Psych Mental Health Remediation

A student nurse working as an aide in a memory care facility asks the charge nurse if there is a neurobiological basis for the deterioration in cognitive function in Alzheimer's disease. Which explanation by the nurse is correct regarding the etiology of neurocognitive decline? "Decreases in neurotransmitters affect parts of the brain responsible for memory." "A decrease in body mass causes a decrease in the mass of the brain." "Untreated psychological problems slow down the thinking and reasoning processes." "Nutritional deficiencies cause a decrease in metabolism that inhibits the amount of glucose available to the brain."

"Decreases in neurotransmitters affect parts of the brain responsible for memory." Rationale Neurocognitive decline is associated with changes in neurotransmitter concentration. Alzheimer's disease has been linked with a decrease in the production and function of acetylcholine (ACh). Alzheimer's disease affects an area of the brain called the nucleus basalis, which contains cholinergic neurons. These neurons provide ACh to areas of the brain responsible for memory and learning.

The nurse is providing discharge education for a client prescribed a tricyclic antidepressant. Which statement by the client indicates the need for additional teaching? "It is best for me to take the full dose of the medication when I get up each morning." "My mood should improve within 7-28 days after starting my medicine." "It may take up to 6-8 weeks for me to experience the full effect of the medication." "The side effects of drowsiness and dizziness usually go away after the first few weeks."

"It is best for me to take the full dose of the medication when I get up each morning." Rationale If possible, the client should take the full dose of tricyclic antidepressants at bedtime to reduce the experience of side effects during the day.

The nurse is interviewing a client about substance abuse. Which responses from the client should alert the nurse that further assessment is needed? "It's just marijuana and everyone does it." "I figured you asked me that question." "I only drink a six pack in the evening." "I have a glass of wine occasionally with a meal." "I smoked ten years ago but that's old news."

"It's just marijuana and everyone does it." "I figured you asked me that question." "I only drink a six pack in the evening." Rationale Rationalization, minimizing, anticipation and avoidance of questions being asked about alcohol and illicit drug use should alert the nurse for further investigation of potential substance abuse.

The nurse is preparing to administer an initial dose of memantine (Namenda) to a newly admitted client with moderate-stage Alzheimer's disease. The client's daughter asks why this new medication was ordered. The daughter states that her mother has been taking rivastigmine (Exelon) to stabilize her memory impairment, but without improvement. Which explanation for the addition of memantine should the nurse provide? "Memantine may be prescribed in combination with rivastigmine, to enhance its effects ." "Memantine increases the appetite and promotes better eating habits." "Memantine reverses the symptoms of dementia and has fewer side effects." "Memantine works like a sedative to relieve anxiety and improve sleep."

"Memantine may be prescribed in combination with rivastigmine, to enhance its effects ." Rationale Memantine (Namenda) is an NMDA receptor antagonist that helps prevent neurodegeneration by reducing excess calcium. Memantine may be prescribed in combination with rivastigmine, a cholinesterase inhibitor, for patients who do not respond to rivastigmine alone.

The husband of a client who is attending an alcoholism rehabilitation program has been advised to attend Al-Anon meetings. Which statement demonstrates the fundamental Al-Anon teaching that will help him cope with his wife's drinking? The client is responsible for his or her own drinking. The client's abstinence must be supervised. Maintenance of sobriety cannot be expected. Significant others need to meet the client's dependency needs.

(1)Rationale Al-Anon teaches family members that they did not cause the disease, nor can they control or cure it. They advocate making the client with alcohol use disorder responsible for their own behavior. Support and education are provided to help the family cope with having a family member with an addiction.

During a meeting with the interdisciplinary treatment team, a client in the acute phase of schizophrenia states that she cannot return to live with her parents because they are trying to kill her. Which statement by the team leader represents a correct therapeutic response? "We met with your parents; they do not appear to be violent people." "You are having a delusion; your parents would never hurt you." "That must be very frightening; tell us why you believe you are in danger." "You are being paranoid; your parents referred you here so that you can be helped."

"That must be very frightening; tell us why you believe you are in danger." Rationale The acute phase of illness is characterized by reality impairment and paranoia; it is not useful to debate or contradict a delusion while a client is in the acute phase. Attempting to see things from the client's perspective will build trust, which is the basis for an effective therapeutic relationship.

A client with stage 3 Alzheimer's disease is living with his son and daughter-in-law. The visiting nurse is educating the family about the progression of the illness, including "sundown syndrome," and is assisting with care planning and comfort measures. Which statement by the daughter-in-law reflects that the teaching has been effective? "We will have locks placed at the top of all the outside doors." "We will not take him out in public because it increases his confusion." "We will remove the TV from his room." "We will limit visitors because he does not recognize anyone."

"We will have locks placed at the top of all the outside doors." Rationale Placing locks at the top of the doors is an important safety intervention. The term "sundown syndrome" refers to behaviors that become more pronounced in the evening. Clients with late stage dementia are prone to wandering, especially at night.

A client with stage 3 Alzheimer's disease is living with his son and daughter-in-law. The visiting nurse is educating the family about the progression of the illness, including "sundown syndrome," and is assisting with care planning and comfort measures. Which statement by the daughter-in-law reflects that the teaching has been effective? "We will have locks placed at the top of all the outside doors." "We will not take him out in public because it increases his confusion." "We will remove the TV from his room." "We will limit visitors because he does not recognize anyone."

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The sibling of a young client with borderline personality disorder asks the nurse why the client has frequent mood changes. Which is the best response by the nurse to explain the neurobiological basis of this behavior? Brief shifts in mood are caused by an imbalance of nervous system chemicals that help regulate emotions. Shifts in mood are the result of an intolerance to certain chemicals found in food substances. Mood changes are due to the client's emotional immaturity and lack of insight into this behavior. Mood changes are common in clients during this phase of life due to hormonal changes.

(1) Rationale Affective instability is characterized by brief shifts in mood. This condition is attributed to excessive limbic reactivity in the neurological circuits responsible for the regulation of the neurotransmitter, GABA.

The nurse is evaluating the progress of an adolescent client with bulimia who is being treated as an outpatient. Which action performed by the client indicates that progress is being made? Shows the nurse a completed food and emotion diary. Asks the nurse many details regarding the nutritional content of foods. Reports spending enjoyable time alone at meals since being discharged. Describes eating meals at different times than other family members eat.

(1) Rationale It is important that a client with an eating disorder is able to connect emotion with the relief-seeking behavior. Completing a diary is an honest manner will assist the client to recognize the eating behavior as an unhealthy attempt to deal with uncomfortable feelings.

The spouse of a heroin addict asks the nurse, "What is methadone maintenance all about?" Which response by the nurse is correct? Methadone reduces cravings and blocks the action of opiates. Methadone reduces craving without any sedative effects. Methadone is less potent than other replacement drugs. Methadone is a deterrent to the use of both "hard" and "soft" drugs.

(1) Rationale Methadone hydrochloride is effective for detoxification maintenance because it reduces the craving for opiates. If opiates are used, it will block the action and the user will not have the euphoric effects which are responsible for the craving. However, methadone can produce sedation at high doses and its use should be carefully supervised.

A 16-year-old female is bought to the emergency department following a suicide attempt. The client reports to the nurse that she is doing poorly in school, is engaging in high-risk sexual activity, and has a history of running away from home. Which assessment is the priority at this time? Sexual abuse. Pregnancy. Physical abuse. Sexually transmitted infections.

(1) Rationale The client's sexual behavior, suicide attempt, and running away indicate possible sexual abuse. Assessing for sexual abuse is the priority.

A 15-year-old female student visits the school nurse to ask about date rape and pregnancy. She confides to the nurse that her boyfriend forced her to have sex against her will. Which initial intervention is the priority for the nurse to implement? Identify the student's immediate concerns and feelings. Administer a pregnancy test. Teach methods of birth control. Explain safe sex practices.

(1) Rationale When the nurse discovers a client has been raped, the nurse needs to respond to the client's immediate concerns. It is most important for the nurse to allow the student to ventilate feelings at the beginning of the interview. The nurse should listen patiently and supportively, understanding that compulsive retelling helps the victim to become gradually desensitized to the rape.

A universal outcome for victims of rape is grief resolution. Which statement by the victim indicates that progress toward this outcome has been made? "I have begun to stop blaming myself for being raped." "If I had not worn that skirt to the party, the rape would not have happened." "I need to make sure that I do not go out alone anymore." "I feel ashamed that I could not defend myself against my attacker."

(1) Rationale When the nurse discovers a client has been raped, the nurse needs to respond to the client's immediate concerns. It is most important for the nurse to allow the student to ventilate feelings at the beginning of the interview. The nurse should listen patiently and supportively, understanding that compulsive retelling helps the victim to become gradually desensitized to the rape.

A client with stage 3 Alzheimer's disease is admitted to a behavioral health hospital. Due to the progression of the disease, the client is experiencing an increase in amnesia and agnosia, and has declined to the point of not recognizing familiar objects and people. Which action should the nurse take to help reduce the client's fear and anxiety and adjust to the new setting? Cover mirrors and pictures if they are upsetting the client. Keep the TV on in the room throughout the day. Provide the client with a stuffed animal. Serve the client's meals in a private room.

(1)Rationale Agnosia is the inability to recognize familiar objects. Clients that experience this cognitive impairment do not recognize themselves in a mirror; this may result in the client thinking that there is a stranger in the room. Covering the mirror provides the client with an increased sense of safety.

An addiction counselor is teaching a client and family about cross tolerance, cross addiction and alcohol, benzodiazepines, and barbiturates. The counselor is also teaching about the dangers of concurrent use. The nurse is correct to state that alcohol and CNS depressants act on which receptors? GABA. Serotonin. Dopamine. Opioid.

(1)Rationale Alcohol and other CNS depressants act specifically on GABA receptors. The fact that these substances produce the same effect in the neurobiological system explains how cross tolerance and cross addiction readily occur. When taken together, they have a synergistic effect that causes an increase in the level and duration of central nervous system (CNS) depression; the combined effect can result in respiratory arrest.

The parents of a child diagnosed with impulsive-type attention deficit/hyperactivity disorder (ADHD) ask the health care provider if their child's diagnosis has any physical basis. Which explanation by the health care provider is correct regarding the neurobiological etiology of this condition? "Altered dopamine levels are present in the impulsive subtype of ADHD." "Altered thyroid hormone levels cause many of the symptoms of ADHD." "Alterations in brain chemicals called neurotransmitters are the same for all subtypes of ADHD." "Alterations in glucose and cortisol in the bloodstream are thought to influence the hyperactive behavior in ADHD."

(1)Rationale Alterations in neurotransmitters contribute to the symptoms in ADHD. The neurotransmitter that is affected relates to the subtype of the disorder. Clients with impulsive-type ADHD have a variation in the dopamine transporter, while clients with inattention-type ADHD have norepinephrine transporter gene variations. These variations explain why a client's response to medication is individualized.

The nurse is caring for a victim of severe emotional violence inflicted by her husband. The client states that the abuse occurs most often when her husband is intoxicated, and that he is always remorseful afterwards. She also tells the nurse that her husband's father was an alcoholic who beat him and his mother. What evidence exists that the husband is at risk of becoming a perpetrator of physical abuse? Past childhood abuse. Feelings of remorse. Temporary behavioral changes. Excessive alcohol consumption.

(1)Rationale An abuse-prone individual is one who has experienced family violence and has likely been abused as a child. The client's husband is at risk for becoming a perpetrator of physical abuse because he witnessed and experienced similar abuse as a child.

A client diagnosed with obsessive-compulsive personality disorder with a comorbid depression has been receiving dialectic behavior therapy (DBT). Which statement by the client indicates that the treatment has been effective? "Yoga and deep breathing help me when I get anxious about upcoming family visits." "I can feel my heart pounding when I practice deep breathing and it gives me a headache." "Listening to relaxing music reminds me of my ex-husband and how I messed up our marriage." "I feel like I can become a movie star after I finish my meditation and exercise sessions."

(1)Rationale Dialectic behavioral therapy consists of mindfulness, deep breathing, and relaxation techniques. It helps the brain to relax by switching from the sympathetic nervous system (arousal) to the parasympathetic nervous system (relaxation). Achieving a decrease in stress and anxiety after practicing any of these techniques demonstrates that the therapy has been effective.

A client is admitted to the medical unit with needle tracks on both arms. A friend has stated that the client uses heroin. The nurse should recognize which group of signs and symptoms in clients suffering from opioid withdrawal? Runny nose, yawning, insomnia, and chills. Slurred speech, excessive drowsiness, and bradycardia. Anxiety, agitation, and aggression. Paranoid delusions, tactile hallucinations, and panic attacks.

(1)Rationale Early withdrawal from opioids resembles a flu-like illness without the temperature elevation. Runny nose, chills, insomnia, and yawning are commonly experienced by clients during opioid withdrawal.

The nurse is providing information about codependent behaviors to the wife of a client with alcoholism. The nurse is correct to identify and point out to the wife which behavior as an example of codependency? She calls in sick for her husband when he is too hung over to work. She prepares dinner for her husband every night. She shops for all her husband's clothes. She frequently drives her husband to work.

(1)Rationale Lying or covering up the client's drinking or drug use, and shielding the client from the consequences, is a behavior that reflects codependency. Calling in sick for her husband because he has a hangover is an example of codependent behavior. Codependency also involves deception and a reflection of a dysfunctional relationship in which an individual feels responsible for covering up and enabling another's destructive action.

During a follow-up visit to the mental health clinic, the mother of a 7-year-old client reports that her son has been having side effects from the medication that was ordered to treat ADHD. The mother states that the client has a decreased appetite, complains of abdominal pain, and has been unable to sleep. The health care provider recommends that the medication be changed to a nonstimulant ADHD drug. Which medication should be recommended for this client? Atomoxetine (Strattera). Methylphenidate (Ritalin). Fluphenazine (Prolixin). Fluoxetine (Prozac).

(1)Rationale Stimulant medications are often prescribed to treat ADHD. Atomoxetine (Strattera) is a nonstimulant selective norepinephrine reuptake inhibitor that is approved for childhood and adult ADHD disorders.

The emergency department nurse is providing care for a rape victim. Which action represents an essential element of care for this client? Providing nonjudgmental care. Conveying outrage that this occurred. Sympathizing with the client's sense of shame. Encouraging the client to divulge all the details

(1)Rationale The nurse's attitude can have an important therapeutic effect on the victim of rape. Displays of shock, horror, disgust, or disbelief can increase anxiety and shame. When providing care for a rape victim, it is essential to maintain a nonjudgemental attitude, and to let the client talk while listening attentively.

Which behaviors indicate that the treatment plan for a client in alcohol rehabilitation has been effective? Abstinent 10 days; states that sobriety is to be accomplished one day at a time; has spoken with employer about returning to work. Abstinent 15 days; states that the drinking problem has been overcome; plans to find a new line of work with new coworkers. Attends Alcoholics Anonymous daily; states that many of the members are real alcoholics; denies having any problems at work. Attends Alcoholics Anonymous once per week; states a willingness to stop drinking during the day; plans to drink occasionally after work.

(1)Rationale The statement "one day at a time" reflects the Alcoholics Anonymous (AA) philosophy. AA promotes a 12-step program that has been successful in helping individuals who desire to stop drinking and abusing substances. Individuals learn about sobriety and responsibility through the support of other members.

A client was admitted to the inpatient unit 48 hours ago with a diagnosis of a Cluster "C" personality disorder. The client is well rested, but refuses to attend meals or group sessions. The client has been started on a SSRI for anxiety but has not demonstrated an effective response. Which other category of anxiolytic medication may be prescribed to produce a more immediate decrease in symptoms? MAOIs. Benzodiazepines. Lithium salts. Psychotropic medications.

(2)Rationale SSRIs can take up to four weeks to be effective. Benzodiazepines may be prescribed to provide immediate relief and can be taken on a PRN basis.

A nursing diagnosis for a client with bulimia nervosa reads as follows: "Ineffective coping related to feelings of loneliness and despair, as evidenced by self-induced vomiting." Which statement reflects the desired outcome for this nursing diagnosis? The client will identify two alternative methods of coping. The client will find new ways to express angry feelings. The client will verbalize two positive things about self. The client will verbalize the importance of eating a balanced diet.

1 Rationale Health teaching for clients with bulimia should respond to impulsivity that leads to unhealthy behavior. Education should include learning new coping skills and strategies.

The nurse is interviewing a client who has recently been admitted for evaluation of a thought disorder manifested by paranoid behavior. According to the client's mother, the client was previously treated for anxiety, but has become more isolated and withdrawn over the last few weeks. He refuses to leave his room, and he states that he is the "King of Mars" and someone is trying to assassinate him. Which type of delusion should the nurse document? Jealous. Grandiose. Somatic. Erotomanic.

2 Rationale Individuals may suffer from several different types of delusions. In this example, the client is experiencing grandiose delusions (irrational ideas regarding his self-worth and identity), as well as persecutory delusions (thoughts of being persecuted or treated malevolently).

A client seeks assistance at a crisis center. The client describes being extremely anxious and unable to sleep since helping with clean-up duties at a school where a student fatally shot a teacher and some classmates. Which intervention is the priority when assisting this client? Allow ventilation of feelings. Refer the client to a member of the clergy. Advise the client to avoid going near the school for at least six weeks. Send the client to an emergency department for further evaluation.

Allow ventilation of feelings.

During a follow-up visit to the mental health clinic, the mother of a 7-year-old client reports that her son has been having side effects from the medication that was ordered to treat ADHD. The mother states that the client has a decreased appetite, complains of abdominal pain, and has been unable to sleep. The health care provider recommends that the medication be changed to a nonstimulant ADHD drug. Which medication should be recommended for this client? Atomoxetine (Strattera). Methylphenidate (Ritalin). Fluphenazine (Prolixin). Fluoxetine (Prozac).

Atomoxetine (Strattera). Rationale Stimulant medications are often prescribed to treat ADHD. Atomoxetine (Strattera) is a nonstimulant selective norepinephrine reuptake inhibitor that is approved for childhood and adult ADHD disorders.

A client was admitted to the inpatient unit 48 hours ago with a diagnosis of a Cluster "C" personality disorder. The client is well rested, but refuses to attend meals or group sessions. The client has been started on a SSRI for anxiety but has not demonstrated an effective response. Which other category of anxiolytic medication may be prescribed to produce a more immediate decrease in symptoms?

Benzodiazipenes

A client has recently been admitted for evaluation of sudden onset psychosis. In addition to a medical assessment and serum drug screen, which other tests should the nurse expect the client will undergo to find a cause for this change in mental status? Brain MRI, PET scan. Skull radiographs, free thyroxin. CT angiography, electromyogram. Carotid Doppler, electrocardiogram.

Brain MRI, PET scan. Rationale Magnetic resonance imaging (MRI) of the brain can detect structural abnormalities or changes. A PET scan can measure blood flow and glucose utilization in regions of the brain.

In which age groups is depression often often underdiagnosed? Children. Adolescents. Young adults. Middle aged adults. Older adults.

Children, adolescents, older adults Rationale Depression in children and adolescents is often overlooked because mood changes are seen as behavioral problems and part of normal development. Children may displayed irritability, disruptive behavior, sadness while adolescents may engage in promiscuous sexual behavior and alcohol and substance abuse. Older adults are more likely to complain of aches and pains than acknowledge feelings of sadness or grief.

A client with long-term alcohol addiction is admitted to the emergency department. Which medications should the nurse anticipate the healthcare provider will prescribe for this client? Diazepam. Methadone. Multivitamins. Thiamine (vitamin B1). Monoamine oxidase inhibitors.

Diazepam. Multivitamins. Correct Thiamine (vitamin B1). Rationale Alcohol withdrawal delirium usually peaks 48-72 hours since last consumption of alcohol. The diazepam has sedative and anticonvulsant properties. Thiamine and multivitamins are usually given to help with nutritional and malabsorption deficiencies common in clients with alcohol addiction.

The nurse is reviewing labs for a client who is taking clozapine, 25mg QD for treatment of disorganized schizophrenia. The labs are documented as follows: RBC 4.5 million/mcL, WBC 1000/mcL, TSH 1.2 mc-IU. Based on these results, which order should the nurse anticipate the health care provider to write? Discontinue clozapine. Administer levothyroxine sodium 25 mcg QD. Administer ferrous sulfate 100mg QD. Decrease clozapine to 12.5 mg QD, start levothyroxine sodium 50 mcg QD.

Discontinue clozapine. Rationale Agranulocytosis is an adverse side effect of clozapine that can cause lethal infections. Based on the client's results, clozapine should be discontinued; the thyroid and RBC results are normal and do not need to be treated.

A newly admitted client diagnosed with schizophrenia who is physically healthy believes that they are in the process of dying and their body is actively decaying and falling apart. Which intervention for this client should the nurse implement? Discuss what they are feeling and acknowledge their fear and anxiety. Discourage the client from discussing their belief of dying and correct their falsehood. Speak to them quietly while holding their hand and maintain eye contact. Allow the client as much privacy and quiet time as possible .

Discuss what they are feeling and acknowledge their fear and anxiety. Rationale The client's delusion of dying and their body decaying is their reality. The nurse should identify and focus on the client's feelings and discuss those and try to divert the client's preoccupation of the delusion.

The interdisciplinary team is planning treatment for a client with stage 2 Alzheimer's disease. The team agrees that involving the client in more therapy groups and activities could help improve memory and relieve some depressive symptoms. The team leader recommends reminiscence therapy. Which statement describes this type of treatment? Facilitates discussions of life's transitions and evokes memories from the client's past. Encourages clients to pick a topic of concern and discuss their fears. Introduces the client to new forms of recreational therapy that may improve memory. Enables clients to develop new skills based on their previous skill sets.

Facilitates discussions of life's transitions and evokes memories from the client's past. Rationale: Reminiscent therapy, or life review therapy, deals with specific life transitions. It can be used to evoke memories of happy times in life. Remembering accomplishments and shared joy helps distract the client from the deficit and gives life meaning.

The school nurse is providing an in-service program to high school girls about date rape drugs. A student expresses interest about particular drugs and asks the nurse what these drugs look like and how they affect the body. Which response by the nurse it correct? Flunitrazepam (Rohypnol) is a pill that dissolves in liquids and causes muscle relaxation and amnesia. Diphenhydramine (Compose) is a pill or capsule that is used to induce sleep. Acetaminophen plus ephedrine (NyQuil) comes in pill and liquid form and causes drowsiness. Cyclobenzaprine (Flexeril) comes in a pill form and causes drowsiness and relaxation.

Flunitrazepam (Rohypnol) is a pill that dissolves in liquids and causes muscle relaxation and amnesia. Rationale Flunitrazepam (Rohypnol) is a date rape pill that is also called "forget-me-not." It dissolves in water, becomes more potent when combined with alcohol, and causes relaxation and amnesia.

The nurse is caring for a 72-year-old client who was admitted for treatment of depression. The nurse notices that the health care provider's order for an antidepressant calls for a dose greater than the usual adult dose. Which action is the correct action for the nurse to take? Hold the medication and consult the health care provider. Check the electronic formulary on the unit's computer. Give the usual adult dose. Implement the order as prescribed.

Hold the medication and consult the health care provider Rationale The dose of antidepressants for an elderly client is often less than the usual adult dose. The nurse should withhold the order and consult the health care provider who prescribed the order. Medication safety is critical to protect the client from harm and it is the nurse's duty to intervene in this situation.

An 85-year-old client is bought to the emergency department after a fall at home. The client appears confused, malnourished, and is severely dehydrated. The client appears reluctant to explain how the fall happened. The client's daughter speaks for the client and does not allow the client to answer questions. Based on this information, which nursing intervention is a priority? Interview the client alone and assess for abuse. Take the history from the daughter because the client is confused. Provide the daughter with nutritional counseling. Request a psychiatric evaluation for the client.

Interview the client alone and assess for abuse Rationale The client's physical signs, appearance and reluctance to talk, in addition to the daughter's behavior indicate possible abuse or neglect. The client should be interviewed alone and then assess for signs of possible abuse and neglect. If upon conclusion of interviewing and assessing the client, the nurse suspects elderly abuse it is required by law the abuse to be reported to "Adult Protective Services".

The treatment team discusses plans regarding two clients who both exhibit self-mutilating behavior. The nurse expresses concerns about the decision to use restraints on one client, while assigning one-to-one supervision for the other. Which ethical principal is the nurse concerned about violating? Justice. Autonomy. Beneficence. Fidelity.

Justice Rationale Implementing different plans of care for clients with the same condition brings into question the issue of fairness. The nurse is concerned about justice, which refers to the fair treatment of both clients with the least restrictive method.

What are some of the family risk factors the nurse should look for when interviewing a client who is suspected of being in an abusive relationship? Mental health problems in the nuclear family. Substance abuse by household members. Family relationships that appear dysfunctional. The ethnic and cultural background of the family. Educational background of client and family members.

Mental health problems in the nuclear family. Substance abuse by household members. Family relationships that appear dysfunctional. Rationale Risk factors for abusive relationships include mental health problems, substance abuse, socioeconomic stressors, and dysfunctional family relationships.

The health care provider is evaluating a client with bulimia who is being treated with fluoxetine (Prozac), a selective serotonin reuptake inhibitor. It is determined that medication has been ineffective because the client's mood and obsessive compulsive behaviors have not improved. Which unconventional antipsychotic agent should the health care provider recommend for the client? Olanzapine (Zyprexa). Sertraline (Zoloft). Lorazepam (Ativan). Zolpidem (Ambien).

Olanzapine (Zyprexa) Rationale Olanzapine (Zyprexa) is an unconventional antipsychotic agent used to treat some mental disorders. It has proven successful in some clients by decreasing compulsions and improving mood.

Which interventions should the nurse encourage the client to do to improve their mood? Participate in daily cardio aerobic exercises. Develop a strong support system in the workplace. Add more caffeinated beverages to the diet. Increase intake of fruits and vegetables. Create an environment that promotes restful sleep.

Participate in daily cardio aerobic exercises. Increase intake of fruits and vegetables. Create an environment that promotes restful sleep. Rationale A well balanced diet, adequate uninterrupted sleep and exercise facilitates stress reduction and improves physical well-being which in turn positively affects an individual's mood.

A client is undergoing treatment for schizophrenia. Which outcome provides evidence that the client's negative symptoms are improving? Refrains from yelling and trying to touch the health care provider for the last 48 hours. Participates in music therapy and states that he enjoys playing the drums. Eats meals in his room instead of causing disturbances during mealtime. Reports having no hallucinations for the last week.

Participates in music therapy and states that he enjoys playing the drums. Rationale An inability to experience pleasure and a desire to remain isolated are examples of negative symptoms exhibited by clients with schizophrenia. By participating in therapy and expressing enjoyment, the client shows a decrease in negative symptoms and evidence that the treatment is being effective.

The nurse is teaching a client with atypical depression who is being treated with a monoamine oxidase inhibitor. The nurse explains that certain foods may cause a severe reaction if consumed while taking this drug. The nurse should tell the client to avoid which foods while taking this medication? Apples, oranges, and milk. Pickles, sausages, and most cheeses. Yogurt, pork, and sweet potatoes. Brussel sprouts, steak, and grapefruit juice.

Pickles, sausages, and most cheeses Rationale Monoamine oxidase inhibitors (MAOIs) inhibit the breakdown of tyramine in the liver. Individuals who are prescribed this class of medication need to avoid foods high in tyramine in order to avoid dangerously high levels of tyramine, which can cause high blood pressure, hypertensive crisis, stroke, and death. In general, the rule of thumb it is best to advise clients who are prescribed MAOIs to avoid any type of food or liquids that is aged, cured or fermented to avoid a drug interaction resulting in a hypertensive crisis.

The nurse notes that a client is experiencing panic-level anxiety during a group meeting in the community room. Which intervention should be implemented immediately? Provide calm, brief, and directive communication. Administer anxiolytic medication, as ordered. Teach the client relaxation techniques. Prepare staff members to restrain the client.

Provide calm, brief, and directive communication Rationale Clients experiencing severe- to panic-level anxiety often feel out of control and need to know they are safe from their own impulses. This can be achieved through firm, short, and simple statements. Reinforcing commonalities in the environment and pointing out reality when there are distortions can also be useful when caring for a severely anxious client.

During a home care visit for a client diagnosed with schizophrenia, the spouse complains to the nurse that the client is refusing to eat or drink anything that is prepared for them. Which intervention should the nurse recommend? Instruct the caregiver to place the prepared food next to the client and leave the room. Teach the caregiver how to gentle force feed the client with soft mechanical diet. Recommend that unopened, prepackaged food to be given to the client. Suggest that a tube feeding nutrition therapy be initiated.

Rationale Clients diagnosed with schizophrenia can experience periods of paranoia and this client may believe their food has been tampered and posioned. Offering the client prepackaged food that has not been open, may be the only alternative to get the client to eat and drink.

The nurse is counseling a client who is newly diagnosed with bipolar disorder. The client experiences symptoms such as agitation and hyperactivity during manic episodes and questions the nurse about the causes. Which should the nurse identify as the cause(s) of bipolar manic episodes? A combination of genetic, biological, and psychological factors. Changes in brain structures that occur during fetal development. Poor sleep habits and nutritional deficiencies. Adverse drug reactions to antidepressant medications.

Rationale During the manic phase of bipolar disease, individuals may experience hyperactivity, agitation, and the inability to sleep. It is a multisystem disorder involving genetics, biological factors, and psychological influences.

The nurse is caring for a client diagnosed with a personality disorder. The client states that he must constantly fend off females who seek his attention. He boasts that he is a former high school baseball player who was once voted most valuable player, and he claims that no other baseball player will ever be as good as he was in baseball and he should play professionally, but his salary would be too high for the professioal leagues to pay him. These statements reflect which personality disorder? Narcissistic personality disorder. Obsessive-compulsive disorder. Histrionic personality disorder. Borderline personality disorder.

Rationale Individuals with narcissistic personality disorders are attention-seeking with an inflated ego. They are grandiose with a sense of personal entitlement. They consider themselves to be special and feel that they deserve special treatment.

A client being treated for depression is sharing a story with an assigned counselor regarding his divorce. He smiles and states that he is not really hurt about her leaving him for a coworker because he knows that she really loves him and is just trying to make him jealous. Which defense mechanism is the client displaying? Reaction formation. Sublimation. Idealization. Rationalization.

Reaction Formation Rationale Reaction formation is the defense mechanism an individual displays in an attempt to deal with unacceptable feelings. Clients using this defense mechanism displays opposite feelings, such as insisting that they are happy when they are actually hurting

Which assessment data supports a diagnosis of acrophobia? Refuses to drive or walk across any type of bridge. Avoids leaving the house for more than an hour. Refuses to go outside to watch baseball even though he loves the sport. Avoids basements due to a fear of encountering spiders.

Refuses to drive or walk across any type of bridge. Rationale Acrophobia is defined as the fear of heights. An individual who is acrophobic would be fearful of going anyplace that involves height such as bridges, overpasses, climbing up a ladder or a mountain, looking out a window of a high rise building. They avoid any type of activity that involves a sense of height.

Which nursing diagnosis is the priority for a client who is being treated with lithium? Risk for Infection. Self-care deficit. Risk for fluid imbalance. Nutritional deficit.

Risk for fluid imbalance Rationale Lithium has a narrow therapeutic window in which blood levels should range between 0.4 and 1.3 mEq/L; levels of 2 mEq/L or greater can result in a life-threatening emergency. Blood levels are dependent on kidney function, and any change in sodium and hydration levels affects the excretion of lithium. A decrease in sodium levels can cause an increase in lithium levels leading to toxicity.

During a therapy session, the nurse is teaching family members of a psychotic client to be alert for command hallucinations. Which risk is of primary concern regarding this type of hallucination? Elopement. Drug abuse. Suicide. Legal problems.

Suicide

The visiting nurse is assessing a client with early-stage dementia who has recently been prescribed donepezil (Aricept). Which information obtained from the client's family member demonstrates that the medication is effective? The client is showering and getting dressed with minimal assistance. The client uses confabulation to cover up memory loss. The client did not attend the family reunion last weekend. The client arranges to have groceries delivered.

The client is showering and getting dressed with minimal assistance. Rationale An expected outcome of donepezil (Aricept) is to help the client maintain some independence in the early stages of dementia. Being able to shower and dress with minimal assistance is evidence of achieving this short term goal.

The psychiatric home care nurse is visiting a Hispanic client who is being treated for depression. The client greets the nurse with a smile and offers to make coffee. The nurse politely declines the coffee and asks how the client is doing. During the session, the nurse notes that the client seems less spontaneous in affect and becomes more withdrawn. Which is the most likely reason for the client's change in behavior? The client may feel rejected by the nurse. The client is experiencing rapid cycling. The client feels the nurse has broached a taboo subject. The client feels nurse's social touch is inappropriate.

The client may feel rejected by the nurse Rationale In the Hispanic culture, good etiquette requires accepting offers of food and spending some time engaging in small talk before discussing more serious issues. The client may be feeling rejected because the nurse did not accept the offer of coffee.

The nurse is counseling a client who is dealing with complicated grief over the death of a spouse. Which statement reflects the most desirable outcome for the client? The client will attend a surviving spousal support groups. The client will plan a memorial tribute for the spouse. The client will stop expressing feelings of loss every day. The client will plan a vacation after finalizing the burial arrangements.

The client will attend a surviving spousal support groups. Rationale A major outcome of grief counseling is to assist the client in sharing their loss and to accept support from others. It is critical for the spouse to share the feelings of loss and grief in a supportive interpersonal environment. Complicated grief is a consistent state of sadness associated with a great loss. It is suspected that there may be a relationship between complicated grief and adjustment disorder. Most people go through the stages of grief at their own pace. Individuals dealing with complicated grief have difficulty progressing through the stages and it may take over a year or more to resolve their sense of lost.

A client with delirium keeps attempting to get out of bed and has fallen twice, despite being under close-observation. The charge nurse calls the health care provider to obtain an order for mechanical restraints. Which statement is correct regarding the mechanical restraint policy? The client will need to remain on close-observation with a documentation note every 15 minutes. The client no longer require close-observation, but must be checked at regular intervals. The client may be sedated and left alone as long as the restraints remain in place. Restraints may be applied based on verbal orders received over the phone.

The client will need to remain on close-observation with a documentation note every 15 minutes. Rationale Restraints are the last option to use to ensure client safety. A written order is required by a health care provider and the client require continued close-observation, even if mechanical restrained.

The nurse is preparing to administer haloperidol (Haldol) to a client diagnosed with schizophrenia. While performing a nursing assessment prior to medication administration, the nurse observes that the client is diaphoretic and disoriented. Vital signs include a temperature of 102° F (38.8° C), a pulse of 120, and a blood pressure of 160/98. Which nursing intervention takes priority? Withhold haloperidol and notify the health care provider of the client's status. Administer benztropine (Cogentin) 1 mg IM to counteract the autonomic side effects. Evaluate the client for dehydration as a cause of hyperpyrexia and tachycardia. Administer Tylenol 500mg PO PRN as ordered for temperature elevation.

Withhold haloperidol and notify the health care provider of the client's status. Rationale The antipsychotic agent, haloperidol (Haldol), should be stopped immediately if the client develops signs of neuroleptic malignant syndrome (NMS). Symptoms include an increase in temperature, pulse, and blood pressure, as well as severe muscle rigidity, confusion, and agitation. The other choices are correct interventions to treat the symptoms but discontinuing the drug which is causing the reaction is the priority.