Psychobiological Disorders
A daycare environment is recommended for a client with incapacitating behaviors resulting from an obsessive-compulsive personality disorder. The client's partner asks the nurse why this approach is necessary. What is the best response by the nurse?
"A neutral atmosphere facilitates the working through of conflicts."
An older client with a diagnosis of dementia is living in a long-term care facility. The client's daughter, who lives 300 miles away, calls the unit to speak to the nurse about her upcoming visit. What should the nurse say in response to her question about the best time of day to visit?
"Around 2:30 in the afternoon is the best time to visit."
A client is admitted to the surgical unit with superficial wounds of both wrists, the result of a suicide attempt. When the nurse enters the room, the client says, "I suppose you're going to ask me about my suicide attempt." What is the best response by the nurse?
"Tell me how you feel about it."
A client with schizophrenia reports having ongoing auditory hallucinations that he describes as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse?
"Try to ignore the voices."
A client with phobias about elevators and large crowds comes to the clinic for help because of feelings of depression related to these fears. What is an appropriate short-term goal for this client?
Describing the thoughts and feelings experienced in terrifying situations
A nurse knows that children with attention deficit-hyperactivity disorder (ADHD) may be learning disabled. This means that these children:
Experience perceptual difficulties that interfere with learning
A client with schizophrenia repeatedly says to the nurse, "No moley, jandu!" The nurse determines that the client is exhibiting:
Neologism
The nurse is caring for a client with a somatoform disorder, conversion-type paralysis. What is the best nursing approach?
Discussing topics other than the paralysis
A constructive but lengthy method of confronting the stress of adolescence and preventing a negative and unhealthy developmental outcome is:
Role experimentation
A client who is in a manic phase of bipolar disorder threatens staff and clients on a psychiatric acute care unit. Place the following interventions in priority order, from the least to the most restrictive.
1. Diversional activities Correct 2. Limit-setting Incorrect 3. Seclusion Incorrect 4. Medication administration Correct 5. Restraints
Which activity is the least therapeutic for a severely depressed client?
Activity selected by the client
A nurse recalls that language development in the autistic child resembles:
Echolalia
What is the prognosis for a normal productive life for a child with autism?
Unlikely because of interference with so many parameters of function
When talking with a female client who displays many of the emotional and physiological symptoms of panic disorder, the nurse should:
Use short sentences and an authoritative voice
What clinical findings may be expected when a nurse cares for an individual with an anxiety disorder? (Select all that apply.)
Worrying about a variety of issues Converting the anxiety into a physical symptom Displacing the anxiety onto a less threatening object Demonstrating behavior common to an earlier stage of development
A client tells the nurse, "I used to believe that I was a princess, but now I know that that's not true." What is the best response by the nurse?
sign of getting better
During the orientation tour for three new staff members, a young, hyperactive manic client greets them by saying, "Welcome to the funny farm. I'm Jo-Jo, the head yo-yo." Which meaning can the nurse assign to the client's statement?
Anxious over the arrival of new staff members
A client is admitted to the psychiatric unit of the hospital with a diagnosis of conversion disorder. The client is unable to move either leg. Which finding should the nurse consider consistent with this diagnosis?
Appearing composed
A depressed client often sleeps past the expected time of awakening and spends excessive time resting and sleeping. Which nursing intervention is appropriate for this client?
Restricting the client's access to the bedroom
A delusional client has refused to eat for the past 24 hours because, he says, "the food is poisoned." How should the nurse respond?
"You feel worried that someone wants to poison you?"
A hospitalized client with a mood disorder begins to be less hyperactive. One day the client says to the nurse, "My husband and I have problems getting along sometimes. We see things differently." Which response is nontherapeutic?
"You seem calmer today than you have been the last several days."
A depressed client tells a nurse, "I want to die." What is the most therapeutic response by the nurse?
"You would rather not live."
A 5-foot 5-inch 15-year-old girl who weighs 80 lb is admitted to a mental health facility with a diagnosis of anorexia nervosa. The nurse recognizes that her problem most likely is caused by:
A desire to control her life
When working with a client who is in an alcohol detoxification program, it is most important for the nurse to:
Address the client's holistic needs
A nurse is caring for a client with dementia. Which clinical manifestations are expected? (Select all that apply.)
Agitation Short attention span Disordered reasoning Impaired motor activities
A client who is addicted to opioids undergoes emergency surgery. During the postoperative period the health care provider decreases the previously prescribed methadone dosage. For what clinical manifestations should the nurse monitor the client?
Agitation and attempts to escape from the hospital
A nurse is monitoring a client with the diagnosis of schizophrenia who is experiencing opposing emotions simultaneously. When providing a change-of-shift report, how should the nurse refer to this emotional experience of the client?
Ambivalence
A nurse is caring for a client who has been hospitalized for alcohol withdrawal. The client decides to attend an Alcoholics Anonymous meeting. What is a basic principle of this group?
Amends must be made to each person who has been harmed.
A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel:
Angry
A nurse knows individuals who are alcoholics use alcohol to:
Blunt Reality
A nurse knows individuals who are alcoholics use alcohol to:
Blunt reality
An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? (Select all that apply.)
Blurred vision Suicidal ideation Difficult urination
The nurse is working with a client who talks freely about feeling depressed. During the interaction the client states, "Things will never change." What findings support the nurse's conclusion that the client is experiencing hopelessness? (Select all that apply.)
Bouts of crying Self-destructive acts Feelings of worthlessness
A hospitalized client with a borderline personality disorder consistently breaks the unit's rules. How will confronting the client about this behavior help the client?
By fostering self-awareness
A nurse is assisting with the administration of electroconvulsive therapy (ECT) to a severely depressed client. What side effect of the therapy should the nurse anticipate?
Confusion immediately after the treatment
A nurse is caring for a newly admitted, extremely depressed client. The most appropriate initial goal for the client
Developing trust in others
A client's history demonstrates a pervasive pattern of unstable and intense relationships, impulsiveness, inappropriate anger, manipulation, offensive behavior, and hostility. The admitting diagnosis is borderline personality disorder. What does the nurse anticipate that this client may attempt to do?
Divide the staff into opposing factions to gain self-esteem
Risk for assaultive behavior is highest in the mental health client who:
Experiences command hallucinations
A nurse is caring for a child with autism. Which intervention is most appropriate in an attempt to promote socialization for this child?
Imitating and participating in the child's activities
A college student is brought to the mental health clinic by his parents. The diagnosis is borderline personality disorder. Which factors in the client's history support this diagnosis? (Select all that apply.)
Impulsiveness Lability of mood Self-destructive behavior
How should a nurse expect a client's anxiety to be manifested physiologically?
Increased blood glucose level
A nurse is caring for an adolescent who has anorexia nervosa. The nutritional treatment of anorexia is composed of several guidelines. Which guidelines should the nurse emphasize? (Select all that apply.)
Increasing food intake gradually Limiting mealtime to half an hour Providing privileges for goal achievement
A client is using ritualistic behaviors. Why should a nurse give the client ample time in which to perform the ritual?
Denial of this activity may precipitate a panic level of anxiety.
A client has just been admitted with the diagnosis of borderline personality disorder. There is a history of suicidal behavior and self-mutilation. The nurse remembers that the main reason that clients use self-mutilation is to:
Express anger or frustration
A man with bipolar disorder, manic episode, has been traveling around the country, dating multiple women, and buying his dates expensive gifts. He is admitted to the hospital when he becomes exhausted and runs out of money. The nurse anticipates that during a manic episode the client is most likely experiencing feelings of:
Grandeur
A client with schizophrenia sees a group of visitors sitting together talking. The client tells the nurse, "I know they're talking about me." Which altered thought process should the nurse identify?
Ideas of reference
A client with a history of alcoholism is found to have Wernicke encephalopathy associated with Korsakoff syndrome. What does the nurse anticipate will be prescribed?
Intramuscular injections of thiamine
An agitated, acting-out, delusional client is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately? (Select all that apply.)
Jaundice Tachycardia
How can the nurse best minimize psychological stress in an anxious client who has been admitted to the psychiatric unit?
Learn what is of particular importance to the client
A client tells a nurse, "I have been having trouble sleeping and feel wide awake as soon as I get into bed." Which strategies should the nurse teach the client that will promote sleep? (Select all that apply.)
Leaving the bedroom when unable to sleep Exercising in the afternoon rather than in the evening Counting backward from 100 to 0 when his mind is racing
A client who has been admitted with a diagnosis of schizophrenia says to the nurse, "Yes, it's March. March is Little Women. That's literal, you know." These statements illustrate:
Loosening of associations
What is the priority nursing intervention for a forgetful, disoriented client with the diagnosis of dementia of the Alzheimer type?
Managing the client's unsafe behaviors
A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? (Select all that apply.)
Multiple losses Declines in health
A nurse is caring for an older adult with the diagnosis of dementia. Which manifestations are expected in this client? (Select all that apply.)
Resistance to change Inability to recognize familiar objects Inability to concentrate on new activities or interests Tendency to dwell on the past and ignore the present
When intimate partner violence (IPV) is suspected, the nurse plays an important role as an advocate for the victim. The advocate role includes several important components. (Select all that apply.)
Planning for future safety Validating the experiences Promoting access to community services
A nurse is caring for a preschool-aged child with a history of physical and sexual abuse. What type of therapy will be the most advantageous for this child?
Play
A nurse is planning care for a client admitted to the unit with a diagnosis of bipolar disorder, manic phase. In which type of room should the nurse tell the admissions clerk to place this client?
Private
A delusional client is actively hallucinating and worried about being stalked by a terrorist group. What defense mechanism does the nurse identify as the most prominent in this situation?
Projection
A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions?
Protecting the client against any suicidal impulses
Which nursing intervention is most important for a client who has the diagnosis of antisocial personality disorder?
Providing clear boundaries and consequences
What is important when the nurse plans care for a client with paranoid ideation?
Providing the client with opportunities for nonthreatening social interaction
A child with attention deficit-hyperactivity disorder (ADHD) often becomes frustrated and loses control. A nurse uses a variety of graduated techniques to manage disruptive behaviors. List the following interventions in order, from the least invasive to the most invasive.
Rationale: Situations that promote inattention, hyperactivity, and impulsivity should be avoided. Monitoring behavior for rising anxiety allows the nurse to cue the child to the behavior or to limit environmental stimuli. When cues of increasing frustration are noted, the child should be given a predetermined word, gesture, or eye contact as a reminder to maintain control. When the child is unable to impose self-control, a simple, concrete directive may be used to interrupt and redirect the unacceptable behavior. Strategic removal, such as a time-out, should be used as a last resort because it may make the child a scapegoat.
An older client with vascular dementia has difficulty following simple directions for selecting clothes to be worn for the day. The nurse identifies that these problems as the result of:
Receptive aphasia
What characteristic of anxiety is associated with a diagnosis of conversion disorder?
Relieved by the symptom
A housekeeping staff member in a mental health unit reports to the nurse that food was found hidden in a client's room. Knowing that the client was admitted with a fluid and electrolyte imbalance because of anorexia nervosa, the nurse should ask housekeeping personnel to:
Report it to the nursing staff if this happens again
An anxious client reports experiencing pain in the abdomen and feeling empty and hollow. A diagnostic workup reveals no physical causes of these clinical findings. What term best reflects what the client is experiencing?
Somatization
A client comes to a mental health center with severe anxiety, evidenced by crying, hand-wringing, and pacing. What should the first nursing intervention be?
Staying physically close to the client
A nurse is caring for a client who is addicted to opioids and who has undergone major surgery. The client is receiving methadone. What is the purpose of this medication?
Switches the user from illicit opioid use to use of a legal drug
A client confides to the nurse, "I've been thinking about suicide lately." What conclusion should the nurse make about the client?
The client is fearful of the impulses and is seeking protection from them.
A client with schizophrenia is experiencing auditory hallucinations. A nurse makes the following statements when interacting with this client. Place these statements in the order in which they should be made.
The nurse should first identify the client's feelings. After the client's feelings have been identified, the nurse should then simply explain why the voices occur. Next the nurse should point out reality. The nurse should attempt to distract the client from the hallucination by engaging in a one-to-one activity; walking is a good choice because it will help the client discharge energy. Eventually the client may engage in a small group activity that may distract him or her from the hallucination.
