxiety level decreases.

The nurse is interviewing a client who witnessed a fatal accident at the workplace and was unable to save a colleague. What assessment findings would support a diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply. a. The accident took place 2 weeks ago b. The client has nightmares about the accident c. The client says the client is "unable to face that place again" d. The client says the client's family describes the client now as "edgy" and "irritable" e. Management is blaming the client for the accident

b. The client has nightmares about the accident c. The client says the client is "unable to face that place again" d. The client says the client's family describes the client now as "edgy" and "irritable" Diagnostic criteria for PTSD include avoidance of the site of the trauma, hyperarousal, and nightmares. However, the 2-week time period suggests a diagnosis of acute stress disorder rather than PTSD. The response of management is a stressor but is not among the diagnostic criteria.

A client with generalized anxiety disorder states that the client is worried about the client's job. The client never feels like the client has control over the client's responsibilities, even though the client puts in extra hours. The client adds that the client is afraid the client will be fired. Which response by the nurse is most therapeutic? a) "It sounds to me like you're doing a good job." b) "Your worries are a feature of your anxiety disorder. Tell yourself that you have nothing to worry about." c) "Has something changed at work that is causing you to worry?" d) "Why do you think you'll be fired?"

c) "Has something changed at work that is causing you to worry?" The nurse begins an assessment by simply asking the client if he or she is currently feeling anxious or worried or has experienced these feelings recently. The nurse also asks the client about obsessive thinking patterns, worrying, compulsions and repetitive activity, specific phobias, and exposure to traumatic events. Once the nurse has determined that signs and symptoms of anxiety do exist, the nurse assesses the possible underlying causes and inquires about family history, recent life events, current stress level, personal history of anxiety, medical and medication history, history of substance abuse, and other possible causes of the anxiety.

Which activity is a function solely of the advanced practice psychiatric-mental health nurse? a) Counseling and crisis management b) Conducting milieu therapy c) Conducting individual psychotherapy d) Intake screening and evaluation

c) Conducting individual psychotherapy The advanced practice psychiatric-mental health nurse may provide psychotherapy (individual, group, family). Examples include all common forms of brief or long-term therapy. The therapist role that the APRN-PMH assumes is formal and structured and often involves contracts (verbal, written, or both) with clients.

The nurse has been unsuccessful in the psychiatric clinical placement and will be obliged to repeat it next semester. The criteria for passing or failing were based on the Psychiatric-Mental Health Nursing Scope and Standards of Practice, which are? a) Future goals for the nursing profession as a whole b) The legal documents that allow a nurse to practice c) Descriptions of the responsibilities for which nurses are accountable d) Explanations of the ideal character of the psychiatric or mental health nurse

c) Descriptions of the responsibilities for which nurses are accountable

Who was responsible for much of the reform of the mental health care system in the 19th century? a) Florence Nightingale b) Hildegard Peplau c) Dorothea Dix d) Sigmund Freud

c) Dorothea Dix Dorothea Dix, a vigorous crusader for the humane treatment of clients with mental illness, was responsible for much of the reform of the mental health care system in the 19th century.

Nursing interventions for physical stress related illness should include what? a) Assessing the need for increased dose of benzodiazepines b) Attending group therapy c) Establishing daily routines of meals and sleeping d) Fostering use of a social support system

c) Establishing daily routines of meals and sleeping Individuals experiencing or at risk for untoward stress responses may benefit from a number of biologic interventions. The importance of (re-)establishing regular routines for activities of daily living (e.g., eating, sleeping, self-care, and leisure time) cannot be overstated. As well as ensuring adequate nutrition, sleep and rest, and hygiene, a routine may help to structure an individual's time and give them a sense of personal control or mastery.

Which skill is in the psychiatric-mental health registered nurse's scope of practice? a) Prescribing psychiatric medications b) Conducting individual psychoanalysis c) Evaluating the effectiveness of psychiatric medications d) Diagnosing psychiatric-mental health conditions

c) Evaluating the effectiveness of psychiatric medications

The nurse is assessing a client with anxiety. What symptom indicates that the the client has adopted a maladaptive behavior in response to stress? a) Tachycardia b) Dyspnea c) Headache d) Pedal edema

c) Headache Tension headache and pain syndromes in an anxious client indicate that the client has not responded to the stress effectively. Tachycardia and dyspnea are the signs related to the flight and fight response to stress, an automatic physiologic response. Pedal edema is not associated with stress.

Who was the first to introduce the concept of interpersonal relations and the therapeutic relationship? a) Mary Nutting b) Florence Nightingale c) Hildegard Peplau d) Linda Richards

c) Hildegard Peplau Hildegard Peplau wrote a publication introducing the concepts of interpersonal relations and the therapeutic relationship within psychiatric-mental health nursing practice.

Which sets professional standards of care? a) States b) Provinces c) Professional nursing organizations d) Hospitals

c) Professional nursing organizations States and provinces grant the legal authority to practice nursing, but professional nursing organizations set standards of care and professional nursing activities.

A client demonstrates sexually inappropriate behavior toward a student nurse. What is an effective way for the student to respond while protecting and respecting the client? a) Ignore the behavior at the time it occurs but report it to staff before leaving clinicals for the day. b) Immediately inform the client that the behavior is unacceptable and will be reported to staff. c) Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client. d) React to the incident with a sense of humor at the time but minimize contact with the client in the future.

c) Report the incident to staff and the clinical instructor so boundaries can be reenforced with the client.

A client reports the client has been experiencing increased stress at work. The client has been managing the stress by drinking 2-3 glasses of wine per evening. Despite the nurse recommending that drinking alcohol is not an effective way to manage the stress, the client reports it is unlikely that the client will be able to stop. Which statement explains why this will be difficult for the client? a) The client is probably physically dependent on alcohol. b) Drinking alcohol is more socially acceptable than taking medications. c) The client has no adaptive coping mechanisms. d) A few glasses of wine each night is not necessarily a problem.

c) The client has no adaptive coping mechanisms. Clients learn to reduce the anxiety they feel in either functional or dysfunctional ways. The nurse first explores with the client what techniques the client has used in the past and helps the client identify and enhance those strategies that are most beneficial. The nurse and client identify maladaptive coping strategies, such as social withdrawal or alcohol use, and replace them with adaptive strategies that suit the client's personal, cultural, and spiritual values. The nurse should not ask the client to give up coping mechanisms, even maladaptive ones, without offering other adaptive mechanisms.

A client with posttraumatic stress disorder (PTSD) holds strong Christian beliefs. The nurse refers the client to an individual from the clergy as a part of treatment. What would be the most appropriate reason for the nurse to take this action? a. It helps the client concentrate on the therapy. b. It helps the client sleep in peace. c. It fosters resilience through allegiance to religious beliefs. d. It helps the client forget the traumatic incident.

c. It fosters resilience through allegiance to religious beliefs. Strong cultural, spiritual, and/or religious identity and allegiance contribute to resilience and, therefore, are highly positive factors in the lives of people with PTSD. As this client is inclined toward spiritual and religious orientation, referring the client to a clergy person would help build resilience in the client. Talking to a member of the clergy would not directly treat concentration issues or insomnia. This intervention will not be directly helpful for the client to forget the traumatic incident.

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? a. The client is extremely irritable in nature. b. The client has extremely negative notions about the self. c. The client has issues with developing trust. d. The client has dissociative identity disorder.

c. The client has issues with developing trust. A client with PTSD usually has difficulties in maintaining relationships. This occurs because the ability to build trust is severely impaired in them. Issues such as irritability, negativity, and having dissociative disorder would have already been treated if the client has had proper treatment.

A nurse observes that a client who has posttraumatic stress disorder (PTSD) is startled even by small noises. What is this behavior indicative of? a. The client is anxious. b. The client is depressed. c. The client is hypervigilant. d. The client is in a dissociated state.

c. The client is hypervigilant. Exaggerated startle response is a common finding in clients with PTSD. It is due to altered arousal and reactive responses associated with the traumatic event. Exaggerated startle response does not indicate anxiety, depression, or dissociation. Depressed clients are usually less reactive to any stimulus. A dissociated state is manifested as the client speaking in a different tone of voice or appearing numb with a blank stare.

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? a. The client may have difficulty hearing. b. The client may have short-term memory loss. c. The client may need to be reoriented. d. The client may not understand the language.

c. The client may need to be reoriented. Dissociation causes disruption in the integrated functions of consciousness, memory, identity, or environmental perception. The nurse may need to repeat relevant information to orient the client to reality. The client is not likely to have difficulty hearing, short-term memory loss, or difficulty understanding the nurse's language.

Which question in the assessment of a client with anxiety is most clinically appropriate? a) "What can I give you to make you feel less anxious right now?" b) "Does your anxiety make you feel less valuable and competent as a person?" c) "Do you think that you're justified in feeling anxious right now?" d) "How do you feel about everything that is happening in your life right now?"

d) "How do you feel about everything that is happening in your life right now?" An open-ended question that prompts the client to describe his or her current feelings is a useful assessment technique. Offering medications or other solutions, asking if the client feels justified in his or her feelings, and questioning the client's self-worth are not normally appropriate, or effective, assessment techniques.

Which statement, made by a client diagnosed with an anxiety disorder, should trigger the nurse's concern about the client's understanding of the use of defense mechanisms? a) "I'm thankful that I have a way to manage my problems." b) "Defense mechanisms provide a sense of control over the uncontrollable." c) "I'm not sure when I'm actually using a defense mechanism." d) "When I have a problem, I just deny it until it goes away."

d) "When I have a problem, I just deny it until it goes away." The dependence on one or two defense mechanisms also can inhibit emotional growth, lead to poor problem-solving skills, and create difficulty with relationships. Denial should not be used to deal with all of one's problems. None of the remaining options present untrue or troubling statements regarding defense mechanisms.

A client approaches the nurse on an inpatient psychiatric hospital unit crying, trembling, and feeling nauseous. The client states, "I've tried everything, I still feel so anxious." Which action by the nurse would be most appropriate? a) Direct the client to continue deep breathing. b) Take the client on a walk around the unit. c) Take the client to the dayroom as a distraction. d) Administer the prescribed PRN anxiolytic medication.

d) Administer the prescribed PRN anxiolytic medication. The client is experiencing severe anxiety. The client tells the nurse the client has tried other strategies but they have not been effective. Given the client's report of symptoms, it would be appropriate to administer a dose of the prescribed PRN anxiolytic medication. Once the client is experiencing a decrease in the uncomfortable physiologic symptoms associated with the severe anxiety, it will be easier to engage the client in nonpharmacological interventions, such as deep breathing, to manage any residual signs and symptoms of the anxiety.

When comparing the theories of mental illness popular in ancient Greece with those popular in the Middle Ages, which is more applicable to the Middle Ages? a) Emotional disorders were believed to be an organic dysfunction. b) Treatment included sedation, good nutrition and hygiene, and music and recreation. c) Mental illness was considered a disturbance of the four body fluids, or "humors." d) Belief in demonic possession and exorcism was common.

d) Belief in demonic possession and exorcism was common.

All of the following pharmacological agents are useful in treating anxiety disorders except which ones? a) Tricyclic antidepressants b) Selective serotonin reuptake inhibitors (SSRIs) c) Benzodiazepines d) Calcium channel blockers

d) Calcium channel blockers Tricyclic antidepressants and SSRIs are known to be useful in reducing anxiety and are sometimes useful in treating the anxiety disorders. Benzodiazepines are an excellent choice for the treatment of symptoms of anxiety; however, they are extremely addictive and should only be given in the case of true anxiety disorders. Calcium channel blockers are not used in treating anxiety disorders.

Which assessment question is most likely to allow the nurse to differentiate between anxiety disorder due to a general medical condition and psychological factors affecting a medical condition? a) Reviewing the client's previous medication administration record and the client's current list of medications b) Questioning the client about the clinician who first diagnosed the medical problem c) Asking the client to provide a detailed explanation of his or her medical problem to determine if the presentation is typical of the problem d) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first

d) Establishing whether the client's anxiety preceded the medical problem or whether the medical problem appeared first Considering the relationship of anxiety with the onset, exacerbation, or remission of the general medical condition can help determine whether a medical condition contributes to anxiety or vice versa. The client's medication list, the identity of the clinician who diagnosed the disease, and the client's symptoms are all aspects of the assessment process, but these are less likely to establish the primary cause.

A client diagnosed with schizophrenia has recently become divorced and is living in public housing. How would the DSM-5 best help in planning this client's care? a) It is used by all mental health professionals to identify and treat the mentally ill client. b) It provides information on all major mental health disorders and their effect on existing health issues. c) It provides the mental health team with links to the latest clinical research on schizophrenia. d) It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client.

d) It is used by the mental health team to identify the psychosocial and environmental factors currently affecting the client.

The goal of the deinstitutionalization movement was to achieve which outcome? a) Move psychiatric clients out of the hospitals and into their families of origin because of the belief that families were the responsible parties. b) Move chronic, older psychiatric clients out of hospitals to make room for younger clients who had better prognoses and were amenable to long-term treatment. c) Empty out large psychiatric hospitals so they could be converted for military use. d) Move psychiatric clients out of the hospitals and into the community in an effort to provide a better quality of life for them.

d) Move psychiatric clients out of the hospitals and into the community in an effort to provide a better quality of life for them.

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? a. The client is dissociating. b. The client is extremely terrified. c. The client is taking a defensive posture. d. The client benefits from supportive touch.

d. The client benefits from supportive touch. The client is having a flashback experience and holds the nurse's hand. This indicates that the client feels safe with touch and that supportive touch would be beneficial for the client. Holding the nurse's hand does not indicate that the client is dissociating. If the client appears numb with a vacant stare it is likely that the client is dissociating. The client must already be terrified by the flashback episode. Holding the nurse's hand does not indicate that the client is taking a defensive posture.

A client with posttraumatic stress disorder (PTSD) is admitted to a psychiatric unit. Which is the most appropriate reason for the head nurse to appoint one nurse to provide complete care for the client? a. The client does not need much care. b. The client would be able to express feelings better. c. The client would be more responsive to therapy. d. The client has difficulty with familiarizing and trusting people.

d. The client has difficulty with familiarizing and trusting people. Limiting the number of staff members who interact with the client would help the client to become familiar with and trust the staff. This is the most appropriate reason for only one nurse being assigned to the client. Clients hospitalized with PTSD need equally good care as that given any other client in the psychiatric facility. If the client has developed trust in the nurse, then the client may be better able to express feelings. Limiting the number of staff members attending to the client would not directly help increase the effectiveness of therapy.