Psych Exam 4

A group of nurses is reviewing information about substances that are abused. The nurses demonstrate understanding of the information when they identify which agent as a stimulant? Select all that apply: A)Nicotine B)Phencyclidine C)Cocaine D)Alcohol E)Heroin

A, C- no rational given

When using the CAGE assessment tool to determine a client's potential risk of alcoholism, the mental health nurse asks the client which question? Select all that apply A)How do you feel when people tell you drink too much? B) When was the last time you had a drink first thing in the morning? C)Have you ever been in trouble with the law as a result of your drinking? D)Have you ever thought you drink too much? E)Do you feel sad or guilty when you drink?

A,B,D,E- no rational given

The nurse is completing the admission of a client who is seeking treatment for alcoholism. The client tells the nurse, "The last time I had any alcohol to drink was at 10 a.m. before I left for the hospital." Which observation would lead the nurse to suspect that the client is experiencing stage 1 of alcohol withdrawal syndrome? Select all that apply. A)Normal blood pressure B) Intermittent confusion C)Hand tremors D)Slight diaphoresis E)Heart rate of 135 beats/min

A,C,D- no rational given

A client diagnosed with bipolar disorder has a lithium drug concentration of 1.2 mEg/L. Which finding would the nurse expect to assess? Select all that apply. A)Metallic Taste B)Slurred Speech C)Ataxia D) Muscle weakness E)Fasciculations F)Diarrhea

A,D,F- Manifestations associated with a lithium concentration less than 1.5 mE/L include a metallic taste in the mouth, diarrhea or loose stools, and muscular weakness or fatigue. Ataxia and slurred speech are associated with lithium blood concentration between 1.5 and 2.5 mEq/L. Fasciculations are associated with a lithium blood concentration over 2.5 mEq/L

A client receiving methadone maintenance therapy has been given information about this treatment. The nurse determines that the education was successful when the client makes which statement? A)I should eat small frequent meals if I get nauseated B)I can have a glass of wine with dinner if I choose C)I should take the drug on an empty stomach D)I might experience diarrhea with this drug

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

The plan of care for a client demonstrating frequent anger includes behavioral interventions. What would the nurse be likely to find? A)Anger Management B)Relaxation training C)Response disruption D)Self-monitoring of cues

A- Anger management is a psychoeducational intervention. Behavioral treatment of anger involves avoidance of provoking stimuli, self-monitoring regarding cues of anger arousal, stimulus control, response disruption, and guided practice of more effective anger behaviors. Relaxation training is often introduced early in the treatment because it strengthens the therapeutic alliance and convinces clients that they can indeed learn to calm themselves when they are angry.

After teaching a group of nurses about crisis, the group leader determines that the education was successful based on which statement by the group? A)Crisis is a time-limited event B)Crisis usually results in negative outcomes C)Events causing a crisis are similar for everyone D)Chronic crisis is a real situation

A- Crisis is a time-limited event (usually no more than 4-6 weeks) that triggers adaptive or nonadaptive responses to maturational, situational, or traumatic experiences. A crisis can have either positive or negative outcomes. By definition, there is no such thing as a chronic crisis. People who live in constant turmoil are not in crisis but in chaos. Although the feelings associated with a crisis are similar, the precipitating event and circumstances are unusual or rare, perceived as a threat and specific to the individual.

A 20-year-old client arrives at the emergency department by ambulance. The client is unconscious, with slow respirations and pinpoint pupils. There are "tracks visible on the client's arms The friend who came with the client reports that the client had just "shot up" heroin and then became unconscious. Which medication would the nurse most likely expect to administer? A)Naloxone B)Varenicline C)Bupropion D)Naltrexone

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

A psychiatric-mental health nurse is teaching a client with obsessive-compulsive disorder (OCD) about the prescribed antidepressant therapy. Which statement by the client indicates the need for additional teaching? A)I should notice a difference in a couple of days B) I should not stop the medicine abruptly C)I need to be careful because I might get sleepy at first D)I should not drink any alcohol while I'm taking this medicine

A- Nurses play an important interdisciplinary role in managing medication for persons with OCD, which includes educating clients and families about medications. Because clients may become discontented with a perceived lack of effect, they should be informed that these medications may take several weeks before their effects are realized. All clients should be warned not to stop taking prescribed medications abruptly. In addition, individuals should be instructed to avoid alcohol and not to operate heavy machinery while taking these medications until the sedative effects are known.

After educating a group of students on the various concepts involving suicide, the instructor determines that the education was successful when the students provide which description of parasuicide? A)a voluntary attempt without death as the aim B)all suicide-related behaviors and suicidal thoughts C)the voluntary act of killing oneself D)a nonfatal act with the intent to die

A- Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death. Suicide is the voluntary act of killing oneself. It is a fatal, self-inflicted destructive act with explicit or inferred intent to die. Suicidality is all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. A suicide attempt is nonfatal, self-inflicted destructive act with explicit or implicit intent to die.

A psychiatric-mental health nurse is conducting a program for a group of nurses working at a primary care center about obsessive-compulsive disorder. One of the nurses asks, "So how would we know if the person's routine is a compulsion?" Which response by the nurse would be most appropriate? A)If the routine interferes with the person's normal activities, then it would be considered a compulsion B)If the person can control the ritual at one time, but not at another time, then the ritual is a compulsion C)If the ritual causes anxiety while the person is doing it, then it would be considered a compulsion D)Any ritual or routine is considered a compulsion if it takes up at least 30 minutes a day

A- Routines are a part of everyday life. Getting up in the morning at the same time and going to work or school structures our lives and helps us be productive. When routines become ritualistic and interfere with normal daily activity, they become compulsions. Compulsions are done to prevent or relieve anxiety; they do not cause anxiety unless the person does not perform the compulsion. Recurrent obsessions or compulsions or both must take up more than 1 hour a day to meet the criteria for diagnosis.

A nurse is assessing a client's social networks. When evaluating this area, the nurse integrates knowledge that what important component? A) Reciprocity B) Demands C) Bonding with one another D) Blood relationships

A- Social networks provide opportunities for give and take. Network members both provide and receive support, aid, services, and information. Reciprocity is particularly important because most friendships do not last without the give and take of support and services. A person who is always on the receiving end eventually becomes isolated from others. Emotional support and bonding may occur in a social network, but this is not a key component. Blood relationships are unrelated to social networks.

Which part of the history for a client who has been admitted to an inpatient psychiatric unit would the nurse identify as the strongest indicator of risk for violence? A)Previous episodes of rage B)Problematic anxiety C)Somatoform disorder D)Panic disorder

A- The client's history of violent behavior is probably the most important predictor of potential for violence. Important markers include previous episodes of rage and violent behavior, escalating irritability, intruding angry thoughts, and fear of losing control. History of other psychiatric disorders would be less of a concern.

During assessment of a client diagnosed with depression, the client states, "I just feel so sad and hopeless. I just don't care anymore. I don't even enjoy doing the crossword puzzles like i used to" The nurse documents this finding as indicative of which condition? A)Anhedonia B)Psychosis C)Delusion D)Dysthymic disorder

A- The client's statements reflect anhedonia, a loss of interest or pleasures such that the client does not experience any enjoyment in activities that were previously considered pleasurable. Dysthymic disorder is a milder but more chronic depression. Delusion is manifested as false, fixed beliefs. Psychosis is a state in which a person experiences symptoms such as hallucinations, delusions, or disorganized thoughts, speech or behavior.

While talking with a client who has been experiencing aggression and intense anger, a nurse identifies that the client feels isolated and anxious. Which statement by the nurse would be most appropriate? A)this must be scary for you B)i really understand how you feel C)once you relax, things will improve D)if you calm down, I can help you

A- The most appropriate response would be to acknowledge and validate the client's feelings, perhaps by stating that this must be scary for the client. In doing so, the nurse helps the client feel understood and supported. The statements about relaxing and calming down do not address the client's underlying feelings. Telling the client that the nurse really understands is nontherapeutic because only the client can truly know what he or she is feeling. page 305, "validating*

A nurse performing an assessment interview is told by the client, 'I'm a type A personality." Based on the client's statement, the nurse would expect which behavior? A) Wanting the interview to be over as quickly as possible B)Speaking slowly, requiring time to consider his answers C)Being pleased with the overall pace of the interview D) Appearing relaxed and easygoing throughout the interview

A- The nurse can anticipate that the client will be competitive, aggressive, and impatient because these characteristics signify the type A personality. People with type B personalities do not exhibit these behaviors and generally are more relaxed, easy going, and easily satisfied. They have an accepting attitude about trivial mistakes and use a problem-solving approach to major problems. People with type C personalities are described as having difficu notion; being introverted, respectful, conforming, compliant, and eager to please; and avoiding conflict. They respond to stress with depression and hopelessness. A person with type D (distressed) personality is indicated when he or she experiences increase negative emotions (depression) and pessimism, and does not share emotions.

After working with a client who has a history of violent behavior to identify possible clues that suggest the behavior is escalating, the nurse and client develop a plan for prevention. Which strategy would they be least likely to include? A)Turning up the music loudly B)Taking a voluntary time out C)Taking slow deep breaths D)Counting to 10

A- Turning up the music loudly would add additional stimulation, which could contribute to increasing the stress and stimulation of the situation. Rather, the suggestion would be to listen to quiet music or read. Counting to 10, taking slow deep breaths, and taking a voluntary time out would be appropriate.

A nurse is assessing a client with excoriation disorder. At which site would the nurse most commonly expect to assess the damage? Select all that apply. A) lower legs B) hands C) face D) joints E) arms

B,C,E- Repetitive and compulsive picking of skin causing tissue damage characterizes excoriation or skin-picking disorder. Although tissue damage can occur anywhere on the body, the face, arms, and hands are the most common sites.

A nurse is obtaining a history from a client who drinks about six cups of coffee and several diet cola drinks per day. The client states, "I just cut down my coffee and soda intake to one per day." Which symptoms would the nurse most likely expect to assess? Select all that apply. A)Diuresis B) Headache C) Yawning D)Flushing E) Fatigue

B,C,E- The client's decreased intake of caffeine could lead to caffeine withdrawal, manifested by headache, drowsiness, fatigue, craving, impaired psychomotor performance, difficulty concentrating, yawning, and nausea. Flushing and diuresis would be characteristic of caffeine overdose.

When assessing a client experiencing aggression, a nurse applies the general aggression model. What would the nurse assess as the person factors? Select all that apply A)client shouting B) clients' personality traits C)insult initiating the behavior D) clients' gender E) previous behavior patterns F)clients attitude

B,D,F- no rational given

A nurse is providing an in-service presentation on coping and adaptation. What information would the nurse most likely include? Select all that apply. A)The same coping strategy is used in each situation B) Coping, when effective, leads to adaptation C)Most coping strategies are similar in their approach D)Reappraisal occurs simultaneously with coping E) Coping is a deliberate and planned effort to manage stress

B,E- no rational given

A group of nursing students is reviewing information about the types of crisis. The students demonstrate understanding of the information when they identify which happening as a developmental crisis? A)Obtaining a job promotion B)going away to college C) Loss of a pet D Earthquake

B- A developmental crisis is one that occurs with normal growth and development, such as going away to college. Obtaining a job promotion or loss of a pet is an example of a situational crisis. An earthquake is an example of a traumatic crisis.

A family has recently lost all their belongings in a house fire and has been living in temporary housing. Although the parents were previously very supportive and able to help their young children with their homework in the evenings, they have been unable to do so under their present circumstances. Based on this information, which nursing diagnosis would be most appropriate for this family? A)Caregiver role strain B)Interrupted family processes C) Compromised family coping D)Ineffective family therapeutic regimen management

B- A nursing diagnosis of interrupted family processes is most appropriate when a usually supportive family is experiencing stressful events that challenge its previously effective functioning. Nurses select compromised family coping when the primary supportive person is providing insufficient, ineffective, or compromised support, comfort, or assistance to thi client in managing or mastering adaptive tasks related to the individual's health challenge. Ineffective family therapeutic regimen management would be appropriate if the family is experiencing difficulty integrating into daily living a program for the treatment of illness and the sequela of illness that meets specific health goals. Caregiver role strain is usually applied to individual family members, often in relation to providing care to a family member

A client's poodle ran in front of a car and was killed. The client continues to be upset by the pet's death and explains to a community counseling center nurse. "I can't stop crying because my Precious meant the world to me, and now my world will never be the same!" If the nurse were to determine that the client was experiencing a crisis, which type of crisis would it most likely be? A)Developmental B)Situational C)Maturational D)Traumatic

B- A situational crisis occurs whenever a specific stressful event threatens a person's biopsychosocial integrity and results in some degree of psychological disequilibrium. The pet's death caused the client to experience a degree of psychological disequilibrium. A developmental or maturational crisis is one involving normal growth and development. A traumatic crisis is initiated by unexpected, unusual events that affect an individual or multitude of people.

A client is prescribed disulfiram as part of the alcohol treatment program to prevent relapse. The client asks the nurse, "How will this drug help me?" Which response by a nurse would be most appropriate? A) It makes the withdrawal symptoms less troublesome B)It can help to prevent you from drinking C)It will help to cure your alcoholism D)It helps to clear the alcohol out of your body

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

A nurse is preparing to administer medications to a client diagnosed with bipolar disorder who is experiencing acute mania. Which action would be most appropriate for the nurse to take? A)Tell the client firmly that medication compliance is vital B)Allow the client to participate in the treatment decision C)Restrain the client before administering the medication D) Notify the primary care provider about the client's refusal of the medication

B- Even during the most acute episodes, it is important for clients to have a sense of empowerment and participation in treatment. Therefore, the nurse would allow the client to participate in treatment decisions. Telling the client firmly that he or she must take the medication or restraining the client would be inappropriate. Notifying the primary care provider would be appropriate only if the client continued to refuse to take the medication after allowing her to participate in the decisions.

A psychiatric-mental health nurse is working with a client diagnosed with obsessive-compulsive disorder (OCD). The client engages in an intense hand-washing ritual, usually once an hour. Which intervention would be most appropriate for the nurse to include in a teaching plan for this client? A) Use cold water when washing hands B)Apply hand cream to the skin after washing C) Use a strong antibacterial soap for washing D) Set up a schedule to wash hands every 20 minutes

B- For the client with cleaning or hand washing compulsions, attention to skin condition is necessary. Encourage the individual to use tepid water when washing and hand cream after washing Remove harsh, abrasive soaps and replace them with moisturizing soaps. A strong antibacterial soap would be harsh. Attempt to decrease the frequency of washing by agreeing on a time schedule and time-limited washing. Setting up a schedule to wash hands every 20 minutes would increase the frequency of the activity.

A nurse is working with a family and using the calgary family model to help address problems that have been identified. The family is in which stage of the model? A)Engagement B)Assessment C) Intervention D) Termination

B- In the assessment stage, problems are identified, and relationships between family and health providers develop. During this stage, the nurse opens space for the family to tell its story. The engagement stage is the initial stage in which the family is greeted and made comfortable. The intervention stage is the core of the clinical work and involves providing a context in which the family can make changes. The termination phase refers to the process of ending the therapeutic relationship.

While assessing an older adult, the nurse allows ample time for the client to respond based on what understanding of the aging process? A) The client is most likely experiencing irreversible memory impairment B)Allowing ample time ensures that the correct answer is given C)The client is experiencing decreased cerebral oxygen flow from reduced activity D) Ample time is needed to weigh the pros and cons of the perceived risk for answering

B- Mental processing speed and reaction time do gradually decrease from mid to late adulthood and may affect how quickly older adults respond to questions. This phenomenon has been labeled the speed-accuracy shift, by which older adults focus more on accuracy than speed in responding. Older adults are more likely to make errors of omission (leave out the answer) than errors of commission (make a guess). Memory impairment or decreased cerebral oxygen flow may be present, but this is not a universal phenomenon.

A psychiatric-mental health nurse is integrating the Calgary Family Assessment Model when caring for a family. The nurse has set up sessions that are amenable for the family as the family works to make changes. The nurse and family are at which stage? A)Engagement B) Intervention C) Assessment D) Termination

B- The Calgary Family Intervention Model (CFIM) is built around four stages: engagement, assessment, intervention, and termination. The nurse and family are in the intervention stage The intervention stage is the core of the clinical work and involves providing a context in which the family can make changes. The engagement stage is the initial stage in which the family is greeted and made comfortable. In the assessment stage, problems are identified and relationships among family members and health providers develop. During this stage. the nurse opens space for the family members to tell their story. The termination phase refers to the process of ending the therapeutic relationship.

A client comes to the emergency department reporting a severe pounding headache in the temples and a stiff neck. The client is flushed and diaphoretic, and the client's pulse is racing. The client states that the client is being treated for depression with an MAOI. Which question by the nurse would be most important to ask at the time? A)"Do you use any herbal remedies?" B)"What have you had to eat or drink today?" C)"When did you last have blood drawn to check your drug level?" D)"Are you having any chest pain?"

B- The client is exhibiting signs of a hypertensive crisis, which can occur when a client is receiving MAOI therapy and ingests food or other substances that contain tyramine. Thus, the nurse should ask the client what the client has had to eat or drink. Drug levels are used to monitor tricyclic antidepressants. Asking about chest pain would be appropriate after obtaining information related to what the client has ingested. Herbal remedies can interact with medications, but this information would be obtained after determining whether the client has ingested foods and fluids containing tyramine.

A nurse is caring for a 30-year-old man whose wife has recently died. The client has been diagnosed with clinical depression and is demonstrating insufficient coping skills. Which action by the nurse would be most important? A)Refer the client for long-term psychotherapy B) Ask the client whether he is thinking about killing himself C)Determine the client's risk of psychosis D)Determine whether anyone in the client's family has had depression

B- The nurse should first ask whether the client is thinking about killing himself, because statistics show that among young, recently widowed. White men between the ages of 20 and 34 years, the suicide risk is 17 times higher than that of married men in the same age group. Social isolation and access to firearms play important roles in this group. Information related to psychosis, psychotherapy, or family history would be less of a priority at this time.

An adolescent client recently tried to overdose because of a relationship breakup. The client's single parent has been drinking excessively to cope with the stress. The client tells the nurse "Whenever I need to talk, my parent is always drunk or away drinking with friends. Based on this information, which nursing diagnosis would be most appropriate for this client's family? A) Caregiver role strain B)Compromised Family Coping C)Ineffective denial D)Ineffective family therapeutic regimen management

B- The nursing diagnosis of compromised family coping is most appropriate when the primary supportive person is providing insufficient, ineffective, or compromised support, comfort, or assistance to the client. Ineffective denial and caregiver role strain are diagnoses that are usually applied to single family members, and ineffective family therapeutic regimen management is used for families experiencing difficulty when managing care for an ill family member with regard to specific health goals

A nurse is developing a presentation for families who have members diagnosed with bipolar disorders. When describing this condition to the group, which would the nurse most likely include? A)Environmental stressors are a key cause of these disorders B)The risk for suicide is high with either depression or mania C)As the person ages, the episodes tend to decrease D)Risk taking behaviors are more common during a depressive episode

B- The risk of suicide is always present for those having a depressive or manic episode. During a depressive episode, the client may feel that life is not worth living. During a manic episode. the client may believe that he or she has supernatural powers, such as the ability to fly. As clients recover from a manic episode, they may be so devastated by the consequences of their impulsive behavior and poor judgment that suicide seems like the only option. Manic or depressive episodes tend to accelerate over time, with each episode leaving a trace and increasing the persons vulnerability for sensitizing the person to have another episode with less stimulation). Environmental conditions contribute to the timing of an episode of the illness but are not a cause of the iliness. During a manic episode, poor judgment and impulsivity lead to risk-taking behaviors

A nurse is developing an education plan for a client who is prescribed escitalopram. Which side effect would the nurse include in this plan? Select all that apply: A)Sedation B)Urinary retention C)Insomnia D)Constipation E)Dry mouth F)Blurred vision

C,D,E- no rational given

A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? A)What was going through your mind when you started screaming B)You will not get your way by screaming C)Stop screaming and walk with me outside D)Why are you so angry and screaming at everyone

C- 'why' questions imply criticism and will often cause the client to become defensive. A closed-ended nontherapeutic statement will not help. If the client is having an outburst, they may not be ready to simply discuss the issue.

When assessing the family's communication patterns, the nurse would start with which area? A) Observing which member initiates the conversation B)Noting which member answers the most questions C) Identifying which family members confide in one another D) Assessing which family member volunteers information

C- Although observing which member speaks first, which member answers the most questions, and which membe family members confide in one another is a place to start examining ongoing communication.

The plan of care for a client diagnosed with depression includes cognitive interventions. A nurse would expect to assist with which intervention? A) Interpersonal therapy B)Social skills training C)Thought stopping D)Activity scheduling

C- Cognitive interventions include measures such as thought stopping and positive self-talk. Social skills training and activity scheduling are behavioral interventions. Interpersonal therapy is used to recognize, explore, and resolve interpersonal losses, role confusion and transitions, social isolation, and deficits in social skills.

A group of nursing students is reviewing information about grief and bereavement. The students demonstrate understanding of the information when making which statement? A)Grief involves confronting the stressor, but bereavement helps to avoid the stressor B)Grief and bereavement are used interchangeably as a response to loss C)Bereavement is the process of mourning and grief is the emotional reaction D)Bereavement is influenced by culture, but grief is not

C- Grief is an intense, emotional reaction to the loss of a loved one. The reaction is a biopsychosocial response that often includes spontaneous expression of pain, sadness, and desolation. Bereavement is the process of mourning and coping with the loss of a loved one. It begins immediately after the loss, but it can last months or years. Individual differences and cultural practices influence grieving and bereavement.

A psychiatric-mental health nurse is assessing a client and suspects that the client is experiencing obsessive-compulsive disorder. Which finding would support the nurse's suspicion? A) Client appears disheveled in appearance B)Speech is fairly loud and rapid C)Clieent includes irrelevant details in answers D)Client reports minimal physical symptoms

C- Most individuals appear neatly dressed and groomed, cooperative, and eager to answer questions. Speech will be at normal rate and volume, but often, individuals with an obsessional style of thinking exhibit circumferential speech. This speech, loaded with irrelevant details, eventually addresses the question. Individuals with OCD do not have a higher prevalence of physical disease than others. However, they may report multiple physical symptoms.

A nursing student is reading an article about protective factors for older adults with mental illness. The article mentions the individual's ability to adapt successfully to stress, trauma chronic adversity. The student identifies this as which process? A)Empty nesting B)Functional status C)Resilience D)Gerotransendence

C- Resilience is an individual's ability to adapt successfully to stress, trauma, or chronic adversity. Functional status is the extent to which a person can independently carry out personal care, home management, and social functions in everyday life, in a way that has meaning and purpose. Gerotranscendence is the ninth stage of development that provides for continued growth in dimensions, such as spirituality and inner strength. An empty nest is a home without children or caregiving responsibilities (common in middle-aged adults).

A family has just lost their home in a fire. An on-call nurse from a community counseling center has been called into the emergency department to help them with this traumatic event. Which priority would the nurse identify for this family? A)Assessing the impact of the loss on their lifestyle B)Arranging for follow-up therapy to deal with the crisis C)Arranging for emergency shelter and food supplies D)Completing a family genogram to determine family patterns

C- Safety interventions to protect people in crisis from harm should include preventing the individuals from committing suicide or homicide, arranging for food and shelter (if needed), and mobilizing social support. Additionally, the priorities of physical needs surpass those of psychosocial needs. After the individual's safety needs are met, the nurse can address the psychosocial aspects of the crisis.

A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states. "I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me. The nurse interprets these statements as indicative of which type of mood? A) Elevated B)Euphoric C)Expansive D)Irritable

C- The client's statements reflect an expansive mood, which is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or elation (feeling high) "ecstatic" *on ton of the world? or sue in the clouds."

A client diagnosed with obsessive-compulsive disorder (OCD) comes to the clinic with a spouse. During the visit, the spouse states. "It isn't normal to always be checking and rechecking to make sure that all of the appliances are turned off before we go out. It is nerve-wracking. We can never get out of the house on time. "Isn't checking once enough?" Which explanation of this behavior would the nurse need to incorporate into the response? A) the client is attempting to exert control over the situation B) the client's behavior reflects a need for safety C)the client performs the ritual to relieve anxiety temporarily D) The client is attempting to use thought-stopping to decrease the behavior

C- The nurse needs to explain to the spouse that the client's compulsion is done to relieve anxiety temporarily. The compulsion is necessary, not pleasurable, and if not performed. increased anxiety and distress occur. The compulsion is an anxiety response, not a means to control the situation or promote safety. Thought stopping is a mechanism used to control obsessions.

A client diagnosed with depression who is receiving antidepressant therapy comes to the clinic for a follow-up appointment. The client tells the nurse, "I've been having trouble moving my bowels since I started this medicine. Is there something I can do to help?" After teaching the person about measures to address this problem, which statement by the client indicates the need for additional teaching? A)"I'll get some more fresh fruits in my diet" B)"I can try eating more whole grains" C)"I'll be sure to drink no more than 4 glasses of water daily" D)"I will try to get more exercise each day""

C- To assist with constipation the client should drink at least 6 to 8 glasses of water each day. Getting more exercise, increasing the consumption of fresh fruits and whole grains in the diet are positive measures to address constipation.

A nurse has completed an assessment of a client who is experiencing significant stress. The assessment revealed intense anger and acting-out behaviors, along with statements of negative emotions. Which nursing diagnosis would be most appropriate? A) Hopelessness B) Low self-esteem C) Ineffective coping D) Disturbed thought processes

C- he assessment information supports the nursing diagnosis of ineffective coping. There is no information related to problems with thought processes. Low self-esteem may be a problem, but there is no information to support this diagnosis. The client also may be experiêncing hopelessness, but the situation does not support this.

A nurse is with an adolescent who eports nothing to live for and wishes to be dead. Which nursing action would be the priority? A)Putting the client in seclusion with a staff member assigned to watch the client at all times B)Ascertaining the client's beliefs about what happens when one dies C)Staying with the client to explore more of the client's thoughts about suicide D)Going to the client's psychiatrist to report the suicidal ideation

C-A true psychiatric emergency exists when an individual presents with one or more symptoms associated with imminent risk for suicidal behavior. The first priority is to provide for the clients safety which initiating the least restrictive care possible. Staying with the client and further exploring the client's thoughts about suicide will enhance safety and allow the nurse to more thoroughly understand the extent of the client's suicidal risk. It would not be appropriate to leave the client alone while the nurse goes to talk with the psychiatrist. Seclusion would by used only as a last resort because it is a highly restrictive environment. Determining the client's beliefs about death would be a topic to be addressed much later in the process.

A client is exhibiting signs of a manic episode manifested by an elevated mood. Which expression would the nurse expect to assess? A)Indiscriminate enthusiasm for interactions B)Lack of restraint with feelings C) Feelings of being on top of the world D)Overvalued sense of self-importance

C-An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or elation (feeling "high, "ecstatic," *on top of the world, or 'up in the clouds). An expansive mood is characterized by lack of restraint in expressing feelings; an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, occupational interactions.

A nurse is assessing a 35-year-old client who is seeking assistance at a local community counseling center. Which statement would indicate that the client is experiencing a crisis? A)No matter what I do I am still overcome by these sad feelings B)I'm confused and hurt; I have lost my best friend and my lover C)I don't understand, I can't seem to function like I usually do D)I'm so upset, my spouse has never left me like this before

C-Crisis occurs when there is a perceived challenge or threat that overwhelms the capacity of the individual to cope effectively with the event. Life is disrupted, and unexpected emotional (e.g. depression) and biologic (e.g.. nausea, vomiting, diarrhea, and headache) responses occur. Functioning is severely impaired. Although feelings of upset, confusion, hurt. and sadness may occur with a crisis, the key component is impaired functioning.

A group of nursing students is reviewing information about suicide and associated concepts. The group demonstrates understanding of the information when members identify which term as the probability that a person will successfully complete suicide? A)suicidal ideation B)parasuicide C)lethality D)suicidality

C-Lethality refers to the probability that a person will successfully complete suicide. Parasuicide is a voluntary, apparent attempt at suicide, commonly called a suicidal gesture, in which the aim is not death (e.g., taking a sublethal drug). The term, suicidality refers to all suicide-related behaviors and thoughts of completing or attempting suicide and suicide ideation. Suicidal ideation is thinking about and planning one's own death.

A nurse is completing an admission assessment of a young client who has a history of depression and who was brought to the hospital by the client's partner. In response to the nurse's question regarding suicidal ideation, the client discloses contemplation of suicide. Which question would be most appropriate for the nurse to ask next? A) "what are your spiritual beliefs about suicide?" B) "What will killing yourself accomplish?" C) "What does your partner think about your desire to kill yourself?" D)" What thoughts have you had about how you would kill yourself?"

D- Assessing for risk includes determining the seriousness of the suicidal ideation, degree of hopelessness, disorders, previous attempt(s), suicide planning and implementation, and availability and lethality of the suicide method. Risk assessment also includes the client's resources, including coping skills and social supports, that can be used to counter suicidal impulses.

A nurse is explaining the concept of cognitive aging to a group of seniors at the senior center when one asks, "So when does this type of aging begin?" Which response by the nurse would be most appropriate? A)Each person begins this type of aging at different times B)Researchers have yet to identify exactly when it starts C)It usually starts sometime during your forties D)It's a life-long process that starts before you were born

D- Cognitive aging is a process of gradual, ongoing. yet highly variable changes in cognitive functions that occur as people get older. Cognitive aging is a life-long process beginning in utero. Although the changes that occur are variable, the onset is not

A nurse is preparing a presentation for family members of clients who have been diagnosed with depression. When describing the family response to depression, which would the nurse include? A)Abuse of the depressed person is a rare occurrence in families. B)Families of women older than 55 years of age with depression experience the majority of problems C)Family members typically can understand how disabling depression can be D)Depression in one family member affects the entire family

D- Depression in one member affects the whole family. Spouses, children, parents. siblings, and friends experience frustration, guilt, and anger when the family member is immobilized and cannot function. It is often hard for others to understand the depth of the mood and how disabling it can be. The lack of understanding and difficulty or living with a depressed person can lead to abuse. Women between the ages of 18 and 45 years constitute the majority of those experiencing depression, and thus their families experience the majority of problems.

A 25-year-old client is seeking counseling for recently and unexpectedly losing a job. Which question would be most appropriate for a nurse to use in assessing the client's response to losing the job? A)What happened to cause you to lose your job B)How did you feel immediately after being told you no longer had a job C)How do you expect yourself to be able to handle this situation D)How have you responded to previous stressful situations

D- Individual responses to a crisis can be best understood by assessing the usual responses of the person to stressful events. The response to the crisis also depends on the meaning of the event to the person. Asking about the cause of job loss, immediate feelings, and how the person expects to handle the situation do not address the client's response to the job loss.

A 57-year-old client with a long history of alcohol dependence is being treated for alcoholism and is in the second week as an inpatient on the psychiatric unit. The client, a retired nurse, is observed wearing a hospital gown with a stethoscope. When asked about the stethoscope, the client replies that the nursing supervisor came to visit and said to wear it "so I'd remember to get well". What does the nurse suspect that the client may be experiencing? A)Wernicke's syndrome B)Delirium tremens C)Malignant hyperthermia D)Korsakoff's amnestic syndrome

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

A client diagnosed with bipolar disorder, having experienced a depressive episode, is prescribed lamotrigine. After educating the client on this medication, the nurse determines that the education was successful when the client makes which statement? A)This drug can affect my liver function B)I have to watch how much salt I use every day C)I need to have my blood tested about once a month D) I need to notify my primary care provider if I develop a skin rash

D- Lamotrigine has a boxed warning for skin rash, which should be reported immediately if it develops. In most cases, the rash is benign, but it is not possible to predict whether the rash is benign or serious (Stevens-Johnson syndrome). Blood testing is needed for other mood stabilizers, such as lithium, divalproex, and carbamazepine. Salt is a concern with lithium therapy. Liver function can be affected by carbamazepine

A group of nursing students is reviewing the physical changes that occur in older adults. The students demonstrate understanding of the information when they identify what as contributing to the client's risk for drug toxicity? A)Reduced brain gray matter volume B)Lower metabolic rate at rest C)Decreased body water D)Reduced liver function

D- Liver function may be reduced because of decreased blood flow and enzyme activity, resulting in increased blood and tissue concentrations of medications. Changes in brain gray matter volume, lower metabolic rate, and decreased body water would not contribute to potential drug toxicity in older adults. Side 32 of lecture

A client who has attempted suicide has an underlying diagnosis of depression. Which medication would the nurse anticipate being ordered for the client? A)tricyclic antidepressant B)atypical antipsychotic C)mood stabilizer D)selective serotonin reuptake inhibitor

D- Medication management focuses on treating the underlying psychiatric disorder. For depression, a nonlethal antidepressant (e.g. selective serotonin reuptake inhibitor) usually is prescribed. For clients with schizophrenia and schizo affective disorder, antipsychotics may be used; however, only clozapine, an atypical antipsychotic, has been shown to be effective

A client prescribed lithium therapy has a plasma blood concentration of 2.2 mEq/L.Which would the nurse expect to assess with moderate toxicity? A) Fine resting hand tremor B) Muscular weakness C)Loose stools D) Confusion

D- Moderate toxicity is associated with confusion, dysarthria, nystagmus, myoclonic twitches, and ECG changes. A fine resting hai side effects which are seen with plasma concentrations less than 1.5 mEq/L Imild toxicity

A psychiatric-mental health nurse is describing uncomplicated bereavement to a group of nurses working with terminally ill clients. Which information would the nurse most likely include in the discussion? A)this type of bereavement is less painful and disruptive than normal bereavement B)uncomplicated bereavement is primarily loss associated with death C)Uncomplicated bereavement differs from normal bereavement because it lasts longer D)Most bereaved persons experience uncomplicated bereavement

D- Most bereaved people experience normal or uncomplicated grief after the loss of a loved one. Uncomplicated grief is painful and disruptive. It can be applied to situations other than loss because of death.

A client has been prescribed naltrexone for treatment of alcohol dependence. The nurse has explained the drug's purpose to the client. The nurse determines that the client has understood the instructions when the client identifies which potential effect about the drug? A) Improves appetite and nutritional status B) Produces the euphoria of alcohol C)Causes itching if alcohol is consumed D)Reduces the appeal of alcohol

D- Naltrexone's effect is unknown. Reports from successfully treated clients suggest three kinds of effects: (1) can reduce craving (the urge or desire to drink). (2) can help maintain abstinence, and (3) can interfere with the tendency to want to drink more if a recovering client slips and has a drink. The medication is not known to cause itching, euphoria, nor improved appetite.

A client diagnosed with obsessive-compulsive disorder engages in storing many items that are considered to be useless. The nurse would categorize the client's symptoms as belonging to which symptom dimension? A) Symmetry/ordering/arranging B)Aggressive/sexual/religious/checking C)Contamination/cleaning D)Collecting/hoarding

D- Obsessive-compulsive symptoms tend to fall into different patterns or dimensions. Collecting/hoarding involves collecting or storing many things or useless objects. Symmetry/ordering/arranging is expressed by the need to be perfect or exact with concerns about symmetry. The individual will take a great deal of time to continually rearrange objects until they are organized in a symmetrical or "just right" fashion. The contamination/cleaning dimension involves worrying about being physically sick, contaminated by dirt or bacteria and is expressed through ritualized washing or cleaning excessively. Aggressive/sexual/religious/checking dimension involves excessive worries or fears that something very bad will happen such as a death of a relative or accident. Individuals may have intrusive thoughts about inappropriate violent, sexual, or religious content and may need to do something repeatedly, such as praying or confessing to avoid or dismiss these thoughts.

After reviewing assessment findings, which client would the nurse identify as having a type D personality? A) A woman who sits quietly reading in a waiting room before seeing her doctor for her annual physical B) A man who threatens the receptionist in the emergency department with bodily harm if a doctor does not see him right away C) A quiet teen who drinks a six-pack of beer against his better judgment because of peer pressure D) A man who reacts negatively to almost everything but never discusses his feelings with anyone

D- Persons with type D or distressed personalities experience increased negative emotions, but do not share their emotions. People with type A personalities are characterized as competitive, aggressive, ambitious, impatient, alert, tense, and restless. Persons with type B personalities do not exhibit these behaviors and generally are more relaxed, easy-going, and easily satisfied. They have an accepting attitude about trivial mistakes and use a problem-solving approach to major problems. People with type C personalities are described as having difficulty expressing emotion; being introverted, respectful, conforming, compliant, eager to please; and avoiding conflict. They respond to stress with depression and hopelessness.

A nurse working with a potentially violent client in a community clinic would implement what intervention to minimize personal risk? A)Waring inexpensive jewelry to distract the client B)Using protective devices C)Keeping the door closed to ensure privacy D)Staying close to a door

D- The nurse can position him- or herself near the door so there is immediate access to an exit in case the client becomes violent. Protective devices would be inappropriate. Closing the door would be unsafe. The nurse should remove or not wear accessories such as jewelry that could be used to harm.

The nurse is conducting an assessment by applying the family system framework model. Which assessment would be important for the nurse? A)Acceptance of the family rules B)Degree of enmeshment in the system C) Adjustment to the family boundaries D) Interpersonal differentiation

D- When applying the family system framework model it is important for the nurse to assess the members interpersonal differentiation which is the process of freeing oneself from the family's emotional chaos, family rules, boundanes, and enmeshment are important areas to assess when applying the family structure model by Minuchin

A client with a history of opioid dependency is exhibiting manifestations of moderate withdrawal. Which of the following would the nurse expect to assess? A)Dysphoria B)Lacrimation C)Rhinorrhea D)Dilated pupils

D- With moderate opioid withdrawal, pupils are dilated. Rhinorrhea, lacrimation, and dysphoria are noted with mild withdrawal.

The psychiatric-mental health nurse is working with a group of older adults diagnosed with depression. Which client would the nurse identify as being at the highest risk for suicide? A)72-year-old B)61-year-old C)69-year-old D)79-year-old

D- suicide is a very serious risk for older adults, especially men. Suicide rates peak during middle age, but a second peak occurs in those age 75 years and older.

A nurse is reviewing the medical records of several clients diagnosed with major depression. The nurse identifies which client as least likely to commit suicide? A) widowed woman B) divorced man C) single woman D) married man

D- the nurse determines that the client least likely to commit suicide is the client who is married. Single, older men living in a rural area have the highest rates of suicide. Unmarried, unsociable men between the ages of 42 and 77 years with minimal social networks and no close relatives have the highest rates of suicide. Women are less likely to complete a suicide but are more likely to attempt suicide. marriage has been identified as a protective factor against mental disorders in older adults