Exam 1 tutoring highlight

• Freud (id/ego/superego; transference/countertransference)

*Id (caveman vibes) - develops at birth-instinctual, driven by pleasure Pleasure principle Reflex action Primary process *Ego (what we show, middle ground)-social reality, helps us decide how to behave Problem solver Reality tester *Superego - -morality (3-5 years old) Moral component Transference §Patient unconsciously and inappropriately transfers onto the nurse feelings or behaviors §Related to significant figures in the patient's life §Often related to individuals in positions of authority §"You remind me of..." Countertransference §Nurse unconsciously and inappropriately displaces onto the client feelings or behaviors §Related to the nurse's past §Reactions may include: over-involvement, rescuing, withholding information, anger

Therapeutic Communication:

- OPEN ENDED QUESTIONS *EXCEPT FOR ASKING THEM IF THEY ARE SUICIDAL - NO JUDGEMENT -NEVER ASK THEM WHY

Stressors-

-"psychological or physical stimuli that are incompatible with current functioning and require adaptation;" "the stimulus that provokes a stress response" •External (environmental, social) •Internal (physiological, psychological)

Stress-

-"the total response to demands or pressures" *Eustress -> POSITIVE

SELECTIVE SEROTONIN REUPTAKE INHIBITORS (SSRIS)

-> SEROTONIN SYNDROME •Fluoxetine (Prozac) •Sertraline (Zoloft) •Paroxetine (Paxil) •Citalopram (Celexa) • Escitalopram (Lexapro) •Fluvoxamine (Luvox)

YOU CAN ONLY BREACH CONFIDENTIALITY WHEN THERE IS...

1.Any threat of harm to person(s) in the community (duty to warn, duty to protect) 2.Suspected child abuse, elder abuse, or abuse of adults that are dependent or with an intellectual or physical disability 3.Allegations of sexual misconduct with a therapist or health care worker

SAFE-T

1.Identify risk factors -> substance abuse, poverty, older men over 75, no family, lost job 2.Identify protective factors -> having a baby, marriage/relationship, job promotion 3.Conduct suicide inquiry "Are you thinking of committing suicide?" 4.Determine risk level/intervention 5.Document

5-4-3-2-1 coping technique

5: Acknowledge FIVE things you see around you. It could be a pen, a spot on the ceiling, anything in your surroundings. 4: Acknowledge FOUR things you can touch around you. It could be your hair, a pillow, or the ground under your feet. 3: Acknowledge THREE things you hear. This could be any external sound. The hum of a computer. If you can hear your belly rumbling that counts but focus on things you can hear outside of your body. 2: Acknowledge TWO things you can smell. Coffee, soda. Maybe you are in your office and smell pencil, or maybe you are in your bedroom and smell a pillow. If you need to take a brief walk to find a scent you could smell soap in your bathroom, or nature outside. 1: Acknowledge ONE thing you can taste, or ONE emotion you can feel. What does the inside of your mouth taste like—gum, coffee, or the sandwich from lunch?

A

A client nervously says, "Financial problems are stressing my marriage. I've heard rumors about cutbacks at work and I am afraid I might get laid off." The client's pulse is 112 beats/minute; respirations are 26 breaths/minute; and blood pressure is 166/88. Which nursing intervention will the nurse implement? A.Direct the client in slow and deep breathing using abdominal muscles. B.Advise the client, "Go to sleep 30 to 60 minutes earlier each night to increase rest." C.Tell the client, "Relax by spending more time playing with your pet." D.Suggest the client consider that a new job might be better than the present one.

ANTIANXIETY AND HYPNOTIC DRUGS

Benzodiazepines •Diazepam (Valium) •Clonazepam (Klonopin) •Alprazolam (Xanax) •Lorazepam (Ativan) •Flurazepam (Dalmane) •Temazepam (Restoril) •Triazolam (Halcion) •Estazolam (ProSom) •Quazepam (Doral) Short-acting sedative-hypnotic sleep agents "Z-hypnotics" •Zolpidem (Ambien) •Zaleplon (Sonata) •Eszopiclone (Lunesta) Melatonin receptor agonists •Ramelteon (Rozerem) •Doxepin (Silenor) •Buspirone (BuSpar)- long term- serotonin agonist

Antianxiety

Benzodiazepines (short-term) Nonbenzodiazepines (long-term)

Intellectual (cognitive) manifestations

Difficulty in concentration, poor memory

Insomnia

Difficulty in falling asleep, broken sleep, unsatisfying sleep and fatigue on waking, dreams, nightmares, night terrors

Gastrointestinal symptoms

Difficulty in swallowing, flatulence, abdominal pain, burning sensations, abdominal fullness, nausea, vomiting, borborygmi, looseness of bowels, loss of weight, constipation

Automatic symptoms

Dry mouth, flushing, pallor, tendency to sweat, giddiness, tension headache, raising of hair

Fear

Fearful of dark, strangers, being left alone, animals, traffic, crowds

Tension

Feelings of tension, fatigability, startle response, moved to tears easily, trembling, feelings of restlessness, inability to relax

Behavior at interview

Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos

Behavior at interview **table**

Fidgeting, restlessness or pacing, tremor of hands, furrowed brow, strained face, sighing or rapid respiration, facial pallor, swallowing, belching, brisk tendon jerks, dilated pupils, exophthalmos • 0 = NONE 1 = MILD 2 = MODERATE 3 = DISABLING 4 = SEVERE, GROSSLY DISABLING TOTAL SCORE = •14-17 = Mild anxiety •18-24 = Moderate anxiety •25-30 = Severe anxiety

Genitourinary symptoms

Frequency of micturition, urgency of micturition, amenorrhea, menorrhagia, development of frigidity, premature ejaculation, loss of libido, impotence

Peplau's Interpersonal Relationship Pre orientation Orientation Working Termination

Interpersonal therapy is most effective in treating: Grief and loss Interpersonal disputes Role transition •Social relationship •Friendship, socialization •Needs are met are both sides •Communication content is superficial •Intimate relationship •Physical and emotional connections, desire to love and be loved •Includes friendship •Therapeutic relationship •Utilizes communication skills to enhance an individual's growth and potential •Mutual identification of areas to explore, evaluation of progress •Client-centered, involved in decision-making process

Herbal and dietary supplements (elevate mood, relaxation):

Kava Passionflower Valerian Chamomile Lavender Lemon balm CBD oil

Depressed mood swings

Loss of interest, lack of pleasure in hobbies, depression, early waking, diurnal

First line antidepressants:

Selective serotonin reuptake inhibitors (SSRI) Selective serotonin norepinephrine reuptake inhibitor (SNRI)

General Adaptation Syndrome

Stage One- alarm/acute stress Sympathetic nervous system response Corticosteroid, endorphin response Stage Two- resistance Stage Three- exhaustion For assessment -> Initially determine level of anxiety

key

Stay with patient​ Encourage client-directed discussion related to events preceding feelings of extreme anxiety​ Have client identify 4 of their positive personality traits Use short simple sentences​** Reframe anxiety producing situations in ways that are positive​ Link client's behavior to feelings​ Help client identify previously effective survival strategies​** Assure client that you are available to assist them in ways they identify​

Cardiovascular symptoms

Tachycardia, palpitations, skipped beats, pain in chest, throbbing of vessels, fainting feelings

Somatic (sensory) symptoms

Tinnitus, blurring of vision, hot and cold flashes, feelings of weakness, picking sensation

D

Which client-focused scenario best demonstrates an example of eustress? A.The client receives notification that their employer is experiencing financial problems and some workers will be terminated. B.The client receives a bank notice that there were insufficient funds in their account for a recent rent payment. C.The client loses a beloved family pet. D.The client prepares to take a vacation to a tropical island with a group of close friends.

A client in crisis needs to identify and rely on available sources of support for assistance. Talking about the situation helps the individual put the crisis in perspective. Identifying coping skills that were used in the past is a good starting point for a client in crisis. The client should be fully involved in developing the plan of care with the knowledge that the staff will respect their decision. Encouraging the use of stress management techniques is helpful during moments of crisis. The client is not expressing psychotic thoughts or problems with self-image. Suggesting exploration of sexual attitudes is not relevant to the loss that the client is experiencing.

Which intervention will the nurse use to help a client who was in a same-sex relationship for three years and says, "My partner just left me. I'm a wreck"? Select all that apply. One, some, or all responses may be correct.

Providing information, regarding support groups or local domestic violence shelters, is a tertiary intervention because it is focused on preventing further abuse. Contacting family members should not be done without the consent of the client; it violates the client's confidentiality. Discussing legal ramifications is unsolicited advice that is outside the nurse's scope of practice. Discussions with the partner are not advised because this could worsen tensions and result in additional violence. Recommendation of a healthy-relationship program for the couple or a social-learning program for the adult are primary interventions intended to reduce the risk of intimate partner violence (IPV). Another primary intervention intended to lower the risk is to take measures to engage influential peers or adults through bystander empowerment within the community.

Which tertiary intervention will the nurse implement for an adult who sustained injuries as a result of physical interpersonal violence? Select all that apply. One, some, or all responses may be correct.

Anxious mood

Worries, anticipation of the worst, fearful anticipation, irritability

Miscellaneous

beta-blockers, antihistamines, anticonvulsants

Seclusion

cannot leave

Defense Mechanism: Altruism Compensation Conversion Denial

compensation: you think you not good enough like other, so you work extra hard

Defense Mechanism: Displacement Dissociation Identification Intellectualization

displacement: you mad at A but you put that madness into B

Defense Mechanism: Projection Rationalization Reaction Regression

projection: you sad or hopeless -> but you see sad or hopeless in other people rationalization: try to convince for their bad habit ex: I eat more bc my metabolism is high

Defense Mechanism: Repression Splitting - maladaptive Sublimation - adaptive Suppression Undoing

regression: go back to old habit (ex: smoking) to help them release anxiety

Theoretical Frameworks (CH 2 -4 Q's)

• Freud (id/ego/superego; transference/countertransference) • Erikson's Stages of Development • Maslow's Hierarchy of Needs • Peplau's Interpersonal Relationships

Anxiety

•"Anticipation of a future threat" •Represents an individual's feelings or experiences- vigilance, cautious or avoidant behaviors •Affects self-esteem, self-worth, overall ability to function •Overlaps with the concept of fear

Mental Health

•"a state of well being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to the community" •Person understands their potential •Person positively copes with stress •Person can work effectively •Person contributes to society

Defense Mechanisms

•Based on Freud's ego defense mechanisms •Automatic behaviors implemented for protection •May be adaptive or maladaptive •Sublimation always considered to be a positive coping mechanism •Refer to the complete list in Halter p. 274, Table 15.2 maladaptive: •projection •splitting- inability to bring positive and negative qualities of self and others into a cohesive whole •adaptive: •sublimation: satisfying an impulse with a substitute object in a socially acceptable way

Patient-Centered Implementation Planning solution

•Based on level of anxiety (refer to Halter, pp. 285-286,Tables 15.9 and 15.10) •Always maintain safety of the milieu •Maintain a calm presence, always discuss the immediate situation, reinforce reality •Verbal communication- ranges from open-ended questions to firm, simple statements •Nonverbal communication to convey interest and assist the individual in feeling understood •Environmental •Always maintain safety •Reduce stimuli •Opportunities for physical activity (as appropriate) •Fluid and food intake •Set boundaries for personal hygiene and sleep hygiene

How stress impacts the mental and physical body:

•Brain- •Heart- •Musculoskeletal- •Pancreas- •Reproductive organs- •Stomach/Intestines- •Other-

DSM-V

•Classifies mental disorders in people •Continuously updated based on new research

Progressive Muscle Relaxation

•Goal- involves tightening and relaxing muscles to relieve tension •Hold each body part (#2, 3, 4, 5) for 3-5 seconds each.

•Quiet Room

•Helps individuals who are too stimulated

•Suicide Warning Signs -> IS PATH WARM?

•Ideation •Substance abuse •Purposelessness •Anxiety •Trapped •Hopelessness •Withdrawal •Anger •Recklessness •Mood change

Involuntary in Emergencies vs Court order

•Least restrictive means for the least amount of time •If you admit yourself voluntary can refuse and accept anything •Involuntary in Emergencies -> cannot refuse treatment if it is emergent, can be in there for up to 5 days, needs evaluation to leave •Involuntary in Court Orders -> cannot refuse treatment if it is emergent

Interventions for Mild to Moderate Levels of Anxiety table

•Maintain a calm presence, always discuss the current situation, reinforce reality

Interventions for Severe to Panic Levels of Anxiety table

•Maintain a calm presence, always discuss the current situation, reinforce reality

SEROTONIN SYDROME

•Nursing Actions •Avoid duplicate serotonin •St. John's Wart (OTC) •Teach s/sx to monitor •Report to mental health provider if sx occur

•MSE (Mental Status Exam)

•OBJECTIVE (observational) data •Mood: verbalized emotional state •Affect: observed emotional state *We cannot prescribe, provide consultations, or provide psychotherapy...that is for an ADVANCED practice nurse

1ANS: D The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother's baseline. 2ANS: B Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient's only hope is pessimistic and would cause further distress. Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective. 3ANS: C Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking. 4ANS: C The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general). 5ANS: C The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. 6ANS: B A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Use of defense mechanisms does not apply. 7ANS: B Body dysmorphic disorder refers to a preoccupation with an imagined defect in appearance in a normal-appearing person. The patient's feet are proportional to the rest of the body. In obsessive-compulsive or related disorder due to a medical condition, the individual's symptoms of obsessions and compulsions are a direct physiological result of a medical condition. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others. People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. 8ANS: A Safety is of highest priority because the patient experiencing panic is at high risk for self-injury related to increased non-goal-directed motor activity, distorted perceptions, and disordered thoughts. Offering an outlet for the patient's energy can occur when the current panic level subsides. Respecting the patient's personal space is a lower priority than safety. Clarification of feelings cannot take place until the level of anxiety is lowered. 9ANS: D Mild anxiety is rarely obstructive to the task at hand. It may be helpful to the patient because it promotes study and increases awareness of the nuances of questions. The incorrect responses have different symptoms. 10ANS: A Teaching about symptoms of anxiety, their relation to precipitating stressors, and, in this case, the positive effects of anxiety will serve to reassure the patient. Advising the patient to discuss the experience with a health care provider implies that the patient has a serious problem. Listening without comment will do no harm but deprives the patient of health teaching. Antioxidant vitamin supplements are not useful in this scenario. 11ANS: D A clear definition of the immediate problem provides the best opportunity to find a solution. Asking about recent upsetting events facilitates assessment of the precipitating event. The patient is unlikely to be able to articulate what interventions will increase feelings of comfort. "Why" questions are nontherapeutic. 12ANS: C A situational crisis arises from events that are extraordinary, external rather than internal, and often unanticipated. Sexual molestation falls within this classification. Maturational crisis occurs as an individual arrives at a new stage of development, when old coping styles may be ineffective. "Organic" and "Tertiary" are not types of crisis 1.Maturational à PUBERTY 2.Situational à INDIVUALIZED 3. Adventitious à Natural disaster 13ANS: A Severe anxiety narrows perceptions and concentration. By speaking in short concise sentences, the nurse enables the patient to grasp what is being said. Conveying urgency will increase the patient's anxiety. Letting the patient know who controls the interview or stating that time is limited is nontherapeutic. 14ANS: D During crisis intervention, the priority concern is patient safety. This question helps assess personal coping skills. The other options are incorrect because the focus of crisis intervention is on the event that occurred immediately before the patient sought help. 15ANS: B Primary care-related crisis intervention promotes mental health and reduces mental illness. The incorrect options are examples of secondary or tertiary interventions.

•PRACTICE QUESTIONS •Question 1- The adult child of a patient diagnosed with major depressive disorder asks, "Do you think depression and physical illness are connected? Since my father's death, my mother has had shingles and the flu, but she's usually not one who gets sick." Which answer by the nurse best reflects current knowledge? •A- "It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system." •B- "You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses." •C- "So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link." •D- "Negative emotions and prolonged stress interfere with the body's ability to protect itself and can increase the likelihood of illness." • •PRACTICE QUESTIONS •Question 2- A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, "Do you think saying a prayer would help?" Select the nurse's best answer. •A- "It could be that prayer is your only hope." •B- "You may find prayer gives comfort and lowers your stress." •C- "I can help you feel calmer by teaching you meditation exercises." •D- "We do not have evidence that prayer helps, but it wouldn't hurt." • •PRACTICE QUESTIONS •Question 3- A patient tells the nurse, "My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking." Which response by the nurse would support the recommendation? • •A- Encourage the patient to imagine being in calm circumstances. •B- Provide the patient with a blank journal and guidance about journaling. •C- Teach the patient to recognize, reconsider, and reframe irrational thoughts. •D- Teach the patient to use instruments that give feedback about bodily functions. • •PRACTICE QUESTIONS •Question 4- A patient reports, "I am overwhelmed by stress." Which question by the nurse would be most important to use in the initial assessment of this patient? •A- "Tell me about your family history. Do you have any relatives who have problems with stress?" •B- "Tell me about your exercise. How much activity do you typically get in a day?" •C- "Tell me about the kinds of things you do to reduce or cope with your stress." •D- "Stress can interfere with sleep. How much did you sleep last night?" • •PRACTICE QUESTIONS •Question 5- A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience? •A- Limbic system •B- Peripheral nervous system •C- Sympathetic nervous system •D- Parasympathetic nervous system • •PRACTICE QUESTIONS •Question 6- A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? •A- Verify the patient's learning style. •B- Lower the patient's current anxiety. •C- Create outcomes and a teaching plan. •D- Assess how the patient uses defense mechanisms. • •PRACTICE QUESTIONS •Question 7- A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? •A- Social anxiety disorder •B- Body dysmorphic disorder •C- Separation anxiety disorder •D- Obsessive-compulsive disorder due to a medical condition • •PRACTICE QUESTIONS •Question 8- A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to... •A- provide for the patient's safety. •B- encourage clarification of feelings. •C- respect the patient's personal space. •D- offer an outlet for the patient's energy. • •PRACTICE QUESTIONS •Question 9- A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as... •A- culturally influenced. •B- displacement. •C- trait anxiety. •D- mild anxiety. • •PRACTICE QUESTIONS •Question 10- A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? •A- Explain that the symptoms result from mild anxiety and discuss the helpful aspects. •B- Advise the student to discuss this experience with a health care provider. •C- Encourage the student to begin antioxidant vitamin supplements. •D- Listen attentively, using silence in a therapeutic way. • •PRACTICE QUESTIONS •Question 11- A patient is seen in the clinic for superficial cuts on both wrists. Initially the patient paces and sobs but after a few minutes, the patient is calmer. The nurse attempts to determine the patient's perception of the precipitating event by asking: •A- "Tell me why you were crying." •B- "How did your wrists get injured?" •C- "How can I help you feel more comfortable?" •D- "What was happening when you started feeling this way?" • •PRACTICE QUESTIONS •Question 12- An adolescent comes to the crisis clinic and reports sexual abuse by an uncle. The adolescent told both parents about the uncle's behavior, but the parents did not believe the adolescent. What type of crisis exists? •A- Maturational •B- Tertiary •C- Situational •D- Organic • •PRACTICE QUESTIONS •Question 13- While conducting the initial interview with a patient in crisis, the nurse should... •A- speak in short, concise sentences. •B- convey a sense of urgency to the patient. •C- be forthright about time limits of the interview. •D- let the patient know the nurse controls the interview. • •PRACTICE QUESTIONS •Question 14- A woman said, "I can't take anymore! Last year my husband had an affair and now we don't communicate. Three months ago, I found a lump in my breast. Yesterday my daughter said she's quitting college." What is the nurse's priority assessment? •A- Identify measures useful to help improve the couple's communication. •B- The patient's feelings about the possibility of having a mastectomy •C- Whether the husband is still engaged in an extramarital affair •D- Clarify what the patient means by "I can't take anymore." • •PRACTICE QUESTIONS •Question 15- Which situation demonstrates use of primary intervention related to crisis? •A- Implementation of suicide precautions for a depressed patient •B- Teaching stress-reduction techniques to a first-year college student •C- Assessing coping strategies used by a patient who attempted suicide •D- Referring a patient diagnosed with schizophrenia to a partial hospitalization program

8ANS: C Patients do not stay in a hospital until every symptom disappears. The nurse must assume responsibility to advocate for the patient's right to the least restrictive setting as soon as the symptoms are under control and for the right of citizens to control health care costs. The health care provider will use the same rationale. Shifting blame will not change the discharge. Security is unnecessary. The nurse can handle this matter. 9ANS: B Nursing staff are responsible for all aspects of milieu management. The observations mentioned in this question directly relate to the safety of the unit. The other options, although part of the nurse's concerns, are unrelated to the observations cited. 10ANS: C Risk for suicide is the priority diagnosis when the patient has both suicidal ideation and a plan to carry out the suicidal intent. Imbalanced nutrition, hopelessness, and chronic low self-esteem may be applicable nursing diagnoses, but these problems do not affect patient safety as urgently as would a suicide attempt. 11ANS: D The statement regarding evil voices tells the nurse that the patient is experiencing auditory hallucinations and may create risks for violence. Safety is the nurse's first concern. The other statements are vague and do not clearly identify the patient's chief symptom. 12ANS: C Adolescents are very concerned with confidentiality. The patient has a right to know that most information will be held in confidence but that certain material must be reported or shared with the treatment team, such as threats of suicide, homicide, use of illegal drugs, or issues of abuse. The incorrect responses are not true, will not inspire the confidence of the patient, or are confrontational. 13ANS: B Countertransference is the nurse's transference or response to a patient that is based on the nurse's unconscious needs, conflicts, problems, or view of the world. See relationship to audience response question. 14ANS: A Only the correct response describes elements of a therapeutic relationship. The remaining responses describe events that occur in social or intimate relationships. 15ANS: A Asking a patient to reflect on feelings about his or her actions does not imply any judgment about those actions, and it encourages the patient to explore feelings and values. The remaining options offer negative judgments. 16ANS: D "Offering self" is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of "offering self," helps to build trust and convey that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but is an example of "offering hope." 17ANS: A Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Close-ended questions such as "Did you feel angry?" ask for specific information rather than showing understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding. 18ANS: C By asking if the patient does not believe that progress has been made, the nurse is reflecting or paraphrasing by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring. 19ANS: A Eye contact and body movements are considered nonverbal communication. There are insufficient data to determine the level of the patient's social skills or an existing cultural barrier. 20ANS: D The amount of eye contact a person engages in is often culturally determined. In some cultures, eye contact is considered insolent, whereas in others eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact. 21ANS: D The correct answer is the most global response. Cultural competence requires ongoing effort. Culture is dynamic, diversified, and changing. The nurse must be prepared to gain cultural knowledge and determine nursing care measures that patients find acceptable and helpful. Interpreting the thinking of individual patients does not ensure culturally competent care. Reducing a patient's ethnocentrism may not be a desired outcome. 22ANS: A Hispanic Americans and Native Americans traditionally treat time in a way unlike the Western culture. They tend to be present-oriented; that is, they value the current interaction more than what is to be done in the future. If engaged in an activity, for example, they may simply continue the activity and appear later for an appointment. Understanding this, the nurse can avoid feelings of frustration and anger when the nurse's future orientation comes into conflict with the patient's present orientation. 23ANS: A The community is a less restrictive alternative than hospitals for treatment of persons with mental illness. The distracters are incorrect and part of the stigma of mental illness. 24ANS: A Nurses have an obligation to protect patients' privacy and confidentiality. Clinical information should not be released without the patient's signed consent for the release.

•PRACTICE QUESTIONS •Question 8— A patient diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The patient's thoughts are now more organized and discharge is planned. The patient's family says, "It's too soon for discharge. We will just go through all this again." The nurse should... A- ask the case manager to arrange a transfer to a long-term care facility. B- notify hospital security to handle the disturbance and escort the family off the unit. C- explain that the patient will continue to improve if the medication is taken regularly. D- contact the health care provider to meet with the family and explain the discharge rationale. • •PRACTICE QUESTIONS •Question 9— A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. These observations relate to... A- coordinating care of patients. B- management of milieu safety. C- management of the interpersonal climate. D- use of therapeutic intervention strategies. • •PRACTICE QUESTIONS •Question 10— A newly admitted patient diagnosed with major depressive disorder has gained 20 pounds over a few months and has suicidal ideation. The patient has taken antidepressant medication for 1 week without remission of symptoms. Select the priority nursing diagnosis. • A- Imbalanced nutrition: more than body requirements B- Chronic low self-esteem C- Risk for suicide D- Hopelessness • •PRACTICE QUESTIONS •Question 11— Which statement made by a patient during an initial assessment interview should serve as the priority focus for the plan of care? • A- "I can always trust my family." B- "It seems like I always have bad luck." C- "You never know who will turn against you." D- "I hear evil voices that tell me to do bad things." • •PRACTICE QUESTIONS •Question 12— An adolescent asks a nurse conducting an assessment interview, "Why should I tell you anything? You'll just tell my parents whatever you find out." Which response by the nurse is appropriate? A- "That isn't true. What you tell us is private and held in strict confidence. Your parents have no right to know." B- "Yes, your parents may find out what you say, but it is important that they know about your problems." C- "What you say about feelings is private, but some things, like suicidal thinking, must be reported to the treatment team." D- "It sounds as though you are not really ready to work on your problems and make changes." • •PRACTICE QUESTIONS •Question 13— A nurse assesses a confused older adult. The nurse experiences sadness and reflects, "This patient is like one of my grandparents ... so helpless." Which response is the nurse demonstrating? A- Transference B- Countertransference C- Catastrophic reaction D- Defensive coping reaction • •PRACTICE QUESTIONS •Question 14— A nurse explains to the family of a mentally ill patient how a nurse-patient relationship differs from social relationships. Which is the best explanation? A- "The focus is on the patient. Problems are discussed by the nurse and patient, but solutions are implemented by the patient." B- "The focus shifts from nurse to patient as the relationship develops. Advice is given by both, and solutions are implemented." C- "The focus of the relationship is socialization. Mutual needs are met, and feelings are shared openly." D- "The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other." • • •PRACTICE QUESTIONS •Question 15— A patient says, "I've done a lot of cheating and manipulating in my relationships." Select a nonjudgmental response by the nurse. • A- "How do you feel about that?" B- "I am glad that you realize this." C- "That's not a good way to behave." D- "Have you outgrown that type of behavior?" • • •PRACTICE QUESTIONS •Question 16— A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." A- "I've also had traumatic life experiences. Maybe it would help if I told you about them." B- "Why do you think you had so much difficulty adjusting to this change in your life?" C- "I hope you will feel better after getting accustomed to how this unit operates." D- "I'd like to sit with you for a while to help you get comfortable talking to me." • •PRACTICE QUESTIONS •Question 17— Which technique will best communicate to a patient that the nurse is interested in listening? • • A- Restating a feeling or thought the patient has expressed. B- Asking a direct question, such as "Did you feel angry?" C- Making a judgment about the patient's problem. D- Saying, "I understand what you're saying." • •PRACTICE QUESTIONS •Question 18— A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. A- "Don't talk that way. Of course you will leave here!" B- "Keep up the good work, and you certainly will." C- "You don't think you're making progress?" D- "Everyone feels that way sometimes." • •PRACTICE QUESTIONS •Question 19— While talking with a patient diagnosed with major depressive disorder, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest. The patient looks at the floor. Which aspect of communication has the nurse assessed? A- Nonverbal communication B- A message filter C- A cultural barrier D- Social skills • • •PRACTICE QUESTIONS •Question 20— A Filipino American patient had a nursing diagnosis of situational low self-esteem related to poor social skills as evidenced by lack of eye contact. Interventions were applied to increase the patient's self-esteem but after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? A- The patient's eye contact should have been directly addressed by role playing to increase comfort with eye contact. B- The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. C- The patient's poor eye contact is indicative of anger and hostility that were unaddressed. D- The nurse should have assessed the patient's culture before making this diagnosis and plan. • •PRACTICE QUESTIONS •Question 21— To provide culturally competent care, the nurse should A- accurately interpret the thinking of individual patients. B- predict how a patient may perceive treatment interventions. C- formulate interventions to reduce the patient's ethnocentrism. D- identify strategies that fit within the cultural context of the patient. • •PRACTICE QUESTIONS •Question 22— A nurse in the clinic has a full appointment schedule. A Hispanic American patient arrives at 1230 for a 1000 appointment. A Native American patient does not keep an appointment at all. What understanding will improve the nurse's planning? These patients are • A- members of cultural groups that have a different view of time. B- immature and irresponsible in health care matters. C- acting-out feelings of anger toward the system. D- displaying passive-aggressive tendencies. • •PRACTICE QUESTIONS •Question 23— A person in the community asks, "Why aren't people with mental illness kept in state institutions anymore?" Select the nurse's best response. • A- "Less restrictive settings are available now to care for individuals with mental illness." B- "There are fewer persons with mental illness, so less hospital beds are needed." C- "Most people with mental illness are still in psychiatric institutions." D- "Psychiatric institutions violated patients' rights." • •PRACTICE QUESTIONS •Question 24— In order to release information to another health care facility or third party regarding a patient diagnosed with a mental illness, the nurse must obtain... A- signed consent by the patient for release of information stating specific information to be released. B- a verbal consent for information release from the patient and the patient's guardian or next of kin. C- permission from members of the health care team who participate in treatment planning. D- approval from the attending psychiatrist to authorize the release of information. • •

Stress Response Mediators

•Perception (the perception of the stressor that determines the person's emotional and psychological reactions to it.) •Temperament (These perceptions are colored by a variety of factors, including genetic structure and vulnerability, childhood experiences, coping strategies, and personal outlook on life and the world. All these factors combine to form a unique personality with specific strengths and vulnerabilities.) •Social Support •Support Groups •Culture •Spirituality and Religion

•Therapeutic Milieu -> Peplau

•Physical & emotional safety •Safe / structured environment •Family and friends help us heal

Assessment

•Physical and psychosocial assessments- anxiety may be secondary to another condition •Initially determine level of anxiety •Assess for safety and injury •Coping styles (history, general satisfaction, support, response) •Potential nursing diagnoses- Anxiety (identify level), ineffective coping, chronic low self-esteem, risk for self-harm •Goals - reduction of anxiety level, reduction in frequency and intensity of signs and symptoms, independent self-care, maintenance of interpersonal relationships, return to baseline function

Interventions primary - secondary - tertiary

•Primary: interventions that support, inform, and educate individuals to prevent suicide •Screenings •Curricula in elementary and secondary education •Parish nursing •Secondary: treatment of a suicidal crisis •Inpatient hospitalization •Outpatient (telephone hotlines) •Tertiary: interventions with family and friends of an individual who has completed suicide •Reduce traumatic aftereffects, implement primary interventions •Grief and loss counseling

ANS: B In most states, prescriptive privileges are granted to master's-prepared nurse practitioners and clinical nurse specialists who have taken special courses on prescribing medication. The nurse prepared at the basic level is permitted to perform mental health assessments, establish relationships, and provide individualized care planning.

•Question 1— A staff nurse completes orientation to a psychiatric unit. This nurse may expect an advanced practice nurse to perform which additional intervention? • A- Conduct mental health assessments. B- Prescribe psychotropic medication. C- Establish therapeutic relationships. D- Individualize nursing care plans. •

ANS: C The correct response demonstrates the best evidence of a healthy recognition of the importance of relationships. Mental health includes rational thinking, communication skills, learning, emotional growth, resilience, and self-esteem. Recalling joy from earlier in life may be healthy, but the correct response shows a higher level of mental health. The other incorrect responses show blaming and avoidance.

•Question 2— A family has a long history of conflicted relationships among the members. Which family member's comment best reflects a mentally healthy perspective? • • A- "I've made mistakes but everyone else in this family has also." B- "I remember joy and mutual respect from our early years together." C- "I will make some changes in my behavior for the good of the family." D- "It's best for me to move away from my family. Things will never change." •

ANS: B The correct response describes a mood alteration, which reflects mental illness. The distracters describe behaviors that are mentally healthy or within the usual scope of human experience.

•Question 3— Which assessment finding most clearly indicates that a patient may be experiencing a mental illness? The patient • • A- reports occasional sleeplessness and anxiety. B- reports a consistently sad, discouraged, and hopeless mood. C- able to describe the difference between "as if" and "for real." D- perceives difficulty making a decision about whether to change jobs.

ANS: C The DSM-V gives the criteria used to diagnose each mental disorder. It is the official guideline for diagnosing psychiatric disorders. The distracters may not contain diagnostic criteria for a psychiatric illness.

•Question 4— A nurse encounters an unfamiliar psychiatric disorder on a new patient's admission form. Which resource should the nurse consult to determine criteria used to establish this diagnosis? • A- International Statistical Classification of Diseases and Related Health Problems (ICD-10) B- The ANA's Psychiatric-Mental Health Nursing Scope and Standards of Practice C- Diagnostic and Statistical Manual of Mental Disorders (DSM-V) D- A behavioral health reference manual •

ANS: D The DSM-V classifies disorders people have rather than people themselves. The terminology of the tool reflects this distinction by referring to individuals with a disorder rather than as a "schizophrenic" or "alcoholic," for example. Deviant behavior is not generally considered a mental disorder. Present disability or distress is only one aspect of the diagnosis.

•Question 5— The DSM-V classifies: • A- deviant behaviors. B- present disability or distress. C- people with mental disorders. D-mental disorders people have. •

ANS: A Hospitalization is justified when the patient is a danger to self or others, has dangerously decompensated, or needs intensive medical treatment. The distracters do not necessarily describe patients who require inpatient treatment.

•Question 6— Inpatient hospitalization for persons with mental illness is generally reserved for patients who • A- present a clear danger to self or others. B- are noncompliant with medication at home. C- have limited support systems in the community. D- develop new symptoms during the course of an illness. • •

ANS: A Tertiary prevention involves services that address residual impairments, with a goal of improved independent functioning. Restraint is a secondary prevention. Genetic counseling and teaching school-age children about substance abuse and dependence are examples of primary prevention.

•Question 7— Select the example of tertiary prevention. A- Helping a person diagnosed with a serious mental illness learn to manage money B- Restraining an agitated patient who has become aggressive and assaultive C- Teaching school-age children about the dangers of drugs and alcohol D- Genetic counseling with a young couple expecting their first child •

•Psychosocial Assessment

•SUBJECTIVE (patient's own words) data •EX: What brought you in today?

SEROTONIN-NOREPINEPHRINE REUPTAKE INHIBITORS (SNRIS)

•Venlafaxine (Effexor) •Desvenlafaxine (Pristiq) •Duloxetine (Cymbalta)

•When it affect normal function of person or it become illegal.

•When do they become a problem?

Physical and psychosocial assessments-

•anxiety may be secondary to another condition •Initially determine the level of anxiety •Assess for safety and injury •Coping styles (history, general satisfaction, support, response) •Goals- •reduction of anxiety level •reduction in frequency and intensity of signs and symptoms •independent self-care •maintenance of interpersonal relationships •return to baseline function

•Prior to admission, remove from the patient room (list not all-inclusive)

•telephone cords •call light cords •plastic bag liners •ensure personal belongings and valuables are secure

Respiratory symptoms

Pressure or constriction in chest, choking feelings, sighing, dyspnea

the Continuum

is a spectrum and we can continuously change depending on how we cope with stressors in our life *Literally everything affects our mental health (EX: culture, religion, poverty, hormones, & FAMILY HISTORY)

ANTIDEPRESSANT DRUGS MONOAMINE OXIDASE INHIBITORS (MAOI)

**TYRAMINE (aged cheese, wine, meat) à HYPERTENSIVE CRISIS •Isocarboxazid (Marplan) •Phenelzine (Nardil) •Selegiline (EMSAM) •Tranylcypromine (Parnate)

Restraint

**renew those orders every 2 hours Physical or medicinal (EX: Benzos are a chemical restraint

TRICYCLIC ANTIDEPRESSANTS (TCAS)

**ANTICHOLINERGIC EFFECTS •Nortriptyline (Pamelor) •Amitriptyline (Elavil) •Imipramine (Tofranil)

depersonalization vs. derealization

Depersonalization -> "out of body", observing self from outside Derealization -> detached from reality / surroundings

1ANS: B This behavior is conventional of a child around the age of 2 years, whose developmental task is to develop autonomy. The distracters indicate the child's behavior is abnormal. 2ANS: A The id operates on the pleasure principle, seeking immediate gratification of impulses. The ego acts as a mediator of behavior and weighs the consequences of the action, perhaps determining that taking the toy is not worth the mother's wrath. The superego would oppose the impulsive behavior as "not nice." The preconscious is a level of awareness rather than an aspect of personality. 3ANS: A The need for food and hygiene are physiological and therefore take priority over psychological or meta-needs in care planning. 4ANS: B The nurse-patient relationship is structured to provide a model for adaptive interpersonal relationships that can be generalized to others. Helping the patient learn to use assertive communication will improve the patient's interpersonal relationships. The distracters apply to theories of cognitive, behavioral, and biological therapy. 5ANS: B Transference refers to feelings a patient has toward the health care workers that were originally held toward significant others in his or her life. Counter-transference refers to unconscious feelings that the health care worker has toward the patient. The superego represents the moral component of personality; it seeks perfection. 6ANS: C Sertraline (Zoloft) is an selective serotonin reuptake inhibitor (SSRI). This antidepressant blocks the reuptake of serotonin, with few anticholinergic and sedating side effects. Clozapine is an antipsychotic. Chlordiazepoxide is an anxiolytic. Tacrine treats Alzheimer's disease. 7ANS: A Muscarinic receptor blockade includes atropine-like side effects, such as dry mouth, blurred vision, and constipation. Gynecomastia is associated with decreased prolactin levels. Movement defects are associated with dopamine blockade. Orthostatic hypotension is associated with á1 antagonism. 8ANS: C Patients taking MAO-inhibiting drugs must be on a low tyramine diet to prevent hypertensive crisis. In the presence of MAO inhibitors, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure. 9ANS: B Depression is thought to be related to lowered availability of the neurotransmitter serotonin. SSRIs act by blocking reuptake of serotonin, leaving a higher concentration available at the synaptic cleft. SSRIs prevent destruction of serotonin. SSRIs have little or no effect on acetylcholine and dopamine production. SSRIs do not produce muscarinic or á1 norepinephrine blockade. 10ANS: B If the reuptake of a substance is inhibited, it accumulates in the synaptic gap, and its concentration increases, permitting ease of transmission of impulses across the synaptic gap. Normal transmission of impulses across synaptic gaps is consistent with normal rather than depressed mood. The other options are not associated with blocking neurotransmitter reuptake. 11ANS: B A patient experiencing severe anxiety has a markedly narrowed perceptual field and difficulty attending to events in the environment. A patient experiencing severe anxiety will not learn readily. Determining preferred modes of learning, devising outcomes, and constructing teaching plans are relevant to the task but are not the priority measure. The nurse has already assessed the patient's anxiety level. Use of defense mechanisms does not apply. 12ANS: B Moderate anxiety causes the individual to grasp less information and reduces problem-solving ability to a less-than-optimal level. Mild anxiety heightens attention and enhances problem solving. Severe anxiety causes great reduction in the perceptual field. Panic-level anxiety results in disorganized behavior. 13ANS: B Giving information in a calm, simple manner will help the patient grasp the important facts. Introducing extraneous topics as described in the distracters will further scatter the patient's attention. 14ANS: B Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication. Buspirone is long acting and is not useful as a prn drug. Amitriptyline and desipramine are tricyclic antidepressants and considered second- or third-line agents. 15ANS: C Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Tyramine-free diets are necessary only with monoamine oxidase inhibitors (MAOIs). Drowsiness is an expected effect and needs to be reported only if it is excessive. Patients should be taught not to deviate from the prescribed dose and schedule for administration.

PRACTICE QUESTIONS Question 1- A parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" Select the nurse's best reply. A- "Your child needs firmer control. It is important to set limits now." B- "This is normal for your child's age. The child is striving for independence." C- "There may be developmental problems. Most children are toilet trained by age 2." D- "Some undesirable attitudes are developing. A child psychologist can help you develop a plan." PRACTICE QUESTIONS Question 2- A 4-year-old grabs toys from other children and says, "I want that now!" From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality? A- Id B- Ego C- Superego D- Preconscious PRACTICE QUESTIONS Question 3- A nurse uses Maslow's hierarchy of needs to plan care for a patient diagnosed with mental illness. Which problem will receive priority? The patient A- refuses to eat or bathe. B- reports feelings of alienation from family. C- is reluctant to participate in unit social activities. D- is unaware of medication action and side effects. PRACTICE QUESTIONS Question 4- A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn patient. Interventions should focus on A- rewarding desired behaviors. B- use of assertive communication. C- changing the patient's self-concept. D- administering medications to relieve anxiety. PRACTICE QUESTIONS Question 5- A patient says to the nurse, "My father has been dead for over 10 years, but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the patient's comment? A- Superego B- Transference C- Reality testing D- Counter-transference PRACTICE QUESTIONS Question 6- A patient is hospitalized for severe major depressive disorder. Of the medications listed below, the nurse can expect to provide the patient with teaching about A- chlordiazepoxide. B- clozapine. C- sertraline. D- tacrine. PRACTICE QUESTIONS Question 7- A drug causes muscarinic receptor blockade. The nurse will assess the patient for A- dry mouth. B- gynecomastia. C- pseudoparkinsonism. D- orthostatic hypotension. PRACTICE QUESTIONS Question 8- A nurse instructs a patient taking a drug that inhibits MAO to avoid certain foods and drugs because of the risk of A- cardiac dysrhythmia. B- hypotensive shock. C- hypertensive crisis. D- hypoglycemia. PRACTICE QUESTIONS Question 9- By which mechanism do SSRI medications improve depression? A- Destroying increased amounts of serotonin B- Making more serotonin available at the synaptic gap C- Increasing production of acetylcholine and dopamine D- Blocking muscarinic and á1 norepinephrine receptors PRACTICE QUESTIONS Question 10- The therapeutic action of neurotransmitter inhibitors that block reuptake cause A- decreased concentration of the blocked neurotransmitter in the central nervous system. B- increased concentration of the blocked neurotransmitter in the synaptic gap. C- destruction of receptor sites specific to the blocked neurotransmitter. D- limbic system stimulation. PRACTICE QUESTIONS Question 11- A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? A- Verify the patient's learning style. B- Lower the patient's current anxiety. C- Create outcomes and a teaching plan. A- Assess how the patient uses defense mechanisms. PRACTICE QUESTIONS Question 12- A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? A- Mild B- Moderate C- Severe D- Panic PRACTICE QUESTIONS Question 13- A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? A- Reassure the patient that all nurses are skilled in providing postoperative care. B- Present the information again in a calm manner using simple language. C- Tell the patient that staff is prepared to promote recovery. D- Encourage the patient to express feelings to family. PRACTICE QUESTIONS Question 14- A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic? A- buspirone B- lorazepam C- amitriptyline D- desipramine PRACTICE QUESTIONS Question 15- When alprazolam is prescribed for a patient who experiences acute anxiety, health teaching should include instructions to A- report drowsiness. B- eat a tyramine-free diet. C- avoid alcoholic beverages. D- adjust dose and frequency based on anxiety level.

Somatic (muscular) symptoms

Pains and aches, twitching, stiffness, myoclonic jerks, grinding of teeth, unsteady voice, increased muscular tone

1Efficacy as a first line of defense for anxiety 2Sedation 3ataxia(imbalance cognition)

The health care provider decides to augment psychotherapy with initiation of a short-term combination therapy of an SSRI in conjunction with a benzodiazepine. Select the most likely options for the information missing from the statements below by selecting from the lists of options provided. The nurse will teach this client that a great benefit of the benzodiazepine will be its (1) __________________. Two common side effects the client will need to monitor and report will be (2) __________________and (3) __________________.

Methamphetamine is often packaged and sold in small plastic bags. An odor of acetone may be produced in the process of making methamphetamine. The pseudoephedrine in cold medicine is used in the production of methamphetamine. Methamphetamine may appear as crystals. Hydrogen peroxide can be used to make methamphetamine, a large amount of any of the ingredients is a warning sign. The large amount of ingredients needed contributes to the strange contents of the trash, along with the excessive amount. The plants are not a sign of methamphetamine production, but instead may be marijuana. Another sign that a home may be being used to grow marijuana is bright lights on 24-hours a day.

The home health nurse suspects that the client's house is being used as a methamphetamine laboratory. Which observation supports this conclusion? Select all that apply. One, some, or all responses may be correct.

Stage 1, the orientation phase of the therapeutic relationship, involves the nurse learning about the client and initial concerns and needs. The client's feelings are the initial focus of the communication. Assessing for suicidal and homicidal thoughts is necessary for safety. Assuring confidentiality helps build trust, which is part of this stage. In the orientation phase the nurse will gather data related to the client's strengths and weaknesses and works with the client to set treatment goals. Discussions concerning treatment techniques, such as journaling and medication, are done in stage 2 of the working phase of the relationship. In the working phase, the nurse guides the client to understand behavioral changes through self-evaluation.

Which response will the nurse use during stage 1 of a therapeutic relationship with a depressed client? Select all that apply. One, some, or all responses may be correct.