6005 Exam 2 (Ch. 10, 15, 14, 13, 12)

The nurse finds a client crying in his room . The client states , " I'm so sad and lonely . I'm sitting here crying like a baby . " The nurse's best response is :

" Are you embarrassing because you're crying ? "

A client tells the nurse " I'm told that I should reduce the stress in my life , but I have no idea where to start . " The best suggestion for the nurse to make would be A. " Why not start by learning to meditate ? That technique will cover everything . " B. " In cases like yours , physical exercise works to elevate mood and reduce anxiety . C. " Most stress is related to conflicts in interpersonal relationships . You can work on becoming more assertive . " D. " Keeping a journal can help you identify sources of stress by looking at activities that put a strain on energy or time or trigger anger or anxiety

" Keeping a journal can help you identify sources of stress by looking at activities that put a strain on energy or time or trigger anger or anxiety

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse?

"Buspirone must be taken daily in order to be effective."

A nurse is discussing the care of a pt w/ a major depressive disorder (MDD) with a new nurse. What statement made by the new nurse indicates more teaching is needed?

"Care during the continuation phase focuses on treating continued manifestations of MDD." -the continuation phase is relapse prevention, tx of manifestations occurs in the acute phase

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." How should the nurse respond to this statement? a) "That is a good observation. Depression does mostly strike people older than 50 years." b) "Depression is seen in people of all ages, from childhood to old age." c) "Depression is most often seen among the middle adult age group." d) "The age of onset for most depressive episodes is given as 18 years."

"Depression is seen in people of all ages, from childhood to old age."

A nurse in an outpatient clinic is giving teaching to a pt that has a new diagnosis of premenstrual dysphoric disorder (PMDD). What statement by the client shows understanding of the teaching?

"I am aware that my PMDD causes me to have rapid mood swings." a s/s of PMDD is emotional lability

A nurse is taking care of a pt w/ schizoaffective disorder. What statement indicates that pt is experiencing depersonalization?

"I am no one, and everyone is me." -this exemplifies a loss of identity

A nurse in a long-term care facility is caring for a pt w/ major neurocognitive disorder and attempts to wander out of the building. The pt says, "I have to get home." What is an appropriate response by the nurse?

"I am your nurse. Let's walk together to your room." -its good for the nurse to reintroduce herself with each new interactions and to promote reality in a calm, reassuring manner

A nurse is discussing care of a sexual assault victim with a new nurse. What statement needs further teaching?

"I can expect manifestations of rape-trauma syndrome to be similar to bipolar disorder." -manifestations of rape-trauma syndrome are similar to PTSD

Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is...

"I know you believe that, Clint, but it's really hard for me to believe."

A nurse is giving teaching to a pt w/ a new prescription for amitriptyline (Elavil). What client statement indicates they understood the teaching?

"I may feel drowsy for a few weeks after starting this medication."

When the family asks a nurse for reassurance about a pt's condition, what is appropriate to say?

"I understand you're concerned. Let's discuss what concerns you specifically."

A nurse analyzes reports from our adult patients of frightening events they encountered. Which patient's report most clearly indicates that the resulting fear was mentally healthy? A. "I saw a large spider crawling along my kitchen wall." B. "I was at the mall when a gunman began firing an assault weapon." C. "I was at home when a storm with heavy thunder and lightning lasted over an hour." D. "I was trapped on an elevator that stopped between floors when the power went out."

"I was at the mall when a gunman began firing an assault weapon."

Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse?

"I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time."

Which statement would best show acceptance of a depressed, mute client? a) "I will be spending time with you each day to try to improve your mood." b) "I would like to sit with you for 15 minutes now and again this afternoon." c) "Each day we will spend time together to talk about things that are bothering you." d) "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

"I would like to sit with you for 15 minutes now and again this afternoon."

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The vomers are coming to execute me," an appropriate response for the nurse would be: a) "You are safe here. This is a locked unit, and no one can get in." b) "I do not believe I understand the word vomers. Tell me more about them." c) "Why do you think someone or something is going to harm you?" d) "It must be frightening to think something is going"

"It must be frightening to think something is going"

What critical information should the nurse provide about the use of lithium?

"It will take one to two weeks and may be longer for this medication to start working fully".

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? a) "Let's look at what you just said, that you can 'never do anything right.'" b) "Tell me what things you think you are not able to do correctly." c) "Is this part of the reason you think no one likes you?" d) "That is the most unrealistic thing I have ever heard."

"Let's look at what you just said, that you can 'never do anything right.'"

A nurse is admitting a new pt w/ bipolar disorder and is scheduled to begin lithium therapy. When collecting medical hx from the pt's adult daughter, which of the following states, made by her, is of highest priority to report to the doctor?

"My mother is currently on furosemide for her congestive heart failure." -diuretics (furosemide) are contraindicated with lithium use d/t risk of toxicity

A nurse is caring for a pt that is on lithium therapy. The pt states he wants ibuprofen for osteoarthritis pain relief. What statement by the nurse is appropriate?

"Regular aspirin would be a better choice than ibuprofen." -aspirin is recommended d/t the risk of lithium toxicity

The physician orders Zoloft 50 mg bid for Margaret, a 68 year old women with MDD. After 3 days of taking the medication, she says to the nurse, "I don't think this is doing any good. I don't feel better." What is the most appropriate response by the nurse?

"Sometimes it takes a few weeks for the medicine to bring about an improvement in symptoms."

A CHN is leading a discussion about rape with a neighborhood task force. What statement made by a neighborhood citizen needs further teaching?

"The majority of rapists are unknown to the victims." -the majority of rapists know their victims

A nursing student arrives late for a clinical experience and is not wearing the correct attire. When the instructor privately criticizes the behavior, the student responds, "I'm always the one who gets caught. You're going to cause me to fail." Select the instructor's best response. A. "Other students get caught as well." B. "I am not trying to cause you to fail. I am here to help you." C. "I am sorry you feel that way. I try to treat all my students equally." D. "The requirements for this experience were discussed during our orientation."

"The requirements for this experience were discussed during our orientation."

A charge nurse is discussing mirtazapine (remeron) with a new nurse. What statement made by the new nurse indicated effective teaching?

"This medication increases the release of serotonin and norepinephrine."

A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse?

"Those feelings are a normal part of the grief response."

A client is demonstrating a moderate level of anxiety. She tells the nurse "I am so anxious that I could fly! I do not know what to do." A helpful response for the nurse to make would be

"What things have you done in the past that helped you feel more comfortable?"

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? a) "What things have you done in the past that helped you feel more comfortable?" b) "Let's try to focus on that adorable little granddaughter of yours." c) "Why don't you sit down over there and work on that jigsaw puzzle?" d) "Try not to think about the feelings and sensations you're experiencing."

"What things have you done in the past that helped you feel more comfortable?"

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse?

"You are grieving for the marriage you did not have. It's natural for you to feel bad."

A nurse is caring for a pt who was recently raped. The pt says, "I never should have been out on the street alone at night." What is an appropriate response of the nurse?

"You believe this wouldn't have happened if you hadn't been out alone?" -this is using the therapeutic communication technique of restating, this promotes reflection and verbalization of feelings

A nurse is caring for a pt w/ Alzheimer's and is beginning to experience noticeable short-term memory loss. When talking about a new prescription for donepezil (Aricept), what should the nurse include?

"You can expect the progression of cognitive decline to slow with donepezil."

What behaviors indicate panic level anxiety?

- They might be unable to focus on their surrounding environment and people around them, emotional paralysis, might be running/shouting/screaming

A nurse is caring for a pt that has substance-induced psychotic disorder and is experiencing auditory hallucinations. The pt says, "The voices won't leave me alone!" What statement are appropriate for the nurse to make?

-"When did you start hearing voices" -"It must be scary to hear voices." -"Are the voices telling you to hurt yourself?" -ask directly about the hallucination, focus on the client's feelings rather than the hallucination, assess risk for harm to self

A nurse in a mental health facility is caring for a 35 yo female who has clinical findings of depression. She lives at home with her husband and 2 young children. She currently smokes and has a hx of asthma. What are the risk factors for depression that she has?

-35 yo -female -hx of chronic asthma -currently cmokes -depression is more prevalent in females btw ages 15-40, it is more common in someone with a chronic medical illness, and is more common in someone with a substance use disorder (like nicotine)

A nurse is completing an admission assessment on a pt w. schizophrenia. What should the nurse document as positive s/s?

-auditory hallucinations -clang associations -delusions of persecution -constantly waving arms

A nurse is caring for a victim of sexual assault. What findings indicate the pt is experienced an initial impact reaction of rape-trauma syndrome?

-emotional outbursts -difficulty making decisions

A nurse is doing an admission assessment on a pt w/ delirium r/t an acute UTI. What are expected findings?

-family report of personality changes -hallucinations -restlessness -someone w/delirium can experience rapid personality changes, they might have perceptual disturbances (like hallucinations or illusions), and will be restless or agitated

A nurse is making a home visit to a pt w/ Alzheimer's to assess the home for safety. What are appropriate suggestions to decrease the risk of injury?

-install childproof door locks -place the pt's mattress on the floor -install light fixtures above the stairs -the locks prevent the client from wandering unsupervised, keeping the mattress on the floor reduces injury r/t falls, lighting on stairs reduces the risk of falls

A nurse is planning a peer group discussion about the DSM-5). What is appropriate to include in the discussion.

-it is used to identify mental health disorders -it establishes diagnostic criteria -it assists nurses in planning care -it indicates expected assessment findinhgs

A nurse is taking care of a pt who is taking phenelizine (nardil). What adverse effects should the nurse watch for?

-orthostatic hypotension -HA

A nurse is discussing early indications of toxicity w/ a pt w/ a new prescription for lithium carbonate for bipolar disorder. What should the nurse include in the teaching?

-polyuria -muscle weakness

A nurse is caring for a pt in restraints. What is appropriate documentation?

-pt was offered 8 z of water q.8 hrs -pt shouted at assistive personal -pt received chlorpromazine (thorazine) 15 mg PO at 1000

A nurse is discussing a silent rape reaction with a new nurse. What should the nurse identify as a characteristic of this type of reaction?

-sudden development of phobias -increased level of anxiety during interview -unwillingness to discuss the sexual assault

A nurse is teaching a pt w/ a new prescription for imipramine (tofranil) how to minimize the anticholinergic effects. What should the nurse include in the teaching?

-void just before taking the medication -wear sunglasses when outside -chew sugarless gum -voiding right before taking it will reduce the urge for hesitancy/retention, wearing sunglasses will reduce photophobia, chewing gum will decrease having a dry mouth

A 35 year old female has manifestations of depression. She lives with her partner and two young children. She smokes and has a history of chronic asthma. Which of the following factors put the client at risk for depression? 1) Age 2) Sex 3) History of chronic asthma 4) Smoking 5) Being married

1) Age 2) Sex 3) History of chronic asthma 4) Smoking

A client is having severe anxiety. Which response is best? 1. "Tell me about how you're feeling right now" 2. "you should focus on the positive things in your life" 3. Why do you believe you are experiencing this anxiety? 4. Lets discuss the medications your provider has prescribed to decrease your anxiety?

1. "Tell me about how you're feeling right now"

Which statement by a patient with depression indicates that nursing interventions have been helpful? 1. "his comment upset me but i reminded myself that it really is not true" 2. "I feel so hopeless about everything, but I am glad you are a good listener" 3. "I feel so much better now that I know how to control my boss's behavior" 4. I am really trying to understand why everyone is against me"

1. "his comment upset me but i reminded myself that it really is not true"

a nurse is working on an acute mental health unit and is caring for a client who has post-traumatic stress disorder. Which of the following findings should the nurse expect? (select all that apply) 1. Difficulty concentrating on tasks 2. Obsessive need to talk about a traumatic event 3. Negative self image 4. Recurring nightmares 5. Diminished reflexes

1. Difficulty concentrating on tasks 3. Negative self image 4. Recurring nightmares

The nurse is providing care for a 28 year old patient admitted for a cardiac arrhythmia. The patient is extremely thin. For what additional signs of anorexia nervosa should the nurse assess? Select all that apply 1. Distorted body image 2. Electrolyte imbalances 3. Dry skin 4. Hyperthermia 5. Hypotension

1. Distorted body image 2. Electrolyte imbalances 3. Dry skin 5. Hypotension

A nurse is collecting data from a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply) 1. Excessive worry for six months 2. impulsive decision making 3. delayed reflexes 4. Restlessness 5. Need for reassurance

1. Excessive worry for six months 4. Restlessness 5. Need for reassurance

which of the following is the most effective treatment for alcoholism? 1. Group support, such as alcoholics anonymous 2. Drug therapy 3. EEC therapy 4. slowly reduce alcohol consumption

1. Group support, such as alcoholics anonymous

A patient is being treated with lorazepam (Ativan) during alcohol withdrawal becomes sleepy after the first two doses and then becomes difficult to arouse when the nurse attempts to give the third dose. Which of the following actions should the nurse take first? 1. Hold the dose and notify the registered nurse or physician 2. Understand that tolerance will occur with benzodiazepines and give the drugs 3. Get the patient up and have him walk with assistance until he is more alert 4. Administer an antidote

1. Hold the dose and notify the registered nurse or physician

examples of behavioral therapy for client with anxiety disorder

1. Relaxation Training 2. Modeling 3. Systemic Desensitization4. Flooding 5. Thought stopping

four classes of medications for anxiety

1. SSRI's (antidepressants)2. SNRI's3. Anxiolytics (anti-anxiety drugs)4. Anticonvulsants, antipsychotics

A patient is experiencing extrapyramidal side effects while taking antipsychotic medication. Which of the patient's medication orders will help reduce these effects? 1. benztropine (Cogentin) 2. chlorpromazine (Thorazine) 3. halperidol (Haldol) 4. lithium carbonate (Eskalith)

1. benztropine (Cogentin)

Key nursing interventions for suicidal patient

1.) Assess the degree and intent. The more planned out, the more likely they are to do it. 2.) Contract for safety. 3.) Accept the patient's feelings in a non-judgmental manner. 4.) Develop trust and rapport. 5.) Stay with the patient. 6.) Millieu safety. Implement appropriate precautions. 7.) Work towards restoration of patient's self-worth and self-esteem. 8.) Introduce alternatives to suicide including positive coping. 9.) Refer to appropriate case manager and community resources. 10.) Discharge occurs when they are felt to be no longer a harm to self or others and this is a team decision.

RN crisis intervention evaluation steps

1.) Have behavioral changes occurred? 2.) Can the individual cite an action plan for dealing with similar stressors like the one that precipitated the crisis?

Side effects of antipsychotic drugs

1.) Lowered seizure threshold- depakote often used. 2.) Diabetes- sliding scale. 3.) Hypotension- monitor FP. 4.) Anticholinergic side effects: dry mouth, blurred vision, constipation, urinary retention. 5.) Anticholinergic toxicity: Hold all meds, give cooling blanket and benzos. 6.) EPS- administer anticholinergic and maybe benadryl. - Akathesia -Aknesthia - Dystonia - Pseudo-parkinsonism - Tardive dyskinesia- no treatment, monitor. - Neuroleptic malignant syndrome- stop med, give cooling blanket, if mild give parlodel, if severe give dantrium, possible ECT.

Evaluation of patient with shizophrenia

1.) No longer actively suicidal. 2.) Compliant with meds 3.) Has a place to go after discharge 4.) Knows when to call the doctor 5.) Positive coping skills

Patient goals during Phase 3 of schizophrenia

1.) Preventing relapse. 2.) Self-care skills. 3.) Adapt to deficits. 4.) Reinforce health teaching.

The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses of the appropriate priority.

1.) Risk for injury related to manic hyperactivity. 2.) Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor. 3.) Disturbed sleep pattern evidenced by sleeping only 4-5 hours per night. 4.) Impaired social interaction evidenced by manipulation of others.

NANDA diagnoses for schizophrenia patients

1.) Risk for other-directed violence. 2.) Disturbed thought process. 3.) Risk for self-directed violence. 4.) Impaired verbal communication. 5.) Medication non-adherence. 6.) Social isolation. 7.) Self-care deficit-hygiene

Patient goals during Phase 1 of schizophrenia

1.) Safety and medical stabilization. 2.) Refrain from acting out on delusions or hallucinations. 3.) Environmental safety. 4.) May need one on one interaction. Group settings may not be possible. 5.) Basic teaching on symptom management.

Patient goals during Phase 2 of schizophrenia

1.) Stabilization. 2.) Adhere to medications. 3.) Attend group. 4.) Accept illness. 5.) Teaching focused on coping skills and when to call MD. 6.) Health teaching.

RN crisis intervention steps

1.) Stay with them if they are panicking. 2.) Discourage lengthy explanations or rationalizations of the situation. This will get them more obsessed. 3.) Help them confront the source or the problem that is creating the crisis. 4.) Encourage exploration of feelings about things that cannot be changed and identify positive coping. Example: What do you do when you get mad instead of hitting someone?

Names of typical antipsychotics

1.) Thorazine- most sedating but least EPS symptoms 2.) Haldol- least sedating but most EPS symptoms 3.) Prolixin-Deconate

RN crisis intervention assessment steps

1.) What brought you in here? 2.) When did it happen? 3.) Assess patient's physical and mental status. 4.) Has the patient experienced this stressor before? 5.) Assess coping skills. 6.) Assess suicide or homicide potential, plan, and means. 7.) Assess the adequacy of support systems. 8.) Determine the level of precise functioning. 9.) Assess perception of personal strengths and limitations. 10.) Assess for substance abuse.

Names of Atypical antipyschotics

1.) Zyprexa 2.) Abilify 3.) Clozaril- watch WBC for agranulocytosis 4.) Seroquel 5.) Respirdal 6.) Consta- depot form improves compliance

The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with Bipolar 1 Disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is...

1.0-1.5 mEq/L

A patient reports seeing children playing on the floor in the hallway of the mental health unit. There are no children anywhere on the unit? Which response by the nurse is best? 1. "The children are fine there. They are just playing" 2. "I don't see any children and there haven't been any children on the unit today. Would you like to take a walk with me?" 3. "Children are not allowed on this unit. I will ask them to leave" 4. " You know there are no children here. It might be time for your medication"

2. "I don't see any children and there haven't been any children on the unit today. Would you like to take a walk with me?"

The nurse is planning care for a patient with an eating disorder. The patient is 40 kg and 68 inches tall. Serum laboratory data is potassium 2.6 mEq/dL, sodium 126 mEq/dL , chloride 95 mEq/dL, and calcium 10.8 mg/dL. Which of these is the priority intervention for this patient? 1. Weigh the patient daily at the same time 2. Maintain an intravenous line of dextrose and electrolytes 3. praise intake of any type of food 4. document intake and output

2. Maintain an intravenous line of dextrose and electrolytes

A patient is starting on lithium for bipolar disorder which of the following nutrients shut the nurse teach about maintaining the diet ? 1. Potassium 2. Sodium 3. Selenium 4. Tyramine

2. Sodium

A nurse is assisting in a serious and prolonged mass casualty incident. Which of the strategies should the nurse use to help prevent the developing a trauma-related disorder? Select all that apply 1. Avoid talking about the incident once it is over 2. Take breaks during the incident for food and water 3. Debrief with others following the incident 4. hold emotions in check in the days following the incident 5. Take advantage of offered counseling

2. Take breaks during the incident for food and water 3. Debrief with others following the incident 5. Take advantage of offered counceling

A patient calls a nurse into the room and says, "quick, Nurse, there is a dog in the corner. Please get him out. I am terrified of dogs." the nurse sees no dog in the corner. Which of the following responses is best? 1. " You know we dont allow dogs in the hospital" 2. "We have been through this before. You know full well that there is no dog in that corner" 3. "I do not see a dog. Let's take a walk down to the snack room" 4. " What kind of dog is it? What makes you scared of dogs?"

3. "I do not see a dog. Let's take a walk down to the snack room"

A patient states, "My doctor says I have obsessive compulsive disorder. What does this mean?" Which response by the nurse is best? 1. "It means that you have experienced a major life stress and will need therapy to help you manage the symptoms" 2. "You can expect to experience periods of high energy and anxiety, alternation with periods of feeling very low" 3. "You may experience involuntary, intrusive thoughts and feel compelled to response with seemingly meaningless actions" 4. "People with obsessive compulsive disorder are very organized. This is a good disorder to have"

3. "You may experience involuntary, intrusive thoughts and feel compelled to response with seemingly meaningless actions"

which of the following responses to anxiety is a cause for concern? 1. A student studies late into the night to prepare for a difficult examination 2. A woman takes deep breaths before going out to the grocery store because shopping makes her nervous 3. A nurse has a glass of wine before a stressful night shift 4. A young man gets the opinions of several of his friends before asking a woman out

3. A nurse has a glass of wine before a stressful night shift

A patient is beginning treatment with paroxetine (paxil) for unipolar depression but after 10 days is still withdrawn and unable to participate in therapy. Which action by the nurse is best? 1. Contact the ordering physician for an increase in the dose 2. Contact the ordering physician for an alternative antidepressant 3. Continue to support the patient while waiting for symptoms to subside 4. Encourage the patient to include St. John's wort, a herbal supplement, in the treatment regimen

3. Continue to support the patient while waiting for symptoms to subside

A patient is being treated on the mental health unit for an anxiety disorder. The patient approaches the nurse and reports feeling dizzy and weak, with a sensation of a racing heart. The nursing care plan includes interventions of imagery exercises and as needed lorazepam (Ativan) for symptoms of anxiety. What should the nurse do first? 1. Instruct the patient to sit and breathe deeply 2. Give the patient the prescribed as needed lorazepam 3. Obtain the patients vital signs 4. Instruct the patient in an imagery exercise

3. Obtain the patients vital signs

A nurse is caring for a client who has de-realization disorder? Which of the following findings should the nurse identify as an indication of de-realization? 1. The client explains that her body seems to be floating above the ground 2. The client has the idea that someone is trying to kill her and steal her money 3. The client states that the furniture in the room seems to be small and far away 4. The client cannot recall anything that happened during the past 2 weeks

3. The client states that the furniture in the room seems to be small and far away

Which statement by a depressed patient causes the nurse to contact the registered nurse or health care provider immediately 1. "Everyone is out to get me" 2. "I have tried to kill myself three times" 3. "I feel so hopeless" 4. "My friend is bringing me a gun"

4. My friend is bringing me a gun

A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? 1. Discuss new relaxation techniques 2. Show the client how to change the behavior 3. Distract the client with a television show 4. Stay with the client and remain quiet

4. Stay with the client and remain quiet

A patient who is a veteran of the gulf war hears the hospital fire alarm go off during a drill and cries, "There are people hiding behind the pillars! They have guns! Be careful!" What action should the nurse take first? 1. Tell the patient that his behavior is inappropriate and that he is frightening the other patients 2. Administer an as-needed anti-psychotic medication as ordered 3. Ask him whether he is afraid of the guns 4. Stay with the patient while calming reorienting him

4. Stay with the patient while calming reorienting him

A nurse is caring for a client who has acute stress disorder. Which of the following findings should the nurse expect? 1. The client remembers details about the traumatic event 2. The client expresses heightened elation about what is happening 3. The client states he first noticed manifestations of the disorder six weeks after the traumatic incident occurred 4. The client expresses a sense of unreality about the traumatic incident

4. The client expresses a sense of unreality about the traumatic incident

Which of the following behaviors by a nurse may aggravate the behaviors of a patient with schizophrenia? 1. Providing written instructions on when to take medications 2. speaking in short simple sentences 3. maintaining a structured environment 4. speaking quietly to other staff members when the patient is present

4. speaking quietly to other staff members when the patient is present

Identification Example a. 8 year old girl dresses up like her teacher and pretends like she is going to teach b. instead of helping their little ones emotionally after their wife dies, they think about only the cold facts and nothing emotionally c. taking fetal position during sleeping - turning to childlike pattern of behavior for comfort, for example d. you know what you are doing; you say you will deal with it later, or after your exam

8 year old girl dresses up like her teacher and pretends like she is going to teach

A client is diagnosed with generalized anxiety disorder. In order to maximize the learning process prior to discharge teaching, which assessment should be performed by the nurse? A. Assessing the clients level of anxiety B. Assessing and documenting the clients vital signs C. Assessing suicide risk D. Assessing availability of support systems

A

A high school basketball player sustains a serious knee injury and states to the school nurse, I will never get to college if I dont receive a basketball scholarship. Which nursing reply would assist the student to see a broader range of possibilities? A. Lets look at the alternatives for funding your college education. B. I know you are feeling helpless now, but you are looking at this from only one perspective. C. Can your family afford knee surgery? D. You now need to prioritize your academics and not focus on basketball.

A

A mother states, You are old enough to clean your own bedroom. Later inspection finds the floor clear, but with everything stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification? A. Shaping B. Extinction C. Stimulus generalization D. Reciprocal inhibition

A

A nurse should recognize which intervention as most appropriate within a behavioral therapy program? A. A child is given a Popsicle for staying dry and clean. B. A child is put in time-out after soiling his or her undergarments. C. A child is allowed to remain in soiled undergarments. D. A child is taught the advantages of staying dry and clean.

A

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred? A. Dichotomous thinking is when an individual views situations as being good or bad or black or white. B. Dichotomous thinking is when an individual takes complete responsibility for situations withoutconsidering other circumstances. C. Dichotomous thinking is when an individual exaggerates the negative significance of an event. D. Dichotomous thinking is when an individual undervalues the positive significance of an event.

A

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of examining the evidence. Which response exemplifies this technique? A. Lets look at the potential reasons why your partner has not participated. B. How would you define irresponsibility? C. Has it occurred to you that your partner may be working on the project at home? D. Are you telling me that you feel totally responsible for this project?

A

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the clients thinking is reflective of which cognitive error? A. Minimization B. Dichotomous thinking C. Arbitrary inference D. Personalization

A

A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child's parent? A. Your child will receive green tokens for completing homework that can be cashed in for desired rewards. B. Your child will receive red tokens when homework is incomplete and this will result in school suspension. C. Your child will receive a time out for each homework assignment not completed. D. Your child, with your assistance, will envision receiving rewards for completed homework.

A

An adolescent client has problems expressing anger appropriately. Which nursing statement would encourage the client to set realistic goals? A. What do you think needs to change about how you express anger? B. How did you feel after attending the anger management session? C. On a scale of 1 to 10, please rate your current level of anger. D. What bothers you about the actions of others when you get angry?

A

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this clients concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations

A

The following North American Nursing Diagnosis Association (NANDA) nursing diagnostic stem was developed for a client on an inpatient unit: Risk for injury. What assessment data most likely led to the development of this problem statement? A. The client is receiving electroconvulsive therapy (ECT) and is diagnosed with Parkinsonism. B. The client has a history of four suicide attempts in adolescence. C. The client expresses hopelessness and helplessness and isolates self. D. The client has disorganized thought processes and delusional thinking.

A

The following outcome was developed for a client: Client will list five personal strengths by the end of day 1. Which correctly written nursing diagnostic statement most likely generated the development of this outcome? A. Altered self-esteem R/T years of emotional abuse AEB self-deprecating statements B. Self-care deficit R/T altered thought processes C. R/T altered thought processes D. Disturbed body image R/T major depressive disorder AEB mood rating of 2/10D. Risk for disturbed self-concept R/T hopelessness AEB suicide attempt

A

The nurse should recognize which acronym as representing problem-oriented charting? A. SOAPIE B. SOLER C. DAR D. PQRST

A

Using a cognitive approach, a nurse would choose which intervention for assisting clients to manage their anger without the use of violence? A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking. B. Provide consequences, such as removal from group therapy, in response to angry outbursts. C. Administer antipsychotic medications and use limit-setting such as a room restriction. D. Administer anti-anxiety medication and encourage participation in a group on medication actions.

A

Which client statement would exemplify the level of cognitive function that you would expect to see in mild anxiety? A. Right now I feel as sharp as a tack. B. Im having a tough time focusing. C. Sometimes I feel like Im having an out-of-body experience. D. All I seem to focus on is my anger.

A

A female client who's at high risk for suicide needs close supervision. To best ensure the client's safety, Nurse Mary should: A check the client frequently at irregular intervals throughout the night B assure the client that the nurse will hold in confidence anything the client says C repeatedly discuss previous suicide attempts with the client D disregard decreased communication by the client because this is common in suicidal clients

A check the client frequently at irregular intervals throughout the night

On the basis of recent findings , which client could the nurse expect to have greater difficulty adjusting to life changes that have occurred over the past year ? A. A 32 - year - old woman who is pregnant , divorcing her husband , and changing residences . B. A 40 - year - old man who has received a promotion and undertaken a weight loss program . C. A 45-year-old woman whose daughter left home to attend college and whose ill mother is moving in. D. A 67 - year - old retired man who lost his home in a hurricane .

A 32 - year - old woman who is pregnant , divorcing her husband , and changing residences .

Suicide

A behavior that is commonly seen in elderly white males. More than 90% have a mental illness.

Currently what is understood to be the causation of schizophrenia? a) A combination of inherited and nongenetic factors b) Deficient amounts of the neurotransmitter dopamine c) Excessive amounts of the neurotransmitter serotonin d) Stress related and ineffective stress management skills

A combination of inherited and nongenetic factors

Which of the following is a correct assumption regarding the concept of crisis?

A crisis situation contains the potential for psychological growth or deterioration.

Margaret, a 68 year old widow is experiencing a manic episode, is admitted to the psych unit after being brought to the ER by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of...

A delusion of persecution

Major Depressive Disorder

A disorder that can be from premenstrual, mood, medical conditions, or substance abuse. May be neurochemical.

Word salad

A group of words that are put together randomly, without any logical connection.

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? a) A history of childhood trauma b) A sibling with the disorder c) A history of sexual abuse d) A previous suicide attempt e) An eating disorder

A history of childhood trauma A sibling with the disorder A history of sexual abuse An eating disorder

Hysteria

A polysymptomatic disorder that usually begins in adolescence, chiefly affects women, and is characterized by recurrent multiple somatic complaints that are unexplained b organic pathology. It is thought to be associated with repressed anxiety.

Delusions

A positive symptom of schizophrenia where the patient has false beliefs.

Derealization

A positive symptom of schizophrenia where there's an alteration in the perception or experience of the external world so that it seems strange or unreal.

Hallucinations

A positive symptoms of schizophrenia. Can be auditory, olfactory, gustatory, visual, illusions, and tactile. Warn a doctor or the patient's family if the patient has command hallucinations.

PTSD (Post Traumatic Stress Disorder)

A prolonged and severe stress reaction to a scary event (chronic stress)

Adjustment disorder

A psychological response to an identifiable stressor or stressors.

Schizophrenia

A psychotic mental disorder with disturbances in thought, perception, and affect.

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? a) Standard antipsychotic medication. b) Tricyclic antidepressant medication. c) Anticholinergic medication. d) A short-acting benzodiazepine medication.

A short-acting benzodiazepine medication

Which room placement would be best for a client experiencing a manic episode? a) A shared room with a client with dementia b) A single room near the unit activities area c) A single room near the nurses' station d) A shared room away from the unit entrance

A single room near the nurses' station

Codependence

A situation in which the significant others in a family group begin to lose their own sense of identity and purpose and exist solely for the abuser

Post-trauma syndrom

A sustained maladaptive response to a traumatic, overwhelming event.

Delusion of reference

A type of delusion where all events within the environment are referred by the psychotic person to him or herself, for example, "someone is trying to get a message to me through the articles in this magazine."

Schizoaffective disorder

A type of schizophrenia where the patient is hyper, hyper-sexual, hyper-emotional, hyper-religious, etc. Usually this patient is on an anti-psychotic and anti-mania drugs such as Depakote.

A nurse is collecting data during admission from a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply) A) Auditory hallucinations B) Lack of motivation C) Use of clang associations D) Delusions of persecution E) Constantly Waving Arms F) Flat affect

A) Auditory hallucinations C) Use of clang associations D) Delusions of persecution E) Constantly Waving Arms

A client has substance induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices wont leave me alone!!" Which of the following statements should the nurse make? (Select all that apply) A) When did you start hearing voices? B) The voices are not real, or else we would both hear them C) It must be scary to hear voices D) Are the voices telling you to hurt yourself E) Why are the voices talking to only you

A) When did you start hearing voices? C) It must be scary to hear voices D) Are the voices telling you to hurt yourself

A nurse in an acute mental health facility is caring for a client who has major depressive disorder and anxiety disorder. Which of the following actions is the nurses priority? A)Placing the client on one to one observation B)Assisting the client to perform ADLs C) Encourage the client to participate in counseling D) reinforce teaching with the client about medication side effects

A)Placing the client on one to one observation

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? Select all that apply. A. The purpose of this exercise is to identify automatic thoughts. B. The purpose of this exercise is to identify rational alternatives. C. The purpose of this exercise is to modify cognitive errors. D. The purpose of this exercise is to eliminate irrational beliefs. E. The purpose of this exercise is to monitor thoughts related to self-esteem.

A, B, C

Client Need: Psychosocial Integrity 25. Which of the following client statements would indicate that teaching about benzodiazepines has been successful? Select all that apply. A. I cant drink alcohol when taking lorazepam (Ativan). B. If I abruptly stop taking buspirone (BuSpar), I may have a seizure. C. Valium can make me drowsy, so I shouldnt drive for awhile. D. My new diet cannot include aged cheese or pickled herring. E. When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax).

A, C

Which of the following nursing interventions fall within the standards of psychiatric mental health clinical nursing practice for a nurse generalist? Select all that apply. A. Assist clients to perform activities of daily living. B. Act as a consultant with other clinicians to provide services for clients and effect system change C. Encourage clients to discuss triggers for relapse D. Use prescriptive authority in accordance with state and federal laws E. Educate families about signs and symptoms of alcohol dependence and withdrawal

A, C, E

A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."

A. "Cognitive reframing will help me change my irrational thoughts to something positive."

A nurse in a hospital is caring for a client who has agoraphobia. Which of the following statements by the client indicates understanding of the goals of treatment? A. "I plan to sit on a park bench for a few minutes each day." B. "I can try participating in group therapy every week." C. "I will join a book club in my neighborhood." D. "I should avoid entering elevators and other closed spaces."

A. "I plan to sit on a park bench for a few minutes each day." Rationale: Agoraphobia is fear of being in places in which help may not be available. This typically manifests as a fear of being outside alone. Therefore, the nurse should identify this statement as understanding of the goals of treatment. The client's phobia does not concern exposure to other people.

a nurse on crisis hotline is speaking to a client who says, "I just took an entire bottle of amitriptylline." Which of the following responses should the nurse take? A. "I'm glad you called, and I want to send an ambulance to help you." B. "You must have been feeling pretty depressed to do that." C. "Do you know how many pills were in the bottle?" D. "Were you trying to kill yourself by taking an overdose?"

A. "I'm glad you called, and I want to send an ambulance to help you." Rationale: Amitriptyline, a tricyclic antidepressant, is used to treat depression. This therapeutic statement shows the nurse's concern for the client's safety and responds to the client's priority need. Maslow's hierarchy of needs states that the client's physical and safety needs come first. Therefore, the client needs to be evaluated immediately.

A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A. "I'm scared that you're going to leave me." B. "I'll go to group therapy if you'll let me smoke." C. "I need to feel that everyone admires me." D. "I sometimes feel better if I cut myself."

A. "I'm scared that you're going to leave me."

A nurse is teaching a client who has obsessive-compulsive disorder and has a new prescription for paroxetine. Which of the following instructions should the nurse include? A. "It can take several weeks before you feel like the medication is helping." B. "Take the medication just before bedtime to promote sleep." C. "You should take the medication when needed for obsessive urges." D. "Monitor for weight gain while taking this medication."

A. "It can take several weeks before you feel like the medication is helping."

A patient at a general medical clinic tells the nurse, "I have so many ailments that I need to see six different doctors. None of them has discovered what is really wrong with me." Which comment should the nurse offer next? A. "Let's review all the medications you currently take." B. "Tell me about allergic reactions you've had to medication." C. "Selecting one primary care provider would be better for you." D. "I'm not sure I understand how you can afford these expenses."

A. "Let's review all the medications you currently take." Rationale: The actual response should be to first explore the patient's feelings about what it has been like to see six doctors and none of them discovering what is wrong.

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A. "Life isn't worth living if I gain weight." B. "Don't pretend likely outcome don't know how fat I am." C. "If I could be skinny, I know I'd be popular." D. "When I look in the mirror, I see myself as obese."

A. "Life isn't worth living if I gain weight."

A nurse is discussing the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.) A. "Methadone is a replacement for physical dependence to opioids." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." D. "Methadone increases the risk for acetaldehyde syndrome." E. "Methadone must be prescribed and dispensed by an approved treatment center."

A. "Methadone is a replacement for physical dependence to opioids." B. "Methadone reduces the unpleasant effects associated with abstinence syndrome." C. "Methadone can be used during opioid withdrawal and to maintain abstinence." E. "Methadone must be prescribed and dispensed by an approved treatment center."

A nurse is providing instructions to a client who has a new prescription for zolpidem. Which of the following instructions should the nurse include? A. "Notify the provider if you plan to become pregnant." B. "Take the medication 1 hr before you plan to go to sleep." C. "Allow at least 6 hr for sleep when taking zolpidem." D. "To increase the effectiveness of zolpidem, take it with a bedtime snack."

A. "Notify the provider if you plan to become pregnant."

A nurse is caring for a client who has generalized anxiety disorder and is experiencing severe anxiety. Which of the following statements should the nurse make? A. "Tell me about how you are feeling right now." B. "You should focus on the positive things in your life to decrease your anxiety." C. "Why do you believe you are experiencing this anxiety?" D. "Let's discuss the medications your provider is prescribing to decrease your anxiety."

A. "Tell me about how you are feeling right now."

A nurse is providing teaching to a client who has alcohol use disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? A. "This medication will prevent seizures during alcohol withdrawal." B. "Taking this medication will decease your cravings for alcohol." C. "This medication maintains your blood pressure at a normal level during alcohol withdrawal." D. "Taking this medication will improve your ability to maintain abstinence from alcohol."

A. "This medication will prevent seizures during alcohol withdrawal."

A nurse is obtaining a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply.) A. "What is your relationship like with your family?" B. "Why do you want to lose weight?" C. "Would you describe your current eating status?" D. "At what weight do you believe you will look better?" E. "Can you discuss your feelings about your appearance?"

A. "What is your relationship like with your family?" C. "Would you describe your current eating status?" E. "Can you discuss your feelings about your appearance?"

Which scenario presents the highest risk for a pregnancy resulting in offspring with an intellectual developmental disability (IDD)? (Select all that apply.) A. 18 year old mother who received no prenatal care B. 32 year old woman diagnosed with anorexia nervosa C. 26 year old father with a history of episodic alcohol abuse D. 38 year old father diagnosed with generalized anxiety disorder

A. 18 year old mother who received no prenatal care B. 32 year old woman diagnosed with anorexia nervosa Rationale: Since fetal malnutrition is a risk factor, both an individual with anorexia and a teenager with no prenatal care could have nutritional intakes that may result in fetal malnutrition.

A person shoplifts merchandise from a community cancer thrift shop. When confronted, the thief replies, "All this stuff was donated, so I can take it." This comment suggests features of which personality disorder? A. Antisocial B. Histrionic C. Borderline D. Schizotypical

A. Antisocial

A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? A. Assess the client's risk for self-harm B. Instill hope for positive outcomes C. Encourage the client to participate in group therapy sessions D. Assist the client to participate in treatment decisions

A. Assess the client's risk for self-harm

A veteran of the war in Afghanistan tells the nurse, "Everyday, something happens that makes me feel like I'm still there. My family has grown impatient with me. They say it's time for me to move on from that time in my life but I can't." What is the nurse's first priority? A. Assess the veteran for suicide risk. B. Refer the veteran for specialized mental health services. C. Assess the veteran for evidence of traumatic brain injury. D. Refer the veteran's family to a posttraumatic stress disorder group.

A. Assess the veteran for suicide risk.

A nurse is planning care for a client who has generalized anxiety disorder. Which of the following interventions should the nurse implement to promote relaxation? A. Assist the client in practicing meditation. B. Recognize the client's spiritual preferences. C. Encourage the client to identify his positive qualities. D. Help the client to identify his previous accomplishments.

A. Assist the client in practicing meditation.

A nurse is caring for a client who has paranoid personality disorder. Which of the following findings should the nurse expect? (Select all that apply.) A. Believes that others are deceiving him B. Desires to be the center of attention C. Views himself as inferior to others D. Demonstrates a grandiose sense of self-importance E. Persistently holds onto grudges

A. Believes that others are deceiving him E. Persistently holds onto grudges

A nurse is caring for a client who takes paroxetine to treat posttraumatic stress disorder and reports that they grind their teeth during the night. The nurse should identify which of the following interventions to manage bruxism? (Select all that apply.) A. Concurrent administration of buspirone B. Administration of a different SSRI C. Use of a mouth guard D. Changing to a different class of antidepressant medication E. Increasing the dose of paroxetine

A. Concurrent administration of buspirone C. Use of a mouth guard D. Changing to a different class of antidepressant medication

A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify a placing the client at risk for conversion disorder? A. Death of a child 2 months ago B. Recent weight loss of 30 lb C. Retirement 1 year ago D. History of migraine headaches

A. Death of a child 2 months ago

A home-health nurse is assessing a client who has obsessive-compulsive disorder (OCD) and finds that the client demonstrates constant repetitive thinking. The nurse knows that this behavior is an attempt to accomplish which of the following? A. Decrease anxiety. B. Prevent aggressive and impulsive behaviors. C. Manipulate others. D. Decrease the time available for interaction with people.

A. Decrease anxiety.

A nurse in an ED is assessing a client who has traumatic injuries following an assault. The client sits quietly and calmly in the examination room and states, "I'm fine." The nurse should recognize the client's behavior as which of the following reactions? A. Denial B. Displacement C. Projection D. Undoing

A. Denial

A nurse is performing an admission assessment for a client who is receiving treatment following a situational crisis. Which of the following assessments by the nurse is the highest priority? A. Determining if the client has psychotic thinking B. Asking the client to identify the cause of the crisis C. Identifying the client's coping skills D. Identifying the client's support systems

A. Determining if the client has psychotic thinking Rationale: Clients experiencing a situational crisis are at greatest risk for injury to themselves or others; therefore, determining if psychotic thinking is present is the highest priority.

A nurse is planning discharge for a client who has BPD. Which of the following interventions should be included for this client? A. Dialectical behavior therapy B. Behavioral contract C. Bibliotherapy D. Safety plan

A. Dialectical behavior therapy

A nurse working on an acute mental health unit is caring for a client who has PTSD. Which of the following findings should the nurse expect? (Select all that apply.) A. Difficulty concentrating on tasks B. Obsessive need to talk about the traumatic event C. Negative self-image D. Recurring nightmares E. Diminished reflexes

A. Difficulty concentrating on tasks C. Negative self-image D. Recurring nightmares

A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply.) A. Difficulty in getting along with other members of a group B. Belief in the ability to become invisible during times of stress C. Display of defense mechanisms when routines are changed D. Claiming to be more important than other persons E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

A. Difficulty in getting along with other members of a group C. Display of defense mechanisms when routines are changed E. Difficulty understanding why it is inappropriate to have a personal relationship with staff

A nurse is preparing an educational seminar on stress for the other nursing staff. Which of the following information should the nurse include in the discussion? A. Excessive stressors cause the client to experience stress B. The body's initial adaptive response to stress is denial C. Absence of stressors results in homeostasis D. Negative, rather than positive, stressors produce a biological response

A. Excessive stressors cause the client to experience stress

A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.) A. Excessive worry for 6 months B. Impulsive decision making C. Delayed reflexes D. Restlessness E. Sleep disturbance

A. Excessive worry for 6 months D. Restlessness E. Sleep disturbance

A nurse is providing instructions to a client who has been experiencing insomnia and has a new prescription for temazepam. The nurse should inform the client that which of the following manifestations are adverse effects of temazepam? (Select all that apply.) A. Incoordination B. Hypertension C. Pruritus D. Sleep driving E. Amnesia

A. Incoordination D. Sleep driving E. Amnesia

A nurse is assessing a client who has illness anxiety disorder. Which of the following are expected for this disorder? (Select all that apply.) A. Obsessive thoughts about disease B. History of childhood abuse C. Avoidance of healthcare providers D. Depressive disorder E. Narcissistic personality

A. Obsessive thoughts about disease B. History of childhood abuse C. Avoidance of healthcare providers D. Depressive disorder

A nurse is caring for a client who requires a crisis intervention for acute anxiety. Which of the following actions is the highest priority? A. Protecting the client from injury B. Determining the cause of the client's anxiety C. Ensuring that the client feels safe D. Identifying the client's coping skills

A. Protecting the client from injury

A nurse in a mental health clinic is attempting to develop a therapeutic relationship with a client. Which of the following actions should the nurse take? A. Set limits for the relationship B. Promote the use of transference by the client C. Instruct the client on how he should behave. D. Engage in friendly interactions with the client.

A. Set limits for the relationship Rationale: Engaging in a friendly relationship meets the needs of both parties in a social relationship. In a therapeutic nurse-client relationship, the goal is to meet client needs through use of problem-solving and therapeutic communication. A social relationship encourages blurring of boundaries and is not part of the professional nurse-client relationship. The nurse should set professional boundaries with the client through limit setting.

A nurse is caring for a young adult client following the sudden death of his wife. The client feels paralyzed in his ability to cope with work and family responsibilities. Which of the following types of crisis is the client experiencing? A. Situational B. Maturational C. Adventitious D. Developmental

A. Situational

A client is admitted with PTSD following a fire in his home in which family members died. Which of the following should the nurse recognize as an adaptive defense mechanism? A. The client begins reading a book when he experiences hand tremors in response to loud noise. B. The client makes a decision to postpone a needed surgery. C. The client focuses on discussing his daily routine when asked about the fire. D. The client develops stomach pains when fire is seen on television.

A. The client begins reading a book when he experiences hand tremors in response to loud noise. Rationale: This is an adaptive use of dissociation by temporarily blocking memories and perceptions from conscious thought. Dissociation involves a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment. This client has a physical response of hand trembling when he hears loud noise, and chooses to dissociate from the loud noise by reading.

A nurse is reviewing the medical record of a client who performs self-injury. Which of the following information should the nurse identify as placing the client at risk for self-harm behaviors? A. The client has borderline personality disorder. B. The client has a parent who has dependent personality disorder. C. The client has a history of bulimia nervosa. D. The client recently received a promotion at work.

A. The client has borderline personality disorder.

A college student has been experiencing significant stress associated with academic demands. Last month, the student began attending yoga sessions three times a week. Which outcome indicates this activity has been successful? A. The student reports improved feelings of well-being. B. The student increases use of caffeine to enhance concentration. C. The student reports, "Now I am sleeping about 10 hours every day." D. The student says, "I withdrew from two courses to reduce my academic load."

A. The student reports improved feelings of well-being.

A nurse is caring for a client who has OCD. Which of the following characteristics are expected findings of OCD? (Select all that apply.) A. ​Difficulty relaxing B. ​Irrational fear of certain objects C. ​Rule-conscious behavior D. ​Unaware of compulsions E. ​Perfectionist behavior

A. ​Difficulty relaxing C. ​Rule-conscious behavior E. ​Perfectionist behavior

A nurse is discussing routine follow-up needs for a pt w/ a new prescription for valproic acid (Depakote). The nurse should inform the patient for the need to routinely monitor what?

AST/ALT and LDH -liver function studies are important d/t the risk of hepatotxicity

What is a desired outcome for the maintenance phase of treatment for a manic client? a) Exhibit optimistic, energetic, playful behavior. b) Adhere to follow-up medical appointments. c) Take medication more than 50% of the time. d) Use alcohol to moderate occasional mood "highs."

Adhere to follow-up medical appointments.

Norepinephrine

Affects "fight or flight" response from arousal to panic. High levels are associated with panic and anxiety disorders.

When is the most critical time to watch a person for attempting to commit suicide?

After beginning antidepressant therapy.

Depression

Alteration in mood with pervasive feelings of sadness, despair, and pessimism. There is a loss of interest in usual activities, and somatic symptoms may be evident. Changes in sleep and appetite patterns are common. More likely experienced by women, those who live alone, and during season changes.

Mania

Alternation of mood with extreme feelings of elation, inflated self-esteem, grandiosity, hyperactivity, hypersexual, agitation, accelerated thinking and speaking.

The defense mechanisms that can only be used in healthy ways are A. Altruism and sublimation B. Suppression and humor C. Idealization and splitting D. Reaction formation and denial

Altruism and sublimation

What defense mechanisms can only be used in healthy ways? a) Suppression and humor b) Altruism and sublimation c) Idealization and splitting d) Reaction formation and denial

Altruism and sublimation

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question?

An SSRI given initially with a MAOI

Agoraphobia

An abnormal fear of open or public places

Dispositional crisis

An acute response to an external situational stressor.

obsessive-compulsive disorder

An anxiety disorder characterized by unwanted repetitive thoughts (obsession) and/ or actions (compulsions).

Social phobia

An excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

Trauma

An extremely distressing experience that causes severe emotional shock and may have long-lasting psychological effects.

GABA

An inhibitory neurotransmitter that decreases the ability of other neurotransmitters to work. Low levels are seen with bipolar, mania, and seizure disorder.

What are the predisposing factors for suicide?

Anger turned inward, hopelessness, desperation and guilt, history of violence or aggression, shame and humiliation, developmental stressors like disease or diability.

Which of the following would be assessed as a negative symptom of schizophrenia? a) Anhedonia b) Hostility c) Agitation d) Hallucinations

Anhedonia

Which clinical presentation is associated with the most commonly diagnosed adjustment disorder (AD)? 1. Anxiety, feelings of hopelessness, and worry 2. Truancy, vandalism, and fighting 3. Nervousness, worry, and jitteriness 4. Depressed mood, tearfulness, and hopelessness

Answer : 4 AD with depressed mood is the most commonly diagnosed adjustment disorder. The clinical presentation is one of predominant mood disturbance, although less pronounced than that of major depression. The symptoms—such as depressed mood, tearfulness, and feelings of hopelessness—exceed what is an expected or normative response to an identified stressor.

Approximately two million American children have experienced the deployment of a parent to Iraq or Afghanistan. How many of these children either lost a parent or have a parent who was wounded in these conflicts? 1. 48,000 2. 26,000 3. 11,000 4. 8,000

Answer: 1 More than 48,000 children have either lost a parent or have a parent who was wounded in Iraq or Afghanistan.

Which information will help the nurse differentiate the diagnosis of posttraumatic stress disorder (PTSD) from the diagnosis of adjustment disorder (AD)? 1. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. 2. AD is more common in women, whereas PTSD is more common in men. 3. AD can occur from severe motor vehicle accidents, while PTSD can occur from the birth of a stillborn. 4. PTSD occurs more often when compared to AD.

Answer: 1 PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events or "less extreme" events, such as being a victim of bullying or being incarcerated.

Which of the following is the most commonly used treatment for clients with adjustment disorder (AD) and its appropriate rationale? 1. Psychotherapy; to examine the stressor and confront unresolved issues 2. Selective serotonin reuptake inhibitors; to stabilize mood and resolve symptoms 3. Eye movement desensitization therapy; to reprocess traumatic events 4. Antianxiety agents; a first-line treatment to address symptoms of anxiety

Answer: 1 Psychotherapy is the most common treatment used for AD. Individual psychotherapy allows the client to examine the stressor that is causing the problem, possibly assign personal meaning to the stressor, and confront unresolved issues that may be exacerbating this crisis.

Which approach should the nurse use to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder (BPD)? 1. Being firm, consistent, and empathic while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to society norms 4. Overlooking inappropriate behaviors to avoid providing secondary gains

Answer: 1 The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement would indicate to a nurse that the student is handling this situation in a healthy manner? 1. "I know that it was not my fault." 2. "My boyfriend has trouble controlling his sexual urges." 3. "If I don't put myself in a dating situation, I won't be at risk." 4. "Next time I will think twice about wearing a revealing

Answer: 1 The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse would provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

The client diagnosed with posttraumatic stress disorder (PTSD) has a nursing diagnosis of posttrauma syndrome R/T surviving a workplace shooting. Which nursing intervention would the nurse add to this client's plan of care? 1. Monitor for substance use 2.Alternate staff members 3. Use a firm approach 4. Offer social skill training

Answer: 1 The nurse must monitor for substance use, as this can be a maladaptive form of coping clients with PTSD employ.

6. Which primary factor should a nurse associate with interpersonal theory when assessing a client? 1. Social processes on personality development 2. Unconscious processes and personality structures 3. Thoughts and perceptual processes 4. Chemical and genetic influences

Answer: 1 The nurse should associate interpersonal theory with the social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior.

Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which nursing response is appropriate? 1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. 2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. 3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. 4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

Answer: 1 The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone.

During couple's therapy, the female client reports that her husband only satisfies his sexual needs and never hers. Which personality structure should the nurse identify as predominantly driving the husband's actions? 1. The id 2. The cathexis 3. The ego 4. The superego

Answer: 1 The nurse should identify that the husband's actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives.

An 11-year-old child wins the science fair competition and is chosen as a cheerleader for the football team. The nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? 1. Industry versus inferiority 2. Identity versus role confusion 3. Intimacy versus isolation 4. Initiative versus guilt

Answer: 1 The nurse should recognize that an 11-year-old child who is successful in school both academically and socially has effectively accomplished the industry versus inferiority developmental stage of Erikson's psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 and 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others.

1. A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. Which other symptom would indicate to the nurse that the child may have been physically abused? 1. The child shrinks at the approach of adults. 2. The child begs or steals food or money. 3. The child is frequently absent from school. 4. The child is delayed in physical and emotional development.

Answer: 1 The nurse would determine that a child who shrinks at the approach of adults in addition to having bruises and burns may be a victim of abuse. Maltreatment is considered, whether or not the adult intended to harm the child.

Which assessment data would a school nurse recognize as a sign of physical neglect in a child? 1. The child is often absent from school and seems apathetic and tired. 2. The child is very insecure and has poor self-esteem. 3. The child has multiple bruises on various body parts. 4. The child has sophisticated knowledge of sexual behaviors.

Answer: 1 The nurse would recognize that a child who is often absent from school and seems apathetic and tired may be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

Which information would be included in a lesson about domestic violence? 1. Power and control are central to the dynamic of domestic violence. 2. Poor communication and social isolation are central to the dynamic of domestic violence. 3. Erratic relationships and vulnerability are central to the dynamic of domestic violence. 4. Emotional injury and learned helplessness are central to the dynamic of domestic violence

Answer: 1 The nursing instructor would include the concept that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

Which nursing diagnosis is the priority when providing nursing care to a client diagnosed with paranoid personality disorder? 1. Risk for violence: directed toward others R/T suspicious thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

Answer: 1 The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T suspicious thinking. Clients diagnosed with paranoid personality disorder are often tense and irritable, which increases the likelihood of violent behavior. The desire for reprisal and vindication is so intense that a possible loss of control can result in aggression and violence.

12. Which statement indicates a nurse has a correct understanding about how eye movement desensitization and reprocessing (EMDR) achieves its therapeutic effect? 1. "The exact biological mechanism is unknown." 2. "It causes an increase in imagery vividness." 3. "This therapy decreases memory access." 4. "EMDR disrupts the fear associated with trauma."

Answer: 1 This statement indicates the nurse has a correct understanding. The exact biological mechanisms by which EMDR achieves it therapeutic effects are unknown. However, some studies have indicated that eye movements cause a decrease in imagery vividness and distress, as well as an increase in memory CO access.

Which of the following nursing diagnoses are typically appropriate for an adult survivor of incest? (Select all that apply.) 1. Low self-esteem 2. Powerlessness 3. Disturbed personal identity 4. Knowledge deficit 5. Nonadherence

Answer: 1, 2 1. An adult survivor of incest would most likely have low self-esteem. 2. An adult survivor of incest would most likely have a sense of powerlessness.

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) 1. The client will relate one empathetic statement to another client in group by day four. 2. The client will identify one personal limitation by day two. 3. The client will acknowledge one strength that another client possesses by day three. 4. The client will list four personal strengths by day three. 5. The client will discuss two lifetime achievements by discharge.

Answer: 1, 2, 3 1. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients. This indicates the client is improving because he or she is reducing self-centeredness. 2. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include identifying one personal limitation. This indicates improvement because the client is realizing humility, something that he or she lacks. 3. The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include acknowledging one strength in another client. This indicates the client is improving because he or she views self as "superior" to others.

The client diagnosed with an adjustment disorder says, "Tell me about medications that will cure this problem." Which responses by the nurse are appropriate? (Select all that apply.) 1. "Medications can interfere with your ability to find a more permanent solution." 2. "Medications may mask the real problem at the root of this diagnosis." 3. "Adjustment disorders are not commonly treated with medications." 4. "Psychoactive drugs carry the potential for physiological and psychological dependence." 5. "Psychoactive drugs will be prescribed only if your problems persist for more than three months."

Answer: 1, 2, 3, 4 1. Adjustment disorders are not commonly treated with medications because of interfering with finding a permanent solution. 2. Adjustment disorders are not commonly treated with medications because of masking the real problem. 3. Adjustment disorder is not commonly treated with medication. 4. Adjustment disorders are not commonly treated with medications because of the potential for physiological and psychological addiction.

The nurse is admitting a client who has been diagnosed with posttraumatic stress disorder (PTSD). Which symptoms might the nurse observe upon assessment? (Select all that apply.) 1. Feelings of guilt that precipitate social isolation 2. Aggressive behavior that affects job performance 3. Relationship problems 4. High levels of anxiety 5. Escalating symptoms lasting less than one month

Answer: 1, 2, 3, 4 1. Characteristic symptoms of PTSD include guilt feelings, especially survivor guilt, that can lead to social isolation. 2. Characteristic symptoms of PTSD include aggressive behaviors and impaired occupational functioning. 3. Characteristic symptoms of PTSD include relationship problems with feelings of detachment or estrangement from others. 4. Characteristic symptoms of PTSD include high levels of anxiety with hypervigilance and exaggerated startle response.

Because of the unique challenges experienced by children of active duty military, which of the following fears would a nurse most likely identify? (Select all that apply.) 1. Fear of not being accepted in new schools 2. Fear of being behind academically 3. Fear of not making friends in new schools 4. Fear of losing athletic standing 5. Fear of discrimination from new school faculty

Answer: 1, 2, 3, 4 1. Military children face unique challenges. They fear not being accepted. 2. Military children face unique challenges. They fear being behind academically. 3. Military children face unique challenges. They fear not making friends. 4. Military children face unique challenges. They fear losing athletic standing as they move from one school to another.

6. Which of the following would a nurse identify as stressors in the lives of military spouses and children? (Select all that apply.) 1. Frequent moves 2. School credit transfer issues 3. Complications of spousal employment 4. Spousal loneliness 5. Loss of military privileges during spousal deployment

Answer: 1, 2, 3, 4 1. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. 2. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include school credit transfer issues. 3. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include complications of spousal employment. 4. The lives of military spouses and children are clearly affected when the service-member's active duty assignments require frequent family moves. These include spousal loneliness.

The nurse is assessing a client for antisocial personality disorder. According to the DSM-5, which symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Age of at least 18 years old 2. Deceitful for personal gain 3. Frequent feelings of being down, remorseful, or hopeless 4. Disregard for and failure to honor financial obligations 5. Avoidance of social events and interaction with others

Answer: 1, 2, 4 1. According to the DSM-5, the client must be at least 18 years, and tI here must be evidence of conduct disorder with onset before age 15. 2. According to the DSM-5, the client is deceitful, as indicated by repeated lying, use of aliases, or conning others for personal profit or pleasure. 4. According to the DSM-5, the client displays consistent irresponsibility, as indicated by repeated failure to sustain consistent work behavior or honor financial obligations.

17. Which of the following student statements indicate that learning has occurred regarding intimate partner violence? (Select all that apply.) 1. "Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner." 2. "Intimate partner violence is used to gain power and control over the other intimate partner." 3. "Fifty-one percent of victims of intimate violence are women." 4. "Women ages 25 to 34 experience the highest per capita rates of intimate violence." 5. "Victims are typically young married women who are dependent housewives."

Answer: 1, 2, 4 1. Intimate partner violence is a pattern of abusive behavior that is used by an intimate partner. 2. It is used to gain power and control over the other intimate partner. 4. Women ages 25 to 34 experience the highest per capita rates of intimate violence.

Which of the following facts would be appropriate to include related to the history of the diagnosis of PTSD? (Select all that apply.) 1. Between 1950 and 1970, little was written about PTSD. 2. During the 1970s and 1980s, there was a major increase in research on PTSD. 3. During the 1970s and 1980s, much research was related to World War II veterans. 4. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III). 5. PTSD did not appear until the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV).

Answer: 1, 2, 4 1. Very little was written about PTSD during the years between 1950 and 1970. 2. This absence was followed in the 1970s and 1980s with an explosion in the amount of research and writing on the subject. 4. PTSD did not appear until the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III).

In planning care for a woman who presents as a survivor of domestic abuse, a nurse would be aware of which of the following data? (Select all that apply.) 1. It often takes several attempts before a woman leaves an abusive situation. 2. Substance abuse is a common factor in abusive relationships. 3. Until children reach school age, they are usually not affected by abuse between their parents. 4. Women in abusive relationships usually feel isolated and unsupported. 5. Economic factors rarely play a role in the decision to stay.

Answer: 1, 2, 4 1. When planning care for a woman who is a survivor of domestic abuse, the nurse would be aware that it often takes several attempts before a woman leaves an abusive situation. 2. When planning care for a woman who is a survivor of domestic abuse, the nurse would be aware that substance abuse is a common factor in abusive relationships. 4. When planning care for a woman who is a survivor of domestic abuse, the nurse would be aware that women in abusive relationships usually feel isolated and unsupported.

Based upon the research with Vietnam veterans, which factors are the best predictors of posttraumatic stress disorder (PTSD)? (Select all that apply.) 1. The severity of the stressor 2. The degree of ego strength 3. The degree of psychosocial isolation in the recovery environment 4. The attitudes of society regarding the experience 5. The presence of preexisting psychopathology

Answer: 1, 3 1. In research with Vietnam veterans, it was shown that one of the best predictors of PTSD was the severity of the stressor. 3. In research with Vietnam veterans, it was shown that one of the best predictors of PTSD was the degree of psychosocial isolation in the recovery environment.

The nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? (Select all that apply.) 1. This client has personality traits that are deeply ingrained and difficult to modify. 2. This client needs medication to treat the underlying physiological pathology. 3. This client uses manipulation, making the implementation of treatment problematic. 4. This client wants instant gratification, which hinders compliance with a plan of care. 5. This client is likely to have secondary diagnoses of substance abuse and depression.

Answer: 1, 3, 4, 5 1. The nurse should consider that individuals diagnosed with antisocial personality disorders have deeply ingrained personality traits, making changes difficult. 3. The nurse should consider that individuals diagnosed with antisocial personality disorders use manipulation frequently to obtain their way. 4. The nurse should consider that individuals diagnosed with antisocial personality disorders use manipulation frequently to obtain their way. 5. The nurse should consider that individuals diagnosed with antisocial personality disorders use manipulation frequently to obtain their way.

. The nurse is admitting a client with a diagnosis of schizotypal personality disorder. Which client findings would make the nurse question this diagnosis? (Select all that apply.) 1. Is the center of attention 2. Has unusual perceptual experiences 3. Has a bipolar disorder 4. Is odd and eccentric but not delusional 5. Has autism spectrum disorder

Answer: 1, 3, 5 1. The nurse would question the diagnosis of a schizotypal personality disorder if the client is the center of attention. These clients have an acute discomfort with and reduced capacity for close relationships. They do not want to be the center of attention. Clients with histrionic personality disorder want to be the center of attention 3. The nurse would question the diagnosis of a schizotypal personality disorder in a client with a bipolar disorder. The DSM-5 criteria states that it does not occur exclusively during the course of a bipolar disorder. 5. The nurse would question the diagnosis of a schizotypal personality disorder in a client with autism spectrum disorder. The DSM-5 criteria states that it does not occur exclusively during the course of autism spectrum disorder.

Place the spectrum of schizophrenic and other psychotic disorder as described by the DSm-5 on a gradient of psychopathology from least to most severe (1-4) 1. Delusional disorder 2. Schizophrenia 3. Schizophreniform disorder 4. Substance-induced psychotic disorder

Answer: 1, 4, 3, 2 Rationale: Schizophrenia and other psychotic disorders has been identified in the DSM-5. These include (on a gradient of psychopathology form least to most severe): schizotypal personality disorder, delusional disorder, brief psychotic disorder, substance-induced psychotic disorder, psychotic disorder associated with another medical condition, catatonic disorder associated with another medical condition, schiopheniform disorder, schizoaffective disorder, and schizophrenia. For the disorders listed the organization is as follows: 1. Delusional disorder 2. Substance-induced psychotic disorder 3. Schizophreniform disorder 4. Schizophrenia

The client has been extremely anxious ever since relocating to another state because of a job transfer. When assessing for the diagnosis of adjustment disorder (AD), within what time frame should the nurse expect the client to exhibit symptoms? 1. Within 1 year of the move 2. Within 3 months of the move 3. Within 6 months of the move 4. Within 9 months of the move

Answer: 2 According to the DSM-5 diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within 3 months of the onset of the stressor.

The client has a nursing diagnosis of complicated grieving related to the death of multiple family members from a tornado. Which action should the nurse take first? 1. Encourage the journaling of feelings. 2. Assess for the stage of grief in which the client is fixed. 3. Provide community resources to address the client's concerns. 4. Suggest attending a grief therapy group.

Answer: 2 Prior to implementing all other nursing interventions presented, the nurse must assess the stage of grief in which the client is fixed. Appropriate nursing interventions are always based on accurate assessments.

Which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Rotate staff members who work with the client. 3. Teach about antianxiety medications to improve medication compliance. 4. Offer sympathy when client engages in self-mutilation.

Answer: 2 Rotate staff members who work with the client in order to avoid client's developing dependence on particular individuals. These interventions are intended to help the individual understand that staff splitting will not be tolerated, and to work toward diminishing clinging and distancing behaviors.

1. The client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions during the assessment interview. Which response would the nurse make? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "Which antipersonality disorder medications have helped you in the past?"

Answer: 2 The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

The client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which information best explains the childhood nurturance of this client's personality disorder? 1. Was provided from many sources, and independent behaviors were encouraged 2. Was provided exclusively from one source, and independent behaviors were discouraged 3. Was provided exclusively from one source, and independent behaviors were encouraged 4. Was provided from many sources, and independent behaviors were discouraged

Answer: 2 The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

Which nursing action is appropriate for a client brought to the emergency department after being raped? 1. Discourage the client from discussing the rape, because this may lead to further emotional trauma. 2. Remain nonjudgmental while actively listening to the client's description of the rape event. 3. Meet the client's self-care needs by assisting with showering and perineal care. 4. Probe for further, detailed description of the rape event.

Answer: 2 The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he/she is safe and that it is not his/her fault. Nonjudgmental listening provides an avenue for catharsis, which contributes to the healing process.

The client presents at an outpatient clinic appointment and states, "My dead husband returned to me during a séance." Which personality disorder should the nurse associate with this behavior? 1. Obsessive-compulsive 2. Schizotypal 3. Narcissistic 4. Borderline

Answer: 2 The nurse should associate schizotypal personality disorder with this behavior. Magical thinking, ideas of reference, illusions, and depersonalization are part of their everyday world. Examples include superstitiousness; belief in clairvoyance, telepathy, or "sixth sense"; and beliefs that "others can feel my feelings."

The nurse is caring for a hospitalized client who is quarrelsome when gratification is delayed. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development? 1. Infancy 2. Childhood 3. Early adolescence 4. Late adolescence

Answer: 2 The nurse should associate the client's behavior with a deficit in the childhood stage of Sullivan's interpersonal theory. The childhood stage in Sullivan's interpersonal theory typically occurs from 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety.

Which statement should a nurse associate with predominance of the superego? 1. "No one is looking, so I will take three cigarettes from Mom's pack." 2. "I don't ever cheat on tests; it is wrong." 3. "If I skip school, I will get into trouble and fail my test." 4. "A little bit of vodka makes me feel good."

Answer: 2 The nurse should associate the statement, "I don't ever cheat on tests; it is wrong," as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the "perfection principle."

The nurse observes a 3-year-old child willingly sharing a stuffed animal with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed? 1. Learning to count on others 2. Learning to delay satisfaction 3. Identifying oneself 4. Developing skills in participation

Answer: 2 The nurse should determine that this client has completed the learning to delay satisfaction stage of development, according to Peplau's interpersonal theory. This stage typically occurs in toddlerhood, when one learns the development of interdependent social relations.

The nurse is teaching staff about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which statement made by a staff member indicates learning has occurred? 1. "Their dramatic style tends to make their interpersonal relationships interesting and fulfilling." 2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." 3. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." 4. "They pay particular attention to details, which can interfere with the development of relationships."

Answer: 2 The nurse should evaluate that learning has occurred when the staff member describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs.

A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's situation, in which phase of development, according to Mahler's theory, should a nurse expect to see a potential deficit? 1. Symbiotic 2. Autistic 3. Consolidation 4. Rapprochement

Answer: 2 The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infant's focus is on basic needs and comfort.

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? 1. Highly lethal methods to commit suicide 2. Suicidal gestures to elicit a rescue response from others 3. Isolation and starvation as suicidal methods 4. Self-mutilation from decreased endorphins in the body

Answer: 2 The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.

Which client is most likely to be admitted to an inpatient facility for self-destructive behaviors? 1. One with antisocial personality disorder 2. One with borderline personality disorder 3. One with schizoid personality disorder 4. One with paranoid personality disorder

Answer: 2 The nurse should expect that a client diagnosed with borderline personality disorder would most likely be admitted to an inpatient facility for self-destructive behaviors. The behavior of clients with borderline personality disorder is unstable, and hospitalization is often required as a result of attempts at self-injury, persistent suicide risk, substance abuse and dependence, or a combination of these behaviors.

When assessing clients, the psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? 1. A possible genetic basis for the client's problems 2. The structure and dynamics of personality 3. Behavioral responses to stressors 4. Maladaptive cognitions

Answer: 2 The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, the ego, and the superego.

1. A male 7-month-old cries and screams every time his mother leaves and will not tolerate anyone else changing his diaper. According to Mahler's developmental theory, the nurse should determine this child's development was arrested at which phase? 1. The autistic phase 2. The symbiotic phase 3. The separation-individuation phase 4. The rapprochement phase

Answer: 2 The nurse should understand that this infant's development was halted in the symbiotic phase of Mahler's developmental theory, which usually occurs between 1 and 5 months of age.

A client diagnosed with an eating disorder experiences insomnia, nightmares, and panic attacks that occur before bedtime. She has never married or dated, and she lives alone. She states to a nurse, "My father has recently moved back to town." Which would the nurse suspect? 1. Possible major depressive disorder 2. Possible history of childhood incest 3. Possible histrionic personality disorder Possible history of childhood physical abuse

Answer: 2 The nurse would suspect that this client may have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

The client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? 1. Allow the clients to apply the autocratic process when developing unit rules. 2. Maintain consistency of care and open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of punitive leadership.

Answer: 2 The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

After a teaching session about grief, a client says to the nurse, "I seem to be stuck in the bargaining stage of grieving over the loss of my daughter." In which phase of the nursing process would this occur, and how would the nurse interpret this statement? 1. Assessment phase; nursing actions have been successful in achieving accurate data. 2. Evaluation phase; nursing actions have been successful in achieving the objectives of care. 3. Implementation phase; nursing actions have been successful in achieving the objectives of care. 4. Diagnosis phase; nursing actions have been successful in achieving accurate data.

Answer: 2 The statement occurs in the evaluation phase. In the evaluation phase of the nursing process, reassessment is conducted to determine if the nursing actions have been successful in achieving the objectives of care. The implementation of client teaching has enabled the client to verbalize an understanding of the grief process and his or her position in the process. Therefore, the nurse's actions can be evaluated as successful. Without the evaluation phase, it would be difficult for the nurse to determine if actions have been successful.

The nursing instructor is explaining the etiology of trauma-related disorders from a learning theory perspective. Which student statement indicates teaching has been effective? 1. "How clients perceive events and view the world affects their response to trauma." 2. "Psychic numbing in PTSD is a result of negative reinforcement." 3. "The individual becomes addicted to the trauma owing to an endogenous opioid response." 4. "Believing that the world is meaningful and controllable can protect an individual from PTSD."

Answer: 2 This statement indicates effective teaching. Learning theorists view negative reinforcement as behavior that leads to a reduction in an aversive experience, thereby reinforcing and resulting in repetition of the behavior. Psychic numbing decreases or protects an individual from emotional pain and, therefore, the learned response is the repetition of this behavior.

The client receiving eye movement desensitization and reprocessing (EMDR) therapy says, "After only three sessions, I am feeling great. Now I can stop and get on with my life." Which response by the nurse is most appropriate? 1. "I am thrilled that you have responded so rapidly to EMDR." 2. "To achieve lasting results, all eight phases of EMDR must be completed." 3. "If I were you, I would complete the EMDR and comply with the health-care provider's orders." 4. "How do you feel about continuing the therapy?"

Answer: 2 This statement is most appropriate. Clients often feel relief quite rapidly with EMDR. However, to achieve lasting results, it is important that each of the eight phases be completed. The nurse's most appropriate response should be to give information to correct the client's misconceptions about the therapy.

Order the description of the progressive phases of Walker's model of the "cycle of battering." (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. This phase is the most violent and the shortest, usually lasting up to 24 hours. 2. In this phase, the man's tolerance for frustration is declining. 3. In this phase, the batterer becomes extremely loving, kind, and contrite.

Answer: 2, 1, 3 In her classic studies of battered women and their relationships, Walker identified a cycle of predictable behaviors that are repeated over time. The behaviors can be divided into three distinct phases that vary in time and intensity both within the same relationship and among different couples. 1. Tension-building phase: In this phase, the man's tolerance for frustration is declining. 2. Acute-battering incident phase: This phase is the most violent and the shortest, usually lasting up to 24 hours. 3. Honeymoon phase: In this phase, the batterer becomes extremely loving, kind, and contrite.

After reporting a sexual assault, a female soldier is diagnosed with a personality disorder. Which of the following consequences may result? (Select all that apply.) 1. Court-martial proceedings 2. Loss of health-care benefits 3. Loss of service-related disability compensation 4. Stigma of a psychiatric diagnosis 5. Service discharge

Answer: 2, 3, 4, 5 2. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are loss of health-care benefits. 3. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are loss of service-related disability compensation. 4. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder. Some of the consequences of this diagnosis are the stigma of a psychiatric diagnosis. 5. Some military women who report their sexual assaults are discharged with a psychiatric diagnosis of personality disorder or adjustment disorder.

Parents ask the nurse why their daughter was diagnosed with posttraumatic stress disorder (PTSD) and others survivors of the terrorist attack were not. Which information should the nurse offer? (Select all that apply.) 1. An individual's stated religious affiliation can affect response to trauma. 2. Responses are affected by how an individual handled previous trauma. 3. Protectiveness of family and friends can help an individual deal with trauma. 4. Control over the possibility of recurrence can affect the response to trauma. 5. The duration of how long the trauma lasted can affect the individual's response.

Answer: 2, 3, 4, 5 2. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of the individual, such as outcomes of previous experiences with stress or trauma. 3. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of the recovery environment, like the cohesiveness and protectiveness of family and friends. 4. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of the traumatic experience, such as amount of control over recurrence. 5. Variables that affect whether an individual exposed to massive trauma develops trauma-related disorders are grouped into characteristics of the traumatic experience, like duration and severity of the stressor.

The client diagnosed with posttraumatic stress disorder (PTSD) asks, "Why did my health-care provider prescribe an antidepressant rather than an antianxiety drug for me?" Which explanations should the nurse make? (Select all that apply.) 1. "I'm not sure, because antianxiety drugs have been approved by the FDA for PTSD." 2. "Antidepressants are now considered first-line treatment choice for PTSD." 3. "Many people experience side effects to antianxiety drugs." 4. "Because of their addictive properties, antianxiety drugs are less desirable." 5. "That is strange because antipsychotics have provided the best results for treatment of PTSD."

Answer: 2, 4, 5 2. Antidepressants, specifically certain selective serotonin reuptake inhibitors, are now considered the first-line treatment of choice for PTSD. 4. Addictive properties of antianxiety agents make them less desirable than other medications used in the treatment of PTSD. 5. There is little positive evidence concerning the use of antipsychotics in the treatment of PTSD. These drugs are only used for short-term control of severe aggression and agitation.

Which factor differentiates a client diagnosed with schizotypal personality disorder from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with schizotypal personality disorder are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with schizotypal personality disorder experience generalized anxiety. 3. Clients diagnosed with schizotypal personality disorder experience social anxiety from paranoid fears, whereas clients diagnosed with schizoid personality disorder would isolate themselves on a continual basis. 4. Clients diagnosed with schizoid personality disorder have magical thinking and depersonalization, whereas clients diagnosed with schizotypal personality disorder do not.

Answer: 3 A client diagnosed with schizoid personality disorder prefers being alone to being with others. However, clients with schizotypal personality disorder have excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

Which behavior would the nurse expect an adolescent (13 to 18 years) to exhibit as a reaction to parental military deployment? 1. May exhibit regressive behaviors and assume blame for parent's departure 2. May become sullen, tearful, throw temper tantrums, or develop sleep problems 3. May participate in high-risk behaviors, sexual acting out, and drug or alcohol abuse 4. May respond to schedule disruptions with irritability and/or apathy and weight loss

Answer: 3 Adolescents (13 to 18 years) may be rebellious, irritable, or more challenging of authority. Parents need to be alert to high-risk behaviors, such as problems with the law, sexual acting out, and drug or alcohol abuse.

Which physically healthy adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. Meets social needs by contact with 15 cats 2. Has a history of depending on intense relationships to meet basic needs 3. Lives with parents and relies totally on public transportation 4. Is serious, inflexible, and lacks spontaneity

Answer: 3 An adult client who lives with parents and totally relies upon public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive behaviors.

The nurse is describing the Transactional Model of Stress and Adaptation. When using this model, which factor would the nurse categorize as intrapersonal? 1. Occupational opportunities 2. Economic conditions 3. Degree of flexibility 4. Availability of social supports

Answer: 3 Degree of flexibility is an intrapersonal factor in this model. Intrapersonal factors that might influence an individual's ability to adjust to a painful life change include social skills, coping strategies, the presence of psychiatric illness, degree of flexibility, and level of intelligence.

Which action would the nurse take to provide trauma-informed care to a homeless client who is combative? 1. Place the client in seclusion 2. Apply soft wrist restraints 3. Allow the client some control 4. Encourage dependent behavior

Answer: 3 Empowering the trauma survivor to guide and direct his or her recovery plan by providing input is reflective of trauma-informed care.

Which fact would the nursing instructor include in the lesson plan regarding suicide among active duty military? 1. On average, two suicides per day occur in the U.S. military. 2. From 2005 to 2009, relationship distress factored in more than 25 percent of military suicides. 3. In 2013, the suicide rate among service members was 18.7 per 100,000. 4. Military suicides are associated with a narcissistic personality disorder diagnosis.

Answer: 3 In 2013, the suicide rate of active duty service members was 18.7 per 100,000.

What is the expected feeling and/or behavior experienced by military families during the "sustainment" cycle of deployment? 1. Feelings alternate between denial and anticipation of loss 2. Feelings alternate between excitement and apprehension associated with homecoming 3. Feelings focus on the establishment of new support systems and new family routines 4. Feelings focus on the struggle to take charge of the details of the new family structure

Answer: 3 In the sustainment cycle, families establish new support systems and new family routines.

The nurse is caring for a client diagnosed with posttraumatic stress disorder (PTSD). Which realistic goal should be included in this client's plan of care? 1. The client will have no flashbacks. 2. The client will be able to feel a full range of emotions by discharge. 3. The client will not require medication to obtain adequate sleep by discharge. 4. The client will refrain from discussing the traumatic event.

Answer: 3 Obtaining adequate sleep without medication by discharge is a goal that should be included in the client's plan of care.

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? 1. Phase I: The tension-building phase 2. Phase II: The acute battering incident phase 3. Phase III: The honeymoon phase 4. Phase IV: The resolution and reorganization phase

Answer: 3 The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? 1. Anxiety 2. Altered thought processes 3. Complicated grieving Altered sensory perception

Answer: 3 The client's survivor guilt is disrupting the normal process of grieving, indicating complicated grieving as the nursing diagnosis.

When planning care for clients diagnosed with personality disorders, which treatment goal is appropriate? 1. To stabilize the client's pathology by using the correct combination of psychotropic medications 2. To change the characteristics of the dysfunctional personality 3. To reduce personality trait inflexibility that interferes with functioning and relationships 4. To decrease the prevalence of neurotransmitters at receptor sites

Answer: 3 The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships.

3. The client diagnosed with paranoid personality disorder becomes aggressive on the unit. Which nursing intervention is most appropriate? 1. Provide objective evidence that reasons for violence are unwarranted. 2. Initially restrain the client to maintain safety. 3. Use clear, calm statements with a confident physical stance. 4. Empathize with the client's paranoid perceptions.

Answer: 3 The most appropriate nursing intervention is to use clear, calm statements with a confident physical stance. A calm attitude provides the client with a feeling of safety and security.

A woman comes to an emergency department with a broken nose and multiple bruises after being physically assaulted by her husband. She states, "The beatings have been getting worse, and I'm afraid next time he will kill me." Which is the appropriate nursing response? 1. "People in general do not change their behaviors. He will likely never change." 2. "There are things you can do to prevent him from losing control." 3. "Let's talk about your options so that you don't have to go home." 4. "Why don't we call the police so that they can confront your husband with his behavior?"

Answer: 3 The most appropriate response by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions on their own without the nurse being the "rescuer."

2. At 11:30 p.m. the client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10 p.m. phone curfew. You will be able to call tomorrow." 4. "A divorce shouldn't be considered until you have had a good night's sleep."

Answer: 3 The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.

The female client has flashbacks of sexual abuse by her uncle. She did not have these memories until recently, when she became sexually active with her boyfriend. The nurse should identify this experience as which part of Sullivan's concept of the self-system? 1. The Oedipus complex 2. The bad me 3. The not me 4. The Electra complex

Answer: 3 The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the not me part of the personality. According to Sullivan, the not me part of the personality develops in response to situations that produced intense anxiety in childhood.

Which reaction to a compliment from a staff member should the nurse identify as a typical response from a client diagnosed with avoidant personality disorder? 1. Interpreting the compliment as a secret code used to increase personal power 2. Feeling the compliment was well deserved 3. Being grateful for the compliment but fearing later rejection and humiliation 4. Wondering what deep meaning and purpose is attached to the compliment

Answer: 3 The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

The mother of a 6-year-old demeans and curses her child for disobedience. In turn, when upset, the child uses swear words at school. According to Peplau, the school nurse recognizes this behavior as unsuccessful completion of which stage of development? 1. Learning to count on others 2. Learning to delay satisfaction 3. Identifying oneself 4. Developing skills in participation

Answer: 3 The nurse should identify that the child using swear words in school has not successfully completed the identifying oneself stage, according to Peplau's interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her.

Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" The nurse should identify this behavior as characteristic of which personality disorder? 1. Schizoid 2. Obsessive-compulsive 3. Histrionic 4. Paranoid

Answer: 3 The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over-gregarious, and seductive.

A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. In which stage of psychosexual development would a nurse identify this behavior as normal? 1. Oral 2. Anal 3. Phallic 4. Latency

Answer: 3 The nurse should identify this behavior as normal, as the 6-year-old client focuses on genital organs in the phallic stage of Freud's psychosexual stages of development because of the discovery of differences between genders. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage.

A married, 27-year-old male works as a mail carrier. He and his spouse have just had their first child. The nurse should recognize that this client is successfully accomplishing which stage of psychosocial development? 1. Industry versus inferiority 2. Identity versus role confusion 3. Intimacy versus isolation 4. Generativity versus stagnation

Answer: 3 The nurse should recognize that a 27-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Erikson's psychosocial developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this task results in the capacity for mutual love and respect.

1. A jilted college student is admitted to a mental health unit following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize that this client has a deficit in which developmental stage? 1. Trust versus mistrust 2. Initiative versus guilt 3. Intimacy versus isolation 4. Ego integrity versus despair

Answer: 3 The nurse should recognize that the client who states, "No one will ever love a loser like me," has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort.

Which symptom should the nurse observe in a client diagnosed with obsessive-compulsive personality disorder? 1. Intrusive and persistent thoughts 2. Unwanted, repetitive ritualistic behavior 3. Lack of spontaneity when dealing with others 4. Feelings of "sixth sense" that are externally imposed

Answer: 3 The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

According to Peplau, the nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? 1. Technical expert 2. Resource person 3. Surrogate 4. Leader

Answer: 3 The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate, according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person—in this case, the child's parent.

A client asks, "Why does a rapist use a weapon during the act of rape?" Which is the most appropriate nursing response? 1. "To decrease the victimizer's insecurity." 2. "To inflict physical harm with the weapon." 3. "To terrorize and subdue the victim." 4. "To mirror learned family behavior patterns related to weapons."

Answer: 3 The nurse would explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience, from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

A survivor of rape presents in an emergency department crying, pacing, and cursing her attacker. A nurse would recognize these client actions as which behavioral defense? 1. Controlled response pattern 2. Compounded rape reaction 3. Expressed response pattern 4. Silent rape reaction

Answer: 3 The nurse would recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension.

A client who has been raped answers a nurse's questions in a monotone voice with single words, appears calm, and exhibits a blunt affect. How would the nurse interpret this client's responses? 1. The client may be fabricating details of the incident. 2. The client may be experiencing a silent rape reaction. 3. The client may be demonstrating a controlled response pattern. 4. The client may be having a compounded rape reaction.

Answer: 3 This client is most likely demonstrating a controlled response pattern. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying sobbing, smiling, restlessness, and tension.

Place the following stages of the codependency recovery process according to Cermak beginning with the first stage (1-4) 1. The Core Issues Stage 2. The Reintegration Stage 3. The Survival Stage 4. The Reidentification Stage

Answer: 3, 4, 1, 2 Rationale: Cermak in 1986 identified four stages in the recovery process for individuals with codependent personality. During the survival stage, the codependent must begin to let go of denial. During the reidentificaiton stage, the individual begins to glimpse their true selves. During the core issues stage, the individual must face the fact that relationships cannot be managed by force or will. During the reintegration stage, control is achieved through self-discipline and self-confidence. The sequence is as follows: Stage 1: The survival Stage Stage 2: The Reidentification Stage Stage 3: The Core Issues Stage Stage 4: The Reintegration Stage

7. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes R/T increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others

Answer: 4 An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

The client is receiving eye movement desensitization and reprocessing (EMDR) treatments. The nurse is most likely caring for which client? 1. One with schizophrenia 2. One with borderline personality disorder 3. One with manic episodes 4. One with posttraumatic stress disorder

Answer: 4 EMDR is used for posttraumatic stress disorder (PTSD). It has been used for depression, adjustment disorder, phobias, addictions, generalized anxiety disorder, and panic disorder, but it has only been empirically validated for PTSD.

A 22-year-old client and a 62-year-old client were involved in motor vehicle accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which client would be predisposed to the diagnosis of adjustment disorder? 1. The 62-year-old, because of memory deficits 2. The 62-year-old, because of uncomplicated bereavement 3. The 22-year-old, because of decreased cognitive processing 4. The 22-year-old, because of lack of developmental maturity

Answer: 4 The 22-year-old would be predisposed to the diagnosis of adjustment disorder because of limited developmental maturity. By comparison in psychosocial theory, the 22-year-old does not have the developmental maturity, life experiences, and coping strategies that the 62-year-old might possess.

Which client response would reflect the impulsive self-destructive behavior that is commonly associated with borderline personality disorder when the day-shift nurse leaves the unit? 1. The client suddenly leans on the nurse's arm and whispers, "The night nurse is evil. You have to stay." 2. The client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." 3. The client suddenly grabs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." 4. The client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

Answer: 4 The client who states, "I cut myself because you are leaving me," reflects impulsive self-destructive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.

The nurse is caring for a client with a diagnosis of adjustment disorder unspecified from a divorce after over 30 years of marriage. Which signs and symptoms would the nurse observe? 1. Re-experiences spouse asking for a divorce, is hyperalert, and has nightmares 2. Has anxiety, begins to shoplift, and exhibits reckless driving 3. Is belligerent, violates others' rights, and defaults on legal responsibilities 4. Reports many physical ailments, refuses to socialize, and has unproductive work performance

Answer: 4 The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, withdrawal from relationships, or impaired work or academic performance, without significant disturbance in emotions or conduct.

During an interview, which client statement should alert the nurse to a potential diagnosis of schizotypal personality disorder? 1. "I don't have a problem. My family is inflexible, and my relatives are out to get me." 2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" 3. "I spend all my time tending my bees. I know a whole lot of information about bees." 4. "I am getting a message from the beyond that we have been involved with each other in a previous life."

Answer: 4 The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life. Examples include superstitiousness; belief in clairvoyance; telepathy, or "sixth sense"; and beliefs that "others can feel my feelings."

7. The physically healthy, 35-year-old, single, male client lives with his parents, who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? 1. Establishing the ability to control emotional reactions 2. Establishing a strong sense of self and character structure 3. Establishing and maintaining self-esteem 4. Establishing a career, personal relationships, and societal connections

Answer: 4 The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, non-achievement of the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others.

Which advice would the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? 1. Have ready access to a gun and learn how to use it. 2. Research lawyers that can aid in divorce proceedings. 3. File charges of assault and battery. 4. Access to the number of a safe house for battered women.

Answer: 4 The nurse would provide information about the accessibility of safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear.

A woman presents with a history of physical and emotional abuse in her intimate relationships. Which would this information lead a nurse to suspect? 1. The woman may be exhibiting a controlled response pattern. 2. The woman may have a history of childhood neglect. 3. The woman may be exhibiting codependent characteristics. 4. The woman may be a victim of incest.

Answer: 4 The nurse would suspect that this client may be a victim of incest. Many women who are battered have low self-esteem and have feelings of guilt, anger, fear, and shame. Women in abusive relationships often grew up in an abusive home.

A client who is in an abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate response? 1. "These clients don't know life any other way, and change is not an option until they have improved insight." 2. "These clients have limited cognitive skills and few vocational abilities to be able to make it on their own." 3. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." 4. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

Answer: 4 The nursing supervisor is accurate when stating that clients who are in abuse relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner: for the children, for financial reasons, for fear of retaliation, for lack of a support network, for religious reasons, or because of hopefulness

Which nursing diagnosis is priority when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T suspicious thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T fear of rejection

Answer: 4 The priority nursing diagnosis for a client diagnosed with avoidant personality disorder should be social isolation R/T fear of rejection. These individuals are extremely sensitive to rejection and consequently may lead a very socially withdrawn life.

The nurse tells a client diagnosed with obsessive-compulsive personality disorder that the nursing staff will start alternating weekend shifts. Which response should the nurse expect from this client? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

Answer: 4 The statement, "You can't make these kinds of changes! Isn't there a rule that governs this decision?" is typical of a client with obsessive-compulsive disorder. The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

The nurse is teaching about trauma- and stressor-related disorders. Which statement by one of the staff members indicates that follow-up instruction is needed? 1. "The trauma that women experience is more likely to be sexual assault and child sexual abuse." 2. "The trauma that men experience is more likely to be accidents, physical assaults, combat, or viewing death or injury." 3. "After exposure to a traumatic event, less than 10 percent of victims develop posttraumatic stress disorder (PTSD)." 4. "Research shows that PTSD is more common in men than in women."

Answer: 4 This statement indicates a need for further instruction. Research shows that PTSD is more common in women than in men.

The nurse is teaching a client about the eight-phase process of eye movement desensitization and reprocessing (EMDR). In which order should the nurse list the phases, starting with the early phases and ending with the last (1-4)? (Enter the number of the phases in the proper sequence, using comma and space format, such as 1, 2, 3, 4) 1. Installation 2. Body scan 3. Reevaluation 4. Desensitization

Answer: 4, 1, 2, 3 EMDR is an integrative psychotherapy approach with a theoretical model that emphasizes the brain's information processing system and memories of disturbing experiences as the basis of pathology. EMDR has been shown to be an effective therapy for PTSD and other trauma-related disorders. The phases are described as Phase 1: History and treatment planning - a thorough history is taken and treatment plan is developed. Phase 2: Preparation - client learns certain self-care techniques, like relaxation techniques Phase 3: Assessment - client specifies a scene or picture from the target event; negative self-belief and positive self-statement developed; client uses 2 scales: Validity of Cognition (VOC) and Subjective Units of Disturbance (SUD) Phase 4: Desensitization - client gives attention to the negative beliefs and disturbing emotions while focusing on the back-and-forth motion of the therapist's finger; SUD scale is used Phase 5: Installation - client gives attention to the positive belief to replace the negative belief; VOC scale is used Phase 6: Body scan - The client must be able to focus on the traumatic event without experiencing bodily tension Phase 7: Closure - client leaves feeling better than he or she felt at the beginning Phase 8: Reevaluation - The therapist determines whether positive changes have been maintained and identifies any new target areas at the beginning of each new therapy session The sequence for the question is as follows: 1. Desensitization 2. Installation 3. Body scan 4. Reevaluation

The diagnosis of catatonic disordered due to another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which conditions? (Select all that apply) A. Epilepsy B. Hypothryiodism C. Hyperadrenalism D. Encephalitis E. Hyperaphia

Answer: A, B, C, D Rationale: A, B, & C. Types of medical conditions that have been associated with catatonic disorder include neurological conditions such as epilepsy. The diagnosis of catatonic disorder due to another medical condition is made when the symptomatology is evidenced from medical history, physical exam, or lab findings to be directly attributable to the physiological consequences of a general medication. D. Encephalitis is a neurological condition that can lead to catatonic disorder due to another medical condition. The diagnosis of a catatonic disorder due to another medical condition is made when the symptomatology is evidenced from medical history, physical exam, or lab findings to be directly attributable to the physiological consequences of a general medical condition

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. The nurse would assess which symptoms and behaviors? (Select all that apply) A. Stressful situation precipitate gambling behaviors B. Anticipation and restlessness can only be relieved by placing a bet C. Winning brings about feelings of sexual satisfaction D. Gambling is used as a coping strategy E. Compulsive gambling began in early adolescence

Answer: A, B, D Rationale: A. In gambling disorder, the preoccupation with the impulse to gamble intensifies when the individual is under stress B. Many impulsive gamblers describe a physical sensation of restlessness and anticipation that can only be relieved by placing a bet. D. Compulsive gambling behaviors really occur before young adulthood; however, gambling behaviors usually begins in adolescences

Which nursing statements exemplify the process that must be completed by nurse in the pre-introductory phase prior to care for clients diagnosis with a substance-related disorders (Select all that apply). A. "I am easily manipulated and need to work on this prior to caring for these clients" B. "Because of my father's alcoholism, I need to examine my attitude toward these clients" C. "I need to review the side effects of the medications used in the withdrawal process" D. ''Ill need to set boundaries to maintain a therapeutic relationship" E. "I need to take charge when dealing with clients diagnosed with substance disorders"

Answer: A, B, D Rationale: A. This statement indicates the nurse has completed the process of reviewing attitudes and beliefs prior to caring for clients diagnosed with substance-related disorders. B. This statement indicates the nurse completed the pre-introductory process of reviewing attitudes and beliefs. It is important for nurses to identify potential areas of need within their own attitudes and beliefs that may affect their relationships with clients diagnoses with this problem. D. Determining the need to set boundaries is an example of a pre-introductory process of reviewing attitudes and beliefs that must be completed by a nurse to a client care.

Which modalities should a nurse recognize as integral parts of a treatment program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

Answer: A, B, D, E Rationale: A. The nurse should recognize that group therapy plays an integral part of treatment programs for clients diagnosed with schizophrenia B. The nurse should recognize that medication management plays an integral part of treatment programs for clients diagnosed with schizophrenia D. The nurse should recognize that supportive family therapy plays an integral part of treatment programs for clients diagnosed with schizophrenia E. The nurse should recognize that social skills training plays an integral part of treatment programs for clients diagnosed with schizophrenia

A nursing supervisor is offering an impaired staff member information regarding a peer assistance program. Which facts should the supervisor include? (Select all that apply) A. A hot-line number will be available in order to call for help B. A verbal contract detailing the method of treatment will be initiated prior to the program C. Peer support is provided through regular contact with the impaired nurse D. Contact to provide peer support will last for one year E. One of the program goals is to intervene early in order to reduce hazards to clients

Answer: A, C, E Rationale: A. Most states provides either a hot-line number that the impaired nurse may call or phone numbers of peer assistance committee members, which are made available for the same purpose C. Peer support is provided through regular contact with he impaired nurse E. One of the goals of treatment is to intervene early to reduce hazards to clients. The peer assistance programs strive to intervene early, reduce hazards to clients, and increase prospects for the nurse's recovery.

A nurse is about to meet with a client suffering from codependency. Which date would the nurse expect to find during the assessment of this client? (Select all that apply) A. Has a long history of focusing thoughts and behaviors on other people B. As a child, experienced overindulgent and overprotective parents C. Is a people pleaser and does almost anything to gain approval D. Exhibits helpless behaviors but actually feels very competent E. Can achieve a sense of control through fulfilling the needs of others

Answer: A, C, E Rationale: A. The codependent person has a long history of focusing thoughts and behavior on other people. C. Codependent clients are "people pleasers" and will do almost anything to get the approval of others. E. Codependent clients achieve a sense of control when they are fulfilling the needs of others.

An adolescent diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which response should the nurse take? A. "Your child has a chemical imbalance of the brain, which leads to altered perceptions" B. "Your child's hallucinations are caused by medication interactions" C. "Your child has too little serotonin in the Bain, causing delusions and hallucinations" D. "Your child's abnormal hormonal changes have precipitated auditory hallucination"

Answer: A. "Your child has a chemical imbalance of the brain, which leads to altered perceptions" Rationale: The nurse should explain that a chemical imbalance of the brain leads to altered perceptions. The current position on the dopamine hypotheses is that positive symptoms (like command hallucinations) may be related to increased numbers of dopamine receptors in the brain causing an imbalance

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors form the behaviors of a non pathological gambler? A. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not B. Pathological gambling occurs more commonly among women, whereas non pathological gambling occurs more commonly among men C. Pathological gambling generally runs an acute course, whereas non pathological gambling runs a chronic course D. Pathological gambling is not related to stress relief, whereas non pathological gambling is related to stress relief

Answer: A. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not Rationale: There is a correlation between pathological gambling and abnormalities in the neurotransmitter, dopamine. This is not the case with non pathological gambling

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. Psychological addiction B. Codependence C. Substance induced disorder D. Intoxication

Answer: A. Psychological addiction Rationale: The nurse should use therm psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure (feel better) or avoid discomfort.

Which nursing diagnosis is the priority for a client experiencing alcohol withdrawal? A. Risk for injury r/t central nervous system stimulation B. Disturbed thought processes r/t tactile hallucinations C. Ineffective coping r/t powerlessness over alcohol use D. Ineffective denial r/t continued alcohol use despite negative consequences

Answer: A. Risk for injury r/t central nervous system stimulation. Rationale: the priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury r/t central nervous system stimulation. Alcohol withdrawal may include the following symptoms: curse tremors of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia

A client diagnosed with major depression and substance use disorder has an altered sleep pattern and demands a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to first try non pharmacological interventions? A. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing tolerance B. Sedative-hypnotics decrease the production of needed liver enzymes. C. Sedative-hypnotics lengthen necessary REM (rapid eye movement) sleep D. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications

Answer: A. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing tolerance Rationale: The nurse should recommend non pharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance and cross-tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction.

The client diagnosed with schizophrenia spectrum disorder is prescribed an antipsychotic. Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? A. Sore throat and malaise B. Light-colored urine and bradycardia C. Anosognosia and avolition D. Dry mouth and urinary retention

Answer: A. Sore throat and malaise Rationale: The nurse should intervene immediately if the client experiences signs of an infectious process - such as a sore throat, fever, and malaise - when taking antipsychotic drugs.

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. To immediately attend AA meetings at least weekly B. To rely on an AA sponsor to help control alcohol cravings C. To incorporate family in AA attendance D. To seek appropriate deterrent medications through AA

Answer: A. To immediately attend AA meetings at least weekly Rationale: The most appropriate client outcome for the nurse to discuss during discharge teaching is attending AA meetings at least weekly. AA is a major self-help organization for the treatment of alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure.

A nursing supervisor is about to meet with a staff nurse suspected of diverting clients' pain medications. Which assessment date would lead the supervisor that the staff nurse is impaired? (Select all that apply) A. Is frequently absent form work B. Experiences mood swings C. Make elaborate excuses for behavior D. Frequently uses the restroom E. Has a flushed face

Answer: B, C, D, E Rationale: B. Mood swings can be a sign of substance abuse. C. The impaired nurse may make elaborate excuses for behavior D. The impaired nurse will frequently use the restroom E. A flushed face is a sign of drug use.

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements by nursing students about hepatic encephalopathy indicate successful teaching? (Select all that apply) A. "A diet rich in protein will promote hepatic healing" B. "This condition results from a rise in serum ammonia, leading to impaired mental functioning" C. "in this condition, an excessive amount of serous fluid accumulates in the abdominal cavity" D. Neomycin and lactulose are used in the treatment of this condition" E. "This condition is caused by the inability of the liver to convert ammonia to urea"

Answer: B, D, E Rationale: B. This statement indicates that teaching has been effective because this condition results from a rise in serum ammonia, leading to impaired mental functioning. D. The instructor should interpret this as successful teaching because neomycin and lactulose are medications used for this disorder. E. The instructor should interpret this as successful teaching because hepatic encephalopathy in the inability of the diseased liver to convert ammonia to aria

A nurse is reviewing the stat laboratory date of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

Answer: B. 100 mg/dL Rationale: The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL.

Which action would the nurse take to establish a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? A. Establish persona contact with family members B. Be reliable, honest, and consistent during interactions C. Share limited personal information D. Sit close to the client to establish rapport

Answer: B. Be reliable, honest, and consistent during interactions Rationale: The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude.

A client with a history of alcohol use disorder is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client sign or symptom should be the nurse's first priority A. Hearing and visual impairment B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

Answer: B. Blood pressure of 180/100 mm Hg Rationale: The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use.

The nurse evaluates the client's patient-controlled analgesia (PCA) pump and notices 50 attempts within a 15 minute period. Which is the best rationale for assess this client for substance addiction? A. Narcotic pain medication is contraindicated for all clients with active substance use disorders B. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control C. There is no need to assess the client for substance addiction. There is an obvious PCA malfunction, because these clients have a higher pain tolerance D. The client is experiencing alcohol withdrawal symptoms and needs accurate assessment

Answer: B. Clients who are addicted to alcohol or benzodiazepines may develop cross-tolerance to analgesics and require increased doses to achieve effective pain control Rationale: The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or bentos may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug.

Which client assessment finding would alert the nurse to question a diagnosis of brief psychotic disorder? A. Has impaired reality testing for a 24 hour period B. Has auditory hallucinations for the past 3 hours C. Has bizarre behavior for 1 day D. Has confusion for 3 weeks

Answer: B. Has auditory hallucinations for the past 3 hours Rationale: This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month and there is an eventual full return to the premorbid level of functioning

A client with schizophrenia spectrum disorder presents with bizarre behaviors and delusions. Which nursing action should be prioritized to maintain this client's safety? A. Monitor for medication non-adherence B. Note escalating behaviors immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

Answer: B. Note escalating behaviors immediately Rationale: The nurse should note escalating behaviors immediately, to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

The nurse is caring for a client with schizophrenia spectrum disorder who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia

Answer: B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia Rationale: The nurse should recognize that positive symptoms of schizophrenia include, but are not limited to, paranoid delusions, neologisms, and echolalia

Parents ask a nurse how they should reply when their son, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which nursing response is appropriate? A. "Tell him to stop discussing the voices" B. "Ignore what he is saying, while attempting to discover the underlying cause" C. "Focus on the feelings generated by the hallucinations and present reality" D. "Present objective evidence that the voices are not real"

Answer: C. "Focus on the feelings generated by the hallucinations and present reality" Rationale: The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception.

The aging client takes an antipsychotic for schizophrenia spectrum disorder and a beta-adrenergic blocking agent for hypertension. Based on an understanding of the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths" B. "Watch your diet and try to engage in some regular physical activity" C. "Rise slowly when you change position from lying to sitting or sitting to standing" D. "Wear sunscreen and try to avoid midday sun exposure"

Answer: C. "Rise slowly when you change position from lying to sitting or sitting to standing" Rationale: The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension

A nurse is preparing a staff education session about the impaired nurse and the consequences of this impairment. Which statement by the staff member indicates successful teaching? A. "The state roads of nursing must be notified with subjective documentation of impairment" B. All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice" C. "Some state boards of nursing administer the treatment programs themselves, while other reference the nurse to tother resources" D. "After a return to practice, a recovering nurse may be closely monitored for several days"

Answer: C. "Some state boards of nursing administer the treatment programs themselves, while other reference the nurse to tother resources" Rationale: Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment programs; evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period.

A client diagnosed with schizophrenia spectrum disorder states, "Cant you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "The voices must sound scary, but I do not hear any voices." D. "The devil only talks to people who are receptive to his influences"

Answer: C. "The voices must sound scary, but I do not hear any voices." Rationale: The most appropriate nursing response is to reassure the client while not reinforcing the hallucination. Reminding the client that "the voices" are not real will prevent validation of the hallucinations. It is also important for the nurse to connect with the client's fears and inner feelings

A clients wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which response by the nurse is therapeutic? A. "Why do you assume responsibility for his behaviors B. "I think you should start to confront his behavior" C. "Your husband needs to deal with the consequences of his drinking" D. "Do you understand what the term enabler means?"

Answer: C. "Your husband needs to deal with the consequences of his drinking" Rationale: The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husbands behavior. Codependency is a typical behavior of spouses of alcoholics. The nurse must help the wife through the stages of recovery beginning with Stage 1: The survival stage in which the partner begins to let go of the denial that problems exists.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 AA meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer orders chlordiazepoxide (Librium) in dosage according to protocol. D. Provide thiamin supplements to prevent Wenicke-Korsakoff syndrome.

Answer: C. Administer orders chlordiazepoxide (Librium) in dosage according to protocol. Rationale: Priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for medication-assisted therapy in alcohol withdrawal to reduce life-threatening complications.

The client diagnosed with schizophrenia spectrum disorder tells the nurse, "I'm sad that the voice is telling me to stop being my psychiatrist" Which symptom is the client exhibiting? A. Magical thinking B. Persecutory delusions C. Command hallucinations D. Altered thought processes

Answer: C. Command hallucinations Rationale: The nurse should determine that the client is exhibit common hallucinations. Clients with command hallucinations could potentially by physically, emotionally, and/or sexually harmful to other or to self

Which data in the history would the nurse expect to find in a client diagnosed with substance-induced psychotic disorder? A. Had delirium B. Had less severe withdrawal symptoms C. Has an opioid use disorder D. Has a fluid and electrolyte imbalance

Answer: C. Has an opioid use disorder Rationale: The prominent hallucinations and delusions associated with substance-9induced or medication-induced disorder are found to be directly attributable to substance intoxication or withdrawal, like opioid use disorder

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? A. The side effects of medication B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. Behaviors needed to be a leader

Answer: C. How to make eye contact when communicating Rationale: The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients to communicate needs and to establish relationships.

The client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." The nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97 F with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? A. Denial B. Fluid volume excess C. Imbalance nutrition: less than body requirements D. Ineffective individual coping

Answer: C. Imbalance nutrition: less than body requirements Rationale: The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements based upon the client's statement regarding lack of nutritional intake for three days. The client is exhibiting signs and symptoms of malnutrition, as well as alcohol withdrawal. The nurse should provide small, frequent feedings of nonirritating foods.

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the physician to treat this disorder. The nurse would give the client information on which medications? A. Escitalopram (Lexapro) and clozapine (Clozaril) B. Citalopram (Celexa) and olanzapine (Zyprexa) C. Lithium carbonate (Lithobid) and naltrexone (ReVia) D. Haloperidol (Haldol) and ziprasidone (Geodon)

Answer: C. Lithium carbonate (Lithobid) and naltrexone (ReVia) Rationale: Lithium carbonate (Lithobid) and naltrexone (ReVia) have demonstrated some effectiveness for gambling disorder

The psychiatrist prescribes haloperidol (Haldol) 50 mg bid, benzotropine (Cogentin) 1 mg pan, and zolpidem (Ambient) 10 mg at bedtime for a client with schizophrenia spectrum disorder. Which client behaviors would warrant the nurse to administer benzotropine? A. Tactile hallucinations B. Tardive dyskinesia C. Muscle rigidity D. Reports of hearing disturbing voices

Answer: C. Muscle rigidity Rationale: An anticholinergic medication such as benzotropine would be used to treat the extrapyramidal symptom of muscle rigidity

The client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill his ex-spouse. Which nursing diagnosis is priority for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk of violence: directed toward others D. Risk for injury

Answer: C. Risk of violence: directed toward others Rationale: The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "When I can't control my cravings, I will faithfully attend Narcotic Anonymous." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

Answer: D. "Taking those pills got out of control. It cost me my job, marriage, and children." Rationale: A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of the a 12 step program (AA)

The nurse holds the hand of a client who is experiencing alcohol withdrawal. The nurse is assessing for which condition? A. Emotional strength B. Wernicke-Korsakoff syndrome C. Tachycardia D. Coarse tremors

Answer: D. Coarse tremors Rationale: The nurse is most likely assessing the client for coarse tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors

The nurse ask the client with schizophrenia spectrum disorder, "Do you receive special messages from certain sources, such as the TV or radio?" The nurse is assessing which potential symptom of this disorder? A. Loose associations B. Paranoid delusions C. Magical thinking D. Delusions of reference

Answer: D. Delusions of reference Rationale: The nurse is assessing for the potential symptom of delusions of reference. A client who believes he or she receives messages through the radio or TV is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward himself or herself. Clients with delusions of reference believe that others are trying to send them messages in various ways, or they must break a code to receive message

Which client statement indicated a knowledge deficit related to a substance use disorder? A. "Although it's legal, alcohol is one of the most widely abused drugs in our society" B. "Tolerance to heroin develops quickly" C. "Flashbacks form lysergic acid diethyl amide (LSD) use may reoccur spontaneously." D. Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless''

Answer: D. Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless'' Rationale: The nurse should determine that the client has a knowledge deficit related to substance use disorder when the client compares marijuana to smoking cigarettes and claims it to be harmless. The evidence of research indicates that smoked marijuana is harmful.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Medication-assisted treatment

Answer: D. Medication-assisted treatment Rationale: Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called medication-assisted treatment.

Which medications would the nurse most likely administer to a client who has a history of opiate withdrawal? A. Haloperidol (Haldol) and acamprosate (Campare) B. Naloxone (Narcan) and naltrexone (ReVia) C. Disulfiram (Antabuse) and lorazepam (Ativan) D. Methadone (Dolophine) and clonidine (Catapres)

Answer: D. Methadone (Dolophine) and clonidine (Catapres) Rationale: The nurse would administer methadone and clonidine for a client who has a history of opiate withdrawal. As the dose of methadone diminishes, renewed abstinence symptoms may be ameliorated by the addiction of clonidine.

Which nursing intervention would be most appropriate when caring for an agitated, suspicious client diagnosed with schizophrenia spectrum disorder? A. Supply neon lights and soft music B. Maintain continual eye contact throughout the interview C. Use therapeutic touch to increase trust and rapport D. Provide personal space to respect the client's boundaries

Answer: D. Provide personal space to respect the client's boundaries Rationale: The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the clients risk for violence. The nurse should observe the client while carrying out routine tasks

Noradrenergic agents

Anti-anxiety. Propranolol Side effects: bradycardia, hypotension, weakness, fatigue, impotence, GI upset, bronchospasms. Clonidine Side effects: dry mouth, sedation, fatigue, hypotension.

Buspirone

Anti-anxiety. Side effects: Dizziness, drowsiness, dry mouth, headache, nervousness, nausea, insomnia.

SNRI's

Anti-anxiety. Side effects: Headache, dry mouth, nausea, somnolence, dizziness, insomnia, asthenia, constipation, diarrhea

Barbiturates

Anti-anxiety. Side effects: Somnolence, agitation, confusion, ataxia, dizziness, bradycardia, hypotension, constipation.

SSRI's

Anti-anxiety. Side effects: nausea, diarrhea, headache, insomnia, somnolence, sexual dysfunction.

Benzodiazepines -alprazolam (Xanax) -chlordia-zepoxide (Librium) -clonazepam (Klonopin) -clorazepate (Tranxene) -diazepam (Valium) -lorazepam (Ativan) -oxazepam (Meprobamate)

Anti-anxiety. Indications: anxiety, insomnia, alcohol withdrawals, seizures and muscle relaxant, depression, panic attacks, nausea and vomiting, during anesthesia. Contraindications: glaucoma Side effects: CNS depression, anorexia, sedation, lethargy, ataxia, headache, visual changes, hypotension and paradoxical reaction.

Benzodiazepines

Anti-anxiety. Side effects: sedation, dizziness, ataxia, decreased motor performance, withdrawal.

Most common drugs for PTSD

Antidepressants: First line is SSRIs (paroxetine and sertraline). Anti-anxiety: alprazolam and buspirone. Anti-HTN: propranolol and clonadine. Instrusive recollections, flashbacks, nightmares, impulsivity, irritability and violent behavior treated with carbamazepine, valproic acid, and lithium in the short term.

Some clients with bipolar disorders may not respond to lithium but many do well when treated with me . I'm particularly effective in treating Rapid cycling . I'm controlling mania within 2 weeks , depression within 3 weeks or longer . Have a guess ... Who am I?

Antiepileptic

I'm a type of medication given to manic patient . I'm a drug with rapid onset that used to reduce the hyperactivity initially until a lithium therapeutic serum level is attained .Have a guess ... Who am I?

Antipsychotic

Unspecified Anxiety Disorder

Anxiety or phobic avoidance predominates but sx do not meet full diagnostic criteria for specific anxiety disorder

Powerlessness

Apathy, verbal expressions of having no control, dependence on others to fulfill needs. Interventions: Encourage client to take as much responsibility as possible for his own self-care practices, help client set realistic goals, help identify areas of his life situation that can be controlled, discuss areas of life that aren't within his ability to control.

A client, who has been prescribed clozapine 6 weeks ago, reports flulike symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention? a) Suggest that the client take something for the fever and get extra rest. b) Advise the physician that the client should be admitted to the hospital. c) Arrange for the client to have blood drawn for a white blood cell count.

Arrange for the client to have blood drawn for a white blood cell count.

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to...

Ask the client to describe what he is hearing.

The nurse is told he will be assigned to an anxious client who is being admitted from the emergency department . The initial action of the nurse should be to A. Assess the client's use of defense mechanisms B. Limit environmental stimuli C. Provide antianxiety medication D. Assess the client's level of anxiety.

Assess the client's level of anxiety.

Nursing interventions for post-trauma syndrome

Assign the same staff as often as possible. Use a nonthreatening, matter-of-fact approach. Respect client's wishes regarding interactions with opposite gender. Be consistent; keep all promises; convey acceptance; spend time with client. Long term goals: Stay with client during periods of flashbacks and nightmares. Obtain accurate history from significant others about trauma and client's response. Encourage client to talk about the trauma at his own pace. Discuss coping strategies used in response to trauma, as well as those used during stressful situations in the past. Assist in trying to comprehend the trauma. Discuss feelings of vulnerability.

Serotonin

Associated with depression, OCD, phobia, and problems with concentration and attention. Affects bodily processes such as sleep, libido, appetite, and body temperature. Low levels may result in feelings of worthlessness and suicide.

Dysthymia cannot be diagnosed unless it has existed for what period of time? a) At least 3 months b) At least 6 months c) At least 1 year d) At least 2 years

At least 2 years

How often should you assess for suicide?

At least once a shift.

The most common comorbid condition in children with bipolar disorder is...

Attention-deficit/hyperactivity disorder

Who am I? I'm the first line of treatment for all types of depression except psychotic depression in which ECT is the first choice Sexual dysfunction is the most significant undesirable outcome reported by clients

Atypical SSRI

buspirone (BuSpar)

Atypical anti-anxiety. Takes 3-4 weeks to build up in system. Avoid grapefruit juice. Contraindicated in liver or kidney issues. Don't take with MAOIs. Side effects: Excitement, fatigue, palpitations, tachycardia, drowsiness, incoordination, paresthesia.

Jim is sometimes seen moving his lips silently or murmuring to himself when he does not realize others are watching . Sometimes when he is conversing with others , he suddenly stops , appears distracted for a moment , and then resumes . Based on these observations , Jim most likely is experiencing which symptom ( s ) ? Select all that apply :

Auditory hallucinations Impaired reality testing

The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing...

Auditory hallucinations.

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy?

Awareness training, social support, and hynotherapy.

1. A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. The therapist provides information about the process of cognitive therapy. B. The therapist uses guided imagery in an effort to elicit automatic thoughts. C. The therapist provides information about how cognitive therapy works. D. The therapist uses reading assignments to reinforce learning.

B

2. Which statement is most accurate regarding the assessment of clients diagnosed with psychiatric problems? A. Medical history is of little significance and can be eliminated from the nursing assessment. B. Assessment provides a holistic view of the client, including biopsychosocial aspects. NURSINGTB.COM C. Comprehensive assessments can be performed only by advanced practice nurses. D. Psychosocial evaluations are gained by subjective reports rather than objective observations.

B

A client diagnosed with schizophrenia is exhibiting nonverbal behaviors indicating that the client is hearing things that others do not. Which nursing diagnosis accurately reflects this clients problem? A. Altered thought processes B. Altered sensory perception C. Anxiety D. Chronic confusion

B

A client is assigned the nursing diagnosis of impaired social interaction R/T sociocultural differences AEB client stating, Although Id like to, I dont join in because I dont speak the language so good. Which correctly written outcome addresses this clients problem? A. The client will collaborate with nursing staff to set specific goals by day 3. B. The client will participate in one group activity of choice by day 2. C. The client will express a desire to interact with others. D. The client will become increasingly independent by discharge.

B

A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, What's that? Which is the most appropriate nursing reply? A. At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon. B. By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve. C. Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety. D. In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate.

B

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, I will always be only a nursing assistant and never an RN. Her nursing advisor understands this is an example of which automatic thought? A. Arbitrary inference B. Overgeneralization C. Dichotomous thinking D. Personalization

B

A nursing instructor is teaching about the behavior technique of modeling. When asked to give an example of this behavioral intervention, which student statement meets the learning objective? A. A child is first rewarded for using a spoon to eat and then rewarded for using a fork, and finally rewarded for cutting food with a knife. B. An adolescent imitates Dad by using and caring for tools appropriately. C. A client and therapist agree to conditions of therapy, stating explicitly in writing the behavior change that is desired. D. A mother tells her child that television can be watched only after homework is completed.

B

A nursing instructor is teaching students about the purpose of using the nursing process in the care of psychiatric patients. Which of the following statements by the student indicates that learning has occurred? A. The nursing process is a method for interviewing the patient in a systematic way. B. The nursing process is used to assist patients to adapt successfully to stressors within the environment. C. The nursing process is used to provide support for the psychiatric diagnosis. D. The nursing process is used primarily to minimize allegations of negligence.

B

According to behavioral theory, the treatment of phobic symptoms should involve which action? A. The manipulation of the environment B. The use of desensitization C. The use of family therapy D. The uncovering of past events

B

An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. The nurse should initially implement which nursing action? A. Redirect the client to activities to decrease stress. B. Explain the unit rules and consequences of breaking the rules. C. Place the client on close observation to insure a trusting relationship. D. Administer an anti-anxiety medication.

B

An adolescent comes from a dysfunctional family where physical and verbal abuse prevails. At school this adolescent bullies and fights with classmates. According to principles of behavior therapy, what is the probable source of this behavior? A. Shaping B. Modeling NURSINGTB.COM C. Premack principle D. Reciprocal inhibition

B

During the implementation phase of the nursing process, a nurse is teaching an adult depressed patient with a cochlear implant about medications. Which modification in the teaching plan would be the most appropriate for this client? A. Using repetition B. Speaking directly face-to-face C. Employing the use of sign language D. A. Providing large-print materials

B

How should a nurse prioritize nursing diagnoses? A. By the established goal of care B. By the life-threatening potential C. By the physicians priority of care D. By the clients preference

B

Parents of a 3-year-old have noticed an improvement in behavior because of using a time out behavioral approach. What aspect of time out therapy may be responsible for this child's improved behavior? A. Negative reinforcement discourages maladaptive behavior. B. Positive reinforcement is removed. C. Covert sensitization is being applied. D. Reciprocal inhibition is eliminated.

B

What is the purpose when a nurse gathers client information? A. It enables the nurse to modify client behaviors related to personality disorders. B. It enables the nurse to make sound clinical judgments and plan appropriate client care. C. It enables the nurse to prescribe the appropriate medications. D. It enables the nurse to assign the appropriate Axis I diagnosis

B

Which nursing diagnosis should a nurse identify as being correctly formulated? A. Schizophrenia R/T biochemical alterations AEB altered thought B. Self-care deficit: hygiene R/T altered thought as AEB disheveled appearance C. Depressed mood R/T multiple life stressors D. Developmental disability R/T early-onset schizophrenia AEB hallucinations

B

Within the nurses scope of practice, which function is exclusive to the advance practice psychiatric nurse? A. Teaching about the side effects of neuroleptic medications B. Using psychotherapy to improve mental health status C. Using milieu therapy to structure a therapeutic environment D. Providing case management to coordinate continuity of health services

B

failed my battalion by giving the wrong order. Fortunately, no one was injured. Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

B

Nurse Mary is assigned to care for a suicidal client. Initially, which is the nurse's highest care priority? A Assessing the client's home environment and relationships outside the hospital B Exploring the nurse's own feelings about suicide C Discussing the future with the client D Referring the client to a clergy person to discuss the moral implications of suicide

B Exploring the nurse's own feelings about suicide

A client with schizophrenia suddenly stops listening to the nurse and starts looking at the ceiling. Which of the following actions should the nurse take? A) stop the interview at this point, and resume when the client is better able to concentrate B) Ask the client "Are you seeing something on the ceiling? C) Tell the client " You seem to be looking at something on the ceiling. I see something there too" D) Continue the interview without comment on the clients behavior

B) Ask the client "Are you seeing something on the ceiling?

A nurse is reinforcing teaching about relapse prevention with a client who has bipolar disorder which of the following information should the nurse include? ( Select all that apply) A) Use caffeine in moderation to prevent relapse B) Difficulty sleeping can indicate a relapse C) Begin taking medications as soon as relapse begins D) Participating in psychotherapy can help prevent a relapse E) Anhedonia is a clinical manifestation of a depressive episode

B) Difficulty sleeping can indicate a relapse D) Participating in psychotherapy can help prevent a relapse E) Anhedonia is a clinical manifestation of a depressive episode

A nurse is caring for a bipolar client who states " I am rich, I must give money to you" Which of the following statements is appropriate for the nurse to respond with? A) Why do you feel the need to give your money away? B) I am here to care for you and cannot accept your money C) I can request that your case manager discuss local charity options with you D) you should know that giving your money away isn't allowed

B) I am here to care for you and cannot accept your money

A client in a mental health facility reports voices telling her "Kill your doctor" Which of the following actions should the nurse take first? A) Use therapeutic communication to discuss the hallucination with the client B) Initiate one-on-one observation of the client C) Focus the client on reality D) Notify the provider of the clients statement

B) Initiate one-on-one observation of the client

A Nurse is contributing to the plan of care for client who has bipolar disorder and is experiencing in manic episode. which of the following interventions should the nurse including the plan of care? (Select all that apply) A) provide flexible client behavior expectations B) Offer concise explanations C) Establish consistent limits D) Disregard client complaints E) Use a firm approach with communication

B) Offer concise explanations C) Establish consistent limits E) Use a firm approach with communication

After a comprehensive assessment, correctly written nursing diagnoses developed for psychiatric clients may include which of the following components? Select all that apply. A. Medical judgments related to the psychiatric disorder B. Unmet client needs present at the moment C. Supporting data that validate the diagnosis D. Outcomes that will be targets for nursing interventions E. Statements of client problems of a functional nature

B, C, E

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? Select all that apply. A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individuals thinking C. To apply cognitive principles in order to change an individuals basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

B, D. E

A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? (Select all that apply.) A. "We need to understand that our sibling is responsible for their disorder." B. "Eliminating codependent behavior will promote recovery." C. "Our sibling should participate in an Al-Anon group to assist with recovery." D. "The primary goal of treatment is abstinence from substance use." E. "Our sibling needs to discuss personal feelings about substance use to help with recovery."

B. "Eliminating codependent behavior will promote recovery." D. "The primary goal of treatment is abstinence from substance use." E. "Our sibling needs to discuss personal feelings about substance use to help with recovery."

A nurse is caring for a client who has borderline personality disorder (BPD). As part of the client's plan of care, the nurse reviews the day's schedule with the client each morning. As the nurse begins to review the schedule with the client, the client says, "Why don't you shut up already? I can read it myself, you know!" Which of the following responses should the nurse give the client? A. "We do this every day. Why are you so angry with me this morning?" B. "I don't like it when you address me with that tone of voice." C. "I know you can, but are you going to read it or not?" D. "Fine. Here is the schedule, and I will expect you to be on time to your therapies."

B. "I don't like it when you address me with that tone of voice." Rationale: The client in this situation has overstepped a limit by addressing the nurse in a less-than-respectful tone of voice. This therapeutic response calls to the client's attention the inappropriate behavior and sets appropriate limits for further communication. This is the best approach to continue communication with this client.

A patient diagnosed with dissociative identity disorder is hospitalized on an acute care psychiatric unit after a suicide attempt. During a team meeting, which staff nurse's comment should prompt the nursing supervisor to intervene? (Select all that apply.) A. "I have never taken care of a patient diagnosed with this disorder." B. "I think this patient was misdiagnosed and probably has schizophrenia." C. "I find myself more fascinated and engaged with this patient than others." D. "I recently read an autobiographical book about someone with this problem."

B. "I think this patient was misdiagnosed and probably has schizophrenia." C. "I find myself more fascinated and engaged with this patient than others." Rationale: The response from the nurse who does not believe in the diagnosis may also impair the care the nurse provides to the patient.

A nurse in an outpatient medical clinic talks to a patient with a long history of malingering and doctor-shopping. The patient continues to express complaints of multiple problems. Select the nurse's best comment to the patient. A. "The treatment team believes you would benefit more from seeing a mental health professional." B. "The treatment team discussed your case and wants to begin a special case management program for you." C. "Because you take a number of medications, it would be safer to have them all filled at the same pharmacy." D. "Diagnostic testing has shown no medical problems and you are using more than your fair share of health care services."

B. "The treatment team discussed your case and wants to begin a special case management program for you."

A nurse is evaluating a client's understanding of a new prescription for clonidine for the treatment of opioid use disorder. Which of the following statements by the client indicates an understanding of the teaching? A. "Taking this medication will help reduce my craving for heroin." B. "While taking this medication, I should keep a pack of sugarless gum." C. "I can expect some diarrhea from taking this medicine." D. "Each dose of this medication should be placed under my tongue to dissolve."

B. "While taking this medication, i should keep a pack of sugarless gum."

The school nurse assesses four adolescents, all of whom outwardly appear healthy. Which adolescent meets one criterion for anorexia nervosa with mild severity? A. 5'2" tall; weight 104 pounds B. 5'7" tall; weight 110 pounds C. 5'5" tall; weight 114 pounds D. 5'8" tall; weight 127 pounds

B. 5'7" tall; weight 110 pounds

A mental health nurse assesses a patient diagnosed with antisocial personality disorder. Which comorbid problem is most important for the nurse to include in the assessment? A. Generalized anxiety B. Alcohol use and abuse C. Compulsions and phobias D. Dysfunctional sleep patterns

B. Alcohol use and abuse

A nurse is discussing the factors for somatic symptom disorder with a newly licensed nurse. Which of the following risk factors should the nurse include? (Select all that apply.) A. Age older than 65 years B. Anxiety disorder C. Childhood trauma D. Coronary artery disease E. Obesity

B. Anxiety disorder C. Childhood trauma

A nurse is planning care for an adolescent who has scoliosis and requires surgical intervention. Which of the following behaviors by the adolescent should the nurse anticipate because it is the most common reaction? A. Identity crisis B. Body image changes C. Feelings of displacement D. Loss of privacy

B. Body image changes

A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." The nurse should identify that the client is using which of the following defense mechanisms? A. Reaction formation B. Denial C. Displacement D. Sublimation

B. Denial

A nurse is discussing acute vs. prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (Select all that apply.) A. Chronic pain B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness

B. Depressed immune system C. Increased blood pressure E. Unhappiness

A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary information to the client? (Select all that apply.) A. Reassure the client that everything will be okay B. Discuss prior use of coping mechanisms with the client C. Ignore the client's anxiety so that she will not be embarrassed D. Demonstrate a calm manner while using simple and clear directions E. Gather information from the client using closed-ended questions

B. Discuss prior use of coping mechanisms with the client D. Demonstrate a calm manner while using simple and clear directions

A nurse is caring for a client who is experiencing a crisis related to anxiety. Which of the following actions should the nurse take? (Select all that apply.) A. Avoid eye contact to prevent escalation of anxiety. B. Establish rapport with the client. C. Identify the cause of the anxiety. D. Validate the client's feelings. E. Develop a flexible crisis intervention plan.

B. Establish rapport with the client. C. Identify the cause of the anxiety. D. Validate the client's feelings. E. Develop a flexible crisis intervention plan.

A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) A. Bradycardia B. Fine tremors of both hands C. Hypotension D. Vomiting E. Restlessness

B. Fine tremors of both hands D. Vomiting E. Restlessness

A nurse is teaching a client who has a new prescription for ramelteon. The nurse should instruct the client to avoid which of the following foods at the time of medication administration? A. Baked potato B. Fried chicken C. Whole-grain bread D. Citrus fruits

B. Fried chicken

A nurse is caring for a client who has bipolar disorder. The client states, "I feel like Superman. I can do anything. I can fly home today and then become a U.S. Senator." Which of the following findings is this client exhibiting? A. Flight of ideas B. Grandiosity C. Reality testing D. Derealization

B. Grandiosity

A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply.) A. Hypothermia B. Hallucinations C. Muscular flaccidity D. Diaphoresis E. Agitation

B. Hallucinations D. Diaphoresis E. Agitation

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) A. Amenorrhea B. Hypokalemia C. Yellowing of the skin D. Slightly elevated body weight E. Presence of lanugo on the face

B. Hypokalemia D. Slightly elevated body weight

A nurse is preparing a client who has chronic anxiety for discharge from the psychiatric unit. Which of the following instructions should the nurse include in the client's discharge plan? A. Contact the crisis counselor once a week. B. Identify anxiety-producing situations. C. Try to repress feelings of anxiety. D. Eliminate stress and anxiety from daily life.

B. Identify anxiety-producing situations. Rationale: Treatment for anxiety disorders includes helping the client recognize signs that her anxiety level is rising and the triggers that cause this type of reaction. The nurse should include this information so the client can limit anxiety-provoking situations or intervene early to reduce anxiety levels.

A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A. Administer flumazenil B. Identify the client's level of orientation C. Infuse IV fluids D. Prepare the client for gastric lavage

B. Identify the client's level of orientation

A patient in the emergency department was seen or the third time in a month with complaints of tremors and paresthesia in the lower extremities. Conversion disorder was diagnosed. While preparing for discharge, the patient says, "Now I'm having chest pain but it's probably nothing." How should the nurse respond? A. Assess the patient's most current laboratory values. B. Interrupt the discharge and arrange additional medical evaluation of the patient. C. Remind the patient, "The diagnostic tests showed you did not have a medical problem." D. Tell the patient, "Being in the emergency department a long time can be very distressing."

B. Interrupt the discharge and arrange additional medical evaluation of the patient.

A nurse is providing preoperative teaching for a client who was informed of the need for emergency surgery. The client has a respiratory rate of 30/min, and says, "This is difficult to comprehend. I feel shaky and nervous." The nurse should identify that the client is experiencing which of the following levels of anxiety? A. Mild B. Moderate C. Severe D. Panic

B. Moderate

Friends invite an adult diagnosed with type 2 diabetes to go on a mountain hike next week. The adult replies, "I can't go because I don't have any hiking shoes." In actuality, this adult fears difficulty with blood glucose management during strenuous activity. Which defense mechanism is evident? A. Displacement B. Rationalization C. Passive aggression D. Reaction formation

B. Rationalization

A nurse enters the room of a client who becomes verbally abusive. Which of the following actions should the nurse take? A. Inform the client of consequences. B. Speak slowly in a low, calm voice. C. Forbid the client from speaking in an abusive manner. D. Remain a distance of 1 ft away from the client.

B. Speak slowly in a low, calm voice.

A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A. Regression B. Splitting C. Undoing D. Identification

B. Splitting

A nurse is involved in a serious and prolonged mass casualty incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma-related disorder? (Select all that apply.) A. Avoid thinking about the incident when it is over B. Take breaks during the incident for food and water C. Debrief with others following the incident D. Avoid displays of emotion in the days following the incident E. Take advantage of offered counseling

B. Take breaks during the incident for food and water C. Debrief with others following the incident E. Take advantage of offered counseling

An individual lives in a community adjacent to a military base. Loud jets fly overhead multiple times daily. The person tells the nurse, "They're so loud I can't hear myself think." What is the nurse's best first action? A. Direct the individual to report the jet noise to local authorities. B. Teach relaxation and stress reduction techniques to the individual. C. Assess the individual or sensory impairments, particularly auditory. D. Encourage the individual to form a community action group to oppose noise pollution.

B. Teach relaxation and stress reduction techniques to the individual.

A nurse plans to lead a group in a residential facility for kindergarten-aged, abused children. Which strategy should the nurse incorporate? A. Building a house using blocks B. Telling a story about a child who felt sad C. Drawing pictures of fun activities at a park D. Reading and discussing a book about abused children

B. Telling a story about a child who felt sad

A nurse is talking with a client who reports experiencing increased stress because a new partner is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." Which of the following recommendations should the nurse make to promote a change in the client's situation? A. Learn to practice mindfulness B. Use assertive techniques C. Exercise regularly D. Rely on the support of a close friend

B. Use assertive techniques

A nurse in a mental health facility is interacting with a client who is angry and becoming increasingly aggressive. Which of the following actions should the nurse take? A. Move the client to a private area so the conversation will not be disturbed. B. Use clarification to determine what the client is feeling. C. Speak to the client using an authoritative voice. D. Maintain constant eye contact with the client.

B. Use clarification to determine what the client is feeling. Rationale: The nurse should speak to the client who displays anger in a voice that is soft, low, and calming. The nurse should use clarification to ensure the client knows his feelings are heard and understood. Clarification can make the client feel less vulnerable and enable the client to channel anger in a less threatening manner.

A nurse is assessing a client who is experiencing chronic stress. Which of the following findings should the nurse expect? A. Hypotension B. Viral infection C. Increased energy D. Increased cognitive awareness

B. Viral infection

Fear

Behavior directed toward avoidance of a feared object or situation.

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? a) Symptoms started right after being robbed at gunpoint. b) Being unable to work for the last 12 months. c) Eating in public makes the client extremely uncomfortable. d) Repeated verbalizing prayers results in a relaxed feeling.

Being unable to work for the last 12 months

Names of anticholinergic agents

Benadryl, Cogentin, or Artane

alprazolam (Xanax)

Benzo. Interactions: alcohol, antacids, oral contracepives, opioids, SSRIs verapamil, rifampin, phenytoin.

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? a) meditation b) breathing exercises c) journal keeping d) biofeedback

Biofeedback

Can you help me remember who I am? I'm a type of disorder that really disturbs the staff . Frequent staff meetings are required for consistent approaches .

Bipolar Disorder

I'm a type of disorder characterized by : Hyperactivity . ignoring eating and sleeping . I can lead to cardiac collapse . My nursing diagnosis include : Risk for other - directed violence , Risk for self - directed violence. Have a guess ... Who am I?

Bipolar Disorder

Tardive dyskinesia

Bizzare facial and tongue movements, stiff neck, and difficulty swallowing. More common with typical antipsychotics. Irreversible. Stop medication.

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? a) Heart rate b) triglycerides c) Blood glucose levels d) Brain norepinephrine

Blood glucose levels

A client with depression has just been prescribed the antidepressant phenelzine (Nardil). She says to the nurse, "The doctor says I will need to watch my diet while I'm on this medication. What foods should I avoid?" What is the correct response?

Blue cheese, red wine, raisins

Side effects of TCA antidepressants

Blurred vision- will go away in a few weeks. Constipation- eat foods high in fiber. Urinary retention- monitor intake and output. Orthostatic hypotension- rise slowly. Seizures- only with history. Tachycardia- monitor blood pressure. Photosensitivity- wear sunblock. Weight gain- reduced calorie diet.

1. Which data-gathering technique is employed during the assessment phase of the nursing process? A. Asking the client to rate mood after administering an antidepressant B. Asking the client to verbalize understanding of previously explained unit rules C. Asking the client to describe any thoughts of self-harm D. Asking the client if the group on assertiveness skills was helpful

C

A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents? A. You are shaping your child's behavior. B. Your child has modeled your behavior. C. You are positively reinforcing your child's behavior. D. You are negatively reinforcing your child's behavior.

C

A client diagnosed with borderline personality disorder states, Get out of here. No one cares about me or my situation! Which nursing reply is an example of a cognitive intervention? A. You have an anti-anxiety medication ordered. It may make you feel better. B. It sounds like you are feeling really frustrated. C. Can you explain further your thinking about your situation? D. No one cares about you?

C

A client diagnosed with major depressive disorder states, Why should I keep trying to get a job? I mess up everything I do. Which correctly written nursing diagnosis best reflects the content and mood themes in this clients statement? A. Hopelessness R/T poor job performance B. Risk for impaired adjustment R/T inadequate social skills AEB isolation C. Altered role performance R/T the fear of failure AEB not seeking employment D. Chronic low self-esteem R/T major depressive disorder AEB self-hatred

C

A client has a nursing diagnosis of Insomnia R/T paranoid thinking AEB midnight awakenings, difficulty falling asleep, and daytime napping. Which is a correctly written and appropriate outcome for this clients problem? A. The client will avoid daytime napping and attend all groups. B. The client will exercise, as needed, before bedtime. C. The client will sleep 7 uninterrupted hours by day four of hospitalization. D. The clients sleep habits will improve during hospitalization.

C

A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of flooding. Which intervention best exemplifies this technique? A. Giving rewards for demonstrating a decrease in fear of spiders B. Encouraging the client to sit through the movie Spiderman C. Accompanying the client to a 1-hour visit to the local zoos spider room D. Offering a computer program that progressively presents anxiety-producing spider scenarios

C

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. I cant give up alcohol right now because I just gave up smoking. B. I just read that red wine has health benefits. C. I may have a minor problem, but I can handle it. D. I don't drink as much as my wife, and nobody thinks she has a problem.

C

A client reports, My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious. Which technique was the friends therapist most likely using? A. Extinction B. Covert sensitization NURSINGTB.COM C. Systematic desensitization D. Reciprocal inhibition

C

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. My baby is refusing to nurse, and I know its because she hates me. B. My baby needs to be under the bilirubin lights, but I resent her time away from me. C. My baby is wonderful, but Im depressed because I wanted twins. D. My baby has an elevated bilirubin, and I know it will get worse and she will die.

C

A mother tells her teenager that in order for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? A. Shaping B. Modeling C. Contracting D. Premack principle

C

A nurse on an inpatient psychiatric unit implements care by scheduling client activities, interacting with clients, and maintaining a safe therapeutic environment. These actions reflect which role of the nurse? A. Health teacher B. Case manager C. Milieu manager D. Psychotherapist

C

A nursing student states, The instructor gave me a failing grade on my research paper. I know its because the instructor doesn't like me. Which cognitive error does a nurse recognize in this students statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

C

A student nurse asks an instructor which resource is best to use when developing nursing outcomes for clients. Which reply by the instructor most accurately answers the students question? A. Use the Nursing Interventions Classification (NIC), as a reference for nursing outcomes. B. Use the NANDA resource to identify appropriate outcomes. C. Use the Nursing Outcomes Classification (NOC), as a reference for nursing outcomes. D. Copy your standard outcomes from a nursing care plan textbook

C

During hospitalization, an attention-seeking client has repeatedly cut herself. After threatening to cut herself again, the nurse states, Here are some Band-Aids so you wont bleed on the sheets. Which is the underlying reason for this nurses response? A. The nurse is using an aversive stimulus in response to the clients manipulative cutting behavior. B. The nurse is using negative reinforcement in response to the clients behavior. C. The nurse is minimizing reinforcement of the clients manipulative behavior with the goal of extinction. D. The nurse lacks empathy for the clients recurring self-injurious behavior.

C

The following clients are seen in the emergency department. The psychiatric unit has one remaining bed. The triage nurse should expect which client to be admitted? A. The client who is experiencing tremors and has a need for medication adjustment B. The client who is experiencing anxiety and a sad mood after separation from spouse C. The client who is a single parent and hears voices stating, Kill your infant son. D. The client who argued with her boyfriend and inflicted a superficial cut on her arm

C

The nurse interviewed a client who was uncooperative, answered questions with minimal responses, and rarely made eye contact. Which is the most complete documentation of baseline data obtained during the interview? A. Appears uncooperative. Exhibits characteristics of depression. B. Maintains poor eye contact throughout interview process. Unable to answer interview questions due to depression. C. States I don't need to be here when discussing admission status. Maintains minimal eye contact and offers little data related to triggers for admission. D. Unwilling to respond openly during interview

C

What is being assessed when a nurse asks a client to identify name, date, residential address, and situation? A. Mood B. Perception C. Orientation D. Affect

C

When a clients husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husbands tardiness. What technique is the nurse using? A. Examination of the evidence B. Decatastrophizing C. Generating alternatives D. Reattribution

C

When using a cognitive approach, a nurse would include which point in teaching a client about panic disorder? A. You might want to stay in the house when you notice the symptoms beginning. B. Medications such as lorazepam (Ativan) should be taken when symptoms start. C. Remind yourself that symptoms of a panic attack are time limited and will end. D. Keep a journal in order to note feelings surrounding the panic attacks.

C

Which statement regarding nursing interventions should a nurse identify as accurate? A. Nursing interventions are independent from the treatment teams goals. B. Nursing interventions are directed solely by written physician orders. C. Nursing interventions occur independently but in concert with overall treatment team goals. D. Nursing interventions are standardized by policies and procedures

C

Which tool would be appropriate for a nurse to use when assessing mental acuity prior to and immediately following electroconvulsive therapy (ECT)? A. CIWA scale B. GGT C. MMSE D. CAPS scale

C

Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important? A Fill out the client's menu and make sure she eats at least half of what is on her tray. B Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal C Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal D Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.

C Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal

Nurse Tamara is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is to: A avoid shopping for large amounts of food B control eating impulses C identify anxiety-causing situations D eat only three meals per day

C identify anxiety-causing situations

A nurse in a outpatient mental health clinic is reinforcing teaching with a client who has a new diagnosis of premenstrual dysphoric disorder. which of the following statements by the client indicates an understanding of the teaching ? A) "I can expect my problems with PMDD to be the worst when I am menstruating" B) "I will use a light therapy 30 minutes a day to prevent further recurrences of PMDD" C) "I am aware that my PMDD causes me to have rapid mood swings" D) "I should increase my caloric intake with a nutritional supplement when my PMDD is active"

C) "I am aware that my PMDD causes me to have rapid mood swings"

A nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse . Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A) "Care during the continuation phase of focuses on treating continued manifestations of MDD" B) "The treatment of MDD during the maintenance phase lasts 6 to 12 weeks" C) "The client is at greatest risk of suicide during the first weeks of an MDD episode" D) "Medication and psychotherapy are most effective during the acute phase of MDD"

C) "The client is at greatest risk of suicide during the first weeks of an MDD episode"

A nurse us assisting with the admission of a 25 year old client who has a new diagnosis of dysthymic disorder. Which of the following findings should the nurse expect? A) Wide fluctuation in moods B)Report of a minimum of five critical findings of depression C) Presence of manifestations for at least 2 years D) Inflated sense of self esteem

C) Presence of manifestations for at least 2 years

Which of the following statements about Electroconvulsive therapy for the treatment of bipolar disorder indicates an understanding? A) "ECT is the recommended treatment for bipolar disorder" B) "ECT is contraindicated for clients who have suicidal ideation" C) "ECT is effective for clients who are experiencing severe mania" D) "ECT is prescribed to prevent relapse of bipolar disorder"

C) Presence of manifestations for at least 2 years

Which of the following are characteristics of accurately developed client outcomes? Select all that apply. A. Client outcomes are formulated by nurses independent from other team members B. Client outcomes are not restricted by time frames. C. Client outcomes are specific and measurable. D. Client outcomes are realistically based on client capability. E. Client outcomes are formally approved by the psychiatrist.

C, D

A nurse is discussing stress management techniques with a group of clients. Which of the following techniques mentioned by a client should the nurse recognize as least effective? A. "I journal when I find it difficult to talk." B. "I pray when I begin to breathe fast." C. "I fix myself a pot of coffee when I get anxious." D. "I exercise when my neck is tense."

C. "I fix myself a pot of coffee when I get anxious."

A nurse is teaching a client who has a new prescription for escitalopram for treatment of generalized anxiety disorder. Which of the following statement by the client indicates understanding of the teaching? A. "I should take the medication on an empty stomach." B. "I will follow a low-sodium diet while taking this medication." C. "I need to discontinue this medication slowly." D. "I should not crush this medication before swallowing."

C. "I need to discontinue this medication slowly."

A nurse is counseling several clients. Which of the following client statements should the nurse identify as expected for fictitious disorder imposed on another? A. "I had to pretend I was injured in order to get disability benefits." B. "I know that my abdominal pain is caused by a malignant tumor." C. "I needed to make my child sick so that someone else would take care of them for a while." D. "I became deaf when I heard that my partner was having an affair with my best friend."

C. "I needed to make my child sic so that someone else would take care of them for a while."

A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A. "I can promote my client's sense of control by establishing a schedule." B. "I should encourage clients who have a schizoid personality to increase socialization." C. "I should practice limit-setting to help prevent client manipulation." D. "I should implement assertiveness training with clients who have antisocial personality disorder."

C. "I should practice limit-setting to help prevent client manipulation."

A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make? A. "Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet." B. "Instead of worrying about your weight, try to focus on other problems at this time." C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments." D. "You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."

C. "I understand you have concerns about your weight, but first, let's talk about your recent accomplishments."

A nurse is caring for a client who has depression. The client refuses to get out of bed, go to activities, or participate in any of the unit's programs. Which of the following responses should the nurse make? A. "You really need to follow the rules of the unit and get out of bed." B. "If you do not get out of bed you will not receive your meal." C. "I will help you get ready and then you can rest after activities." D. "You should rest until you feel able to join the group."

C. "I will help you get ready and then you can rest after activities."

A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? A. "I will take the medication at bedtime." B. "I will follow a low-sodium diet while taking this medication." C. "I will need to discontinue this medication slowly." D. "I will be at risk for weight loss with long-term use of this medication."

C. "I will need to discontinue this medication slowly."

A nurse assesses four adolescents diagnosed with various eating disorders. Which comment would the nurse expect from the adolescent diagnosed with anorexia nervosa? A. "I look good because when I overeat, I purge myself." B. "I love sweets. I make myself throw up so I can eat more." C. "I've lost 60 pounds but I'm still a size 2. I want to be a size 0." D. "I've hidden my eating disorder from everyone, even my parents."

C. "I've lost 60 pounds but I'm still a size 2. I want to be a size 0."

The nurse assesses a new patient suspected of having a schizotypal personality disorder. Which assessment question is this patient most likely to answer affirmatively? A. "Do some types of situations frighten you?" B. "Do you often have episodes of prolonged crying?" C. "Is anyone in your family diagnosed with a mental illness?" D. "Is it ever very important for you to do everything correctly?"

C. "Is anyone in your family diagnosed with a mental illness?"

The nurse interviews the parents of a 7 year old child diagnosed with moderate autism spectrum disorder. Which comment from the parents best describes autistic behaviors? A. "My child occasionally has temper tantrums." B. "Sometimes my child wakes up with nightmares." C. "My child swings for hours on our backyard gym set." D. "Toilet training was more difficult for this child than my other children."

C. "My child swings for hours on our backyard gym set." or D. "Toilet training was more difficult for this child than my other children." The question is asking for specific behaviors.

Shortly after hospitalization, an adolescent diagnosed with anorexia says to the nurse, "Being fat is the worst thing in the world. I hope it never happens to me." Which response by the nurse is appropriate? A. "You need to gain weight to become healthier." B. "Your world would not change if you gained a few pounds." C. "Tell me how your world would be different if you were fat." D. "Your attractiveness is not defined by a number on the scales."

C. "Tell me how your world would be different if you were fat."

A nurse is discussing OCD with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the underlying reason clients with OCD perform ritualistic behaviors? A. "The ritualistic behavior provides sexual satisfaction." B. "The client performs ritualistic behavior to boost self-esteem." C. "The ritualistic behavior temporarily relieves anxiety." D. "The client performs ritualistic behavior to decrease feelings of shame."

C. "The ritualistic behavior temporarily relieves anxiety."

After a power outage, a facility must serve a dinner of sandwiches and fruit to patients. Which comment is most likely from a patient diagnosed with a narcissistic personality disorder? A. "These sandwiches are probably contaminated with bacteria." B. "I suppose it's the best we can hope for under these circumstances." C. "You should have ordered a to-go meal from a local restaurant for me." D. "I would rather wait until the dietary department can prepare a meal."

C. "You should have ordered a to-go meal from a local restaurant for me."

A nurse is caring for a group of clients on a mental health unit. Which of the following should the nurse recognize as a maladaptive defense mechanism? A. A client slams a drawer after misplacing her wallet. B. A man buys his partner a gift after flirting with his secretary. C. A client forgets to schedule needed appointments when fearing chemotherapy. D. A client ignores the thought of pain when scheduled for oral surgery.

C. A client forgets to schedule needed appointments when fearing chemotherapy. Rationale: Repression occurs when a person deals with anxiety by unconsciously putting the unacceptable or stress-producing thought out of her consciousness. In this case, the repression is maladaptive because the client is not receiving the appropriate health care. A delay in chemotherapy might make the therapy ineffective. The defense mechanism is considered maladaptive if the action interferes with healthy functioning, both physically and mentally.

A nurse observes a client who has OCD repeatedly applying, removing and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A. Narcissistic behavior B. Fear of rejection from staff C. Attempt to reduce anxiety D. Adverse effect of antidepressant medication

C. Attempt to reduce anxiety

A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A) Narcissistic behavior B) Fear of rejection from staff C) Attempt to reduce anxiety D) Adverse effect of antidepressant medication

C. Attempt to reduce anxiety

A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply.) A. Demonstrates extreme anxiety when placed in a social situation B. Often engages in magical thinking C. Attempts to convince other clients to relinquish their belongings D. Becomes agitated if personal area is not neat and orderly E. Blames others for personal past and current problems

C. Attempts to convince other clients to relinquish their belongings E. Blames others for personal past and current problems

A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse include in the teaching? A. Chew the gum for no more than 10 min B. Rinse out the mouth immediately before chewing the gum C. Avoid eating 15 min prior to chewing the gum D. Use of the gum is limited to 90 days

C. Avoid eating 15 min prior to chewing the gum

A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A. Chlordiazepoxide B. Bupropion C. Disulfiram D. Carbamazepine

C. Disulfiram

A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should expect prescriptions for which of the following medications to promote long-term abstinence from alcohol? (Select all that apply.) A. Lorazepam B. Diazepam C. Disulfiram D. Naltrexone E. Acamprosate

C. Disulfiram D. Naltrexone E. Acamprosate

A nurse is caring for a client who is receiving moderate sedation with diazepam IV. The clients is oversedated. Which of the following medications should the nurse expect to administer to this client? A. Ketamine B. Naltrexone C. Flumazenil D. Fluvoxamine

C. Flumazenil

A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? A. Orient the client frequently to time, place and person B. Offer fluids and nourishing diet as tolerated C. Implement seizure precautions D. Encourage participation in group therapy sessions

C. Implement seizure precautions

A nurse is planning care for a client who has a prescription for alprazolam. For which of the following adverse effects should the nurse plan to monitor? A. Decreased urine output B. Manifestations of seizure activity C. Inability to recall events D. Increase in white blood cell count

C. Inability to recall events Rationale: Alprazolam is a benzodiazepine medication used to manage anxiety and panic disorders. Anterograde amnesia, impaired recall of events that take place after dosing, is an adverse effect. Other adverse effects of benzodiazepines include central nervous system depression, anterograde amnesia, sleep-related behaviors (such as eating meals while sleeping), and paradoxical effects of excitation, euphoria, and heightened anxiety.

A nurse is planning care for a client who demonstrates manipulative behavior. Which of the following interventions should be included in the plan of care? A. Allow manipulation so as to not raise the client's anxiety. B. Avoid discussing past behaviors with the client. C. Institute consequences for manipulative behavior. D. Bargain with the client to discourage manipulative behavior.

C. Institute consequences for manipulative behavior.

A nurse is planning a staff education on substance use in older adults. Which of the following information should the nurse include in the presentation? A. Older adults require higher doses of a substance to achieve a desired effect B. Older adults commonly use rationalization to cope with a substance use disorder C. Older adults are at an increased risk for substance use following retirement D. Older adults develop substance use to mask manifestations of dementia

C. Older adults are at an increased risk for substance use following retirement

A nurse in a mental health facility is planning care for a client who has OCD and is newly admitted to the unit. Which of the following actions should the nurse plan to take regarding the client's compulsive behaviors? A. Isolate the client for a period of time. B. Confront the client about the senseless nature of the repetitive behaviors. C. Plan the client's schedule to allow time for rituals. D. Set strict limits on the behaviors so that the client can conform to the unit rules and schedules.

C. Plan the client's schedule to allow time for rituals. Rationale: OCD is an anxiety disorder characterized by recurrent patterns of behavior a client feels driven to perform. This behavior can be a physical action or a mental act that is aimed at neutralizing anxiety or distress. In the initial phase of treatment, the nurse should allow adequate time for the client to perform rituals to help the client handle anxiety. The nurse can gradually increase limits on client behavior as the client's anxiety becomes more manageable.

While weighing patients on an eating disorders unit, the nurse overhears a psychiatric technician say, "I wish I had an eating disorder; maybe I'd lose a little weight." What is the nurse's best action? A. Report the clinical observation to the nursing supervisor B. Ask the psychiatric technician, "What did you mean by that comment?" C. Privately discuss the importance of sensitivity with the psychiatric technician D. Immediately interrupt the interaction between the patient and psychiatric technician

C. Privately discuss the importance of sensitivity with the psychiatric technician

A nurse is counseling a client for the management of anxiety. The client is consistently late for appointments and ignores household chores. The client states, "I'm just too stressed. I need someone to take care of me." The nurse identifies this behavior as an example of which of the following defense mechanisms? A. Dissociation B. Introjection C. Regression D. Repression

C. Regression

A nurse is caring for a client who is having difficulty sleeping and is pacing the floor. The client's head is down, and he is wringing his hands. Which of the following actions should the nurse take? A. Encourage the client to go back to bed. B. Give the client a PRN sleeping medication. C. Remain with the client. D. Explore alternatives to pacing the floor with the client.

C. Remain with the client. Rationale: Remaining nearby the client will help to alleviate feelings of abandonment and reassures the client of his safety. A client who is given a PRN sleeping medication will not be alleviated of severe anxiety. This action will only temporarily suppress the feelings.

A nurse in the ED is caring for a client who reports chest pain, headache, and shortness of breath. He continues to state, "I don't know why my wife left me." The client receives a diagnosis of anxiety. The nurse realizes the client's findings support which level of anxiety? A. Mild B. Moderate C. Severe D. Panic

C. Severe Rationale: Chest pain, headache, shortness of breath, and focus on one particular item are all findings associated with severe anxiety. Panic level of anxiety causes the client to lose touch with reality and is associated with unintelligible speech or the inability to speak.

A nurse in an acute care mental health facility is admitting a client who reports feeling depressed, sad, moody, and overly anxious. Which of the following is the nurse's assessment priority? A. Coping abilities B. Support systems C. Suicide risk D. Psychiatric history

C. Suicide risk

A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization? A. The client describes a feeling of floating above the ground B. The client has suspicions of being targeted in order to be killed and robbed C. The client states the furniture in the room seems to be small and far away D. The client cannot recall anything that happened during the past 2 weeks

C. The client states that the furniture in the room seems to be small and far away

When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first?

Call for sufficient help to control the situation safely.

What causes schizophrenia?

Chemical and neuro abnormalities with strong genetic links. It is more common in relatives.

Clang association

Choice of words that are governed by sounds, usually in the form of rhyming.

What is a possible outcome criterion for a client diagnosed with anxiety disorder? a) Client demonstrates effective coping strategies b) Client reports reduced hallucinations. c) Client reports feelings of tension and fatigue. d) Client demonstrates persistent avoidance behaviors.

Client demonstrates effective coping strategies

A possible outcome criteria for a client with anxiety disorder is

Client demonstrates effective coping strategies.

Working to help the client view an occurrence in a more positive light is referred to by which term? a) Flooding b) Desensitization c) Response prevention d) Cognitive restructuring

Cognitive restructuring

Working to help the client view an occurrence in a more positive light is referred to by which term?a) Floodingb) Desensitizationc) Response preventiond) Cognitive restructuring

Cognitive restructuring.

Signs of depression from age 9-12

Common symptoms include morbid thoughts and excessive worrying. They may reason that they are depressed because they have disappointed their parents in some way. There may be a lack of interest in playing with friends.

Signs of depression from age 3-5

Common symptoms may include accident proneness, phobias, aggressiveness, and excessive self-approach for minor infarctions.

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of adjustment disorder with depressed mood. The priority nursing diagnosis for Nina would be...

Complicated grieving related to breakup of marriage.

During the nurse's psychosocial assessment of a patient experiencing anxiety, the patient states: "I'm paralyzed with fear will all presentations and I feel I might get heart attack if I present my project". This indicates the possibility of

Compulsion

Concrete thinking

Concreteness or literal interpretations of the environment. Represents regression to an earlier level of cognitive development.

Factitious disorder

Conscious, intentional feigning of physical or psychological symptoms. Pretending to be ill in order to receive emotional care and support.

Akathesia

Continuous restlessness and fidgeting.

Each time a client is scheduled for a therapy session she develops headache and nausea . The nurse might interpret this behavior as : a . Conversion b . Reaction formation c . Projection d . Suppression

Conversion

Maturational/developmental crisis

Crises that occur in response to situations that trigger emotions related to unresolved conflicts in one's life. These are of internal origin and reflect underlying developmental issues that involve dependency, value conflicts, sexual identity, control, and capacity for emotional intimacy.

Marie, age 56, is the mother of 5 children. Her youngest child, who had been living at home and worked outside the home and has devoted her life to satisfying the needs of her husband and children. Since the departure of her last child from home, Marie has become more and more despondent. Her husband had become very concerned, and takes her to the local mental health center. This type of crisis is called... The most appropriate nursing intervention is...

Crisis of anticipated life transitions. Begin grief work and assist her to recognize area of self-worth separate and apart from her children.

Crisis resulting from traumatic stress

Crisis precipitated by an unexpected external stressor over which the individual has little or no control and as a result of which he feels emotionally overwhelmed and defeated.

Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called...

Crisis resulting from traumatic stress.

What term is used to identify the condition demonstrated by a person who has numerous hypomanic and dysthymic episodes over a two-year period? a) Bipolar II disorder b) Bipolar I disorder c) Cyclothymia d) Seasonal affective disorder

Cyclothymia.

A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the childs requests, whereas the mother usually consents. The childs choice is the result of which component of operant conditioning? A. Conditioned stimuli B. Unconditioned stimuli C. Aversive stimuli D. Discriminative stimuli

D

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, I failed my battalion by giving the wrong order. Fortunately, no one was injured. Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

D

A client is experiencing auditory hallucinations. Using a cognitive strategy, the nurse would encourage the client to do which of these? A. Try singing Happy Birthday until the voices are gone. B. Document what the voices are saying, to note cause and effect. C. Try listening to music using headphones for distraction. D. Remind yourself that the voices are symptoms of your disease.

D

A client states, I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store. Using a cognitive approach, which nursing reply would be most therapeutic? A. Are other issues from your past affecting your ability to move on? B. Describe your current feelings about your loss. C. Lets talk about something that will help you move on. D. Can anyone predict when a car accident will happen?

D

A client who has slept 6 hours the previous night reports this to the assigned psychiatric nurse. What should be the initial nursing action to address this situation? A. Provide warm milk and a backrub. B. Give a sleep medication. C. Hold a relaxation group before bedtime. D. Review the clients normal sleep pattern

D

A kindergarten rule states that if unacceptable behavior occurs, a childs personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy? A. Classical conditioning B. Conditioned response C. Positive reinforcement D. Negative reinforcement

D

A mother tells her teenager that in order for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? A. Shaping B. Modeling C. Contracting D. Premack principle

D

A nurse charts Verbalizes understanding of the side effects of Prozac. This is an example of which category of focused charting? A. Data B. Problem C. Action D. Response

D

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client? A. Thought patterns are triggered by specific stressful stimuli. B. Thought patterns contain the clients fundamental beliefs and assumptions. C. Thought patterns are flexible and based on personal experience. D. Thought patterns include a predominance of automatic thoughts.

D

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion? A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

D

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, What's cognitive therapy and how can it help me? Which is the nurses most appropriate reply? A. It is a system of techniques in which you use positive thinking to improve your mood. B. It is a long-term interpersonal approach that emphasizes the role of early childhood experiences. C. It is an interpersonal treatment approach that specifically targets magical thinking. D. It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors.

D

An instructor overhears a student say, That family seems to disagree more than agree. The family seems to be dysfunctional. To further assess the familys situation, which would be an appropriate instructor reply? A. Families who disagree can be a challenge to the treatment team. B. You seem very critical of the family. Do you believe that you are unable to help them? C. Lets bring the family in for an educational session to improve their communication. D. What appears to trigger family disagreements?

D

During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique? A. Before you can smoke, you must first take a half-hour walk. B. When you have the urge to smoke, imagine being short of breath. C. Youll receive $1 for each cigarette not smoked and forfeit $2 for each cigarette smoked. D. When you have the urge to smoke, hold your breath and then rhythmically breathe.

D

During an intake interview, which question would assist the nurse in gathering data about the clients judgment? A. What brought you to the hospital? Do you know what day and season it is now? B. On a scale of 1 to 10, how would you rate your stress level? C. What does the phrase a rolling stone gathers no moss mean to you? D. If you found a stamped, addressed envelope in the street, what would you do?

D

Parents decide to try the nurse practitioners suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents? A. Correct your childs behavior by spanking for a specified time period. B. Ignore the childs negative behavior. C. Add positive reinforcement for acceptable behavior. D. Temporarily move your child to an area where behavior is not being reinforced.

D

Which assumption is most reflective of a behavioral theory model? A. Mental illness is characterized by structural and biochemical alterations. B. Thought processes influence behaviors. C. All personality development has a social context. D. There is a basic relationship between stimulus and response.

D

Which expected client outcome should a nurse identify as being correctly formulated? A. Client will feel happier by discharge. B. Client will demonstrate two relaxation techniques. C. Client will verbalize triggers to anger by end of session. D. Client will initiate interaction with one peer during free time within 2 days.

D

Which nursing response would be appropriately used in the evaluation phase of the nursing process? A. If I were in your situation, I would not repeat a behavior that has caused problems. B. What do you think needs changing, and what do you want to do differently? C. What exactly will it take to carry out your plan, and what else do you need to do? D. B. It sounds like your saying this new approach is working for you.

D

During postprandial monitoring, a female client with bulimia nervosa tells the nurse, "You can sit with me, but you're just wasting your time. After you sat with me yesterday, I was still able to purge. Today, my goal is to do it twice." What is the nurse's best response? A "I trust you not to purge." B "How are you purging and when do you do it?" C "Don't worry. I won't allow you to purge today." D "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."

D "I know it's important for you to feel in control, but I'll monitor you for 90 minutes after you eat."

A 24-year old client with anorexia nervosa tells the nurse, "When I look in the mirror, I hate what I see. I look so fat and ugly." Which strategy should the nurse use to deal with the client's distorted perceptions and feelings? A Avoid discussing the client's perceptions and feelings B Focus discussions on food and weight C Avoid discussing unrealistic cultural standards regarding weight D Provide objective data and feedback regarding the client's weight and attractiveness

D Provide objective data and feedback regarding the client's weight and attractiveness

A male client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is Nurse Alice most likely to administer to reduce the symptoms of alcohol withdrawal? A naloxone (Narcan) B haloperidol (Haldol) C magnesium sulfate D chlordiazepoxide (Librium)

D chlordiazepoxide (Librium)

A nurse in an acute mental health facility is caring for a client who has bipolar disorder. Which of the following actions is the nurses priority? A) Set consistent limits for expected client behavior. B) Administer prescribed medications as scheduled C) Provide step by step instructions during hygiene activities D) Monitor for escalating behavior

D) Monitor for escalating behavior

A nurse is caring for a client who was involved in heavy combat and observed war casualties. The nurse should suspect that the client is suffering from PTSD if the client makes which of the following statements? A. "I check any room I enter because the enemy is still after me and could be hiding anywhere." B. "My child was born with a birth defect due to an exposure I had overseas." C. "I killed four enemy soldiers with my bare hands and saved my entire battalion." D. "In my dreams, all I can see are the wounded reaching out and trying to grab me."

D. "In my dreams, all I can see are the wounded reaching out and trying to grab me." Rationale: Many clients who have PTSD repeatedly re-experience the ordeal in the form of flashback episodes, memories, nightmares, or frightening thoughts, especially when they are exposed to events or objects reminiscent of the trauma. This client's statement about haunting dreams is typical of a client who has PTSD.

A nurse is providing teaching to a client who has a new prescription for buspirone to treat anxiety. Which of the following information should the nurse include? A. "Take this medication on an empty stomach." B. "Expect optimal therapeutic effects within 24 hr." C. "Take this medication when needed for anxiety." D. "This medication has a low risk for dependency."

D. "This medication has a low risk for dependency."

A community mental health nurse talks with a 6 year old child whose divorced parents have shared custody. Which initial question will best help the nurse explore the child's perception of home life? A. "Is your life different from your friends' lives?" B. "Are you happiest at your mother's or your father's house?" C. "Do you find it hard to move back and forth between two homes?" D. "What are some of the good and bad things about living in two homes?"

D. "What are some of the good and bad things about living in two homes?"

A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. I am expected to finish others' work because of their laziness!" When discussing effective communication, which of the following statements by the client to the coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that i have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."

D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."

A nurse in a mental health clinic is assessing a client who was brought in by her adult daughter stating that her mother has not been able to leave her home for weeks because she is afraid to be outdoors alone. The nurse should anticipate planning care for managing which of the following phobias? A. Xenophobia B. Acrophobia C. Mysophobia D. Agoraphobia

D. Agoraphobia

A patient is hospitalized with a diagnosis of anorexia nervosa. The nurse reviews the patient's laboratory results below: Na+ 143 mEq/L K+ 3.1 mEq/L Cl- 102 mEq/L Mg+ 2.2 mEq/L Ca+ 8.4 mg/dL PO4- 3.0 mg/dL The nurse should take which action next? A. Measure the patient's body temperature B. Inspect the patient's skin and sclera for jaundice C. Assess the patient's mucous membranes for erosion D. Auscultate the patient's heart rate, rhythm and sounds

D. Auscultate the patient's heart rate, rhythm and sounds

A nurse is assessing a client who has illness anxiety disorder. Which of the following findings should the nurse expect? A. Prior physical health followed by the need for two surgeries within the last three months. B. Obsession over a fictitious defect in physical appearance. C. Sudden unexplained loss of peripheral sensation. D. Constant worry about the undiagnosed presence of an illness.

D. Constant worry about the undiagnosed presence of an illness.

A nurse is caring for a client who has been diagnosed with OCD and is constantly picking up after others in the day room. The nurse should recognize that the client uses this behavior to do which of the following? A. Limit the amount of time available to interact with others. B. Focus attention on meaningful tasks. C. Manipulate and control others' behaviors. D. Decrease anxiety to a tolerable level.

D. Decrease anxiety to a tolerable level.

A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? A. Encourage the client to spend time alone in their room B. Monitor the client for self-farm once per day C. Allow the client unlimited time to discuss physical manifestations D. Discuss alternative coping strategies with the client

D. Discuss alternative coping strategies with the client

A nurse is planning care for a client who has dependent personality disorder. Which of the following actions should the nurse plan to take? A. Monitor the client closely to prevent self-mutilation. B. Set limits to prevent exploitation of other clients. C. Discourage flamboyant or seductive behaviors. D. Give positive feedback when client is assertive with staff or clients.

D. Give positive feedback when client is assertive with staff or clients. Rationale: The client who has dependent personality disorder has great difficulty demonstrating assertive behavior and commonly relies on others to make decisions. The nurse should encourage the client to be more assertive and independent.

A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following actions should the nurse include in the client's plan of care? A. Allow the client to select preferred meal times B. Establish consequences for purging behavior C. Provide the client with a high-fat diet at the start of treatment D. Implement one-to-one observation during meal times

D. Implement one-to-one observation during meal times

A nurse is assessing a client who has PTSD following a sexual assault. Which of the following is an expected finding? A. Sleeping 12 hr or more each day. B. Increasing sense of attachment to others. C. Constant need to talk about the event. D. Increasing feelings of anger.

D. Increasing feelings of anger.

A nurse is assessing a client who has a diagnosis of conversion disorder. Which of the following is an expected finding? A. Frequent manic episodes. B. Refusal of medication due to paranoia. C. Preoccupation with manifestations of various illnesses. D. Involuntary loss of a sensory function.

D. Involuntary loss of a sensory function.

An adult required a heart transplant 5 years ago. Multiple medical complications followed, resulting in persistent irritability, depression, and insomnia. The adult's spouse says, "I've walked on eggshells for five years, never knowing when something else will go wrong." What is the nurse's priority intervention regarding the spouse? A. Explore the spouse's feelings, showing care and compassion. B. Encourage the spouse to attend a community support group. C. Teach stress reduction and relaxation techniques to the spouse. D. Refer the spouse to the primary care provider or health assessment.

D. Refer the spouse to the primary care provider or health assessment.

A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? A. Three to six weeks of treatment is required to achieve therapeutic benefit B. Combining alcohol with alprazolam will produce a paradoxical response C. Alprazolam has a lower risk for dependence than other antianxiety medications D. Report confusion as a potential indication of toxicity

D. Report confusion as a potential indication of toxicity

A nurse is caring for a client who is to undergo a surgical procedure. Which of the following preexisting conditions can be a contraindication for the use of ketamine as an intravenous anesthetic? A. Peptic ulcer disease B. Breast cancer C. Diabetes mellitus D. Schizophrenia

D. Schizophrenia

A nurse in an acute mental health facility is caring for a client who jumps out of her chair and begins to shout angrily at the clients around her. Which of the following actions should the nurse take first? A. Call for assistance to place the client in restraints. B. Escort the client to an unlocked seclusion room. C. Offer the client a PRN antianxiety medication. D. Speak to the client calmly, giving simple directions.

D. Speak to the client calmly, giving simple directions.

A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A. Discuss new relaxation techniques B. Show the client how to change the behavior C. Distract the client with a television show D. Stay with the client and remain quiet

D. Stay with the client and remain quiet

A nurse is collecting an admission history for a client who has acute dress disorder (ASD). Which of the following client behaviors should the nurse expect? A. The client remembers many details about the traumatic incident B. The client expresses heightened elation about what is happening C. The client remembers first noticing manifestations of the disorder 6 weeks after the traumatic incident occurred D. The client expresses a sense of unreality about the traumatic incident

D. The client expresses a sense of unreality about the traumatic incident

A nurse is caring for a client who has schizophrenia and generalized anxiety disorder. The client has a prescription for alprazolam 0.25 mg PO every 8 hr PRN anxiety. For which of the following client statements should the nurse consider administering alprazolam? A. The client states, "I see purple bugs crawling on the wall." B. The client tells the nurse that he is too tired to attend the group meeting. C. The client tells the nurse he is a government agent. D. The client states, "My heart is pounding out of my chest."

D. The client states, "My heart is pounding out of my chest."

A combat veteran from two tours of the war in Afghanistan tells the nurse, "Some guys in my unit have posttraumatic stress disorder, but I never had any problems other than my hearing is not as good as it once was." Which explanation for this comment should the nurse consider? A. The veteran wants to demonstrate toughness and strength. B. The veteran shows indicators of derealization and depersonalization. C. The veteran may be rationalizing this reaction to memories of combat. D. The veteran may have amnesia associated with the combat experience.

D. The veteran may have amnesia associated with the combat experience. Rationale: Although this may be true, Dr. Clark thinks more information should have been provided as it does not automatically mean the veteran was exposed to an explosive device. She knows many veterans who have suffered hearing loss as a result of long-term exposure to other loud experiences.

A nurse at a walk-in mental health clinic is assessing a client experiencing severe anxiety. The nurse should recognize the client might exhibit which of the following manifestations? A. Attention-seeking conduct B. Mild difficulty problem solving C. Mild fidgeting D. Threatening behavior

D. Threatening behavior Rationale: The client experiencing severe anxiety can have feelings of confusion and impending doom. The client may feel the need to be aggressive and defensive, speaking with loud, rapid speech and possibly making threats and demands of others.

A nurse is caring for a client who professes a deep and everlasting love for his girlfriend one day, and then the next day refuses to speak to her or allow her to visit. The nurse recognizes this client behavior is an example of which of the following defense mechanisms? A. Repression B. Splitting C. Sublimation D. Undoing

D. Undoing Rationale: The nurse correctly identifies this as an example of undoing which is the attempt to make up for or reverse prior behavior. Splitting is the inability to combine both positive and negative qualities of an individual.

A nurse on the psychiatric unit is assessing a client who has moderate anxiety disorder. Which of the following findings should the nurse expect? A. Rapid speech B. Chills C. Distorted perceptual field D. Urinary frequency

D. Urinary frequency Rationale: The nurse should expect the client who has moderate anxiety disorder to exhibit urinary frequency, as well as headache, backache, and insomnia. Rapid speech and distorted perceptual field are indicative of severe anxiety disorder. Chills are indicative of panic level anxiety.

A nurse on a mental health unit is caring for a client who has generalized anxiety disorder. The client received a telephone call that was upsetting, and now the client is pacing up and down the corridors of the unit. Which of the following actions should the nurse take? A. Instruct the client to sit down and stop pacing. B. Allow the client to pace alone until physically tired. C. Have a staff member escort the client to her room. D. Walk with the client at a gradually slower pace.

D. Walk with the client at a gradually slower pace. Rationale: When the client is experiencing increased anxiety, it is important for the nurse to remain with the client and promote a calm atmosphere. By walking with the client at a gradually slowing pace, the nurse provides gross motor activity as an anxiety outlet that helps to calm the client and demonstrates therapeutic offering of self.

A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care? A. Teach the client to recognize how stress brings on a personality change in the client B. Repeatedly present the client with information about past events C. Make decisions for the client regarding routine daily activities D. Work with the client on grounding techniques

D. Work with the client on grounding techniques

The primary goal in working with an actively psychotic, suspicious client would be to...

Decrease his anxiety and increase trust.

Antipsychotics: aripiprazole (Abilify), asenapine (Saphris), chlorpromazine, olanzapine (Zyprexa), quetiapine (Seroquel), risperidone (Risperdal), ziprasidone (Geodon)

Decreases alertness. Sugarless candy, ice chips, sips of water. Foods high in fiber. Encourage activity. Calorie-controlled diet. Observe for palpitations, syncope, or weakness. Monitor blood glucose.

Clint, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Clint's belief is an example of a...

Delusion of persecution.

Believing someone is out to get them Believing you are a superhero jealousy that a partner is unfaithful with no reason A false belief that one is sick or physically disabled is somatic. believing someone is controlling one's mind.

Delusions

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? a) Altruism b) Denial c) Undoing d) Suppression

Denial

A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years . This behavior suggests the use of A. Denial B.. Displacement C. Rationalization D. Introjection

Denial

Risk for suicide

Depressed mood; feelings of hopelessness and worthlessness; anger turned inward on self; misinterpretations of reality; suicidal ideation, plan, and available means. Interventions: Create safe environment, formulate short-term verbal or written contract with client that he will not harm himself during a specific time period, secure a promise from client that he will seek out a staff member if thoughts of suicide emerge, maintain close observation of client, maintain special care in administration of meds, make rounds at frequent irregular intervals, encourage verbalizations of honest feelings, encourage client to express angry feelings within appropriate limits, identify community resources that client may use, orient client to reality, spend time with client.

I'm a kind of a disorder caused by a deficiency of serotonin and norepinephrine . Dopamine , acetylcholine , and GABA systems are also believed to be involved in my pathophysiology Can you help me remember who am I ?

Depression

I'm a type of disorders . If your client has me , he / she should be evaluated for suicidal or homicidal ideation You should provide him with careful unobtrusive observation around the clock . " God wants me dead " " I am wicked and I should die " . Depressed and pessimistic view " I deserve to be this way . "Have a guess .. Who am I ?

Depression

What comorbidities exist with schizophrenia and why?

Depression and substance abuse are the most common. Most are diabetic because the medications cause hyperglycemia. Others are bad teeth, overweight, COPD. Patients have poor overall health because of self-medications and poor personal hygiene.

What statement about the comorbidity of depression is accurate? a) Depression most often exists in an individual as a single entity. b) Substance abuse and depression are seldom seen as comorbid disorders. c) Depression may coexist with other disorders but is rarely seen with schizophrenia. d) Depression is commonly seen in individuals with medical disorders.

Depression is commonly seen in individuals with medical disorders.

What can be said about the comorbidity of anxiety disorders? a) Anxiety disorders generally exist alone. b) Depression may occur prior to onset of anxiety. c) Anxiety disorders virtually never coexist with mood disorders. d) Substance abuse disorders rarely coexist with anxiety disorders.

Depression may occur prior to onset of anxiety.

Complicated grieving

Depression, preoccupation with thoughts of loss, self-blame, grief avoidance, inappropriate expression of anger, decreased functioning in life roles. Interventions: Determine stage of grief in which client is fixed, develop a trusting relationship with client, encourage client to express anger, help client to discharge pent-up anger through participation in large motor activities; teach normal stages of grief and behaviors associated with each stage; encourage client to review the relationship with the lost concept/entity; communicate to client that crying is acceptable, assist client in problem-solving as he attempts to determine methods for more adaptive coping with experienced loss, encourage client to reach out for spiritual support, encourage client to attend support group with people who are going through same thing.

Schizophrenia is best characterized as presenting which personality trait? a) Split b) Multiple c) Ambivalent d) Deteriorating

Deteriorating

Nursing interventions for complicated grieving

Determine the stage of grief in which the client is fixed. Identify behaviors associated with this stage. Develop a trusting relationship client Convey an accepting attitude, and enable the client to express feelings openly. Encourage client to express anger. Help client discharge pent-up anger through participation in large motor activities. Teach normal stages of grief and behaviors associated with each stage. Encourage client to review the relationship with the lost concept. Communicate to client that crying is acceptable. Encourage client to reach out for spiritual support.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of importance to this particular client? a) Ascertain how long ago the trauma occurred. b) Find out if the client uses acting-out behavior. c) Determine the use of chemical substances for anxiety relief. d) Establish whether the client has chronic hypertension related to high anxiety.

Determine the use of chemical substances for anxiety relief.

What is the primary nursing diagnosis for someone with paranoid schizophrenia?

Diagnosis: A threat to others. Safety is a very big concern, which is why it is so important to assess at the beginning of every shift for voices, thoughts of hurting self or others, mood, and anxiety. Stay with the client.

Insomnia

Difficulty falling asleep, difficulty staying asleep, lack of energy, difficulty concentrating, verbal reports of not feeling well rested.

The most appropriate crisis intervention with Amanda who is experiencing disabling anxiety in the aftermath of a tornado taking her home is...

Discuss stages of grief and feelings associated with each.

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon wen Jenny gets home from school. Jenny is afraid to invite friends over because of her mother's behavior. This type of crisis is called...

Dispositional crisis

Dissociative disorders

Disruption in the usually integrated effects of the consciousness, memory, identity, or perception. When anxiety becomes overwhelming and the personality becomes disorganized. Defense mechanisms break down and behavior occurs with little or no participation of the conscious personality. Characterized by severe anxiety that has been repressed and is being expressed in the form of physiological symptoms and dissociative behaviors.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." What is the best initial approach to managing this behavior? a) Reprimand the client by stating, "What an offensive thing to suggest!" b) Clarifying the nurse-client relationship by stating, "I don't have sex with clients." c) Distracting the client by suggesting, "It's time to work on your art project."

Distracting the client by suggesting, "It's time to work on your art project."

What are the nursing interventions for a patient with paranoid schizophrenia?

Do not increase their paranoia. Open medicine containers in front of them. Explain what's on their food tray. Explain who you are and do not play along with their delusions. Help improve insight. Ask them about how they feel. Do not use therapeutic touch because intentions could be interpreted to sexual advances or an attempt to harm them. Keep them in isolation because being around people heightens anxiety. No group therapy.

Nursing interventions for client that is panicking

Do not leave the patient alone. Maintain calm, nonthreatening, matter of fact approach. Use simple words and brief messages, spoken calmly and clearly. If hyperventilation occurs, assist with breathing in a paper bag. Administer tranquilizing medications. When the level of anxiety has been reduced, explore with the client possible reasons for its occurrence. Teach the client signs and symptoms of escalating anxiety.

Side effects of depression drugs

Dry mouth- sugarless candy or frequent sips of water/ice chips Sedation- give at bedtime and don't drive Discontinuation syndrome- taper off gradually HTN crisis- if you consume tyramine foods while taking MAOIs discontinue med. stat. Administer anti-HTN med and external cooling measures Rash- usually resides on its own Orthostatics- safety Weight gain or loss- treat accordingly

Side effects of all antidepressants

Dry mouth- sugarless candy, ice chips, oral hygiene. Sedation- take at bedtime, do not drive when tired. Nausea- take with food. Discontinuation syndrome- taper gradually.

When is risk for suicide increased?

During the first 2-4 weeks of taking an antidepressent because they now have the psychic energy to actually carry out suicidal thoughts.

Can you help me remember who am I ? l'm a long lasting painful contractions of the muscles l can cause your head to be rotated to one side in a stiffly fixed position and Your eyes to be pulled up . l'm a side effect of antipsychotic medications

Dystonia

Crises reflecting psychopathology

Emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crisis or which psychopathology significantly impairs or complicates adaptive resolution. Examples are personality disorders, anxiety, bipolar or schizophrenia.

A client experiencing a panic attack keeps repeating, "Im dying, I can't breathe.". What action by the nurse should be most therapeutic initially? a) Encouraging the client to take slow, deep breaths b) Verbalizing mild disapproval of the anxious behavior c) Asking the client what he means when he says "I am dying." d) Offering an explanation about why the symptoms are occurring

Encouraging the client to take slow, deep breaths

Tony, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing diagnosis for Tony is to...

Ensure a safe environment for him and others.

In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must...

Establish a relationship with each of the personalities separately.

Nursing interventions for client with PTSD

Establish a trusting relationship. Stay with client during periods of flashbacks and nightmares. Obtain an accurate history from significant others about the trauma and the client's specific response. Encourage the client to talk about the trauma at his or her own pace. Discuss the coping strategies used in response to the trauma, as well as those used during stressful situations in the past. Assist the individual to try to comprehend the trauma if possible.

A mature, professional couple plans a large wedding in a city 100 miles from their home. Which response is most likely to be associated with this experience? A. Distress B. Eustress C. Acute stress D. Depersonalization

Eustress

Body dysmorphic disorder

Exaggerated by the belief that the body is deformed or defective in some way. Ex: Thinning hair or wrinkles or "green gas coming from the rectum." Often associated with eating disorders or schizophrenia. Repression of morbid anxiety seems to be underlying factor.

Etiology of Bipolar

Excess dopamine/norepinephrine and functional deficiency of these neurotransmitters with depression. Could be a side effect of polypharmacy or steroid use (roid rage).

Crises occur when an individual...

Experiences a stressor and perceives coping strategies to be ineffective.

A client prescribed a selective serotonin reuptake inhibitor mentions taking the medication along with the St. John's wort daily. The nurse should provide the client with what information regarding this practice? a) Agreeing that this will help the client to remember the medications. b) Caution the client to drink several glasses of water daily. c) Suggest that the client also use a sun lamp daily. d) Explain the high possibility of an adverse reaction.

Explain the high possibility of an adverse reaction.

Nursing interventions for fearful patient

Explore the client's perception of threat to physical integrity or threat to self-concept. Discuss the reality of the situation with the client in order to recognize aspects that can be changed and those that cannot. Include the client in making decisions related to the selection of alternative coping strategies. Encourage the client to explore underlying feelings that may be contributing to irrational feats, and to face them rather than suppress them.

Spiritual distress

Expresses anger toward God, expresses lack of meaning in life, sudden changes in spiritual practices, refuses interactions with significant others or with spiritual leaders.

Low self-esteem

Expressions of helplessness, uselessness, guilt, and shame; hypersensitivity to slight or criticism; negative, pessimistic outlook; lack of eye contact; self-negating verbalizations. Interventions: Be accepting of client and spend time with him even though pessimism and negativism may seem objectionable, promote attendance in therapy groups that offer client simple methods of accomplishment, encourage client to recognize areas of change and provide assistance towards this effort, teach assertiveness techniques, teach effective communication techniques such as using "I" messages, encourage independence in performing ADLs, show client how to perform activities in which he is having difficulty, keep strict records of food and fluid intake, before bedtime provide nursing measures to promote sleep such as a back rub.

Which of the following is the most appropriate therapy for a client with agoraphobia?

Facing her fear in gradual step progression.

Symptoms of moderate postpartum depression

Fatigue, irritability, loss of appetite, sleep disturbances, and loss of libido.

The major distinction between fear and anxiety is that... A. Fear is a psychological experience ; anxiety is a physiological experience B. Fear is a response to a specific danger ; anxiety is a response to an unknown danger . C. Fear enables constructive action ; anxiety is dysfunctional . D. Fear is a universal experience ; anxiety is neurotic .

Fear is a response to a specific danger ; anxiety is a response to an unknown danger .

What is the major distinction between fear and anxiety? a) Fear is a universal experience; anxiety is neurotic. b) Fear enables constructive action; anxiety is dysfunctional. c) Fear is a psychological experience; anxiety is a physiological experience. d) Fear is a response to a specific danger; anxiety is a response to an unknown danger.

Fear is a response to a specific danger; anxiety is a response to an unknown danger

Panic attacks in Latin American individuals often involve demonstration of which behavior? a) Repetitive involuntary actions b) Blushing c) Fear of dying d) Offensive verbalizations

Fear of dying

A symptom commonly associated with panic attacks? a) Obsessions b) Apathy c) Fever d) Fear of impending doom

Fear of impending doom.

Signs of depression up to age 3

Feeding problems, tantrums, lack of playfulness and emotional expressiveness, failure to thrive, or delays in speech and gross motor development.

Crisis

Feeling helpless to change. Not believing you have resources to deal with precipitating stressor. Levels of anxiety rise to the point that the individual becomes nonfunctional, thought to become obessional, and all behavior is aimed at relief of the anxiety being experienced. The feeling is overwhelming and may affect the individual mentally, emotionally, and physically.

Symptoms of adolescent depression

Feelings of sadness, loneliness, anxiety, and hopelessness may be perceived as the normal emotional stresses of growing up. Common symptoms are inappropriately expressed anger, aggressiveness, running away, delinquency, social withdrawal, sexual acting out, substance abuse, restlessness, apathy, loss of self-esteem, sleeping and eating disturbances, and psychosomatic complaints.

Depersonalization disorder

Feelings of unreality or detachment from environment.

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? a) Eustress b) Fight or Flight c) Resistance d) Exhaustion

Fight or Flight

Maintenance phase of schizophrenia

Final phase of schizophrenia where the person can be out in the community and is compliant with medications, and knows when to call the doctor. They are able to recognize triggers.

Which side effects of lithium can be expected at therapeutic levels? a) Fine hand tremor and polyuria b) Nausea and thirst c) Ataxia and hypotension d) Coarse hand tremor and gastrointestinal upset

Fine hand tremor and polyuria

PTSD

Flashbacks, intrusive recollections, nightmares, psychological numbness related to the event, dissociation, amnesia, anxiety, and anger.

What are the nursing interventions for someone that has disorganized schizophrenia?

Focus on safety. This patient will usually be in an institution.

Severe anxiety

Focuses on one detail with limited attention span. Over behavior is aimed at relieving anxiety. Extended periods of repressed severe anxiety can result in psychoneurotic patterns of behaving. (anxiety disorders, somatoform disorders, and dissociative disorders)

Food to avoid with MAOIs

Food containing tyramine such as aged cheeses, dried fruit, red wine, smoked and processed meats, soy sauce.

Bipolar 1

Full syndrome of manic or mixed syndromes

Anticonvulsants- Mood stabilizers clonazepam (Klonopin), carbamazepine (Tegretol), Valproic acid (Depakote), lamotrigine (Lamictal), topiramate (Topamax), oxcarbazepine (Trileptal)

Give with food or milk for GI upset. May decrease alertness. Regular blood tests. Valproic acid- monitor bleeding time. Lamotrigine- severe rash. Topiramate- decreased effectiveness of birth control. Risk for suicide.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nursing intervention? a) Interacting with a neutral attitude b) Using concrete language c) Giving multistep directions d) Providing nutritional supplements

Giving multistep directions

Which behavior would be characteristic of a client during a manic episode? a) Going rapidly from one activity to another b) Taking frequent rest periods and naps during the day c) Being unwilling to leave home to see other people d) Watching others intently and talking little

Going rapidly from one activity to another

A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displayinga) Flight of ideas b) Distractability c) Limit testing d) Grandiosity

Grandiosity

A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." What term should the nurse use to identify this behavior? a) Flight of ideas b) Distractability c) Limit testing d) Grandiosity

Grandiosity

A crawling feeling on the skin Hearing ordinary sounds that aren't there, like doors closing or footsteps Hearing voices, including those that command a person to do something Seeing lights or patterns A sensation of floating or being outside one's body Smelling an odor for which there is no explanation; this is rare

Hallucinations

John is a client at the mental health clinic. He is depressed, has been expressing suicidal ideations, and has been seeing the psychiatric nurse every 3 days. He has been taking 100 mg of sertraline daily for about a month, receiving small amounts of the medication from his nurse at each visit. Today he comes to the clinic in a cheerful mood, much different than he seemed just 3 days ago. How might the nurse assess this behavioral change?

He may have decided to carry out his suicide plan.

Mrs. X was admitted to your unit with mania. Upon observation you see her taking her clothes off in the dining room. What is the best action?

Help her re-dress and tell her she has to wear her clothes.

What are some key words that indicate a person wants to commit suicide?

Hopeless, worthless, life is not worth living, and they are giving prized gifts away.

Symptoms of childhood depression

Hyperactivity, delinquency, school problems, psychosomatic hyperactivity, delinquency, school problems, psychosomatic complaints, sleeping and eating disturbances, social isolation, delusional thinking, and suicidal thoughts or actions.

Side effects of MAOIs

Hypertensive crisis- foods with tyramine, discontinue med. Rash

The goal of cognitive therapy wit depressed clients is to...

Identify and change dysfunctional patterns of thinking.

Mutism

Inability or refusal to speak.http://coursewareobjects.elsevier.com/objects/ST/lewispre9e/index.html

Disturbed thought processes

Inappropriate thinking, confusion, difficulty concentrating, impaired problem-solving ability, inaccurate interpretation of environment, memory deficit

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to...

Increase energy and elevate mood.

Stimulants

Increases dopamine levels (cocaine/amphetamines). May precipitate dopamine onset.

ECT

Induction of a grand mal seizure through the application of electrical current to brain. Treats suicidal and severe depression. Considered when antidepressant in not working.

Side effects of SSRIs

Insomnia- take in morning. Headache- give analgesic. Weight loss- early in therapy. Sexual dysfunction Serotonin syndrome- discontinue med.

What would a client experience during a progressive relaxation session? a) Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed b) Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter c) Having a nurse enter the client's energy field to rebalance it and bring harmony d) Being led into a positive imaginary sensory experience

Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed

The ultimate goal of therapy for a client with DID is...

Integration of the personalities into one.

Stress

Inviduals reaction to any change that requires an adjustment or response, which can be physical, emotional, or mental.

Dystonia

Involuntary muscle movements of face, arms, legs, and neck.

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a) Makes jokes to relieve tension. b) Makes jokes to relieve tension. c) Justifies illogical ideas and feelings. d) Behaves in ways that are the opposite of his or her feelings.

Justifies illogical ideas and feelings.

In teaching a client about his antidepressant medication, fluoxetine, which of the following would the nurse include?

Keep taking this medication, even if you don't feel it is helping. It sometimes takes a while to take effect. Don't take this medication with the migraine drugs "triptans."

When is the typical onset of schizophrenia?

Late teens or early twenties, although causes of five and six year olds have been reported. Early onset is 18-25 and is poorly controlled. Later onset is 25-35, and if you are a female you most likely will have a better outcome with later onset.

Nursing care for a client with somatic symptom disorder would focus on helping her to...

Learn more adaptive coping strategies.

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse should identify this cognitive distortion as what response? a) Self-blame b) Catatonia c) Learned helplessness d) Discounting positive attributes

Learned helplessness

Moderate anxiety

Less alert. More tense. Assistance with problem may be needed. Muscular tension and restlessness are evident. Anxiety at the moderate to severe level that remains unresolved over an extended period of time can contribute to a number of physiological disorders like migraines, IBS, and cardiac arrhythmias.

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? a) NANDA handbook b) DSM-IV-TR c) Quick Mental Status Assessment d) Life-Changing Event Questionnaire

Life-Changing Event Questionnaire

Dopamine

Linked to motor movement disorders, ADHD, addictions, paranoia, and schizophrenia.

I need your help : Who am I? I'm the first choice of treatment for acute mania . I have to reach therapeutic blood level to be effective ( 7-14 days or longer ) . During the active phase : 300-600 mg by mouth is given two to three times a day to reach therapeutic blood level .8 to 1.4 mEq / L Blood should be drawn 8 to 12 hours after the last dose of me is taken .

Lithium

You should take me with meals to diminish nausea. Sodium depletion and dehydration increase the chance for development of my toxicity . I'm like chlorpromazine , can cause thirst and dry mouth Sugarless gum and adequate fluid intakes will be helpful to the client . You should take me each day to help prevent relapses . Kidney and thyroid check periodically is a must Have a guess .. Who am I?

Lithium

Conversion disorder

Loss in body function related to psych conflict. Affect voluntary or motor function paralysis. Coordination disturbances and halluncinations. Primary and secondary gain. Symptoms manifest around anxiety provoking situation.

Conversion disorder

Loss of or change in body function that can't be explained by any known medical disease.

What would a CT scan show of a patient with schizophrenia?

Lower brain volume and more cerebrospinal fluid. Lower gray matter in frontal and temporal lobes. Atrophy of the brain. Post mortem will show a lot of tissue loss.

stress-related medical condition

Lower immunity Burnout migraine, cluster, or tension headaches hypertension Coronary artery disease Cancer Asthma

My most serious side effect is the increase in the blood pressure with the possible development of intracranial hemorrhage , hyperpyrexia , convulsions , coma , and death. I can cause Hypertensive crisis within a few hours after ingestion of the contraindicated substance and food that contains tyramine . Have a guess .. Who am I?

MAOI

Instruct the client to restrict tyramine if they are taking (blank)

MAOIs

A recent diagnosis of cancer has caused a client severe anxiety. Which of the following interventions should the nurse include in the care plan? Select all that apply. a. Maintain a calm, non-threatening environment b. Explain relevant aspects of chemotherapy c. Encourage the client to verbalize her concerns regarding the diagnosis d. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress e. Provide distractions for the client during periods of stress f. Teach the stages of grieving to the client.

Maintain a calm, non-threatening environment Encourage the client to verbalize her concerns regarding the diagnosis Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress

Riddilin parent education

Maintain a consistent schedule

Nursing interventions for Bipolar client

Maintain low level of stimuli. Close observation for safety issues. Milieu safety. Set limits on manipulative behavior. Don't argue or try to reason with a manic client. They don't get it. Merely state the limits and expectations. Intervene at first sign of agitation to prevent escalation. Maintain calm and non-judgmental attitude toward the client, some are very sexual. Have sufficient staff available for crisis or take down if necessary. Begin to work on positive coping and importance of compliance with meds when patient deemed teachable.

The nurse is planning care for a patient experiencing the acute phase of mania. Which is the priority intervention?

Maintain stable cardiac status.

The most appropriate nursing intervention with Jenny who is afraid to invite her friends over because she says her mother is always drunk is...

Make arrangements for her to start attending Alateen meetings.

A newly admitted depressed client isolates herself in her room ad just sits and stares into space. How best might the nurse being an initial therapeutic relationship with this client?

Make frequent short visits to her room and sit with her.

Schizophrenia is more common in what gender?

Males.

Specific phobia

Marked, persistent, and excessive or unreasonable fear when in the presence of, or when anticipating an encounter with, a specific object or situation.

Ginger, age 19 and an only child, left 3 months ago to attend a college of her choice 500 miles away from her parents. It is Ginger's first time away from home. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called... The most appropriate nursing intervention with Ginger would be to...

Maturational/developmental crisis Work with Ginger on unresolved dependency issues.

Serotonin syndrome

May occur when two drugs that potentiate serotonergic neurotransmission are used concurrently. Symptoms are hypertension, changes in level of consciousness, tachycardia, hyperthermia, and seizures. If on SSRI do not take MAOIs or St. John's wort, tramadol, or stimulants.

What is the most common reason schizophrenic patients return to the hospital?

Medication non-compliance. Ask them, "What do you think will happen if you stop taking your meds? I know this must be difficult for you." Don't say, "I understand exactly how you feel."

Selective inattention is first noted when experiencing which level of anxiety? a) Mild b) Moderate c) Severe d) Panic

Moderate

Bipolar disorder

Mood disorder manifested by cycles of mania and depression.

Medications for Mental Health

Mood stabilizers Antidepressants Antianxieties Neuroleptics

diazepam (Valium)

Most common benzo. Used for anxiety, alcohol withdrawal, reversal status epilepticus, skeletal muscle spasms. Contraindicated with liver problems. Side effects: headache, confusion, slurred speech.

Panic anxiety

Most intense state of anxiety. May experience hallucinations or delusions. Characterized by wild or extreme actions. Can be life threatening. Key nursing intervention is to take control of the situation for the client and keep them safe. Extended periods of functioning at this level may result in psychotic behavior. (schizophrenia, schizoaffective, and delusional disorders)

Which client will probably be at greatest risk for experiencing untoward effects of stress ? A. Mr. A, who sought medical help for his stress-related symptoms and follows a regimen of medication, proper diet, and rest. B. Mr. B, who finds much satisfaction in implementing highly creative innovations in his work. C. Mr. C, who can depend on the interested support of family, friends, and co-workers. D. Mr. D, who chooses not to deal with the stress-producing situation

Mr. D who chooses not to deal with the stress - producing situation .

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?

Ms. T stays in her home for fear of being in a place from which she cannot escape.

Identity disorder

Multiple personality disorder. Various degrees in incapacity. May or may not be aware of other personalities. Usually has one dominant personality. Again emerges with stress. Associated with history or trauma like rape.

Lorraine has been diagnosed with somatic symptom disorder. Which of the following symptom profiles would you expect when assessing Lorraine?

Multiple somatic symptoms in several body systems.

Akinesia

Muscular weakness

Have a guess .. Who am I ? l'm a type of psychotic symptoms I render the person inert and unmotivated . People are usually do not care about me , they thought that I'm nice but in fact .... I'm not My symptoms are : anhedonia , apathy , lack of motivation and lack of thought process .

Negative Schizophrenia Symptoms

Beck's cognitive theory suggests that the etiology of depression is related to what factor? a) Sleep abnormalities b) Serotonin circuit dysfunction c) Negative processing of information d) A belief that one has no control over outcomes

Negative processing of information

Nina has been hospitalized with adjustment disorder with depressed mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder?

Nina's symptoms will likely remit once she has accepted the change in her life.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client will demonstrate what behavior? a) Poor retention of recent events b) A weight loss from anorexia c) No pleasure from previously enjoyed activities d) Difficulty with tasks requiring fine motor skills

No pleasure from previously enjoyed activities

Crisis of anticipated life transitions

Normal life-cycle transitions that may be anticipated but over which the individual may feel a lack of control.

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? a) Having the client repeatedly touch "dirty" objects b) Not allowing the client to seek reassurance from staff c) Not allowing the client to wash hands after touching a "dirty" object d) Telling the client that he or she must relax whenever tension mounts

Not allowing the client to wash hands after touching a "dirty" object

Prenatal risk factors for schizophrenia

Older fathers. Lack of oxygen to fetus, viral infections, and exposure to toxins. Low thyroid levels can worsen symptoms.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? a) Onset of action is from 1 to 3 weeks or longer. b) They tend to be more effective for men. c) Recent memory impairment is commonly observed. d) They often cause the client to have diurnal variation.

Onset of action is from 1 to 3 weeks or longer.

How do you communicate with anxious patients?

Open communication, encouragement, encourage activities, encourage problem solving, stay with patient during acute panic

Affect

Outward manifestation of emotion.

During the nurse's psychosocial assessment of a patient experiencing anxiety, the patient states: "I keep reliving the accident". This indicates the possibility of.

PTSD or acute stress disorder

Clinical manifestations of Panic

Palpitations, trembling, sweating, chest pain, SOB, feat of going crazy, fear of dying, excessive worry, difficulty concentrating, and sleep disturbance.

A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result? A. Mild B. Moderate C. Severe D. Panic

Panic

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? a) Panic attacks with agoraphobia b) Obsessive-compulsive disorder c) Post-traumatic stress response d) Generalized anxiety disorder

Panic attacks with agoraphobia

Delusionsionary thinking is a characteristic of which form of anxiety? a) Chronic anxiety b) Acute anxiety c) Severe anxiety d) Panic level anxiety

Panic level anxiety

What stage of anxiety does a crisis represent?

Panic stage

The relaxation response calls upon the initiation of what process? a) Sympathetic activation b) Parasympathetic activation c) Brainstem deactivation d) Increased cortisol production by the adrenals

Parasympathetic activation

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regiments would most appropriately be ordered for John?

Paroxetine and group therapy.

The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? Select all that apply:

Patient identifies three signs and symptoms of relapse. Patient describes the purpose of each medication he has been prescribed. Patient identifies two ways to problem-solve a specific situation.

Generalized anxiety disorder

Persistant and chronic anxiety and worry for 6 months or longer. Norepinephrine abnormalities is seen with panic disorder. Also low levels of serotonin and GABA are seen with this disorder.

Prodromal phase of schizophrenia

Phase 1 of schizophrenia. When the person is off to themselves. Isolative behaviors. Not threatening.

Somatizatiom

Physical symptoms suggesting medical disease, but without demonstrable organic pathology or no physical reason to cause the complaint. It is a strong presumption that psychological factors are the major cause of the symptoms.

Hypochondriasis

Preoccupation with a disease or body part. MD shopping. Anxiety and depression are common. Adamantly irritated and reject psych role in their condition. May even get upset by reading about a disease and think they have it.

With implosion therapy, a client with phobic anxiety would be..

Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

What is PACT?

Program of assertive community treatment. This is community treatment for those with chronic disease. The goals are to enhance the quality of life of the patient and help them live independently to lessen the family's burden of providing care.

A client diagnosed with substance dependence states to the nurse , " My wife causes me to abuse methamphetamines . She uses and expects me to . " The client is using which defense mechanism ? a . Rationalization b . Denial c. Reaction formation d . Projection

Projection

The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? a. Provide consistency among staff members when working with the patient. b. Negotiate limits so the patient has a voice in the plan of care. c. Allow only certain staff members to interact with the patient. d. Attempt to control the patient's emotions

Provide consistency among staff members when working with the patient.

Margaret, age 68, is diagnosed with bipolar 1 disorder, current episode manic. She is extremely hyperactive and has not lost weight. One way to promote adequate nutritional intake for Margaret is to:

Provide high-calorie, nutritious finger foods and snacks that Margaret can eat "on the run."

Somatization disorder

Psychological needs expressed in the form of physical symptoms. Symptoms may be vague, dramatized, or exaggerated in presentation.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with which term? a) Senile dementia b) Hypertensive crisis c) Psychomotor agitation d) Central serotonin syndrome

Psychomotor agitation

The ultimate goal of therapy for a client with DID is most likely achieved through...

Psychotherapy and hypnosis

A client experiencing a manic episode neters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse?

Quietly walk with her back to her room and help her change into something more appropriate.

When a client experiences four or more mood episodes in a 12-month period, which term is used to describe this behavior? a) Dyssynchronous b) Incongruent c) Cyclothymic d) Rapid cycling

Rapid cycling

A person who recently gave up smoking and now talks constantly about how smoking fouls the air , causes cancer , " burns " money that could be better spent to feed the poor , and so forth is using a Denial b . Displacement C. Rationalization d . Reaction Formation

Reaction formation

Nursing interventions for manic episode

Recognize the purpose manipulative behaviors serve for the client: to reduce feelings of insecurity by increasing feelings of power and control. Set limits on manipulative behaviors. Do not argue, bargain, or try to reason with the client. Provide positive reinforcement for nonmanipulative behaviors. Help the client recognize that he or she must accept consequences of own behaviors and refrain from attributing them to others. Help client identify positive aspects about self, recognize accomplishments, and feel good about them.

The most common course of schizophrenia is an initial episode followed by what course of events? a) Recurrent acute exacerbations and deterioration b) Recurrent acute exacerbations c) Continuous deterioration d) Complete recovery

Recurrent acute exacerbations and deterioration

Bipolar 2

Recurrent bouts of depression with hypomania

OCD

Recurrent obsessions or compulsions that are severe enough to be time consuming or to cause marked distress or significant impairment. Repetitive behaviors relieve anxiety. Don't force clients to stop behaviors; instead let them observe them, but wean them off slowly.

An obsession is defined as a. Thinking of an action and immediately taking the action. b. A recurrent, persistent thought or impulse. c. An intense irrational fear of an object or situation. d. A recurrent behavior performed in the same manner.

Recurrent, persistent thought or impulse

A client tells the nurse " My doctor thinks my problems with stress relate to the negative way think about things , and he wants me to learn a new way of thinking . " The nurse should be prepared to help the client understand and apply a cognitive technique called : A. Priority restructuring. B. Reframing/restructuring. C. Guided imagery. D. Assertivene

Reframing / restructuring

An 11 year old child who's father died recently asks his mother for help with picking out clothes for the day and zipping his coat . This behavior is an example of : a . Regression b . Displacement c. Denial d . Sublimation

Regression

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that...

Relieves her anxiety,

A 20 - year - old was sexually molested at age 10 years by an older man but can no longer remember the incident . The ego defense mechanism in use is... A. Repression B. Projection C. Reaction Formation D. Displacememnt

Repression

Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder?

Repression of anxiety

Crisis intervention

Requires problem-solving skills that are often diminished by the level of anxiety accompanying disequilibrium.

What is the priority nursing diagnosis for a hyperactive manic client during the acute phase of treatment? a) Risk for injury b) Ineffective role performance c) Risk for other-directed violence d) Impaired verbal communication

Risk for injury

Margaret, a 68-year old widow, is brought to the emergency room by her sister-in-law. Margaret has a history of bipolar disorder and has been maintained on medication for many years. Her sister-in-law reports that Margaret quit taking her medication a few months ago, thinking she didn't need it anymore. She is agitated, pacing, demanding, and speaking very loudly. Her sister-in-law reports that Margaret eats very little, is losing weight, and almost never sleeps. "I'm afraid she's going to just collapse!" Margaret is admitted to the psych unit. The priority nursing diagnosis for Margaret is...

Risk for injury related to hyperactivity.

Margaret, age 68, is a widow of 6 months. Since her husband died, her sister reports that Margaret has become socially withdrawn, has lost weight, and does little more each day than visit the cemetary where her husband was buried. She told her sister today that she "didn't have anything more to live for." She has been hospitalized with major depressive disorder. The priority nursing diagnosis for Margaret would be...

Risk for suicide

Ellen has a history of childhood physical and sexual abuse. She was diagnosed with dissociative identity disorder (DID) 6 years ago. She has been admitted to the psych unit following a suicide attempt. The primary nursing diagnosis for Ellen would be...

Risk for suicide related to unresolved grief.

Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemia medication daily. She has become very depressed and her mother reports that Carol refuses to change her diet and often skips her meds. Carol has been hospitalized for stabilization of her blood sugar. The psych nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time?

Risk-prone health behavior related to denial and seriousness of her illness as evidenced by refusal to follow diet and take medication.

Ineffective coping

Ritualistic behavior, obsessive thoughts, inability to meet basic needs, and severe level of anxiety.

Can you help me remember who am I ? I'm the safest medication and the first line of R/ used to treat anxiety disorders . I don't cause tolerance have fewer problematic side effects than other classes .

SSRI

I'm a class of medications . l'm specific to serotonin and have little or no ability to block muscarinic and other receptors . I have fewer autonomic effects than the Tricyclic drugs . I do not cause as much sedation or have cardiac toxicity . I'm faster in action than TCAs .I need your help : Who am I

SSRI

The nurse is planning care for a patient with depression who will be discharged to home soon. What aspects of teaching should be the priority on the nurse's discharge plan of care?

Safety Risk

An outpatient psychiatric nurse assesses a patient diagnosed with hoarding disorder. The patient has lost 12 pounds in the past two months, appears disheveled, and is wearing dirty clothing with poor hygiene. What is the nurse's priority action? A. Review the patient's medication regimen. B. Ask the patient, "What types of foods have you been eating?" C. Refer the patient to a psychologist for cognitive behavioral therapy (CBT). D. Schedule a home visit to assess the safety of the patient's living conditions.

Schedule a home visit to assess the safety of the patient's living conditions.

Can you help me remember who I am ?? I'm a devastating brain disease that affects a person's thinking , language , emotions , social behavior , & ability to perceive reality . One of My main symptom is auditory hallucinations . People having me avoid relationships because they feel anxious with emotional closeness .

Schizophrenia

Acute or schizophrenic phase

Second phase of schizophrenia where the person is a threat to others or to themselves.

Clozaril

Seizures, agranulocytosis, and hypersalivation are frequently associated with this antipsychotic medication. A baseline WBC count must be taken before starting and weekly for the first 6 months of treatment. Only a one-week supply of medication is dispensed at a time.

Mild anxiety

Seldom a problem. Heightened awareness. Some coping responses include eating, drinking, sleeping, physical exercise, smoking, crying, laughing, and talking to people with whom they feel comfortable.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal what characteristic? a) Good memory and concentration b) Delusions of persecution c) Self-deprecatory ideation d) Sexual preoccupation

Self-deprecatory ideation

Delirium is commonly associated with what medical diagnosis?

Sepsis. Make sure to get a WBC count when someone comes to the ED. Low oxygen saturation can also cause delirium, such as patients with COPD.

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore. " In light of this change, which nursing intervention is most appropriate?

Set limits on the amount of time Sandy may engage in the ritualistic behavior.

Pain disorder

Severe pain that interferes with work or social functioning. Frequent visits to doctor. Symptoms of depression are evident. Dependence on addictive substances. They manifest themselves as primary (avoidance), secondary (attention/support), or tertiary (family) gains. Manifests when they want to get out of something or gain attention. Drug abuse related to prescriptions not street drugs.

Which of the following may be influential in the predisposition to PTSD?

Severity of the stressor and availability of support systems.

Lorraine, a client diagnosed with somatic symptom disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the basis for Lorraine's statement?

She doesn't understand the correlation of symptoms and stress.

Cogentin

Should be administered if patient is experiencing EPS symptoms from taking an antipsychotic medication.

A client has just been admitted to he psych unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess?

Slumped posture, delusional thinking, feelings of despair, anorexia.

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? a) social support b) cultural support c) life satisfaction d) cognitive reframing

Social support

A client has reached the stable plateau phase of schizophrenia. What is the appropriate clinical planning focus for this client? a) Safety and crisis intervention b) Acute symptom stabilization c) Stress and vulnerability assessment d) Social, vocational, and self-care skills

Social, vocational, and self-care skills

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to...

Stay with John and reassure him of his safety.

A client who is experiencing a panic attack has just arrived at the ER. Which is the priority nursing intervention for the client?

Stay with the client and reassure of safety.

Eustress

Stress that produces from positive experiences this can cause as much anxiety as a negative stressor

Dopamine

Strongly influences thinking and motor movement in the brain. Low levels produce Parkinson's and high levels cause you to be excited, suspicious, paranoid, have delusions, and hallucinate.

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions?

Structure the client's schedule so that she has plenty of time for washing her hands.

A client reports becoming involved with legislation that promotes gun safety after the death of a child by accidental shooting . Which defense mechanism is the client exhibiting ? a. Sublimation b. Identification c. Regression d. Repression

Sublimation

substance/medication induced anxiety disorder

Substances that can induce an anxiety disorder: alcohol, caffeine, cannabis, hallucinogens (including PCP), inhalants, opioids, sedatives, hypnotics and anxiolytics, and stimulants (including cocaine)

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? a) Suddenly tremble severely b) Exhibit stoic behavior c) Report both nausea and vomiting d) Laugh inappropriately

Suddenly tremble severely

Psychiatric emergencies

Suicidal or homicidal people. Overdose. Uncontrollable anger. Alcohol intoxication.

Andrew, a NYC firefighter, and his entire unit responded to the terrorist attacks at the WTC. Working as a team, he and his best friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured, but survived. Since that time, Andrew has frequent nightmares and anxiety attacks. He says to the mental health worker, "I don't know why Carlo had to die and I didn't?" This statement by Andrew suggests that he is experiencing... Intervention with Andrew would include...

Survivor's guilt Anti-anxiety meds, encouraging expression of feelings, participation in a support group.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John?

Survivor's guilt.

Senescence

Symptoms are not very different from those of younger adults, however, depressive syndromes are often confused by other illnesses associated with the aging process. They are often misdiagnosed as senile dementia, when in fact the memory loss, confused thinking, or apathy symptomatic of dementia actually may be a result of depression.

Lithium toxicity

Symptoms begin to appear at blood levels greater than 1.5. Will have blurred vision, ataxia, tinnitus, persistant nausea, an vomiting that can progress to impaired consciousness, nystagmus, seizures, or coma. Thiazide diuretics, ACE inhibitors, and NSAIDS can increase toxicity level.

Neuroleptic malignant syndrome

Symptoms include severe parkinsonian muscle rigidity, very high fever, tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma. Discontinue med immediately. Administer Parlodel or Dantrium.

Negative symptoms of schizophrenia

Symptoms of schizophrenia that are absent but should be present. Patient will be inert and unmotivated. May have a bland of flat affect, apathy, and emotional ambivalence.

Positive symptoms of schizophrenia

Symptoms of schizophrenia that are present but should be absent. Includes hallucinations, delusions, bizarre behavior, and derealization.

Onset, peak, and duration of postpartum depression

Symptoms usually begin within 48 hours of delivery, peak at about 3-5 days, and last approximately 2 weeks.

I'm a type of antidepressants my side effects include: Drowsiness , dizziness , and postural hypotension which usually subside after the first few weeks of therapy . You can manage the postural hypotension by teaching the client to stay well hydrated and rise slowly You should take me at night time. Have a guess ... Who am I?

TCA

Lithium patient teaching

Take on regular basis, even when feeling well. Do not drive until lithium levels are stabalized. Do not skimp on dietary sodium intake. Drink 6-8 large glasses of water a day and avoid excessive caffeine. Notify doctor of vomiting or diarrhea since these can cause sodium loss. Carry card saying you are taking lithium.

Which side effect of antipsychotic medication is generally nonreversible? a) Anticholinergic effects b) Pseudoparkinsonism c) Dystonic reaction d) Tardive dyskinesia

Tardive dyskinesia

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? a) Schedule the client to attend group therapy that includes those who have relapsed. b) Teach the client and family about behaviors associated with relapse. c) Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse. d) Help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

Teach the client and family about behaviors associated with relapse.

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse? a) Schedule the client to attend group therapy that includes those who have relapsed. b) Teach the client and family about behaviors associated with relapse. c) Remind the client of the need to return for periodic blood draws to minimize the risk for Relapse. d) Help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

Teach the client and family about behaviors associated with relapse.

Symptoms of maternity blues

Tearfulness, desponsdency, anxiety, and subjectively impaired concentration.

A child with bipolar disorder also had ADHD. How would these co-morbid conditions most likely be treated?

The bipolar condition would be stabilized first before medication for the ADHD would be given.

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid PRN. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for the medication?

The client develops tremors and a shuffling gait.

Select the best example of altruism. A. After recovering from a gunshot wound, a police officer attends a local support group. B. After recovering from open heart surgery, an individual plays tennis three times a week. C. An individual who received a liver transplant volunteers at a local organ procurement agency. D. An individual with a long-standing fear of animals volunteers at a community animal shelter.

The correct answer could either be C or D C. An individual who received a liver transplant volunteers at a local organ procurement agency. D. An individual with a long-standing fear of animals volunteers at a community animal shelter.

PTSD

The development of characteristic symptoms following exposure to an extreme traumatic stressor involving a personal threat to physical integrity or to the physical integrity of others.

The desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety is...

The individual will maintain anxiety at a manageable level.

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? a) The individual's perception of the event b) The individual's degree of spirituality c) The effect of the individual's health-sustaining behaviors d) The amount of social support available to the individual

The individual's perception of the event

The nurse is planning care for a patient with an eating disorder. What outcomes are appropriate? Select all that apply?

The patient will experience a decrease in depression. The patient will identify methods to control anxiety. The patient will identify two people to contact if suicidal thoughts occur.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on which information? a) No research exists to suggest genetic transmission. b) Much depends on the socioeconomic class of the individuals. c) Highly creative people tend toward development of the disorder d) The rate of bipolar disorder is higher in relatives of people with bipolar disorder

The rate of bipolar disorder is higher in relatives of people with bipolar disorder

Dissociation

The splitting off of clusters of mental contents from conscious awareness, a mechanism central to hysterical conversion and dissociative disorder.

The parent of an adolescent recently diagnosed with schizophrenia says to the nurse, "This is entirely my fault. I should have spent more time with my child when he was a toddler." Which response by the nurse is correct? A. "Schizophrenia is genetically transmitted, so it was not in your control." B. "Your child's disorder is more likely the result of an undetected head injury." C. "Environmental toxins are directly implicated in the origins of schizophrenia." D. "Lack of prenatal care causes schizophrenia rather than early childhood events."

The textbook identifies "a" as the correct choice, but although there is a connection with genetics and schizophrenia it is not 100% as was presented in answer a. Although schizophrenia is a biological disorder, it may not always be caused by genetics and there is a combination of factors (see page 14) that could have caused the disorder. It would have been more appropriate to state to the parent that as science has developed in the field of schizophrenia, there is enough evidence to support that it is "no-fault" illness and that it is result of a combination of many factors

Signs of depression from age 6-8

There may be vague physical complaints and aggressive behavior. They may cling to parents and avoid new people and challenges. They may lag behind their classmates in social skills and academic competence.

Atypical antipsychotics

These drugs produce minimal side effects. They treat positive and negative symptoms. They may improve neurocognitive defects and decrease affective symptoms. They cause weight gain, glucose deregulation, hypertension, and decreased self-esteem related to weight gain.

Typical antipsychotics

They antipsychotics are less expensive but more prone to causing EPS symptoms.

Purpose of depression drugs

They improve mood and work to increase the brain's concentration of serotonin, dopamine, norepinephrine by blocking their reuptake.

Generally, which statement regarding ego defense mechanisms is true? a) They often involve some degree of self-deception. b) They are rarely used by mentally healthy people. c) They seldom make the person more comfortable. d) They are usually effective in resolving conflicts.

They often involve some degree of self-deception.

Associate looseness

Thinking characterized by speech in which ideas shift from one unrelated subject to another.

Stabilization phase of schizophrenia

Third phase of schizophrenia where the person needs to go to the hospital and get stabilized on medications.

verapamil (Calan, Isoptin)

This is a calcium channel blocker also used as a mood stabilizer. Decreased alertness. Take vital signs before taking. Give with food to minimize GI upset. Encourage fluids and fiber.

Hyperglycemia and diabetes

This is a common adverse reaction of taking atypical antipsychotics. Clients with risk factors should undero fasting blood glucose test at beginning of treatment and periodically after starting.

A nurse is educating a client about his lithium therapy. She is explaining the signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for?

Tinnitus, severe diarrhea, ataxia

A charge nurse is discussing mental status exams with a new nurse. Which statement made by the new nurse indicates more teaching?

To assess remote memory, I should have the client repeat a list of objects." -this is appropriate to assess immediate memory not remote

The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg cholorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered?

To decrease psychotic symptoms.

The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is

To determine if the anxiety is of primary or secondary origin.

The primary focus of family therapy for clients with schizophrenia and their families is...

To promote family interaction and increase understanding of the illness.

Pseudoparkinsonism

Tremors, shuffling gait, drooling, rigidity.

Anxiety Bipolar disorder Depression Eating disorders Obsessive-compulsive disorder Personality disorders Post Traumatic Stress Disorder (PTSD) Psychosis Schizoaffective disorder Schizophrenia Self harm Suicide

Types of mental health disorders

Education for the client who is taking MAOIs should include which of the following?

Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification.

Algonia

Unable to speak -Mental Health

Self-care deficit

Uncombed hair, dissheveled clothing, offensive body odor.

Oculogyric crisis

Uncontrolled rolling back of the eyes.

Fugue

Unexpected travel away from home. Does not act abnormal. Assumed identity may be simple and uncomplicated. Confused and frightened when they come out of it. Usually picked up by police or taken to ER. Quick recovery but have no memory of their fugue state.

Illness anxiety disorder

Unrealistic or inaccurate interpretation of physical symptoms or sensations, leading to preoccupation and fear of having a serious disease.

Postpartum depression

Varies from feelings of the "blues" to moderate depression, to psychotic depression or melancholia.

The category of adjustment disorder with disturbance of conduct identifies the individual who...

Violates the rights of others to feel better.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to implement which intervention? a) Waiting quietly for the client to reply b) Prompting the client if the reply is slow c) Repeating the question if the client does not answer promptly d) Reviewing the client's medical record to support the client's response

Waiting quietly for the client to reply

Imbalanced nutrition: less than body requirements

Weight loss, poor muscle tone, pale conjunctiva and mucous membranes, poor skin turgor, weakness

Delusion of persecution

When a patient feels threatened and believes that others intend to harm or persecution toward him or her in some way.

Neologisms

When a psychotic person invents new words that are meaningless to others by having symbolic meaning to the psychotic person. As a nurse you should seek clarification, such as asking what the word means to them.

Panic

When stress or stressful situations drive an individual to disequalibriation.

Delusion of control or influence

When the patient believes a certain object or person have control over his or her behavior.

Circumstantiality

When the patient delays in reaching the point of a communication because of unnecessary and tedious details.

Somatic delusion

When the patient has a false idea about the functioning of his or her body.

Nihilistic delusion

When the patient has a false idea that the self, a part of the self, others, or the world is nonexistent.

Delusion of grandeur

When the patient has an exaggerated feeling of importance, power, knowledge, or identity.

Tangentiality

When the patient never really gets to the point of the communication.

Perseveration

When the patient persistently repeats the same work or idea in response to different questions.

Amnesia

When you can't recall important information. Usually appears alert and gives no indication to observers that something is wrong. Onset of amnesic episode usually follows severe stress.

Social isolation/impaired social interaction

Withdrawn, uncommunicative, seeks to be alone, dysfunctional interaction with others, discomfort in social situations.

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? a) Withhold medication and notify the physician. b) Continue to administer medication as ordered. c) Advise the client to limit fluids for 12 hours. d) Advise the client to curtail salt intake for 24 hours.

Withhold medication and notify the physician.

What do you do when lithium levels are not within normal range?

Withhold the dose.

What are the nursing interventions for someone with catatonic schizophrenia?

Work towards meeting basic self-care needs because this disease is characterized by extreme psycho-motor retardation. Watch for a change in behavior in four to five days. Promote self-care.

Nursing interventions for ineffective coping

Work with the client to determine the types of situations that increase anxiety and result in ritualistic behaviors. Initially meet the client's dependency needs as required. In the beginning of treatment, allow plenty of time for rituals. Support the client's efforts to explore the meaning and purpose of the behavior. Provide a structured schedule of activities for the client, including adequate time for completion of rituals. Gradually begin to limit the amount of time alotted for ritualistic behaviors as the client becomes more involved in other activities. Help the client learn ways of interrupting obsessive thoughts and ritualistic behaviors with techniques such as thought-stopping, relaxation techniques, or physical exercise.

The client sees no connection between her liver disorder and her alcohol intake . She believes that she drinks very little and that her family is making something out of nothing . The nurse interprets these behaviors as indicative of the client's use of which of the following defense mechanism ?

a Denial b . Displacement C. Rationalization d . Introjection

posttraumatic stress disorder (PTSD)

a disorder characterized by haunting memories, nightmares, social withdrawal, jumpy anxiety, numbness of feeling, and/or insomnia that lingers for four weeks or more after a traumatic experience

Delirium tremens

a disorder involving sudden and severe mental changes or seizures caused by abruptly stopping the use of alcohol

Conversion Example a. a man can become ill when he sees his wife with someone else; students can develop terrible anxiety, preventing them from taking their finals b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. woman says she doesn't want the pregnancy but then when gives birth says she is in love with the baby and it's the best thing to happen to her

a man can become ill when he sees his wife with someone else; students can develop terrible anxiety, preventing them from taking their finals

mania

a mood disorder marked by a hyperactive, wildly optimistic state

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a) a neologism. b) clang association. c) blocking. d) a delusion.

a neologism

Which of the following is an example of a patient who requires emergency admission to a mental health facility?

a pt w/ borderline personality disorder who assaulted a homeless man with a metal rod -this is an emergency b/c he is a danger to himself and others

A nurse decides to put a pt in seclusion over night d/t being under-staffed, and the pt. fights with other pts. This is an example of what?

a tort -this is violating a civil right; this is false imprisonment

Repression Example a. providing grieving consultations with others while you are also grieving over the death of your husband b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. substituting socially appropriate behavior in place of inappropriate thoughts/behavior

a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood

A nurse is caring for a pt who is experiencing extreme mania d/t bipolar disorder. Prior to giving lithium carbonate, the nurse notes that the lithium blood level is 1.2 mEq/L. What is an appropriate action of the nurse?

administer the next dose of lithium carbonate as scheduled -during a manic episode the lithium blood level should be btw 0.8-1.4 mEq/L, so administering the next dose is ok

My symptoms include sore throat , fever , malaise , and mouth sores . Blood work usually done every week for six months and then every two months . I'm a serious side effects of antipsychotics and can be fatal . Have a guess ... Who am I

agranulocytosis

generalized anxiety disorder

an anxiety disorder in which a person is continually tense, apprehensive, and in a state of autonomic nervous system arousal sxs restless "on edge" Shaking Palpations Dry mouth N/V Hot flashes Chills Polyuria Hyper vigilance

Anxiety

an uncomfortable feeling of dread that occurs from prolonged periods of stress

A client, age 18 years, is referred to the mental health center by the primary care physician. The following history is given. The client and her mother began to visit colleges to which the client had applied. When not traveling, the client spent the summer cooking gourmet meals for her family. Eventually, the mother noticed that the client was eating only tiny portions of the food, saying she wasn't hungry because she had tasted while she cooked. At summer's end the client had a physical examination for the school sports program. Her weight had dropped from 130 to 95 pounds and she had amenorrhea. The history and symptoms are most consistent with the medical diagnosis of

anorexia nervosa.

I'm a drug that block the cholinergic activity in the CNS . They used me to relieve drug induced extra pyramidal adverse effects such as muscle weakness , involuntary muscle movement , pseudo parkinsonism , and tardive dyskinesia . Have a guess ... Who am I

anticholinergics

(blank) should be used only on a short-term basis because of addiction and dependency develop easily

anxiolytics

A nurse is talking to a pt w/ schizophrenia when he suddenly stops focusing on the nurse's questions and begins to look at the ceiling and talk to himself. What action should the nurse take?

ask the client, "Are you seeing something on the ceiling?" -ask the pt directly about the hallucination to identify client needs and assess potential risk for injury

A nurse is giving therapy with several pts and families. Effective communication with pts and families is based on what?

attending to verbal and nonverbal behaviors

Health teaching of patients taking anti-anxiety include (blank), (blank), and (blank)

avoid alcohol avoid caffeine avoid driving a car

I'm a class of medications that is used to treat anxiety disorders . If you take me , you have to avoid alcoholic beverages . I should be taken on a short term basis because I can cause addiction and dependency . I need your help : Who am I ?

benzodiazepines

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes a) biofeedback b) guided imagery c) therapeutic touch d) assertive training

biofeedback.

The nursing care plan contains the direction "observe for refeeding syndrome." The nurse should closely monitor for complications associated with

cardiovascular dysfunction

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? a) Guided imagery b) cognitive re-framing c) wishful thinking d) confrontational assertion

cognitive re-framing

The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that includes with characteristics? a) Dark colored and modest b) colorful and outlandish c) Compulsively neat and clean d) ill-fitted and ragged

colorful and outlandish

I'm a type of anxiety disorders I'm a kind of ritualistic behaviors that the individual feels driven to perform in an attempt to reduce anxiety . Have a guess ... Who am I ?

compulsions

Which defense mechanism ? A woman who is very jealous of co - workers says , " Oh , yes , she won the award . Those awards don't mean anything anyway , and I wonder what she had to do to be chosen . "

de-evaluation

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is a) assertiveness b) journal keeping c) deep breathing d) restructuring and setting priorities

deep breathing.

Agoraphobia

delete

A man reacts to news of the death of a loved one by saying , " No , I don't believe you . The doctor said he was fine " . Which defense mechanism is he using ?

denial

A client who asked for and was refused a request to leave the work left the manager office and went to his room , where he Kicked the wall . Which defense mechanism did he use ?

displacement

A withdrawn client is assessed as having distorted thinking that is not reality based . A nursing diagnosis that should be considered for her would be

disturbed thought processes

Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille?

duloxetine (Cymbalta)

generalized anxiety disorder

excessive worrying, or free-floating anxiety, that lasts and cannot be attributed to any single identifiable source

Hallucinations

false sensory experiences, such as seeing something in the absence of an external visual stimulus

Delusions

fixed but patently false beliefs despite proof of contrary

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe?

fluoxetine (Prozac)

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat a) avocado salad plate. b) fruit and cottage cheese plate. c) kielbasa and sauerkraut. d) liver and onion sandwich.

fruit and cottage cheese plate.

Undoing Example a. when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves b. if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem c. giving a flower to his wife to make up for what he did d. when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

giving a flower to his wife to make up for what he did

The patient is Seeing a little girl in the corner, when no children are allowed on the unit and you see no child

hallucination

mild anxiety

heightened perceptual field; slight discomfort, mild tension relieving behavior; this can be healthy and pushes us to be successful

A man goes to an interview that means a great deal to him He is being interviewed by the top executive of the company . He has recently had foot surgery and , on entering the interview room , he stumbles and looses his balance . There is a stunned silence , and then the man states calmly , " I was hoping I could put my best foot forward . " With everyone laughing , the interview continuing in a relaxed manner . Which defense mechanism did he use ?

humor

A nurse on an outpatient mental health clinic is preparing for an initial client interview. While conducting the interview what is of highest priority?

identify the client's perception of her mental health status -assessment is priority action using the nursing process approach, identifying the pt's information provides key info for the psychosocial hx

Devaluation Example a. when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves b. if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem c. mother who saw her son being run over by a car, later says they don't remember what happened d. when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem

Anhedonia

inability to experience pleasure

A nurse is caring for a pt on a mental health unit. The pt reports hearing voices that say "kill your doctor." What is the priority action that the nurse should take?

initiate one-to-one observation of the client

Intellectualization Example a. 8 year old girl dresses up like her teacher and pretends like she is going to teach b. instead of helping their little ones emotionally after their wife dies, they think about only the cold facts and nothing emotionally c. taking fetal position during sleeping - turning to childlike pattern of behavior for comfort, for example d. you know what you are doing; you say you will deal with it later, or after your exam

instead of helping their little ones emotionally after their wife dies, they think about only the cold facts and nothing emotionally

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all) a) insulin resistance b) a high resting heart rate c) digestive problems d) obesity

insulin resistance & obesity

Social Anxiety Disorder

intense fear of social situations, leading to avoidance of such

A charge nurse is doing a class about therapeutic communication to new nurses. Which statement, made by a new nurse, requires more teaching regarding nonverbal communication?

intonation -this is the tone of one's voice

Phobia

irrational fear

What is the first-line drug used to treat mania? a) lithium carbonate b) carbamazepine c) lamotrigine d) clonazepam

lithium carbonate

Displacement Example a. providing grieving consultations with others while you are also grieving over the death of your husband b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. woman says she doesn't want the pregnancy but then when gives birth says she is in love with the baby and it's the best thing to happen to her

man comes home and yells at wife, wife yells at kid, kid kicks the dog

lithium

medication for Bipolar Disorder

Abuse

misuse, excessive or improper use. May refer to substances or individuals

A nurse is planning for a pt. with a mental health disorder. What is appropriate to include as a psychobiological intervention?

monitor for adverse effects of meds

Dissociation Example a. when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves b. if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem c. mother who saw her son being run over by a car, later says they don't remember what happened d. when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

mother who saw her son being run over by a car, later says they don't remember what happened

moderate anxiety

narrow perceptual field; grasp less of what is going on; can attend to more if pointed out by another (selective inattention)

My symptoms include decreased LOC & autonomic dysfunction , including hyperpyrexia , tachycardia , diaphoresis , and drooling . I'm a life threatening side effects I'm a syndrome that occurs in 1 % of individuals previously on antipsychotic Have a guess ... Who am I

neuroleptic malignant

A nurse is talking to a new pt. What is a barrier to therapeutic communication?

offering advice

Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder?

olanzepine (Zyprexa) carbamazepine (Tegretol) lamotrigine (Lamictal)

I'm one of the positive symptoms of schizophrenia . The patient who has me may believe that his food is poisoned so you have to offer him / her foods in a sealed container .Have a guess ... Who am I

persectory delusion

A nurse is working on a mental health flood and is admitting a pt w/ MDD and comorbid anxiety disorder. What is of highest priority for the nurse to do?

place the client on one-to-one observation

A nurse is making a home visit to a pt w/ late stage Alzheimer's. The pt's primary caregiver, the spouse, wants to discuss concerns about the pt's nutrition and the stress of providing care. What is an appropriate action of the nurse?

provide information on resources for respite care -this will give the caregiver a break once and a while

Altruism example a. providing grieving consultations with others while you are also grieving over the death of your husband b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. substituting socially appropriate behavior in place of inappropriate thoughts/behavior

providing grieving consultations with others while you are also grieving over the death of your husband

I need your help : Who am I I'm a side effects of antipsychotic medications . I frequently appear within the first month of treatment My symptoms are : shuffling purposeless gait , a mask like face , slurred speech and drooling .

pseudoparkinsonism

Meditation is successful in promoting stress reduction because it brings about which outcome? a) prevents endorphin release b) changes the client's energy field c) quiets the sympathetic nervous system d) activates the parasympathetic nervous system

quiets the sympathetic nervous system

Which defense mechanism? Alice viewed her therapist as the most wonderful loving , and insightful therapist she had ever had . When her therapist refused to write her a prescription for Valium , Alice shouted at her that she was the " Stupidest , most uncaring , and thickheaded person and she demanded another therapist " right away " .

reaction formation

panic disorder

recurrent unexpected panic attacks

I'm one of the positive symptoms of schizophrenia . The patient who has me always misinterpret the action of others .... For ex . The patient may believe " If two people are talking . so they definitely talk about me ... the people in the T.V. are referring to me " Have a guess, who am I?

referential delusions

A nurse is talking to a pt on the mental health facility. The pt says, "I can't sleep. I stay up all night." The nurse says, "You are having difficulty sleeping?" What therapeutic communication technique is the nurse using?

restating

S/S of generalized anxiety disorder

restlessness, fatigue, poor concentration, irritability

Can you help me remember who I am ? I'm a rare syndrome and life threatening . The risk of me is higher if SSRIs is administered in combination with a second Serotonin enhancing agent ( MAOI ) . My symptoms include : incordination , confusion , Hyperactivity , restlessness , tachycarida , fever , elevated blood pressure , seizures ( status epilepticus ) , tonic rigidty , abdominal pain , diarrhea , bloating .

serotonin syndrome

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to a) question the client's motive. b) set verbal limits. c) initiate physical confrontation d) prepare the client for seclusion

set verbal limits.

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as a) mild. b) moderate. c) severe. d) panic.

severe

Sublimation Example a. providing grieving consultations with others while you are also grieving over the death of your husband b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. substituting socially appropriate behavior in place of inappropriate thoughts/behavior

substituting socially appropriate behavior in place of inappropriate thoughts/behavior

what is the only conscious level defense mechanism

suppression

The nurse planning to teach a client to use Benson's relaxation techniques to treat hypertension is essentially teaching the client to A. switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode . B. alter the internal state by acting on electronic signals related to physiologic processes . C. replace stress - producing activities with daily stress - reducing pleasant activities . D. reduce catecholamine production .

switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode .

Regression Example a. 8 year old girl dresses up like her teacher and pretends like she is going to teach b. instead of helping their little ones emotionally after their wife dies, they think about only the cold facts and nothing emotionally c. taking fetal position during sleeping - turning to childlike pattern of behavior for comfort, for example d. you know what you are doing; you say you will deal with it later, or after your exam

taking fetal position during sleeping - turning to childlike pattern of behavior for comfort, for example

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of a) acute dystonia. b) tardive dyskinesia. c) cholestatic jaundice. d) pseudoparkinsonism.

tardive dyskinesia

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should a) question the physician's order because the dose is excessive. b) explain the long-term nature of benzodiazepine therapy. c) teach the client to limit caffeine intake. d) tell the client to expect mild insomnia.

teach the client to limit caffeine intake.

A nurse hears a new nurse discussing a pt's hallucinations in the hallway with another nurse. What should the nurse do first?

tell the nurse to stop discussing the behavior

A pt tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." What action should the nurse take?

tell the pt that she must report it to staff b/c it concerns the health and safety of others -using the principle of veracity that nurse must be truthful and tell the client she is going to report what was said

A nurse is interviewing a 25 yo pt with a new diagnosis of dysthymia. What should the nurse expect.

the presence of manifestations for at least 2 yrs -the manifestations of dysthymic disorder last for at least 2 yrs

A nurse is told during a change of shit report that a pt is stuporous. During assessment what is expected?

the pt arouses briefly in response to a sternal rub -a pt that is stuporous requires vigorous or painful stimuli to elicit a response

A nurse is looking at a medical record of a pt who has a new prescription for bupropion (Wellbutrin) for depression. What finding would have highest priority for the nurse to report to the doctor?

the pt had a motor vehicle crash last year and sustained a head injury -the greatest risk is developing seizures, bupropion can lower seizure threshold and should be avoided in people with a hx of head injury

Panic Anxiety

unable to focus on the environment and experience emotional paralysis; hallucinations take the place of reality; mute and have extreme psychomotor agitation leading to exhaustion

Projection Example a. when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves b. if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem c. mother who saw her son being run over by a car, later says they don't remember what happened d. when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves

Rationalization Example a. when someone tells you oh this person is a sheep, they are this, they are that; they are probably projecting aspects of themselves b. if your friend wins an award, instead of being supportive you tell them it's only a little award and doesn't mean much, to protect your own fragile self-esteem c. mother who saw her son being run over by a car, later says they don't remember what happened d. when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

when you are late, you make up a lie on the spot and tell the person it is because you got into a car accident, even though that is not true

When a client reports that lithium causes an upset stomach, the nurse should make which suggestion associated with taking the medication? a) with meals b) with an antacid c) 30 minutes before meals d) 2 hours after meals

with meals

Reaction Formation Example a. a man can become ill when he sees his wife with someone else; students can develop terrible anxiety, preventing them from taking their finals b. man comes home and yells at wife, wife yells at kid, kid kicks the dog. c. a woman cannot enjoy a sexual experience due to unwanted/painful experience in the past/childhood d. woman says she doesn't want the pregnancy but then when gives birth says she is in love with the baby and it's the best thing to happen to her

woman says she doesn't want the pregnancy but then when gives birth says she is in love with the baby and it's the best thing to happen to her

An acute phase nursing intervention aimed at reducing hyperactivity is demonstrated by which intervention? a) writing in a diary b) exercising in the gym c) directing unit activities d) orienting a new client to the unit

writing in a diary

Suppression Example a. 8 year old girl dresses up like her teacher and pretends like she is going to teach b. instead of helping their little ones emotionally after their wife dies, they think about only the cold facts and nothing emotionally c. taking fetal position during sleeping - turning to childlike pattern of behavior for comfort, for example d. you know what you are doing; you say you will deal with it later, or after your exam

you know what you are doing; you say you will deal with it later, or after your exam

What is the physiologic basis for the success of guided imagery? a) β-Endorphin release raises the pain threshold. b) Imagery raises the body level of cortisol and epinephrine. c) The sympathetic nervous system is stimulated to produce a quiet state. d) Brain catecholamines are less available to transmit pain impulses.

β-Endorphin release raises the pain threshold.