Chapter 34: Care of the patient with a Psychiatric Disorder

37. The nurse instructs a patient who has just been prescribed a protocol of fluoxetine HCl (Prozac) that the drug takes ____ to ____ weeks to take effect.

ANS: 2, 4 two, four Antidepressants of this type take 2 to 4 weeks before any effect is felt by the patient

36. The nurse recognizes that a woman who has experienced physical abuse and has inadequate income to care for herself and her family would be categorized under Axis ______.

ANS: 4 four Axis 4 queries the environmental and psychosocial information of a patient.

12. The nurse cautions a patient to watch his step. What response indicates concrete thinking? a. The patient fixedly begins to watch his feet. b. The patient immediately examines his watch. c. The patient begins to watch the nurse's feet. d. The patient stands rigidly in one place without moving.

ANS: A Concreteness is an indication of disordered thinking. The patient is unable to translate any words except by a very concrete definition.

5. A young man with malaria spikes a temperature of 105° F and begins to hallucinate. How should the nurse assess this? a. Delirium b. Psychotic break c. Possible stroke d. Anxiety disorder

ANS: A Delirium is an organic mental disorder that is frequently brought on by a severe physical illness, such as fever.

30. The patient is concerned about confidentiality and asks the nurse not to tell anyone what is said. What is the best response by the nurse? a. "I am required to report any intent to hurt yourself or others." b. "Conversations between patient and nurse are confidential." c. "What we say can be secret. What I write in the chart is available to the health team." d. "I can't help you unless you trust me."

ANS: A No secrets are allowed to be kept by a member of the health care team.

2. When the patient with a psychosis is thought to be a danger to self or others, by what method should the patient be admitted to the hospital? a. Probating b. Nurse's request c. Physician's order d. Family request

ANS: A Probating can be done if the individual is thought to be a danger to self or others.

34. Adjunctive therapies are used for which reasons? (Select all that apply.) a. To increase self-esteem b. To promote positive interaction c. To enhance reality orientation d. To stimulate communication e. To increase energy

ANS: A, B, C The purpose of adjunctive therapies is to increase self-esteem, promote positive interaction, and enhance reality orientation.

35. What are considered warning signs of suicide? (Select all that apply.) a. Talking about suicide b. Increased interactions with friends and family c. Drug or alcohol abuse d. Difficulty concentrating on work or school e. Personality changes

ANS: A, C, D, E Warning signs of suicide include talking about suicide, decreased interactions with friends and family, drug/alcohol abuse, difficulty concentrating on work or school, and personality changes.

29. What disorder is a severe form of self-starvation that can lead to death? a. Bulimia nervosa b. Anorexia nervosa c. Teenage nervosa d. Obesity nervosa

ANS: B Anorexia nervosa is a severe form of self-starvation that can lead to death.

25. A 14-year-old survivor of a school shooting screams and dives under a table when firecrackers go off. What does this behavior represent? a. Phobia b. Post-traumatic stress disorder c. Obsessive-compulsive disorder d. Disordered thinking

ANS: B Post-traumatic stress disorder describes a response to an intense traumatic experience that is beyond the usual range of human experience

8. A profound, disabling mental illness is characterized by bizarre, nonreality thinking. What is the illness? a. Manic depressive b. Schizophrenia c. Paranoia d. Bipolar

ANS: B Schizophrenia, a thought process disorder, is one of the most profoundly disabling mental illnesses.

4. When all five axes of the Diagnostic and Statistical Manual of Psychiatric Disorders, V, are used, it provides what type of assessment approach to comprehensive care? a. Personalized b. Individualized c. Holistic d. Organic

ANS: C Using all five axes of the DSM-V provides a holistic assessment.

9. A patient believes himself to be the president of the United States and that terrorists are trying to kidnap him. The nurse records these observations as which type of behavior? a. Absent behavior b. Positive behavior c. Negative behavior d. False behavior

ANS: B The behaviors of schizophrenic individuals can be categorized as positive (or excessive) or negative (or absent). Examples of positive behaviors include hallucinations, delusions, and disordered thinking. Examples of negative behaviors include apathy, social withdrawal, and flat affect.

27. The nurse is told that a patient believes he was born into the wrong body. What is the correct terminology for the desire to have the body of the opposite sex? a. Homosexuality b. Transsexualism c. Heterosexuality d. Bisexuality

ANS: B Transsexualism is a persistent desire to be the opposite sex and to have the body of the opposite sex.

10. The patient talks with his dead brother and arranges furniture so that his brother will have a place to sit. How should the nurse document this behavior? a. Disordered thinking b. Anhedonia c. Hallucination d. Alogia

ANS: C A hallucination is a sensory experience without a stimulus trigger. Disordered thinking occurs when the individual is not able to interpret information being received in the brain. Anhedonia describes lack of expressed feelings. Alogia is reduced content of speech.

21. The home health nurse assesses a patient who creates elaborate excuses for not leaving home. Further questioning reveals the patient had not left home for 6 months. How should this be documented? a. Mania b. Depression c. Agoraphobia d. Anxiety

ANS: C Agoraphobia is a high level of anxiety in which an anxiety attack could occur in individuals who avoid other people, places, or events.

1. The nurse is discussing the differences between a patient with a neurosis and one with a psychosis. What is true of the patient experiencing a neurosis? a. The patient experiences a flight from reality. b. The patient usually needs hospitalization. c. The patient has insight that there is an emotional problem. d. The patient has severe personality deterioration

ANS: C An individual with a neurosis has insight that he has an emotional problem. A person with psychosis is out of touch with reality and has severe personality deterioration. Treatment for neurosis is usually completed in the outpatient setting, while treatment for psychosis often requires hospitalization.

20. The nurse is assessing a female patient who has become rapidly and exceedingly anxious because her fingernail polish is chipped. What type of anxiety should the nurse conclude that the patient is exhibiting? a. Signal anxiety b. General anxiety c. Anxiety traits d. Panic disorder

ANS: C An individual with anxiety traits has anxious reactions to relatively nonstressful events. Signal anxiety is a learned response to an event such as test taking. An individual with general anxiety worries over many things. A panic attack occurs suddenly and typically peaks within 10 minutes.

18. A home health nurse has a patient who is taking lithium. What should be included in the teaching plan? a. Examine her skin closely for eruptions b. Take her blood pressure twice a day to check for hypertension c. Have her drug blood level checked every month d. Avoid aged cheese and red wine

ANS: C Lithium has a very narrow therapeutic window. The drug blood levels should be closely monitored.

14. The nurse is caring for a patient with a diagnosis of catatonic schizophrenia. What behavior is consistent with this diagnosis? a. Talks excitedly about going home b. Suspiciously watches the staff c. Stands on one foot for 15 minutes d. States he has a cat under his bed that talks to him

ANS: C Maintaining a rigid pose for long periods of time is an example of behavior expected with catatonic schizophrenia.

24. A patient is frequently late for appointments because he goes back to his room numerous times to assure himself that none of his belongings have been stolen. What does this behavior represent? a. Senseless behavior b. Controlled repetition c. Obsessive-compulsive d. Anxiety tension

ANS: C Obsessive-compulsive disorders have two features: thoughts that are recurrent, intrusive, and senseless; and behaviors that are performed repeatedly and ritualistically.

11. What is the prognosis for a schizophrenic patient who is exhibiting positive behaviors? a. Guarded b. Poor c. Good d. Repeatable

ANS: C Prognosis for schizophrenic patients who are exhibiting positive behavior patterns is good.

31. What is the term for a long-term and intense form of psychotherapy developed by Sigmund Freud that allows a patient's unconscious thoughts to be brought to the surface? a. Adjunctive b. Behavior c. Psychoanalysis d. Cognitive

ANS: C Psychoanalysis technique was developed by Sigmund Freud and is a long-term and intense therapy.

28. The patient complains of recurrent, multiple physical ailments for which there is no organic cause. How should the nurse assess this? a. Obsessive-compulsive disorder b. Phobia anxiety disorder c. Somatoform disorder d. Delusional disorder

ANS: C Somatoform disorder is characterized by recurrent, multiple physical complaints for which there is no organic cause.

33. A patient who is taking a monoamine oxidase inhibitor (MAOI) asks the nurse about the addition of St. John's wort to help with his depression. What would be the best response of the nurse? a. "That is a great idea. Alternative therapies can be very helpful." b. "You will feel better sooner if you include phenylalanine." c. "Did you know that St. John's wort can raise your blood pressure dramatically?" d. "You will need to drink lots of water."

ANS: C St. John's wort can raise blood pressure dramatically in people who are also taking MAOIs.

3. The Diagnostic and Statistical Manual of Psychiatric Disorders, V (DSM-V), is used by most hospitals and is the current tool used to examine mental health and illness. What approach does the DSM-V use to classify mental disorders? a. Holistic system b. Hierarchical system c. Multiaxial system d. Evaluation system

ANS: C The DSM-V is a multiaxial system

19. The nurse alters the care plan for a patient with depression to include what type of activity? a. Domino game with three other patients b. Ping-Pong game with one other patient c. Group outing to view wildflowers d. Magazine to read alone

ANS: C The quiet, noncompetitive trip to view wildflowers would be the best option. Depressed people should not be put in situations where they must concentrate or compete

6. A patient admitted for delirium demonstrates increased disorientation and agitation only during the evening and nighttime. What is the term applied to this type of delirium? a. Disordered thinking b. Schizophrenia c. Dementia d. Sundowning syndrome

ANS: D A patient with sundowning syndrome displays increased disorientation and agitation only during evening and nighttime. Disordered thinking occurs when an individual is not able to interpret information being received in the brain. Disordered thinking is one characteristic of schizophrenia, which is a large group of psychotic disorders that includes non-reality-based thinking. Dementia is an altered mental state secondary to cerebral disease

16. For the past 3 weeks, the nurse has observed a patient interacting with staff and other patients, helping decorate the dining room for a party, and leading the singing in the activity room. Today, the patient tearfully refuses to dress or get out of bed. The nurse recognizes these behaviors as evidence of which psychiatric disorder? a. Unipolar depression b. Dysthymic disorder c. Hypomanic episode d. Bipolar disorder

ANS: D Bipolar disorder can cause the patient to experience a sudden shift in emotion from one extreme to the other.

23. When a patient is experiencing a panic attack, how should the nurse best assist the patient? a. Assist with reality orientation b. Aid in decision making c. Assist with rational thought d. Coach in deep breathing

ANS: D Coaching in relaxation techniques such as deep breathing is an effective intervention for a patient who is experiencing a panic attack.

7. Dementia is an organic mental disease secondary to what problem? a. Chemical imbalance b. Emotional problems c. Circulatory impairment d. Cerebral disease

ANS: D Dementia describes an altered mental state secondary to cerebral disease.

32. What is the typical schedule for electroconvulsive therapy (ECT)? a. 3 treatments over 2 weeks b. 6 treatments over 2 months c. 8 treatments over several weeks d. 10 treatments over several weeks

ANS: D ECT is done as a treatment for depression, mania, and schizoaffective disorders that have not responded to other treatments. The usual protocol is 10 treatments over several weeks.

26. What should the nurse preparing a patient for a scheduled appointment for electroconvulsive therapy (ECT) remind the patient to do? a. Drink plenty of fluids before ECT to ensure adequate hydration. b. Bring a change of clothes in case of incontinence. c. Be prepared for visual disturbances after the treatment. d. Arrange for transportation to and from the appointment.

ANS: D If the patient has not arranged for adequate transportation to and from the appointment, the treatment will be canceled because driving after ECT is dangerous. The patient is typically NPO before the procedure. Incontinence and visual disturbances are not common following the procedure.

13. The nurse asks a patient with schizophrenia if he had any visitors on Sunday. Which response indicates loose association? a. "No." b. "Yes! I had 90 visitors who came from every state in the union." c. "Sunday is the Sabbath. Do we have visitors on the Sabbath?" d. "We visited Yellowstone Park last summer."

ANS: D Loose association is a type of disordered thinking that occurs when the individual cannot interpret information and the conversation does not flow.

22. When a patient demonstrates accelerated heart rate, trembling, choking, and chest pain along with acute, intense, and overwhelming anxiety, the nurse should recognize that the patient is most likely experiencing what condition? a. Terror b. Fright c. Fear d. Panic

ANS: D Panic can be defined as an attack of acute, intense, and overwhelming anxiety.

17. The nurse recognizes that researchers have identified that hereditary factors account for what percentage of mood disorders? a. 10% to 15% b. 20% to 30% c. 35% to 50% d. 60% to 80%

ANS: D Research indicates that hereditary factors account for 60% to 80% of mood disorders.

15. What is the term used for the beginning stage of schizophrenia, characterized by a lack of energy and complaints of multiple physical problems? a. Prepsychotic b. Residual c. Acute d. Prodromal

ANS: D The prodromal phase is the beginning stage of schizophrenia. Hallucinations and delusions sometimes occur in the prepsychotic stage. In the acute phase, individuals often lose touch with reality. The residual phase follows the acute phase and the symptoms of that phase are similar to those of the prodromal stage

38. The nurse explains that an alternative therapy that uses essential oils and scented candles to help a patient relax and focuses on the atmosphere of the moment is ______________.

ANS: aromatherapy Aromatherapy uses essential oils and scented candles to soothe the senses and make people aware of the here and now of the pleasant environment.

39. The nurse recognizes that stress can cause an ulcer, which is classified as a _______________ illness.

ANS: psychophysical Psychophysical illness addresses the stress-related problems that can result in physical signs and symptoms. Psychophysiological disorders are thought to have an emotional basis, manifested as a physical illness.