Mental Health Ch. 13-16

When discussing the symptoms of post-traumatic stress disorder (PTSD), the nurse should make which statement? a. "When experiencing a flashback, the client generally experiences a slowing of responses." b. "PTSD causes agitation and hypervigilance but rarely chronic depression." c. "The symptoms can neither occur almost immediately or even take years to manifest." d. "PTSD is an emotional response that does not cause significant changes in brain chemistry."

"The symptoms can neither occur almost immediately or even take years to manifest." The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. None of the other statements correctly describe the symptoms of PTSD.

Which statement by a patient diagnosed with schizophrenia who is experiencing paranoid thinking most clearly indicates the antipsychotic medication was effective? a. "I think the staff wants to help me." b. "I finished my project in arts and crafts group." c. "A nurse on the night shift gave me too much medicine." d. "I don't need to take medicine anymore. I do not have any problems."

a. "I think the staff wants to help me." Recognizing that the staff desires to be helpful suggests the paranoia is gone or has subsided. Reporting that they finished an art project is a statement of accomplishment. Thinking the nurse is giving too much medicine reflects paranoia. Believing that they no longer have a problem reflects anosognosia.

A patient diagnosed with bipolar disorder has taken lithium for 1 year with good results. Today, the patient phones the nurse to report symptoms. Which complaint would the nurse address as a priority? a. "I've had very bad diarrhea for 3 days." b. "I notice my hand trembling occasionally." c. "In the past 6 months, I have gained 8 pounds (3.6 kg)." d. "I have been taking my medications with a heavy meal."

a. "I've had very bad diarrhea for 3 days." Diarrhea makes this patient vulnerable to dehydration, which can result in increased concentration of lithium in the blood. This increased drug concentration can lead to lithium toxicity. Fine tremors and weight gain are expected side effects associated with lithium therapy. The nurse should be sensitive to these concerns, but they are not a priority. The patient should take the medication with meals. Eating a heavy meal is not a priority.

When discussing the symptoms of posttraumatic stress disorder (PTSD), the nurse correctly makes which comment? a. "The symptoms can occur almost immediately or can take years to manifest." b. "PTSD causes agitation and hypervigilance but rarely chronic depression." c. "PTSD is an emotional response that does not cause significant changes in brain chemistry." d. "When experiencing a flashback, the patient generally experiences a slowing of responses."

a. "The symptoms can occur almost immediately or can take years to manifest." The onset of PTSD symptoms can occur as early as a month after exposure, but a delay of months or years is not uncommon. PTSD can cause chronic depression. There are significant changes in brain chemistry. Flashbacks can cause a quickening of responses.

Which information about comorbidity would be included when educating the parents of an adolescent diagnosed with schizophrenia? a. "Watch your child for signs of substance abuse." b. "Make sure your child does not become dehydrated." c. "With schizophrenia, your child will not experience any depression." d. "Contact the healthcare provider immediately if your child has anxiety."

a. "Watch your child for signs of substance abuse." Substance use disorders involving alcohol, marijuana, and nicotine occur in nearly half of the people who are diagnosed with schizophrenia. Substance use is linked to higher rates of treatment nonadherence. Schizophrenia may cause polydipsia, which is a compulsive drinking of excess fluids, not dehydration. Depression frequently cooccurs in individuals with schizophrenia. Anxiety cooccurs with schizophrenia, but it is not necessary to contact the healthcare provider immediately if these symptoms present.

A patient diagnosed with depression begins a new prescription for phenelzine. Which food is safe for this patient to consume? a. Fresh fish b. Pepperoni c. Chocolate d. Guacamole

a. Fresh fish Phenelzine is a monoamine oxidase inhibitor antidepressant medication. It is important to avoid foods high in tyramines. Fresh fish is safe. Pepperoni and chocolate are foods high in tyramines, which may cause a hypertensive crisis. Guacamole is made from overripe avocados, which are high in tyramines.

Which cause of schizophrenia is currently understood? 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. A combination of inherited and nongenetic factors Causation is a complicated matter. Schizophrenia is most likely caused by a combination of inherited genetic factors and extreme nongenetic factors (e.g., viral infection, birth injuries, and nutritional factors) that can affect the genes governing the brain or directly injure the brain. Changes in dopamine and serotonin are signs of schizophrenia but are not thought to be the cause of the disease. Stress and ineffective stress management are risk factors but are not thought to cause schizophrenia.

Which statement is true regarding normal anxiety? Select all that apply. One, some, or all responses may be correct. a. A degree of anxiety is necessary and healthy. b. Unlike fear, it is a reaction to a specific danger. c. It is a factor in the achievement of personal goals. d. It motivates people to make and survive change in their lives. e. It provides the energy needed to achieve tasks related to living.

a. A degree of anxiety is necessary and healthy. c. It is a factor in the achievement of personal goals. d. It motivates people to make and survive change in their lives. e. It provides the energy needed to achieve tasks related to living. Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. Fear is a reaction to a specific danger, whereas anxiety is a vague sense of dread related to an unspecified or unknown danger.

What symptom can the nurse expect a client diagnosed with depersonalization disorder to manifest? a. A feeling of detachment from one's body or mental processes b. Worry about having a serious disease based on symptom misinterpretation c. Aimless wandering with confusion and disorientation d. Existence of two or more personalities that take control of behavior

a. A feeling of detachment from one's body or mental processes Depersonalization is characterized by a sense of unreality or self-estrangement. None of the other options present an expected characteristic of depersonalization disorder.

Which nursing consideration is important when preparing to administer aripiprazole to a patient for the treatment of schizophrenia? a. Administer aripiprazole in the deltoid. b. Administer aripiprazole in the gluteal site only. c. Use a Z-track method when administering aripiprazole in the gluteal. d. Monitor the patient for excess sedation for 3 hours after the injection.

a. Administer aripiprazole in the deltoid. Aripiprazole is a second-generation antipsychotic that should be administered intramuscularly in the deltoid or gluteal site. A Z-track method is not used when administering aripiprazole in the gluteal site. A patient receiving aripiprazole does not require monitoring for excess sedation for 3 hours after the injection.

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

a. An eating disorder c. A history of sexual abuse d. A history of childhood trauma e. A sibling with the disorder Sexual and physical abuse in childhood or trauma increases the risk of this disorder. Genetics are strongly associated with this disorder. First-degree relatives have twice the risk. OCD tends to occur along with anxiety disorders 76% of the time. Other comorbid conditions include major depressive disorder, bipolar disorder, and eating disorders. Suicide while a concern is not among the most common issues for the client diagnosed with OCD.

Which comorbid disorder is most prevalent in patients with bipolar II disorder? a. Anxiety b. Phobias c. Sleep disorders d. Attention-deficit/hyperactivity disorder (ADHD)

a. Anxiety About 75% of patients with bipolar II disorder have comorbid anxiety disorders. Phobias are more common in patients with bipolar I disorder. Sleep disorders are common in cyclothymic disorder. ADHD is common in children with cyclothymic disorder.

Which mental health disorder can be a direct physiological result of hyperthyroidism? a. Anxiety b. Panic attacks c. Generalized anxiety disorder d. Obsessive-compulsive disorder (OCD)

a. Anxiety Anxiety can be a direct physiological result of hyperthyroidism. Panic attacks are a key feature of panic disorders. Generalized anxiety disorder is excessive worry, which is out of proportion to the true effect of events or situations. It is often comorbid with major depressive disorder and other anxiety disorders. OCD is characterized by both obsession and compulsions that may occur as a result of a genetic disposition or trauma.

Which information would the nurse include in medication education for a patient prescribed a benzodiazepine to treat anxiety for obsessive-compulsive behavior? Select all that apply. One, some, or all responses may be correct. a. Caffeine beverages should be avoided. b. Antacid use can affect medication absorption. c. Benzodiazepines have a quick onset of action. d. Medication should be taken on an empty stomach. e. The medication is recommended for long-term use.

a. Caffeine beverages should be avoided. b. Antacid use can affect medication absorption. c. Benzodiazepines have a quick onset of action. Benzodiazepines are used most commonly for treatment of anxiety disorders because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods only until other medications or treatments reduce symptoms. Beverages containing caffeine should be avoided because they decrease the desired effects of the drug. Antacids may delay absorption. Medications should be taken with or shortly after meals to reduce gastrointestinal discomfort.

A patient says, "I have to wash my hands five times before I can eat breakfast." Which behavior is the patient demonstrating? a. Compulsion b. Superstition c. Perfectionism d. Contamination

a. Compulsion The patient is demonstrating a compulsion, a ritualistic behavior. Perfectionism, superstition, and contamination are obsessions.

Which behavior is important to include when teaching the patient and the family to recognize possible signs of impending mania? a. Decreased sleep b. Increased appetite c. Decreased social interaction d. Increased attention to body functions

a. Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. Increased appetite, decreased social interaction, and increased attention to bodily functions do not indicate impending mania.

Which symptom in a patient with schizophrenia can be categorized as a positive symptom? a. Delusions b. Dysphoria c. Loss of motivation d. Impaired judgment

a. Delusions The behavioral traits not normally found in healthy patients are called positive symptoms of schizophrenia and include delusions, hallucinations, bizarre behavior, and paranoia. Dysphoria and suicidal intentions are affective symptoms of schizophrenia, which involve emotions and their expression. Behaviors that are present in healthy people but lacking in patients with schizophrenia are negative symptoms, such as loss of motivation and alogia (poverty of thought or inability to speak). Impaired judgment and illogical thinking are the cognitive symptoms associated with schizophrenia.

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. Denial b. Undoing c. Suppression d. Altruism

a. Denial Denial involves escaping unpleasant reality by ignoring its existence. Altruism is a healthy coping mechanism involving helping others. Undoing occurs when a person makes up for an act that is regretted. Suppression is the conscious denial of a disturbing situation.

The symptoms of an adjustment disorder can include which characteristics? (Select all that apply.) a. Depression b. Guilt c. Anger d. Social withdrawal e. Overachieving

a. Depression b. Guilt c. Anger d. Social withdrawal In contrast to acute stress disorder responses, which are quite severe and include anxiety and fear, symptoms of an adjustment disorder can run the gamut of all forms of distress including guilt, depression, and anger. These feelings may be combined with other manifestations of distress, including physical complaints, social withdrawal, or work or academic inhibition. The behaviors associated with overachieving are not seen in individuals diagnosed with an adjustment disorder.

Which teaching point would be most beneficial for the parents of a teenager who was admitted several weeks ago after a suicide attempt? a. Depression is beyond voluntary control, but it can be managed. b. The patient needs to be able to express anger directly at the parents. c. The parents should also seek therapeutic help because depression is hereditary. d. The patient should stop taking prescribed medicines if the patient mentions suicide.

a. Depression is beyond voluntary control, but it can be managed. Family support is key to improving the prognosis for depressed teenagers. Crucial to this is the parents' understanding that depression is involuntary but can be managed. The patient does need to find ways to express feelings, but expressing anger is not always a solution. Depression can be hereditary, but this does not address the parent's concern. The patient should not stop taking prescribed medications without consulting the doctor.

A patient is experiencing a panic attack. The nurse can be therapeutic by taking which action? a. Encouraging the patient to take slow, deep breaths b. Verbalizing mild disapproval of the anxious behavior c. Offering an explanation about why the symptoms are occurring d. Asking the patient what is meant when they say "I am dying"

a. Encouraging the patient to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse must tell the patient to "breathe with me" and keep the patient focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. Verbalizing mild disapproval does not assist the patient. With a panic attack, the nurse should use minimal communication. Teaching the patient about why the symptoms are occurring will not be effective; that would be distracting to a patient who is in a panic state. Asking the patient to explain what is meant by "dying" is nontherapeutic when the patient is in the panic state.

Which intervention is appropriate for stage 2 of the staged model of trauma treatment? a. Engaging in memory work b. Social skills training c. Providing a predictable environment d. Enhancing problem-solving skills

a. Engaging in memory work Appropriate interventions for stage 2 of the staged model of trauma treatment include regulating emotion through symptom reduction and memory work. Social skills training occurs in stage 3. Providing a safe, predictable environment occurs in stage 1. Enhancing problem-solving skills occurs in stage 3.

Which nursing intervention is an appropriate response to anosognosia in a patient with schizophrenia experiencing psychosis? a. Establish trust and rapport. b. Convey empathy and support. c. Reduce excessive stimulation. d. Explain the diagnosis in a confident manner.

a. Establish trust and rapport. Anosognosia is common in patients with severe mental illness and is not denial or resistance to accepting the diagnosis. The patient cannot recognize they have an illness. It is important for the nurse to establish trust and rapport with the patient, because this will allow the nurse to provide treatment and implement interventions to help the patient remain safe and gain awareness of their illness. Empathy and support are not helpful if the patient does not recognize that they are ill. Reducing excessive stimulation is an intervention for a patient who is restless or agitated. Explaining the diagnosis in a confident manner will not promote the patient's awareness of their illness.

A patient diagnosed with panic disorder is prescribed chlordiazepoxide. Which instruction is the most appropriate suggestion by the nurse? a. Follow contraceptive methods. b. Stop the medication after 3 months. c. Change the medication if there is insomnia. d. Coffee and tea are fine to drink and will not interact with the medication.

a. Follow contraceptive methods. Chlordiazepoxide belongs to the benzodiazepine class of antianxiety drugs. It causes congenital anomalies in the fetus; therefore the patient should avoid becoming pregnant. As caffeine decreases the efficacy of the benzodiazepines, the nurse should suggest the patient avoid drinking coffee and tea. The nurse should suggest discussing continuing medication with the healthcare provider after 3 to 4 months. Abruptly stopping the medication can cause withdrawal symptoms like dry mouth, tremors, and convulsions.

A patient diagnosed with major depressive disorder has vegetative symptoms. With which aspect is the patient likely to have the most difficulty? a. Grooming b. Anger at God c. Hallucinations d. Excessive eating

a. Grooming Vegetative signs of depression include grooming and hygiene deficiencies; significantly reduced appetite; and changes in sleeping, eating, elimination, and sexual patterns. Spiritual distress, hallucinations from disturbed thought processes, and excessive eating are not associated with the vegetative signs of depression.

The nurse is caring for a child who is demonstrating posttraumatic stress behaviors related to being sexually abused. Which intervention would the nurse include in the child' s plan of care? Select all that apply. One, some, or all responses may be correct. a. Introducing and practicing relaxation techniques with the child b. Assuring the child that everything discussed will be kept confidential c. Directing the discussion to focus only on the issue of the possible abuse d. Avoiding the use of sexually oriented terms that could trigger anxiety in the child e. Providing the child with puppets to facilitate communication about the possible abuse

a. Introducing and practicing relaxation techniques with the child e. Providing the child with puppets to facilitate communication about the possible abuse Appropriate interventions to assist a child through the process to resolve a traumatic experience include helping the child to identify and cope with feelings through the use of art and play to promote expression and teaching relaxation techniques before trauma exploration to restore a sense of control over thoughts and feelings. There is no reason to restrict the use of certain terms unless it is known to trigger anxiety. Although information is normally confidential, such a statement is not true in situations of abuse. The child should be in control of the discussion; the nurse facilitates but does not limit the discussion.

Which outcome for a patient with mania during the acute phase indicates that the treatment plan was successful? a. Is free of injury b. Is highly distractible c. Ignores food and fluid d. Reports racing thoughts

a. Is free of injury Risk for injury is a diagnosis of high priority for patients with mania because of their hyperactivity. Lack of injury is a highly desirable outcome. A patient with mania will be distractible and report racing thoughts as part of the disease process. This is not as high a priority as injury prevention. Ignoring the need for food and fluid is common during the acute phase and could eventually lead to hypovolemia and starvation; however, the higher priority is preventing injury.

Which physiological condition of a patient prescribed clozapine would the nurse monitor? Select all that apply. One, some, or all responses may be correct. a. Liver function b. Kidney function c. Total red blood cell count d. Total white blood cell count e. Total water intake and output

a. Liver function d. Total white blood cell count Agranulocytosis is the most common symptom of clozapine. It is characterized by a reduced white blood cell count (less than 3000/mm ) and liver impairment, therefore the nurse should frequently monitor the liver function and total white blood cell count. Clozapine does not have an effect on the kidneys; therefore the total water intake and output and kidney function do not need to be monitored. Clozapine reduces white blood cell count but does not affect red blood cell count; therefore red blood cell count need not be monitored.

Which term applies to the patient's behavior when displaying a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extremely goal-directed activity? a. Mania b. Hypomania c. Flight of ideas d. Loose associations

a. Mania Mania is a period of intense mood disturbance with persistent elevation, expansiveness, irritability, and extremely goal-directed activity or energy. Mania commonly occurs with bipolar I disorder. Hypomania refers to a low-level and lessdramatic mania. Flight of ideas is a continuous flow of accelerated speech with abrupt changes from topic to topic. Loose associations represent the disordered way that a person is processing information and thoughts that are only loosely connected to each other in the person's conversation.

Which nursing consideration is a primary focus when planning care for a patient in the acute phase of mania? a. Medical stabilization b. Focus on the prevention of relapse c. Decreasing the risk of lithium toxicity d. Limiting the severity of future episodes of mania

a. Medical stabilization During the acute phase of mania, planning focuses on medically stabilizing the patient while maintaining safety. Focusing on the prevention of relapse, decreasing the risk of lithium toxicity, and limiting the severity of future episodes of mania are the focus of planning during the maintenance phase.

Which area of instruction would the nurse include when educating the family of a patient diagnosed with schizophrenia? Select all that apply. One, some, or all responses may be correct. a. Medication side effects b. Stress as a psychotic trigger c. Relapse prevention strategies d. Need for family to take over the management of care e. Family's role in achieving positive treatment outcomes

a. Medication side effects b. Stress as a psychotic trigger c. Relapse prevention strategies e. Family's role in achieving positive treatment outcomes Education is essential and includes teaching the patient and family about the illness, including the causes, medications and side effects, coping strategies, what to expect, and relapse prevention. This knowledge will help the patient and family to appreciate the effect of stress and the importance of treatment on a good outcome. The patient who returns to a warm, concerned, and supportive environment is less likely to experience relapse. The patient should always be involved in the management of their care to the extent of their abilities.

Which initial outcome is most appropriate for a patient with a 6-year history of schizophrenia when beginning a community rehabilitation program? a. Lead the morning exercise group. b. Participate actively in scheduled programming. c. Apply for employment in a local sheltered workshop. d. Report that no auditory hallucinations have occurred.

b. Participate actively in scheduled programming. Participation in scheduled activities of the program should occur first. After the patient is accustomed to the program, the patient might lead a group or apply for employment. Hallucinations commonly continue to occur in patients diagnosed with schizophrenia.

When a toddler ' s mother is hospitalized for several months, the child experiences difficulty with parent-child attachment as a result of the prolonged separation. Which outcome is the most appropriate? a. Mother and child show signs of healthy bonding. b. The father is able to assume the mother's role in her absence. c. The mother is discharged and returned home as soon as possible. d. The child is able to transfer nurturing needs to another available adult.

a. Mother and child show signs of healthy bonding. An overall attachment outcome would be for the parent and child to demonstrate an enduring affectionate bond. Because the child is experiencing distress from the mother's absence, the most appropriate outcome would be to improve that bonding. Also, it may not be possible for the father to assume the mother's role. It is beyond the control of the child, the mother, or the nurse to expect the mother to be discharged quickly. The child needs to improve the bond with the mother, not with another available adult.

A young adult invites eight people to dinner. On the morning of the party, the young adult multitasks and makes progress preparing each food item on the menu. As the time approaches for the guests to arrive, which change indicates an increased anxiety level? a. Muscles become tense. The person must stop cooking to use the bathroom every 10 to 15 minutes. b. Blood pressure and pulse rates increase slightly. The person notices feelings of mild muscle tension. c. Fond memories of family reunions and the good food that was served drift in and out of the person's thoughts. d. The person notices there are cobwebs in the corner of the dining room and removes them before the guests arrive.

a. Muscles become tense. The person must stop cooking to use the bathroom every 10 to 15 minutes. Increased muscle tension and frequency or urgency of urination are indications of an increased anxiety level. Other observable symptoms are fine hand tremors, restlessness, nervousness, inability to concentrate, flushing, and sweating. Mild muscle tension, slightly elevated blood pressure and pulse rate, memories of past good times, and last-minute housecleaning do not indicate increasing anxiety.

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. Posttraumatic stress response c. Obsessive-compulsive disorder d. Generalized anxiety disorder

a. Panic attacks with agoraphobia Panic disorder with agoraphobia is characterized by recurrent panic attacks combined with agoraphobia. Agoraphobia involves intense, excessive anxiety about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurred. Generalized anxiety disorder, posttraumatic stress response, and obsessive-compulsive disorder do not feature intense anxiety about being in places or situations from which escape might be difficult.

Which situation most closely resembles the use of dissociation? a. Performing mundane tasks on "autopilot" b. Feeling angry with a coworker who shirks work c. Developing a headache to avoid an unpleasant task d. Finding a socially acceptable reason to meet a need

a. Performing mundane tasks on "autopilot" Mild, fleeting dissociative experiences are relatively common; for example, one says one is on "automatic pilot" when driving home from work and cannot recall the last 15 minutes before reaching the house. Dissociative events do not correlate with getting angry at a coworker, developing headaches, or finding a socially acceptable reason to meet a need.

Which documentation entry accurately describes a patient who presents with disorganized thoughts and reports hearing voices? a. Positive symptoms of schizophrenia b. Negative symptoms of schizophrenia c. Cognitive symptoms of schizophrenia d. Affective symptoms of schizophrenia

a. Positive symptoms of schizophrenia The patient is presenting with positive symptoms of schizophrenia, which includes the presence of something that should not be present, such as hallucinations, delusions, paranoia, disorganized thoughts, and bizarre behaviors. Negative symptoms are the absence of something that should be present, such as the inability to enjoy activities or being uncomfortable in social situations. Cognitive symptoms can include subtle or obvious impairment in memory, thinking, and attention. Affective symptoms involve motions and their expressions.

Which is the priority of care for a patient experiencing hyperactive mania? a. Preventing injury b. Improving self-esteem c. Encouraging mobility d. Improving verbal communication

a. Preventing injury Risk for injury is high, which is related to the patient's hyperactivity and poor judgment. Patients with mania have overinflated self-esteem. Hyperactivity is a common symptom in mania; patients do not need encouragement to be more mobile. Another feature of mania is loud, rapid and clanging verbal communication.

Which problem is potentially present for a patient diagnosed with severe obsessive-compulsive disorder (OCD)? a. Sleep disturbance b. Excessive socialization c. Command hallucinations d. Altered state of consciousness

a. Sleep disturbance Patients who must engage in compulsive rituals for anxiety relief rarely are afforded relief for any prolonged period. The high anxiety level and need to perform the ritual may interfere with normal routines such as sleep. Excessive socialization is not a likely feature of OCD because patients feel shame and humiliation regarding behavior. Command hallucinations are a feature of schizophrenia. Patients with OCD do not have an altered state of consciousness.

Which assessment tool would the nurse use while assessing an adult patient with dissociative identity disorder? a. Somatoform questionnaire b. Child dissociative checklist c. Child sexual behavior inventory d. Posttraumatic stress disorder (PTSD) screening

a. Somatoform questionnaire Dissociative identity disorder is a type of dissociative disorder. Somatoform questionnaire is an assessment tool used to assess dissociative identity disorder in patients. Child dissociative checklist is used to assess dissociative disorders in children and not in adults. Child sexual behavior inventory is used to assess children with attachment disorder. PTSD screening is an assessment tool used while assessing a patient with PTSD.

Which intervention would be included in the plan of care for a patient who takes lithium? a. Dietary teaching to restrict daily sodium intake b. Periodic laboratory monitoring of renal and thyroid function c. Required laboratory tests to monitor serum potassium level d. Importance of discontinuing the medication if weight gain occurs

b. Periodic laboratory monitoring of renal and thyroid function Two major long-term risks of lithium therapy are hypothyroidism and impairment of the kidney's ability to concentrate urine; therefore a person receiving lithium therapy must have periodic follow-ups to assess thyroid and renal function. Sodium intake for patients who take lithium is not restricted. Potassium levels are not affected by this medication. Weight gain is a common side effect associated with this medication, but the patient should continue taking the medication.

Which statement regarding bipolar I disorder is true? Select all that apply. One, some, or all responses may be correct. a. The median age for onset is 18 years. b. Approximately 6% of the adult population has bipolar I disorder. c. The disorder is more common among women than men. d. Severe postpartum depression increases the risk for developing the disorder. e. Women with a bipolar disorder are more likely than men to commit suicide.

a. The median age for onset is 18 years. d. Severe postpartum depression increases the risk for developing the disorder. e. Women with a bipolar disorder are more likely than men to commit suicide. The median age of onset for bipolar I disorder is 18 years. Women who experience a severe postpartum psychosis within 2 weeks of giving birth have a four times greater chance of subsequent conversion to bipolar disorder. Women with a bipolar disorder are more likely than men to commit suicide. The percentage of the population at risk for bipolar I or bipolar II disorder is nearly 4%. Men and women have nearly equal rates of bipolar disorders.

Which method would the nurse choose to reduce anorexia in a patient who has low self-esteem and avoids food? a. The nurse allows family members to remain with the patient during meals. b. The nurse gives food low in fiber to the patient. c. The nurse gives a large quantity of low-calorie food to the patient. d. The nurse gives tea and coffee frequently to the patient.

a. The nurse allows family members to remain with the patient during meals. Low self-esteem and reduced food intake are symptoms of depression. Patients can be encouraged to take food in the presence of their family members as it increases their self-esteem. Taking food rich in fiber helps reduce constipation. Small amounts of high-calorie and high-protein food should be given frequently to meet the patient's nutritional demands. The patient must not be given tea or coffee frequently as they cause insomnia.

A nurse is caring for a patient with anorexia. After several weeks, the patient is energetic and has an improved appetite. Which effective nursing intervention did the nurse likely use with the patient? a. The nurse offered foods that the patient liked. b. The nurse instructed the patient to avoid exercising. c. The nurse offered three high-calorie meals during the day. d. The nurse provided high-fat foods to help the patient gain weight.

a. The nurse offered foods that the patient liked. Anorexia is characterized by reduced appetite and low body weight. The nurse should follow proper nursing interventions to provide good nutrition to the patient, which may include offering foods that the patient prefers. A patient with anorexia may benefit from light (but not excessive) physical activity as it may stimulate the appetite. The patient may not be able to eat one complete meal at a time. Several high-calorie, high-protein snacks during the day is preferred. The nurse should give the patient high-calorie foods in small quantities to meet the nutritional demands of the body.

A nurse caring for a patient with depression instructs the patient to rest after group activity. The nurse provides warm milk to the patient in the morning and at night. Which change would the nurse expect to find in the patient after implementation of this these interventions? a. The patient sleeps several hours. b. The patient interacts with the nurse. c. The patient maintains good hygiene. d. The patient has an increased appetite.

a. The patient sleeps several hours. Patients with depression often have insomnia. The nurse should ensure that patients rest adequately after group activity. This helps reduce fatigue, which can intensify the symptoms of depression. The patient can be given warm milk at night to induce sleep. Encouraging the patient to interact with the nurse or practice good hygiene or improving the patient's appetite may be treatment goals, but they are not directly related to the nurse's intervention with warm milk.

In a teaching session, the nurse uses strategies that would induce a slight degree of anxiety in the patients attending the session. Which outcome is the nurse ' s intention for this action? a. The patients would be more focused during the session. b. The patients would be more expressive during the session. c. The patients would be more comfortable during the session. d. The patients would be more willing to participate in the session.

a. The patients would be more focused during the session. Mild anxiety causes patients to see, listen, and grasp more information. This helps the patients to focus more on whatever is taught during the teaching session. Mild anxiety is unlikely to improve the patient's expression, comfort level, or willingness to participate. The nurse should involve the patient in discussion so that the patient expresses feelings and should modify the environment of teaching to make the patient comfortable.

Which action must occur before the nurse can administer lithium in a patient who is experiencing mania? a. The physical examination and laboratory tests are analyzed. b. The initial doses of antipsychotic medication have brought behavior under control. c. Seclusion has proven ineffective as a means of controlling assaultive behavior. d. Electroconvulsive therapy can be scheduled to coincide with lithium administration.

a. The physical examination and laboratory tests are analyzed. Lithium should not be given to patients with impaired renal or thyroid function. A thorough physical examination and various laboratory tests are necessary to rule out other organic causes for the behavior and to ensure that the lithium can be excreted normally. Frequently, antipsychotic medications are prescribed until the effects of lithium are present, usually after 10 days. Seclusion is not indicated. Lithium does not have to be scheduled with electroconvulsive therapy.

Which statement about structural dissociation of the personality is true? a. Trauma is the basis for this type of disorder. b. This disorder results in a split in the personality causing a lack of integration. c. No known link exists between this disorder and early childhood loss or trauma. d. Nurses perceive clients with this disorder as easy to care for.

a. Trauma is the basis for this type of disorder. The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment. None of the other options are accurate statements regarding this disorder.

Which assessment finding indicates a patient is experiencing extrapyramidal symptoms? Select all that apply. One, some, or all responses may be correct. a. Tremor b. Drooling c. Dry eyes d. Constipation e. Shuffling gait

a. Tremor b. Drooling e. Shuffling gait Fluphenazine is a first-generation antipsychotic medication. These medications commonly cause extrapyramidal symptoms, which include masklike faces, stiff and stooped posture, shuffling gait, drooling, tremor, "pill-rolling" movements, and akathisia. Constipation and dry eyes are anticholinergic side effects.

Which side effect does the nurse anticipate when caring for a patient with schizophrenia who was given an injectable dose of dopamine (D ) antagonists for the limbic center? Select all that apply. One, some, or all responses may be correct. a. Tremors b. Difficulty walking c. Increased energy d. Loosening of reflexes e. Pacing back and forth f. Muscular contraction in the neck

a. Tremors b. Difficulty walking e. Pacing back and forth f. Muscular contraction in the neck D2 antagonists are first-generation antipsychotics that are used less frequently because of their side effects. The medications block D2 receptors, causing extrapyramidal side effects that include pacing and general restlessness (akathisia), muscular contractions (acute dystonia), gait impairment, and tremors (pseudoparkinsonism). These agents do not loosen reflexes or increase energy, though akathisia can sometimes be confused with increased energy.

When the nurse remarks to a patient with depression, "I see you are trying not to cry. Tell me what is happening." The nurse would be prepared to take which action? a. Wait quietly for the patient to reply. b. Prompt the patient if the reply is slow. c. Repeat the question if the patient does not answer promptly. d. Review the patient's medical record to support the patient's response.

a. Wait quietly for the patient to reply. Patients who are depressed think slowly and take long periods to formulate answers and respond. The nurse should be prepared to wait for a reply. It is inappropriate to prompt the patient or repeat the question if the patient doesn't answer promptly. The nurse is not communicating with the patient by simply reviewing the patient's medical record.

A patient who has been diagnosed with dissociative identity disorder asks, "What exactly are 'alters '? My healthcare provider told me I have several of them. " Which statement by the patient illustrates that the education provided has been effective? a. "Alters are never aware of each other." b. "Alters are separate personalities that take over during stress." c. "Alters are based in mysticism and religiosity, such as demons." d. "Alters are just like me, but they have no memory of the trauma I went through."

b. "Alters are separate personalities that take over during stress." Dissociative identity disorder appears to be associated with at least two dissociative identity states: one is a state or personality that functions on a daily basis and blocks access and responses to traumatic memories and another state (also referred to as an alter state) is fixated on traumatic memories. Each alter has its own memories, behavior patterns, and characteristics. Transition from one personality to another (switching) occurs during times of stress. Alters may be aware of the existence of each other to some degree. It is believed that alters develop from severe sexual, physical, or psychological trauma in childhood; they are not based in mysticism and religiosity. Alters are not just like the host; they have different behaviors and memories.

A patient hospitalized for major depression has been taking sertraline for the past week and has verbalized increased energy and improved sleep. Which question is the highest priority the nurse would ask? a. "Do you think your depression is less severe?" b. "Are you having any thoughts of harming yourself?" c. "Have you experienced any side effects from this drug?" d. "How has your appetite changed since starting this drug?"

b. "Are you having any thoughts of harming yourself?" The patient is starting to experience increased energy, but suicidal thoughts may still remain. The patient may now have the energy for self-harm. Asking the patient if they feel the depression is lifting is not as high a priority as asking about suicidal thoughts. It is important to assess for other side effects, such as appetite changes and depression, but suicide is the highest priority.

The nurse is caring for a child with posttraumatic stress disorder (PTSD). The parents ask the nurse about psychopharmacological interventions. Which statement is the best response by the nurse? a. "Medication that cures PTSD has undesirable side effects." b. "Certain medications can be taken to help minimize symptoms of PTSD." c. "Your child could be cured of PTSD with natural supplements rather than drugs." d. "Pharmacological interventions are the optimal treatment for children with PTSD."

b. "Certain medications can be taken to help minimize symptoms of PTSD." There are no Food and Drug Administration (FDA)-approved medications for children who have PTSD. Rather, certain medications can be prescribed to help manage the symptoms of PSTD, such as anxiety or depression. Medications that treat some of the PTSD symptoms do have some side effects, but these are not always undesirable; the healthcare provider and the parents must consider risk versus benefits. There are no medications that can cure PTSD, not even with the use of natural supplements or drugs. The optimal treatment for children with PTSD is cognitive behavioral therapy (CBT), and this intervention can be used in addition to medication.

Which question is to ask during the assessment of a patient diagnosed with anxiety disorder? a. "How often do you hear voices?" b. "Have you ever considered suicide?" c. "How long has your memory been bad?" d. "Do your thoughts always seem jumbled?"

b. "Have you ever considered suicide?" The presence of anxiety may cause an individual to consider suicide as a means of finding comfort and peace. Suicide assessment is appropriate for any patient with higher levels of anxiety. Hearing voices is associated with psychosis. Memory loss is associated with various types of dementia. Jumbled thoughts are associated with thought disorders or dementia.

Which belief voiced by a patient with schizophrenia correlates with exhibiting grandiose delusions? a. "My brain is rotting." b. "I am President of the United States." c. "The food in the hospital is being poisoned." d. "The nurse has romantic feelings for me."

b. "I am President of the United States." Grandiose delusions involve believing that one is a powerful or important person, such as the President of the United States. Believing that the brain is rotting away is an example of somatic delusions. Believing that food is being poisoned is an example of persecutory delusions. Believing that the nurse has romantic feelings for them is an example of erotomanic delusions.

Which statement would show acceptance of a patient who is depressed, withdrawn, and silent? 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."

b. "I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the patient without making demands is a good way to show acceptance. Telling the patient that the nurse will try to improve the patient's mood is false reassurance and not likely to improve the patient's depression. A patient who is withdrawn and silent is not ready to talk about things that are bothering them or share their thoughts with others.

A patient has taken citalopram for 2 years for dysthymic disorder. The patient' s outcomes have been achieved, and the patient wants to discontinue the medication. After consultation with the healthcare provider, which information would the nurse provide? a. "Citalopram is an antidepressant medication that is usually taken for life." b. "It's important for you to gradually stop taking this drug, over 2 to 4 weeks." c. "Because your depression is alleviated, you may now discontinue the medication." d. "Stopping this medication suddenly can cause neuroleptic malignant syndrome."

b. "It's important for you to gradually stop taking this drug, over 2 to 4 weeks." Selective serotonin reuptake inhibitor (SSRI) medication should not be discontinued abruptly. Abrupt cessation can lead to serotonin withdrawal. The duration of treatment with citalopram is individualized based on the patient's symptoms, but it is usually not taken lifelong. Neuroleptic malignant syndrome is an adverse effect associated with use of antipsychotic medications, not SSRIs.

A nurse caring for a patient with mania observes that the patient has persistent gastrointestinal upset. The nurse believes that the patient is showing advanced signs of lithium toxicity and tests the serum levels of lithium in the patient. Which concentration of lithium does the nurse expect to find in the patient' s blood serum? a. 0.5 mEq/L b. 1.8 mEq/L c. 2.5 mEq/L d. 3.4 mEq/L

b. 1.8 mEq/L Serum levels of more than 1.8 mEq/L can cause advanced signs of toxicity such as gastrointestinal upset, mental confusion, incoordination, and sedation. A serum level of 0.5 mEq/L indicates the therapeutic level of lithium. Serum levels of 2.5 and 3.4 mEq/L indicate severe toxicity. The symptoms of severe toxicity include oliguria, convulsions, severe hypotension, and death.

Which child is at greatest risk for developing attachment problems as a result of a neurobiological development? a. A 10-year-old female b. A 4-year-old female c. A 13-year-old male d. A 7-year-old male

b. A 4-year-old female The developing brain is particularly vulnerable to adverse events because the most rapid brain development occurs in the first five years of life. The right hemisphere is involved in processing social-emotional information, promoting attachment functions, regulating body functions, and in supporting the individual in survival and in coping with stress. Since the right brain develops first and is involved with developing templates for relationships and regulation of emotion and bodily function, early attachment relationships are particularly important for healthy development and life-long health.

Which symptom can the nurse expect a patient with depersonalization disorder to demonstrate? a. Aimless wandering with confusion and disorientation b. A feeling of detachment from one's body or mental processes c. Existence of two or more personalities that take control of behavior d. Anxiety about having a serious disease based on symptom misinterpretation

b. A feeling of detachment from one's body or mental processes Depersonalization is characterized by a sense of detachment from one's own body. Aimless wandering can be caused by a variety of reasons, including dementia or dissociative fugue. Having two or more distinct personalities is associated with dissociative identity disorder. A patient with a somatic disorder has anxiety about a serious disease.

Which individual demonstrates the greatest risk for experiencing major depression? a. A male teenager who failed to make the football team b. A female young adult who recently gave birth to her first child c. An older adult woman who retired after 25 years of factory work d. A middle-aged man who is a self-employed small business owner

b. A female young adult who recently gave birth to her first child Among women, rates peak between adolescence and early adulthood. It is particularly important to screen for depression among women of reproductive age, especially those who have children or plan to become pregnant. Although the male teenager and the retired woman do have characteristics that put them at risk for depression (e.g., disappointment, being a teenager, retirement, being female), they are less at risk than the female young adult who recently gave birth. The middle-aged man's risk for major depression is relatively small.

The nurse determines the patient has understood nutritional instructions while taking a prescribed monoamine oxidase inhibitor if the patient selects which food item from the menu? a. An avocado salad plate b. A fruit and cottage cheese plate c. Smoked sausage and sauerkraut d. A liver and onion sandwich

b. A fruit and cottage cheese plate Fruit and cottage cheese do not contain tyramine. Avocados; fermented food such as sauerkraut, smoked, or processed meat; and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, hypertensive crisis, and eventually a cerebrovascular accident.

Which statement about the comorbidity of anxiety disorders is true? a. Anxiety disorders generally exist alone. b. A secondary anxiety disorder may coexist with the first. c. Anxiety disorders virtually never coexist with mood disorders. d. Substance abuse disorders rarely coexist with anxiety disorders.

b. A secondary anxiety disorder may coexist with the first. In many instances, when one anxiety disorder is present, a second one coexists. Healthcare providers and researchers have clearly shown that anxiety disorders frequently cooccur with other psychiatric problems. Major depression often cooccurs and produces a greater impairment with poorer response to treatment. Substance abuse can coexist with anxiety disorders, as the patient may turn to substances to deal with the unpleasant anxiety symptoms. Some substances can cause anxiety symptoms.

Which is the usual age of onset for cyclothymic disorders? a. Childhood b. Adolescence c. Middle adulthood d. Late adulthood

b. Adolescence Cyclothymic disorders usually begin in adolescence or early adulthood. They typically begin later than childhood but earlier than middle or late adulthood.

A patient is fearful of riding in elevators and always takes the stairs. Which brain structure is involved in this fear and behavior? a. Thalamus b. Amygdala c. Hypothalamus d. Pituitary gland

b. Amygdala The amygdala plays a role in anxiety disorders. It alerts the brain to the presence of danger and brings about fear or anxiety to preserve the system. Memories with emotional significance are stored in the amygdala and are implicated in phobic responses. The thalamus relays sensory information to other brain centers. The hypothalamus is involved in regulation of the autonomic nervous system. The pituitary gland secretes regulatory hormones.

Which action is included in the nursing plan of care for a patient diagnosed with panic-level anxiety who is exhibiting severe hyperactivity? a. Place the patient in seclusion. b. Attend to the patient's physical needs. c. Help the patient identify the source of anxiety. d. Communicate using simple, loud, clear statements.

b. Attend to the patient's physical needs. The nursing care plan for a patient diagnosed with anxiety who is exhibiting severe hyperactivity is to attend to the patient's physical needs. Severe hyperactivity is characteristic of a panic level of anxiety and attending to physical needs such as elimination, fluids, and nutrition are important. Seclusion should only be initiated after all other interventions have been tried and are unsuccessful. Helping a patient identify the source of anxiety is more effective for a patient experiencing mild to moderate anxiety. When the nurse is communicating with a patient experiencing severe anxiety, a low-pitched voice should be used.

When planning patient care, which factor would be the least likely concern for a patient with depression who shows psychomotor retardation? a. Having constipation b. Being anxious about death c. Being unable to perform usual activities d. Being unable to bathe or to dress self

b. Being anxious about death Patients experiencing depression usually do not have death anxiety. They are more likely to welcome the idea of dying. A patient with psychomotor retardation has vegetative signs of depression and often is constipated and too tired to engage in activities and lacks the energy to attend to personal hygiene.

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

b. Being unable to work for the last 12 months. GAD is characterized by symptomology that lasts 6 months or longer. Repeatedly verbalizing prayers is a compulsion. Feeling uncomfortable eating in public is agoraphobia. Posttraumatic stress disorder symptoms occur after a stressful event, such as being robbed at gunpoint.

Which category of medication used to treat anxiety has a potential for dependence? a. Tricyclics b. Benzodiazepines c. Selective serotonin reuptake inhibitors d. Selective serotonin norepinephrine reuptake inhibitors

b. Benzodiazepines Benzodiazepines commonly are prescribed for anxiety because they have a quick onset of action; however, because of the potential for dependence, these medications ideally should be used for short periods. Benzodiazepines are not recommended for patients with a known substance abuse history. Tricyclics, selective serotonin reuptake inhibitors, and selective serotonin norepinephrine reuptake inhibitors do not create dependency.

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? a. Projection b. Reaction formation c. Rationalization d. Undoing

b. Reaction formation Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion. Undoing involves a person making up for an act that they regret. Projection refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. Rationalization consists of justifying illogical or unreasonable ideas by developing acceptable explanations that satisfy the teller and the listener.

Which condition is most likely present when a patient diagnosed with schizophrenia who has been taking perphenazine for 12 weeks is instructed to go on bed rest and follow a diet rich in proteins and carbohydrates? a. Agranulocytosis b. Cholestatic jaundice c. Postural hypotension d. Autonomic dysfunction

b. Cholestatic jaundice Patients with schizophrenia who are taking perphenazine, a first-generation antipsychotic drug, may experience toxic effects from long-term therapy. The nurse should identify the signs and symptoms of the toxic effects, like cholestatic jaundice, which results from collection of bile juice in the gallbladder. The patient should be instructed to go on bed rest and consume a diet rich in proteins and carbohydrates. Agranulocytosis is characterized by dangerously low levels of white blood cells; this condition is not related to bed rest and diet changes. Postural hypotension is characterized by a drop in blood pressure with a change in position and cannot be managed by a protein-rich diet. The autonomic nervous system controls involuntary actions of the body, and autonomic dysfunction is not treated by bed rest and diet changes.

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

b. Cognitive restructuring The purpose of cognitive restructuring is to change the individual's negative view of an event or a situation to a view that remains consistent with the facts but that is more positive. This is not necessarily true of any of the other options.

Which symptom would alert a healthcare provider to a possible diagnosis of schizophrenia in a young adult patient? a. Excessive sleeping with disturbing dreams b. Command hallucinations to hurt roommate c. Withdrawal from college because of failing grades d. Chaotic and dysfunctional relationships with family and peers

b. Command hallucinations to hurt roommate People diagnosed with schizophrenia all have at least one psychotic symptom, such as hallucinations, delusional thinking, or disorganized speech. Excessive sleeping, failing grades, and chaotic and dysfunctional relationships do not describe schizophrenia but could be caused by a number of problems.

A patient with premenstrual dysphoric disorder is prescribed fluoxetine. Which information would the nurse give the patient? a. Stop the medication immediately if the side effects are severe. b. Consult their primary healthcare provider if agitation occurs. c. Take acetaminophen if there is fever. d. May cause dry mouth and blurred vision.

b. Consult their primary healthcare provider if agitation occurs. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI), which is a class of drug known for having low side effects. The nurse should advise the patient to consult the primary healthcare provider about any side effects, such as agitation or anxiety. Stopping the drug abruptly may cause serotonin withdrawal, so the patient should be advised not to stop the drug without first consulting the healthcare provider. Acetaminophen or any other over-the-counter drugs should not be taken without consulting the primary healthcare provider, as it can lead to drug interactions. SSRIs are known to have low occurrence of side effects, and they do not cause dry mouth or low vision as some other antidepressants do.

Which assessment finding can the nurse expect in a patient experiencing a panic level of anxiety? a. Withdrawal b. Depersonalization c. Scattered attention d. Distorted perceptual field

b. Depersonalization The nurse can expect to find depersonalization in a patient experiencing a panic level of anxiety. Depersonalization is the sense of feeling unreal. Withdrawal, scattered attention, and a distorted perceptual field are more likely to occur in the patient experiencing severe anxiety.

What information should the nurse give to the family of a client who has had a dissociative episode? a. Ways to intervene to prevent self-mutilation and suicide attempts. b. Dissociation is a method for coping with severe stress. c. Dissociation suggests the possibility of early dementia. d. Brief periods of psychotic behavior may occur.

b. Dissociation is a method for coping with severe stress. Childhood physical, sexual, or emotional abuse and other traumatic events are associated with adults experiencing dissociative symptoms. None of the other options are true.

Which type of dissociative disorder does the patient who suddenly travels away from home and lacks the ability to recall their identity and past life events have? a. Derealization disorder b. Dissociative fugue disorder c. Depersonalization disorder d. Dissociative identity disorder

b. Dissociative fugue disorder Rationale Dissociative fugue disorder is a subtype of dissociative amnesia. The patient with dissociative fugue travels away from home unexpectedly and does not have the ability to recall their identity and some past life events. Patients with derealization disorder have false perceptions about their surroundings. Patients with depersonalization disorder feel like they are observing their own thoughts and body from outside themselves. Patients with dissociative identity disorder exhibit one or more personalities that alternately dominate each other.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? a. Asking the client what he means when he says, "I am dying." b. Encouraging the client to take slow, deep breaths c. Offering an explanation about why the symptoms are occurring d. Verbalizing mild disapproval of the anxious behavior

b. Encouraging the client to take slow, deep breaths Slow diaphragmatic breathing can induce relaxation and reduce symptoms of anxiety. Often the nurse has to tell the client to "breathe with me" and keep the client focused on the task. The slower breathing also reduces the threat of hypercapnia with its attendant symptoms. The client needs help to regain composure and stabilize vital signs; the only option that addresses these issues is the correct option.

A patient approaches the nurse's station, begins tapping a finger on the desk, and tells the nurse, "I am feeling pretty anxious." Which nursing action will assist this patient? a. Move the patient to a quieter setting. b. Escort the patient to an exercise class. c. Offer the patient antianxiety medication. d. Encourage the patient to attend art therapy.

b. Escort the patient to an exercise class. The nurse's best action is to escort the patient to an exercise class. The patient is displaying a sign of moderate anxiety by tapping their fingers on the desk, and it is ideal to provide this patient outlets for working off excess energy. A patient experiencing severe to panic levels of anxiety should be moved to a quieter setting. Medication is offered to a patient experiencing severe to panic levels of anxiety only after all other interventions have been tried and are unsuccessful. Art therapy will not offer an outlet for expending excess energy the way an exercise class will.

A nurse prepares the plan of care for a school-age child diagnosed with reactive attachment disorder. Which initial outcome would be the focus of the nurse ' s intervention? a. Decreasing impulsive behavior b. Expressing feelings through artwork c. Verbally recounting traumatic experiences d. Correctly identifying the date, time, and place

b. Expressing feelings through artwork Children with reactive attachment disorder have a consistent pattern of inhibited, emotionally withdrawn behavior caused by a lack of early bonding experiences with a primary care giver. Traumatized children need to learn strategies to regulate emotion and arousal levels. Helping the child express feelings and identify emotions is essential and helps the child feel in control. A school-age child is capable of self-expression using art and therapeutic drawing. There is no indication the child needs to decrease impulsive behavior. The child should learn relaxation techniques before exploring traumatic experiences. Disorientation is not expected for a patient diagnosed with reactive attachment disorder.

Which factor is considered in posttraumatic stress disorder (PTSD) in children? a. There are no specific risk factors; anything can cause PTSD. b. Good social support can help build a child's resilience to PTSD. c. PTSD is a genetic condition, which comes from one or both parents. d. All people are born predisposed to PTSD because of brain chemistry.

b. Good social support can help build a child's resilience to PTSD. Environmental factors can cause certain children to be more susceptible to PTSD. Therefore children with good social support are more resilient when faced with PTSD triggers. There are environmental, biological, and psychological risk factors for PTSD. PTSD is not a genetic condition, although there may be genetic factors that put children at a higher risk of getting PTSD. It is not accurate that all people are born predisposed to PTSD because not everyone has the same neurobiological makeup

Which patient action indicates a negative symptom of schizophrenia? a. Refusing to eat anything that is not tasted by the staff first b. Having difficulty focusing on any task for more than a few minutes c. Communicating using a pattern of speech identified as "word salad" d. Reporting hearing voices telling the patient that the world will end soon

b. Having difficulty focusing on any task for more than a few minutes Attention impairment is considered a negative symptom because it represents a diminution or loss of normal brain function. Paranoia, hallucinations, and distorted speech are considered positive symptoms because they are an exaggeration or distortion of normal brain function.

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? a. Overeating b. Hypervigilance c. Passivity d. A drive to be perfect

b. Hypervigilance PTSD in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance. None of the other options are characteristic of PTSD in a young child.

Which behavior best supports the diagnosis of posttraumatic stress disorder (PTSD) in a 4-year-old child? a. Overeating b. Hypervigilance c. A drive to be perfect d. Passivity

b. Hypervigilance PTSD in preschool children may manifest as irritability, aggressive or self-destructive behavior, sleep disturbances, problems concentrating, and hypervigilance. PTSD is not associated with overeating, a drive to be perfect, or passivity.

Which therapeutic intervention can the nurse implement within the scope of nursing practice guidelines to help a patient diagnosed with a mild anxiety disorder regain control? a. Flooding b. Modeling c. Thought stopping d. Systematic desensitization

b. Modeling Modeling calm behavior in the face of anxiety or unafraid behavior in the presence of a feared stimulus are interventions that can be used independently, within the scope of practice guidelines. Flooding, thought stopping, and systematic desensitization require agreement of the treatment team. Healthcare providers such as psychiatrists or psychiatric nurse practitioners would be providing those interventions.

A patient diagnosed with panic disorder begins a new prescription for lorazepam. Which daily activity would the nurse instruct the patient to discontinue? a. Knitting b. Mowing the lawn c. Playing video games d. Preparing dinner for the family

b. Mowing the lawn Lorazepam is a benzodiazepine commonly prescribed for short-term management of anxiety. These medications may make it unsafe to handle mechanical equipment, such as a lawn mower. It would be safe for the patient to knit, play video games, and prepare meals.

Which drug can be used to treat alogia, avolition, and anhedonia in patients with schizophrenia? a. Molindone b. Olanzapine c. Thiothixene d. Thioridazine

b. Olanzapine Olanzapine is a second-generation antipsychotic prescribed to treat positive symptoms, like hallucination and delusion, and negative symptoms, like alogia, avolition, and anhedonia. Molindone is a medium-potency first-generation antipsychotic and does not treat alogia, avolition, or anhedonia. Thiothixene is a highpotency first-generation antipsychotic prescribed to treat positive symptoms like hallucination and delusion. Thioridazine is a low-potency first-generation antipsychotic used to treat positive symptoms of schizophrenia.

A patient is running from chair to chair in the solarium. The patient is wide-eyed and keeps repeating, "They are coming! They are coming!" The patient is not able to respond to staff directions or calming attempts. The level of anxiety can be assessed at which level? a. Mild b. Panic c. Severe d. Moderate

b. Panic Panic-level anxiety results in markedly disorganized, disturbed behavior including confusion, shouting, and hallucinating. Individuals may be unable to follow directions and may need external limits to ensure safety. In mild anxiety, the patient is able to work effectively toward a goal. Severe anxiety is manifested by greatly reduced and distorted perceptual field. A patient with moderate anxiety has a narrowed perceptual field and is less able to pay attention.

Delusionary thinking is a characteristic of which form of anxiety? a. Chronic anxiety b. Panic level anxiety c. Severe anxiety d. Acute anxiety

b. Panic level anxiety Panic level anxiety is the most extreme level and results in markedly disturbed thinking greater than in any of the other options.

A 20-year-old was molested at age 10 but can no longer remember the incident. The nurse determines which defense mechanism is in use? a. Projection b. Repression c. Displacement d. Reaction formation

b. Repression Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. Projection refers to the unconscious rejection of emotionally unacceptable features and attributing them to others. Displacement is the transference of emotions associated with a particular situation or person to another nonthreatening situation or person. Reaction formation involves controlling unacceptable emotions behaviors by developing the opposite emotion or behavior.

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a. Projection b. Repression c. Displacement d. Reaction formation

b. Repression Repression is a defense mechanism that excludes unwanted or unpleasant experiences, emotions, or ideas from conscious awareness. This is not the outcome of any of the other options.

Which term describes a child who is able to regain mental stability after a traumatic event? a. Mature b. Resilient c. Autonomous d. Independent

b. Resilient The term resilient refers to positive adaptation, or the ability to maintain or regain mental health despite adversity. Maturity, autonomy, and independence do not best describe the ability to regain mental stability after a traumatic event.

The nurse is providing teaching to a patient just before surgery. The patient is becoming more and more anxious as the information is presented. Soon the patient begins to report dizziness and heart pounding. The nurse observes obvious trembling and that the patient appears confused. Which intervention would the nurse take immediately? a. Reinforcing the preoperative teaching by restating it slowly b. Staying calm, remaining at the bedside, and reducing environmental stimuli c. Having the patient read the teaching materials instead of listening to them d. Having a familiar family member read the preoperative materials to the patient

b. Staying calm, remaining at the bedside, and reducing environmental stimuli Patients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. Stay calm, remain with the patient, and minimize environmental stimuli. Restating the preoperative teaching slowly, having the patient read the teaching materials instead of listening to them, and having a familiar family member read the preoperative materials to the patient would not be effective because the nurse is still attempting to teach someone who has a severe level of anxiety.

Which statement is true of the relationship between bipolar disorder and suicide in adolescence? a. Patients need to be monitored only in the depressed phase because this is when suicides occur. b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. c. Patients with bipolar disorder are not considered high risk for suicide. d. As long as patients with bipolar disorder adhere to their medication regimen, there is little risk for suicide.

b. Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide. Overall, the suicide statistics for bipolar disorder is severe. Suicide accounts for 5% of deaths among women and 10% among men with bipolar disorder. With adolescents, suicide attempts associated with bipolar disorder are about 18% according to one study. Suicides occur in both the depressed and the manic phase. Patients with bipolar disorder are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only patients who stop medications commit suicide.

A patient attempted suicide 3 days ago. When the nurse asks about the related events, the patient says, "I don 't want to think about that now, but maybe we could talk about it later." Which defense mechanism has the patient used? a. Repression b. Suppression c. Rationalization d. Intellectualization

b. Suppression Defenses against anxiety can be adaptive or maladaptive. Suppression is a conscious, deliberate effort to avoid painful and anxiety-producing memories. Repression is an unconscious exclusion of unpleasant or unwanted experiences, emotions, or ideas from conscious awareness. In this scenario, the patient is aware of the memory. Rationalization consists of justifying illogical or unreasonable ideas, actions, or feelings by developing acceptable explanations. Intellectualization is a process in which events are analyzed based on facts and without passion, rather than including feeling and emotion.

Which instruction would the nurse include in the diet chart of a patient experiencing mania who is on lithium therapy? a. Reduce sodium intake. b. Take lithium with meals. c. Take lithium before breakfast. d. Avoid taking lithium before going to bed.

b. Take lithium with meals. Lithium should be given with meals and not taken on an empty stomach before breakfast because lithium causes irritation of the stomach lining. Patients on lithium therapy should ensure they have adequate salt in their diets because lithium decreases sodium reabsorption, leading to a possible deficiency of sodium. Lithium intake should not affect the patient's sleep patterns.

Which potential side effect of antipsychotic medications does the Abnormal Involuntary Movement Scale (AIMS) assessment detect? a. Acute dystonia b. Tardive dyskinesia c. Cholestatic jaundice d. Pseudoparkinsonism

b. Tardive dyskinesia An AIMS assessment should be performed periodically on patients who are being treated with antipsychotic medication known to cause tardive dyskinesia. The AIMS assessment does not detect acute dystonia, cholestatic jaundice, or pseudoparkinsonism.

Which side effect of antipsychotic medication is generally nonreversible? a. Dystonic reaction b. Tardive dyskinesia c. Pseudoparkinsonism d. Anticholinergic effects

b. Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects of anticholinergic effects, pseudoparkinsonism, and dystonic reaction often appear early in therapy and can be minimized with treatment.

A patient who has depression tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of which feature of depression? a. Self-blame b. Catatonia c. Helplessness d. Discounting positive attributes

c. Helplessness Helplessness is demonstrated by a person's inability to solve problems and the inability to carry out tasks because they seem too difficult. Many patients with depression experience self-blame, even for events that are beyond their control. Catatonia is not a feature of helplessness. Patients with depression may discount positive attributes, but that is not the same feature of depression as helplessness.

Which nursing intervention is designed to help a patient with schizophrenia manage relapse? a. Schedule the patient to attend group therapy that includes those who have relapsed. b. Teach the patient and family about behaviors associated with relapse. c. Remind the patient of the need to return for periodic blood draws to minimize the risk for relapse. d. Help the patient and family adapt to the stigma of chronic mental illness and periodic relapses.

b. Teach the patient and family about behaviors associated with relapse. By knowing what behaviors signal impending relapse, interventions can be invoked quickly when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted. Scheduling group therapy, reminding the patient of periodic blood draws, and helping the patient and family adapt to the stigma of mental illness are not interventions designed to help manage a relapse.

When a patient has been prescribed lorazepam for generalized anxiety disorder, which action would the nurse take? a. Tell the patient to expect mild insomnia. b. Teach the patient to limit caffeine intake. c. Explain the long-term nature of benzodiazepine therapy. d. Question the healthcare provider's prescription because the drug is likely to be ineffective.

b. Teach the patient to limit caffeine intake. Caffeine is an antagonist of antianxiety medication; therefore patients should avoid beverages containing caffeine because it will decrease the desired effects of the drug. Quitting lorazepam—a benzodiazepine—after the first month of use may cause insomnia. Benzodiazepine therapy should be used only for short periods of time because it has a potential for dependence. Benzodiazepines have a quick onset of action and are shown to be effective in the treatment of anxiety disorders.

A nurse is performing an assessment of a child diagnosed with disinhibited social engagement disorder. Which behavior would the nurse expect to find in the child? a. The child throws stones at strangers. b. The child willingly goes with a stranger. c. The child cries when touched by a stranger. d. The child hides when a stranger approaches.

b. The child willingly goes with a stranger. Disinhibited social engagement disorder is characterized by absence of normal fear toward strangers and unresponsiveness to separation from a caregiver. The child demonstrates no normal fear of strangers. A child throwing stones at a stranger is indicative of antisocial behavior. A child crying when being touched by a stranger demonstrates sensitive behavior. A child hiding when approached by a stranger reflects shyness and is not a symptom of disinhibited social engagement disorder.

Which topic would take priority when planning a series of psychoeducational groups for people diagnosed with schizophrenia? a. How to give and receive compliments b. The importance of taking medication correctly c. How to complete an application for employment d. Ways to dress and behave when attending community events

b. The importance of taking medication correctly Although completing applications, dressing and behaving correctly, and giving and receiving compliments are important, correct self-management of pharmacotherapy takes priority. The patient cannot maintain remission without the appropriate medication.

A nurse tries to communicate with a patient with depression who is severely withdrawn and avoids interaction. How would the nurse approach the patient? a. The nurse should leave the patient alone. b. The nurse should talk to the patient about the weather. c. The nurse should say, "Things will be fine, don't be upset." d. The nurse should ask the patient about their family members.

b. The nurse should talk to the patient about the weather. Patients with depression often avoid interacting with others. In such cases, the patient's attention must be drawn toward the surrounding environment. This helps the patient to focus on reality. Leaving the patient unattended is unsafe and may make the patient feel lonely and cause further withdrawal. Telling the patient "Things will be fine" is providing false reassurance and minimizes the patient's feelings. There is no reason to ask the patient about their family.

A patient with obsessive-compulsive disorder takes several hours to maintain hygiene. Which appropriate method would the nurse follow to help the patient in maintaining hygiene? a. The nurse dresses the patient. b. The nurse talks about self-care with the patient. c. The nurse gives continuous directions to the patient. d. The nurse gives a wide variety of clothing options to the patient.

b. The nurse talks about self-care with the patient. Patients with obsessive-compulsive disorder spend several hours maintaining hygiene. The nurse should talk with patients regarding self-care and encourage them to express their feelings and thoughts about self-care, as it can help reduce the compulsive behavior. The nurse should not dress the patient but can assist the patient in dressing. The nurse should encourage the patients to perform the task independently. The nurse should give simple directions to the patient to enhance self-hygiene. Limiting the choice of clothing helps the patient to select clothes quickly.

As a part of group therapy, a patient with anxiety disorder was asked to deliver a speech to the group. However, the patient was unable to perform the given task and started avoiding the nurse. Which action would the nurse take to relieve the anxiety of the patient? Select all that apply. One, some, or all responses may be correct. a. The nurse leaves the patient alone in a room. b. The nurse talks slowly and calmly with the patient. c. The nurse asks the patient to write a list of their strengths. d. The nurse encourages the patient to discuss the reason for fear. e. The nurse gives strict instructions to the patient to complete the given task.

b. The nurse talks slowly and calmly with the patient. c. The nurse asks the patient to write a list of their strengths. d. The nurse encourages the patient to discuss the reason for fear. The symptoms of generalized anxiety disorder include inability to perform a given task and avoiding interacting with others. The nurse should make the patient feel safe by talking slowly and calmly. The nurse can increase the self-esteem of the patient by giving them the task of writing and assessing their strengths. The nurse encourages the patient to discuss the reason for fear. It helps the nurse to identify possible stressors and to eliminate them from the patient's surroundings. The nurse should not leave the patient alone but stay with the patient to convey acceptance. The nurse should avoid giving strict instructions to the patient as it may hinder nurse-patient communication. Brief instructions enable the patient to respond in a healthy manner.

Which laboratory test would be most helpful in determining the cause of sore throat, fever, and malaise in a patient who started taking clozapine 3 weeks ago? a. Urinalysis b. Liver panel c. Serum lithium level d. Complete blood cell count

d. Complete blood cell count Agranulocytosis is the reduction of white blood cells (WBCs) and is a possible adverse effect of antipsychotic drugs, particularly clozapine. Chief complaints are flulike symptoms. A complete blood cell count would show the reduction in WBCs. Serum lithium level, liver panel, and urinalysis are not necessary.

Which statement concerning syndromes seen in other cultures—such as piblokto, Navajo frenzy witchcraft, and amok—is true? a. They are physical disorders, not mental disorders. b. They are culture-bound syndromes that are not dissociative disorders. c. They are dissociative disorders, such as dissociative identity disorders. d. They are myths or rumors, because they have not been sufficiently studied to be classified as real.

b. They are culture-bound syndromes that are not dissociative disorders. Certain culture-bound disorders exist in which there is a high level of activity, a trance-like state, and running or fleeing, followed by exhaustion, sleep, and amnesia regarding the episode. These syndromes, if observed in individuals native to the corresponding geographical areas, should be differentiated from dissociative disorders. These are not physical disorders, myths, or rumors.

Generally, which statement regarding ego defense mechanisms is true? a. They seldom make the person more comfortable. b. They often involve some degree of self-deception. c. They are usually effective in resolving conflicts. d. They are rarely used by mentally healthy people.

b. They often involve some degree of self-deception. Most ego defense mechanisms, with the exception of the mature defenses, alter the individual's perception of reality to produce varying degrees of self-deception. This information helps eliminate the other options as the correct statement.

Which defense mechanism has an adaptive use? a. Splitting b. Undoing c. Projection d. Conversion

b. Undoing Undoing is a defense mechanism with an adaptive use. Splitting and conversion do not have adaptive uses and are almost always pathological. Projection is a defense mechanism that is considered immature and does not have an adaptive use.

Which assessment parameter takes priority when assessing a patient taking olanzapine daily? a. Height b. Weight c. Pupillary response to light d. Integrity of mucous membranes

b. Weight An important part of the nurse's role in the community is monitoring the patient's response to medications, compliance, and potential side or adverse effects. Key side effects of sexual dysfunction and weight gain are particularly important to monitor in patients taking antipsychotic medications. Olanzapine is an atypical antipsychotic drug that can cause significant weight gain, which results in diabetes for many patients. Neither height, pupil response, nor mucous membrane integrity takes priority over weight.

Which term is correct to use when documenting that a patient with schizophrenia stated, "Cheese dog run fast"? a. Neologism b. Word salad c. Circumstantiality d. Magical thinking

b. Word salad A word salad is a jumble of words that is meaningless to the listener and results from an extreme level of disorganization. A neologism is an invented word. Circumstantiality refers to verbal expression with excessive detail. Magical thinking means believing that one's thoughts or actions can affect others.

Which food can be included in the diet of a depressive patient who is prescribed a monoamine oxidase inhibitor? a. Chocolate b. Yogurt c. Ginseng d. Fava beans

b. Yogurt Patients who are prescribed monoamine oxidase inhibitors must avoid food substances that contain vasopressors because of food-drug interactions such as high blood pressure. Yogurt is safe for the patient as it contains a very low amount of tyramine. Chocolate must be avoided because it can cause reactions because of the presence of phenylethylamine. Ginseng can cause a headache and mania-like reaction in the patient, so it must be excluded from the diet. Fava beans contain dopamine, which can cause side effects such as agitation and an increase in blood pressure, so they must be avoided.

A patient is displaying symptomology reflective of a moderate anxiety. To help the patient regain control, the nurse would respond in which way? a. "You need to calm yourself." b. "What is it that you would like me to do to help you?" c. "Can you tell me what you were feeling just before your attack?" d. "I will get you some medication to help calm you."

c. "Can you tell me what you were feeling just before your attack?" A response that helps the patient identify the precipitant stressor is most therapeutic. It is nontherapeutic to tell a patient "You need to calm yourself." If the patient is capable of self-calming, the patient already would have done so. Asking, "What is it that you would like me to do to help you?" is focusing the attention on the nurse. Getting medication may not be necessary if the nurse is able to help the patient lower their anxiety level.

A patient receives a new prescription for sertraline 50 mg daily. The patient phones the nurse and says, "I read on the internet that this drug is for depression. I have social anxiety, not depression." Which response would the nurse provide? a. "The website was incorrect. Sertraline is an antianxiety medication rather than an antidepressant." b. "Thank you for informing us of this error. I will discuss the situation with your healthcare provider and call you back shortly." c. "Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." d. "It is important for you to take the medication. Try to have confidence in your healthcare provider's judgment about how to help you."

c. "Certain antidepressant medications work well for managing anxiety. It may take several weeks for you to feel the full benefit." Selective serotonin reuptake inhibitors (SSRIs) are considered the first line of defense in most anxiety disorders, including social anxiety. Sertraline and paroxetine are SSRIs with calming effects. The nurse should provide accurate information to the patient and respond therapeutically to evidence that the patient is trying to self-educate via the internet. Telling the patient to have faith in the healthcare provider is false reassurance.

Which statement made by the patient supports a diagnosis of schizophrenia? a. "Every morning I enjoy the humming of birds; it relaxes me." b. "Every day my friends wait for me in front of my gate for our morning walk." c. "Every day birds sing songs for me and spread flowers on the path where I walk." d. "Everyone feels as if I am a burden to them; I would like to put an end to their problem."

c. "Every day birds sing songs for me and spread flowers on the path where I walk." Patients with schizophrenia have delusions of self-importance and state false events related to them, like birds singing songs for them and spreading flowers on their path. The statement that every morning the patient enjoys the humming of birds indicates that the patient has no impaired perception and is able to connect with reality. The statement that every morning the patient's friends wait for them is normal. The statement that everyone feels the patient is a burden indicates that the patient feels worthless and has suicidal intentions but does not indicate schizophrenic symptoms.

A patient with dissociative identity disorder reports an increased awareness of surroundings and a reduction in dissociative episodes. Which instruction provided by the nurse while teaching the grounding techniques helped the patient to alleviate symptoms? a. "Have a positive insight." b. "Write your feelings in a diary." c. "Hold an ice cube in your hand." d. "Sit straight and upright in the chair."

c. "Hold an ice cube in your hand." The nurse teaches grounding techniques like holding an ice cube, stomping feet, deep breathing techniques, and counting to a patient with dissociative identity disorder. It helps the patient to increase awareness and to reduce the dissociative episodes by causing distractions. In cognitive-behavioral therapy, the nurse teaches the patient to have a positive insight, to help develop problem-solving abilities, and to reduce stress. Journal writing is a technique in which the nurse instructs the patient to write feelings and experiences in a diary. It helps the nurse to identify the stressors and helps the patient to acknowledge their feelings. Sitting straight in an upright position helps the patient attentively listen to a speaker; it is not a grounding technique.

Which statement demonstrates an expression of anxiety rather than fear? a. "I can't stand spiders." b. "You'd never get me on a roller coaster." c. "I dislike knowing when I'm older, I won't have enough money." d. "I can't imagine why anyone would want to parachute out of an airplane."

c. "I dislike knowing when I'm older, I won't have enough money." Anxiety is an emotion without a specific object that is provoked by the unknown or by new experiences. Being worried about future finances is a common expression of anxiety. An intense dislike for spiders, roller coasters, and parachuting are fears because they are focused.

Which statement by a patient indicates understanding of the medication teaching provided concerning a prescribed selective serotonin reuptake inhibitor (SSRI)? a. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." b. "I will not take any over-the-counter medication while on this medication." c. "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." d. "I will report increased thirst and urination to my healthcare provider."

c. "I will immediately report any symptoms of high fever, fast heartbeat, or abdominal pain." High fever, fast heartbeat, or abdominal pain describe symptoms of serotonin syndrome, a life-threatening complication of SSRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the healthcare provider, and would not have been educated to report increased thirst and urination as a side effect of an SSRI.

Buspirone is prescribed for a patient with anxiety. Which instruction would the nurse provide to this patient? a. "Take this medication on an empty stomach." b. "Take this medication only when you feel anxious." c. "It will take 2 to 4 weeks for you to feel the full benefit." d. "Avoid aged cheese products while you are taking this medication."

c. "It will take 2 to 4 weeks for you to feel the full benefit." Buspirone is an alternative antianxiety medication that does not cause dependence, but 2 to 4 weeks are required for it to reach full effect. It should be taken with food. The drug may be used for long-term treatment and should be taken regularly. Aged cheese products should be avoided when taking monoamine oxidase inhibitors (MAOIs).

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. Which explanation would the nurse provide? a. "Children this age usually have imaginary friends." b. "The child needs more one-on-one attention." c. "The imaginary friend is a coping mechanism the child is using." d. "It is nothing to worry about unless the child starts to isolate socially."

c. "The imaginary friend is a coping mechanism the child is using." Often, traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be caused by trauma. For example, a child may use imaginary friends as a coping mechanism. Some children do have imaginary friends, but in this instance the "friend" appeared during cancer treatments. There is no indication the child needs more one-on-one time. Telling the parents there is nothing to worry about is nontherapeutic.

The nurse is teaching a patient with dissociative disorder about risk factors. Which statement made by the patient indicates the teaching was effective? a. "Dissociative disorder is the same as epilepsy." b. "I must have gotten this disorder from one of my parents." c. "Traumatic events are the most basic cause of dissociative disorder." d. "Toxins in the environment could have caused the dissociative disorder."

c. "Traumatic events are the most basic cause of dissociative disorder." Dissociative disorder is most often caused by traumatic events, which could include motor vehicle accidents, natural disasters, emotional or physical abuse, neglect, incest, or other negative experiences. Dissociation is not linked to genetics, so it is incorrect for the patient to say the disorder came from the parents. Dissociation is not the same as epilepsy, although they have similarities and may be treated similarly with medication. Toxins in the environment do not cause dissociative disorder.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of greatest importance to this particular client? a. Find out if the client uses acting-out behavior. b. Establish whether the client has chronic hypertension related to high anxiety. c. Ascertain how long ago the trauma occurred. d. Determine the use of chemical substances for anxiety relief.

d. Determine the use of chemical substances for anxiety relief. Substance abuse often coexists with post-traumatic stress disorder. It is often the client's way of self-medicating to gain relief of symptoms.

Which statement would the nurse provide to a patient with schizophrenia who will not eat because of a delusion of being poisoned? a. "No one is trying to poison you." b. "Your beliefs are delusional; this is why you are hospitalized." c. "You must feel frightened to think someone is trying to poison you." d. "Let's sit down and talk about your belief about your food being poisoned."

c. "You must feel frightened to think someone is trying to poison you." An appropriate nursing response is to focus on the patient's feelings. The response, "You must feel frightened to think someone is trying to poison you," focuses on the patient's feelings. The nurse should not debate the delusional content; therefore, the statement, "No one is trying to poison you," is an inappropriate response. The statement, "Your beliefs are delusional; this is why you are hospitalized," is inappropriate because it debates the delusional belief and does not focus on the patient's feelings. The nurse should not dwell excessively on the delusion; therefore, the statement, "Let's sit down and talk about your belief about your food being poisoned," is not appropriate.

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. Anticholinergic medication. b. Standard antipsychotic medication. c. A short-acting benzodiazepine medication. d. Tricyclic antidepressant medication.

c. A short-acting benzodiazepine medication. A short-acting benzodiazepine is the only type of medication listed that would lessen the client's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety; tricyclic antidepressants have very little antianxiety effect and have a slow onset of action; and a standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

The nurse anticipates that the nursing history of a patient diagnosed with obsessive-compulsive disorder (OCD) will reveal which aspect? a. Paranoia b. Schizophrenia c. A sibling with the disorder d. A history of childhood shyness

c. A sibling with the disorder Research shows that first-degree biological relatives of those with OCD have a higher frequency of the disorder than exists in the general population. OCD does not occur in high frequency in those with paranoia, schizophrenia, or childhood shyness.

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

c. Altruism and sublimation Altruism and sublimation are known as mature defenses. They cannot be used in unhealthy ways. Altruism results in resolving emotional conflicts by meeting the needs of others, and sublimation substitutes socially acceptable activity for unacceptable impulses. Suppression and humor can be used in a maladaptive manner. Idealism, splitting, and reaction and denial can also be used in a maladaptive manner.

Which term applies to a patient diagnosed with schizophrenia who states, "There is nothing wrong with me! I am just in the hospital because aliens are trying to inject me with their DNA"? a. Anosognosia b. Affective blunting c. Associative looseness d. Negative symptoms

c. Associative looseness The patient's comment reflects an unusual speech pattern and indicates delusional thinking. One such pattern is called associative looseness, which results from illogical thinking and loosely connected thoughts. Anosognosia refers to an inability to realize an illness exists. Affective blunting relates to the patient's outward expression of emotion. Associative looseness results from haphazard and illogical thinking where concentration is poor and thoughts are only loosely connected. Negative symptoms include social isolation, anergia, lack of motivation, blunted affect, and inattention to personal hygiene.

Which type of hallucination is a patient diagnosed with schizophrenia most likely to experience? a. Visual b. Tactile c. Auditory d. Olfactory

c. Auditory Patients diagnosed with schizophrenia may experience hallucinations arising out of any of the senses; however, auditory hallucinations are experienced by 60% of people with schizophrenia at some time during their lives. Visual hallucinations more commonly are associated with substance abuse and withdrawal. Tactile and olfactory hallucinations are rare.

A nurse observes that a patient often looks at their own reflection in the mirror. Which disorder does the patient likely have? a. Panic disorder b. Hoarding disorder c. Body dysmorphia disorder d. Obsessive-compulsive disorder (OCD)

c. Body dysmorphia disorder Body dysmorphic disorders are characterized by a preoccupation with an imagined defective body part. Patients with body dysmorphia often pay excessive attention to body parts that they imagine to be defective. As a result, they may develop obsessivecompulsive behaviors such as often checking mirrors. In patients with OCD, they perform repeated activities or rituals. In hoarding disorder, the patient accumulates and collects all materials for future use. Patients with panic disorder may have an unusual fear of future events.

A child who was physically and sexually abused is at great risk for demonstrating which characteristic? a. Depression b. Suicide attempts c. Bullying, abusive behavior d. Becoming active in a gang

c. Bullying, abusive behavior Children who have been abused are at risk for abusing others, as well as for developing dysfunctional patterns in close interpersonal relationships. While the other characteristics may occur, none are as characteristic as the correct option.

According to attachment theory, relationship disorders are related to trauma associated with which factor? a. Culture or religion b. Siblings or strangers c. Caregivers or parents d. Insufficient food or shelter

c. Caregivers or parents Attachment patterns or schemas are formed early in life through interaction and experiences with caregivers, and this relationship is embedded in implicit emotional and somatic memories. Attachment theory does not address culture/religion, siblings, strangers, or food and shelter.

Which action would the nurse take in treating the patient taking lithium carbonate who repeatedly requests water to drink and has slurred speech? a. Provide food to the patient. b. Prepare the patient for hemodialysis. c. Check the patient's blood lithium level. d. Report to the primary healthcare provider.

c. Check the patient's blood lithium level. Excessive thirst, slurred speech, and polyuria are early signs of lithium toxicity. The nurse should check the lithium level of the patient frequently. Food does not help prevent or treat lithium toxicity. Hemodialysis can be administered to eliminate the drug in case of severe toxicity. The nurse can report to the primary healthcare provider but after checking the lithium levels in the blood.

A nurse is caring for a patient with severe depression. After 4 months of treatment, the nurse tells the patient, "Depression is an illness that is beyond a person ' s voluntary control." In which phase of treatment is this an appropriate statement by the nurse? a. Acute phase b. Orientation phase c. Continuation phase d. Maintenance phase

c. Continuation phase There are three phases of treatment for depression: the acute phase, the continuation phase, and the maintenance phase. After 4 to 9 months of treatment, patients are in the continuation phase, during which they are educated about depression in hopes that they will better adhere to the treatment plan and avoid relapse. Explaining depression is beyond a person's control is an example of this teaching. The other stages of treatment have different goals, such as the acute phase (the initial 12 weeks) in which the patient is given interventions to simply reduce symptoms of depression. The orientation phase is not one of the three phases of the treatment. After 1 year of treatment, patients are typically in the maintenance phase, where they may already be well educated about depression and the treatment focuses on avoiding further complications from relapse of the illness.

What can be said about the comorbidity of anxiety disorders? a. Substance abuse disorders rarely coexist with anxiety disorders. b. Anxiety disorders virtually never coexist with mood disorders. c. Depression may occur prior to onset of anxiety. d. Anxiety disorders generally exist alone.

c. Depression may occur prior to onset of anxiety. In many instances, major depression may occur prior to the onset of panic disorder or may occur at the same time. Clinicians and researchers have clearly shown that anxiety disorders frequently co-occur with other psychiatric problems. Major depression often co-occurs and produces a greater impairment with poorer response to treatment.

The nurse is meeting with a 23-year-old patient and the patient's parents. The parents tell the nurse that the patient has periods of time in which the patient seems like a different person. After each episode, the patient has no recollection of what happened. The nurse understands that this could be caused by which disorder? a. Adjustment disorder b. Acute stress disorder c. Dissociative identity disorder d. Posttraumatic stress disorder (PTSD)

c. Dissociative identity disorder Dissociative identity disorder affects individuals by altering their personalities, causing them to "switch" from one personality to another. Often, the individual is not aware of the personality transition until other people point it out. These changes in personality can be subtle or dramatic and can last from periods of minutes to months. Adjustment disorder is a trauma-related disorder that is similar to PTSD but is usually caused by events that are less traumatic than the ones that cause PTSD. It does not cause different personalities. Acute stress disorder may manifest after a traumatic event, but the stress usually starts to resolve. PTSD is a trauma-related disorder that causes individuals to become panicked when they think about or remember certain traumatic events in their lives, but it does not cause different personalities.

Which nursing intervention is appropriate to include in the care plan for a patient with psychosis experiencing poor self-esteem? a. Introduce pet therapy. b. Seek areas of commonality. c. Engage regularly with the patient. d. Involve the patient in planning treatment.

c. Engage regularly with the patient. Engaging regularly with a patient with poor self-esteem is important in establishing a trusting nurse-patient relationship. Pet therapy may help patients who avoid interaction with peers increase their comfort level with other people. Seeking areas of commonality is beneficial when a patient is experiencing denial, such as in the case of anosognosia. Involving the patient in planning treatment is beneficial when the patient is nonadherent or resistant to treatment.

What is the major distinction between fear and anxiety? a. Fear enables constructive action; anxiety is dysfunctional. b. Fear is a universal experience; anxiety is neurotic. c. Fear is a response to a specific danger; anxiety is a response to an unknown danger. d. Fear is a psychological experience; anxiety is a physiological experience.

c. Fear is a response to a specific danger; anxiety is a response to an unknown danger. Fear is a response to an objective danger; anxiety is a response to a subjective danger. This information helps identify the correct option.

A symptom commonly associated with panic attacks? a. Apathy b. Obsessions c. Fear of impending doom d. Fever

c. Fear of impending doom A patient experiencing a panic attack feels a sense of impending doom. The feelings of terror present during a panic attack are so severe that normal function is suspended, the perceptual field is limited severely, and misinterpretation of reality may occur. An obsession is an unwanted, intrusive thought. Apathy is an attitude of not caring. Fever is not associated with a panic attack.

Which scale would the nurse use during a clinical interview to measure phobias present in children? a. Yale-Brown obsessive-compulsive scale b. Hoarding scale self-report c. Fear questionnaire d. Panic disorder severity scale

c. Fear questionnaire The fear questionnaire is used to measure phobias present in the patients. The patients are questioned about the different types of fear that they experience. The rating is given according to the intensity. The Yale-Brown obsessive-compulsive scale is used to measure the severity of compulsive behavior. The hoarding scale self-report is used to measure hoarding in a patient. The panic disorder severity scale is used to measure panic symptoms.

Which is the recommended starting dose of selective serotonin reuptake inhibitors in older adult patients with depression? a. The lowest adult dose b. The normal adult dose c. Half the lowest adult dose d. Half the normal adult dose

c. Half the lowest adult dose Older adult patients with depression are frequently prescribed selective serotonin reuptake inhibitors as a first-line treatment. They must be administered half the lowest adult dose to avoid adverse effects from drug accumulation. The lowest adult dose, normal adult dose, and half the normal adult should not be administered to older adult patients. These doses would cause severe toxic effects in older adult patients.

To best support the improvement of an anxious individual' s sense of control and competence, the nurse takes which action? a. Provides lavish amounts of praise when the individual accomplishes assigned tasks b. Educates the individual regarding the usefulness of stress management techniques c. Helps the individual identify several stressful situations that they were successful in managing d. Has the individual describe how one demonstrates control and competence over stress

c. Helps the individual identify several stressful situations that they were successful in managing Positive self-concepts result from positive experiences, leading to perceived competence and acceptance. Assisting the patient in identifying such situations will aid in building confidence and their perception of being competent. Being praised for successes is appropriate, but it must be reserved for situations that the individual recognizes as meaningful. Although stress management techniques are important, they are not linked directly to a sense of competence. Describing how one demonstrates control and competence is applicable, but it has limited favor in actually assisting the patient in feeling competent.

Which electrolyte imbalance can occur in patients with schizophrenia who are experiencing polydipsia? a. Hypokalemia b. Hypocalcemia c. Hyponatremia d. Hypercalcemia

c. Hyponatremia In patients with schizophrenia, polydipsia occurs because of dry mouth. Patients experience excessive thirst because of antipsychotic drugs and drink a lot of water. Polydipsia is characterized by hyponatremia, confusion, and severe symptoms of schizophrenia and is caused by the inability of the kidneys to filter excess fluids. Hypokalemia is a condition that produces reduced levels of potassium, which can be caused by antibiotics. Hypocalcemia refers to increased levels of calcium resulting from vitamin D deficiency or defective absorption. Hypocalcemia can also result from impaired metabolism of vitamin D in the body. Hypercalcemia is an increase in levels of calcium seen during hyperparathyroidism.

Which assessment information indicates paranoia in a patient with schizophrenia? a. Feelings of superiority to others b. False perception of environment c. Irrational fear of harm from others d. Impaired ability to think abstractly

c. Irrational fear of harm from others Patients with paranoia experience an irrational fear of harm from others ranging from mild to severe. The patients suspect that others want to harm them, and they react defensively toward caregivers and other patients. Feelings of superiority are seen in patients with delusions. Patients with derealization have false perceptions of the environment and may misinterpret the stimuli in the environment. An impaired ability to think abstractly is seen in patients with disorders of concrete thinking.

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a. Behaves in ways that are the opposite of his or her feelings. b. Misses appointments. c. Justifies illogical ideas and feelings. d. Makes jokes to relieve tension.

c. Justifies illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. None of the other options present with this behavior.

If the health record mentions that the patient habitually relies on rationalization, the nurse might expect the patient to exhibit which behavior? a. Miss appointments. b. Make jokes to relieve tension. c. Justify illogical ideas and feelings. d. Behave in ways that are the opposite of their feelings.

c. Justify illogical ideas and feelings. Rationalization involves justifying illogical or unreasonable ideas or feelings by developing logical explanations that satisfy the teller and the listener. Missing appointments may be another defense mechanism such as denial or suppression. Making jokes is a way of using humor as a way to deflect attention from a difficult matter. Reaction formation occurs when unacceptable feelings or behaviors are controlled by developing the opposite emotion or behavior.

Which cue will the nurse anticipate when reviewing the care plan for a patient with schizophrenia and a nursing diagnosis of impaired ability to perform hygiene? a. Paranoia b. Anosognosia c. Lack of energy d. Internalized stigma

c. Lack of energy Patients with a lack of energy may be unable to perform hygiene. Patients experiencing paranoia generally mistrust others, exhibit withdrawn behavior, are suspicious, and may have a risk for displaying violence. Anosognosia refers to a patient's unawareness of their condition. Internalized stigma causes a negative selfimage and risk of loneliness.

A new patient is diagnosed with generalized anxiety disorder. It is most important for the nurse to assess this patient for which additional problem? a. Conduct disorder b. Alcohol use disorder c. Major depressive disorder d. Obsessive-compulsive disorder (OCD)

c. Major depressive disorder Clinicians and researchers have shown clearly that anxiety disorders frequently cooccur with other psychiatric problems. A patient with major depressive disorder needs to be observed for suicide risk. Although conduct disorder, alcohol use disorder, and OCD are possibilities, the most likely comorbid problem is depression.

Beck' s cognitive theory suggests that the etiology of depression is related to which process? a. Sleep abnormalities b. Serotonin circuit dysfunction c. Negative processing of information d. A belief that one has caused the symptoms purposefully

c. Negative processing of information Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, selfdeprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue. Beck's theory does not suggest the etiology is related to sleep abnormalities, serotonin dysfunction, or a belief that a patient has caused the symptoms purposefully.

A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of which factor? a. Altruism b. Trait anxiety c. Normal anxiety d. A rude awakening

c. Normal anxiety Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Altruism is the act of doing good for others. Trait anxiety and a rude awakening are not terms used to describe normal anxiety.

A young adult applying for a position is mildly tense but eager to begin the interview. This can be assessed as showing which behavior? a. Denial b. Compensation c. Normal anxiety d. Selective inattention

c. Normal anxiety Normal anxiety is a healthy life force needed to carry out the tasks of living and striving toward goals. It prompts constructive actions. Denial and compensation are defense mechanisms, which are not in use in this situation. Selective inattention is present in worsening stages of anxiety.

During an assessment, the nurse says to the patient with breast cancer, "You are wearing a pretty dress." Which patient activity is the reason for giving this statement? a. Behaving irritably b. Looking very worried c. Not interacting with the nurse d. Frequently looking at her outfit

c. Not interacting with the nurse Patients with depression tend to remain silent and are unwilling to interact with people. By telling the patient that she is wearing a pretty dress, the nurse is encouraging the patient to interact by drawing her attention to the surroundings. This helps the patient to emphasize and focus on reality. If the patient looks irritable, the nurse should ask, "What are you irritated at?" This would help the nurse understanding the patient's feelings. If the patient looks worried, the nurse should ask the patient, "What is bothering you?" This can help the nurse to know the patient's perceptions and feelings. If the patient is frequently looking at her attire, then the nurse should draw the patient's attention to the present discussion by saying, "It's time to discuss your illness."

Which outcome is a possible criterion for a patient diagnosed with anxiety disorder? a. Patient reports reduced hallucinations. b. Patient reports feelings of tension and fatigue. c. Patient demonstrates effective coping strategies. c. Patient demonstrates persistent avoidance behaviors.

c. Patient demonstrates effective coping strategies. The patient demonstrating effective coping strategies is the only desirable outcome. Reduced hallucinations is an outcome associated with distorted thinking or psychosis. Feelings of tension indicate increased anxiety levels. Avoiding situations that cause anxiety indicate the person is experiencing anxiety.

Which nursing intervention is appropriate if a patient with schizophrenia on the unit begins giving away possessions to the other patients and saying goodbye? a. Place the patient in isolation. b. Implement patient rounds every 15 minutes. c. Place the patient in a room by the nurse's station. d. Teach and guide the patient to practice coping skills.

c. Place the patient in a room by the nurse's station. The patient is demonstrating behaviors associated with self-harm or suicide. The patient requires close monitoring; therefore, placing them in a room by the nurse's station allows for closer monitoring. Placing the patient in isolation is inappropriate and will provide the space and time to possibly harm themselves. Implementing patient rounds every 15 minutes is predictable and allows the patients time to harm themselves. Teaching and guiding the patient to practice coping skills is not an intervention to prevent them from harming themselves.

A mental health nurse plans care for four patients. These patients are diagnosed with reactive attachment disorder, disinhibited social engagement disorder, adjustment disorder, and acute stress disorder, respectively. The nurse would plan interventions designed to assist these patients to cope with which aspect? a. Feelings of guilt b. Self-care deficits c. Reactions to trauma d. Impaired social skills

c. Reactions to trauma The common feature of these disorders is exposure to trauma. Disorders included under the trauma umbrella include posttraumatic stress disorder, reactive attachment disorder, disinhibited social engagement disorder, acute stress disorder, and adjustment disorder. Feelings of guilt, self-care deficits, and impaired social skills represent problems that may or may not be present for patients diagnosed with these disorders.

A nurse observes that a child is withdrawn from their parents and does not interact much with them. On inquiry, the nurse finds that the child has been a victim of domestic violence and does not interact with anybody. Which clinical condition is the child likely to have? a. Separation anxiety b. Developmental delays c. Reactive attachment disorder d. Disinhibited social engagement behavior

c. Reactive attachment disorder Reactive attachment disorder is considered when the child is emotionally withdrawn and does not often show attachment to a caregiver. Separation anxiety is a fear that a child has when separated from the caregiver. Developmental delays are seen when normal developmental milestones in physical, mental, cognitive, and speech areas in a child are delayed. Disinhibited social engagement behavior is seen when the child is ready to engage in unfamiliar social events without having normal fear.

Which statement is accurate regarding the relationship between depression and schizophrenia? a. Suicide attempts usually occur early in the course of schizophrenia. b. Antipsychotic medications alleviate symptoms of depression for patients diagnosed with schizophrenia. c. Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. d. Nicotine use in patients diagnosed with schizophrenia stimulates neurotransmitters, resulting in a decreased incidence of depression and suicide.

c. Regular assessments should occur for both depression and suicide risk in patients diagnosed with schizophrenia. Almost half of people with schizophrenia will attempt suicide; therefore assessments for depression and suicide should occur throughout the patient's life. Both depression and suicide attempts can occur at any point in the illness. Antipsychotic medications do not alleviate symptoms of depression for patients diagnosed with schizophrenia. Nicotine use is higher in patients diagnosed with schizophrenia; nicotine stimulates some neurotransmitters, but this does not result in a decreased incidence of depression.

An individual who is able to regain mental stability after a traumatic event is said to be demonstrating what trait? a. Autonomy b. Maturity c. Resilience d. Independence

c. Resilience The term resilience refers to positive adaptation, or the ability to maintain or regain mental health despite adversity. None of the other terms suggest such an ability.

Which information identifies a distinguishing factor of psychosis? a. Is caused by moderate to severe anxiety b. Incorporates delusions into an individual's reality c. Results in a significant misrepresentation of what is real d. Is dependent on an individual's baseline cognitive function

c. Results in a significant misrepresentation of what is real Psychosis is disintegrative and involves a significant distortion of reality. Psychosis emerges with the panic level of anxiety. Delusional thinking may not be demonstrated by all individuals with psychosis. Cognitive function is not a predisposing factor for the development of psychosis.

Assessment of the thought processes of a patient diagnosed with depression is likely to reveal which aspect? a. Good memory and concentration b. Delusions of persecution c. Self-deprecatory ideation d. Sexual preoccupation

c. Self-deprecatory ideation Patients with depression do not feel good about themselves. They have a negative, self-deprecating view of the world. Patients with depression often have difficulty concentrating. Delusions of persecution are found in patients with schizophrenia. Sexual preoccupation is found in patients with mania.

When the healthcare provider explains the results of a chest x-ray that shows hemoptysis (coughing blood), the patient says, "I can 't understand what you're saying. You're talking so fast. All I hear is a loud clicking on my watch." The patient is wet with perspiration. Which level of anxiety is evident? a. Mild b. Panic c. Severe d. Moderate

c. Severe Indicators of severe anxiety include cognitive reactions such as narrowed perceptual field, selective attention, distortion of time/events, and detachment, and physical reactions such as diaphoresis, tense muscles, and decreased hearing. Mild anxiety is demonstrated by normal vital signs, minimal muscle tension, broad perceptual field, and awareness of environmental and internal stimuli. There are also feelings of relative comfort, a relaxed appearance, and automatic performance. Panic is characterized by a distinct inability to respond to any stimuli other than those occurring internally and a sense of being out of control, physically and emotionally. Moderate anxiety is demonstrated by slightly elevated vital signs; moderate muscle tension; alert, narrow, or focused attention; and inability to problem solve, learn, and be attentive. There is also a feeling of readiness, energy, ability to learn, and interest in the situation.

Before transferring a patient for a scheduled procedure, the patient tells the nurse, "I feel like I am going to die." Based on the statement the patient made, which level of anxiety is the patient experiencing? a. Mild b. Panic c. Severe d. Moderate

c. Severe The patient is experiencing severe anxiety, which is associated with a sense of impending doom. Characteristics of mild anxiety include restlessness, irritability, and impatience. A patient experiencing panic may have anxiety so severe that they are unable to communicate. Moderate anxiety is characterized by findings that include tension behavior, poor concentration, and voice tremors.

Which phase of schizophrenia is a patient in when they report diminishing symptoms and the ability to "remember things clearly again ?" a. Acute b. Prodromal c. Stabilization d. Maintenance

c. Stabilization The patient with diminishing or stabilizing symptoms with movement toward a previous level of functioning is in the stabilization phase of schizophrenia. The acute phase is when symptoms vary from mild to severe and become disabling. During this phase, the patient experiences delusions, hallucinations, withdrawn behaviors, and other functional impairment. The prodromal phase is the first phase in which the patient presents with mild changes in thinking and mood, but symptoms are insufficient to meet the diagnostic criteria for schizophrenia. The maintenance (or residual) phase is when the condition has stabilized and a new baseline is established.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? a. Report both nausea and vomiting b. Exhibit stoic behavior c. Suddenly tremble severely d. Laugh inappropriately

c. Suddenly tremble severely Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity. None of the other options are associated with this cultural response to stress.

Parents express concern when their 5-year-old child, who is receiving treatment for cancer, keeps referring to an imaginary friend, Candy. Which response should the nurse provide to best address the parent's concerns? a. Children of this age usually have imaginary friends. b. The child needs more of their one-on-one attention. c. The imaginary friend is a coping mechanism the child is using. d. It is nothing to worry about unless the child starts to socially isolate.

c. The imaginary friend is a coping mechanism the child is using. Often traumatized children feel responsible for what happened to them and are frightened by flashbacks, amnesia, or hallucinations that may be due to trauma. For example, a child may use imaginary friends as a coping mechanism. This option addresses the parents' concern most effectively.

A patient who has depression is prescribed monoamine oxidase inhibitors (MAOIs). The nurse gives the diet chart to the patient. Which food can the patient consume according to the diet chart? a. The patient eats lot of cheese. b. The patient eats bananas. c. The patient eats carrots. d. The patient eats dried fish.

c. The patient eats carrots. The patient eats carrots as they contain less or no tyramine and are safe. MAOIs increase the levels of tyramine. So a patient on MAOIs should consume foods that have no or very low levels of tyramine, as an increase in tyramine levels can cause high blood pressure and hypertensive crisis. The patient avoids eating cheese, bananas, and dried fish as they contain high levels of tyramine.

A patient who must undergo cataract surgery next week reports chest pain, feelings of choking, and hot flashes. Which disorder would the nurse recognize the patient may be experiencing? a. The patient has agoraphobia. b. The patient has social phobia. c. The patient has panic disorder. d. The patient has separation anxiety disorder.

c. The patient has panic disorder. This patient is displaying panic before surgery and reports of chest pain, feelings of choking, and hot flashes; breathing difficulty and chills may also occur. Social phobia is a social anxiety disorder characterized by fear when exposed to social groups. Patients will feel distress during public speaking. A patient with separation anxiety disorder is afraid of being isolated or separated from a loved one. It is characterized by gastrointestinal disturbances and headache. Patients who have agoraphobia fear certain places. They avoid going to such places to reduce anxiety.

A nurse observes a patient who often pulls out their hair. Which condition does the nurse report to the primary healthcare provider based on this observation? a. The patient has trichorrhexis. b. The patient has trichophagia. c. The patient has trichotillomania. d. The patient has Rapunzel syndrome.

c. The patient has trichotillomania. Psychiatric patients often pull out hair to relieve stress. This condition is called trichotillomania. Trichorrhexis is a defect in the hair shaft where the hair becomes thin and breaks off easily. Patients who secretly swallow the pulled hair have a condition called trichophagia. The masses of hair present in the stomach are referred to as Rapunzel syndrome.

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. Telling the client that he or she must relax whenever tension mounts b. Not allowing the client to seek reassurance from staff c. Having the client repeatedly touch "dirty" objects d. Not allowing the client to wash hands after touching a "dirty" object

d. Not allowing the client to wash hands after touching a "dirty" Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval. None of the other options reflect accurate information regarding this form of therapy.

A nurse is caring for an adult patient who has trauma-related disorder. The patient reports to the nurse that they have started using relaxation techniques and are sleeping better. Which outcome would the nurse identify with this behavior? a. The patient is feeling nervous. b. The patient is feeling less confident. c. The patient is able to manage anxiety. d. The patient has improved self-esteem.

c. The patient is able to manage anxiety. The patient's behavior shows that the patient is able to manage anxiety, which enables the patient to sleep better and use relaxation techniques. A patient who is nervous may not sleep properly or use relaxation methods. Using relaxation techniques and having adequate sleep will make the patient more confident. Positive behaviors like maintaining eye contact and positive talk about self indicates an improvement in the patient's self-esteem.

A family member of an individual recovering from alcohol use disorder states, "All my mother talks about now is how bad drinking is when she drank for years." Which statement reflects the nurse's understanding? a. The recovering individual is demonstrating adaptive sublimation. b. The recovering individual is demonstrating maladaptive displacement. c. The recovering individual is demonstrating adaptive reaction formation. d. The recovering individual is demonstrating maladaptive intellectualization

c. The recovering individual is demonstrating adaptive reaction formation. The nurse understands that the recovering individual is demonstrating adaptive reaction formation, when unacceptable feelings or behaviors are controlled and kept out of awareness by developing the opposite behavior or emotion. An example is a recovering individual constantly talking about the harm of drinking. Sublimation is an unconscious process of substituting a mature and socially acceptable activity for immature and unacceptable impulses. Displacement is the transference of emotions associated with a particular person, object, or situation to another nonthreatening person, object, or situation. Intellectualization is a process in which events are analyzed based on remote, cold facts and without passion rather than incorporating feeling and emotion into the processing.

Which condition would prompt the primary healthcare provider to prescribe 25 mg of diphenhydramine hydrochloride? a. Peptic ulcer and asthma b. Mydriasis and photosensitivity c. Tremors and tardive dyskinesia d. Excessively dry mucous membranes

c. Tremors and tardive dyskinesia Patients with schizophrenia are generally prescribed antipsychotic drugs. These drugs cause extrapyramidal side effects, such as tremors, and abnormal involuntary movements, such as tardive dyskinesia. Diphenhydramine hydrochloride 25 mg (intramuscular or intravenous route) is prescribed to such patients to treat extrapyramidal side effects. Diphenhydramine hydrochloride is contraindicated in patients with peptic ulcer and asthma because it causes stomach distress (e.g., nausea, vomiting, and diarrhea). Physostigmine and benzodiazepines are administered to control these symptoms. Photosensitivity and mydriasis are symptoms of anticholinergic toxicity. Dry mucous membranes can be a symptom of anticholinergic toxicity but are not a major concern with the administration of diphenhydramine hydrochloride.

When caring for a child with posttraumatic stress disorder, which intervention would the nurse include in the patient's plan of care? a. Provide a changeable environment. b. Help the patient learn positive avoidance. c. Use developmentally appropriate language to explore feelings. d. Promote arousal to build tolerance to stress.

c. Use developmentally appropriate language to explore feelings. When caring for a child with posttraumatic stress disorder, it is important to use developmentally appropriate language to explore feelings. To make the child comfortable, it is important to provide a safe and predictable environment rather than a changeable one. The patient may tend to avoid any mention of the traumatic event. However, the patient should be helped to overcome avoidance to promote desensitization to the emotions related to the event. The patient should be taught relaxation therapies to alleviate arousal.

Which serotonin norepinephrine reuptake inhibitor (SNRI) is used to treat generalized anxiety disorder? a. Fluoxetine b. Oxazepam c. Venlafaxine d. Escitalopram

c. Venlafaxine Venlafaxine is an SNRI used to treat generalized anxiety. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used to treat obsessive-compulsive disorder, depression, panic attacks, and premenstrual dysphoric disorder. Oxazepam is a benzodiazepine used to treat generalized anxiety disorder. Escitalopram is an SSRI used to treat generalized anxiety disorder.

A war veteran was diagnosed with dissociative disorder after returning home. The veteran ' s family asks the nurse, "Is this diagnosis the same as schizophrenia?" Which statement is the nurse's response? a. "These symptoms are sometimes a cry for help. Many of our war veterans have difficulty asking for help." b. "Schizophrenia is a thought disorder with a genetic origin, but a dissociative disorder results in delusions and hallucinations." c. "Persons diagnosed with dissociative disorders and schizophrenia are both out of touch with reality. Normal function will resume when the medication reaches a therapeutic level." d. "It is not the same as schizophrenia. The trauma of war can cause overwhelming anxiety, which then leads to a form of mental disconnection. With treatment, a return to optimal functioning is expected."

d. "It is not the same as schizophrenia. The trauma of war can cause overwhelming anxiety, which then leads to a form of mental disconnection. With treatment, a return to optimal functioning is expected." It is a common misconception that dissociative disorders and schizophrenia are the same. The nurse has a responsibility to educate the family and offer the hope for optimal functioning. Dissociative symptoms, or "mindflight," can reduce the disturbing feelings and protect the veteran from full awareness of the trauma; these symptoms should not be dismissed as a resistance to seeking help. Delusions and hallucinations often occur in schizophrenia, but a patient diagnosed with a dissociative disorder would not be expected to have delusions or hallucinations. Persons diagnosed with dissociative disorders have cognitive distortions that result from trauma, but reality testing is intact. Medication is not used commonly to treat dissociative disorders.

Which outcome is the primary purpose of performing a physical examination before beginning treatment for any anxiety disorder? a. Protect the nurse legally. b. Establish the nursing diagnoses of priority. c. Obtain information about the patient's psychosocial background. d. Determine whether the anxiety is primary or secondary in origin.

d. Determine whether the anxiety is primary or secondary in origin. The symptoms of anxiety can be caused by a number of underlying physical disorders. The treatment for secondary anxiety is treatment of the underlying cause. The main reason for searching for an underlying medical condition is to treat the root cause, not to protect the nurse legally or establish the priority nursing diagnosis. After a physical disorder has been ruled out, the nurse can then focus on the patient's psychosocial background.

A patient has been taking citalopram for 2 years for depression. The patient' s outcomes have been achieved, and the patient wants to discontinue the medication. After consultation with the healthcare provider, which information should the nurse provide? a. "Citalopram is an antidepressant medication that usually is taken for life." b. "Stopping this medication suddenly can cause serotonin syndrome." c. "Because your depression is alleviated, you may discontinue the medication." d. "It's important for you to gradually stop taking this drug over 2 to 4 weeks."

d. "It's important for you to gradually stop taking this drug over 2 to 4 weeks." Selective serotonin reuptake inhibitors ( SSRIs) should be tapered off gradually over a period of 2 to 4 weeks to avoid a withdrawal syndrome. Symptoms of the withdrawal syndrome include headache, gastrointestinal upset, dizziness, insomnia, anxiety, and flulike symptoms. Citalopram is not necessarily given for life. Serotonin syndrome is a potentially life-threatening consequence of drug interactions with SSRIs. The patient should not be advised to discontinue the medication unless the healthcare provider has advised it and the patient can be safely tapered down.

Which statement by the family member of a person with schizophrenia demonstrates effective learning about the disease? a. "The disease probably resulted from the mother's smoking during pregnancy. Nicotine is actually a neurotransmitter." b. "If our family had more money, we could afford the promising psychoneuroimmunological treatments available in other countries." c. "The disease could be cured if our politicians and laws allowed for more stem cell research. Adult stem cells hold so much promise." d. "The disease probably was caused by problems with several genes. These genes cause changes in how certain brain chemicals work."

d. "The disease probably was caused by problems with several genes. These genes cause changes in how certain brain chemicals work." Acknowledging that the disease was probably caused by problems with genes indicates that the person understands the basic information about causative factors of schizophrenia. Rationalizing the use of stem cell research, blaming the problem on the mother's smoking behavior, and having funds to afford alternative treatments do not indicate an understanding about the mental disorder.

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. "Try not to think about the feelings and sensations you're experiencing." 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. "What things have you done in the past that helped you feel more comfortable?"

d. "What things have you done in the past that helped you feel more comfortable?" Because the client is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. While distraction may be helpful in some situations, it is not the initial intervention.

A patient 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 is helpful for the nurse to make? a. "Let's try to focus on that adorable little granddaughter of yours." b. "Why don't you sit down over there and work on that jigsaw puzzle?" c. "Try not to think about the feelings and sensations you're experiencing." d. "Which things have you done in the past that helped you feel more comfortable?"

d. "Which things have you done in the past that helped you feel more comfortable?" Because the patient is not able to think through the problem and arrive at an action that would lower anxiety, the nurse can assist by asking what has worked in the past. Often what has been helpful in the past can be used again. The nurse is changing the subject by asking about the granddaughter. A patient with anxiety is not likely able to work on a jigsaw puzzle. A patient with anxiety is focused on the feelings and sensations being experienced.

Which difference distinguishes moderate anxiety from severe anxiety? a. Severe anxiety centers on panic behavior. b. Moderate anxiety motivates learning and creativity. c. The person experiencing severe anxiety is unable to focus on details of any kind. d. A person experiencing moderate anxiety can be redirected when instructed to do so.

d. A person experiencing moderate anxiety can be redirected when instructed to do so. The person experiencing moderate anxiety blocks selected areas but can attend to other areas when directed to do so. Severe anxiety occurs before panic. Mild, not moderate, anxiety motivates learning and creativity. Severe anxiety results in focus on details related to relieving the source of the anxiety.

An obsession is defined as what? a. Thinking of an action and immediately taking the action b. An intense irrational fear of an object or situation c. A recurrent behavior performed in the same manner d. A recurrent, persistent thought or impulse

d. A recurrent, persistent thought or impulse Obsessions are thoughts, impulses, or images that persist and recur so that they cannot be dismissed from the mind. An intense, irrational fear of an object or situation is called a phobia. A recurrent behavior is considered a compulsion. Thinking of an action and then rapidly taking the action indicates lack of impulse control.

The nurse caring for a patient who is experiencing a panic attack anticipates that the psychiatrist would prescribe a stat dose of which type of medication? a. Anticholinergic medication b. Standard antipsychotic medication c. Tricyclic antidepressant medication d. A short-acting benzodiazepine medication

d. A short-acting benzodiazepine medication A short-acting benzodiazepine is the only type of medication listed that would lessen the patient's symptoms of anxiety within a few minutes. Anticholinergics do not lower anxiety, tricyclic antidepressants have very little antianxiety effect and have a slow onset of action, and standard antipsychotic medication will lower anxiety but has a slower onset of action and the potential for more side effects.

The nurse provides care to a patient who presents with alterations in identity with fragmented memories of events that happened in the past. During the initial assessment, the patient reports using substances to "help calm down." When completing the psychosocial assessment, the nurse learns that the patient is not in any intimate relationships, has no children, and has stopped showing up for work regularly. Which short-term outcome does the nurse anticipate planning for this patient? a. Makes new friends; performs social roles well b. Perceives the work environment accurately; improves family role c. Monitors intense feelings of anxiety; prevents the onset of depression d. Abstains from use of substances for coping; performs work adequately

d. Abstains from use of substances for coping; performs work adequately The patient may have a dissociative disorder based on the symptoms they've described. The overall goal for a patient with dissociative disorder is to develop an integrated and complete perception of self. Outcomes are directly related to the signs and symptoms that the patient displays. Therefore abstaining from substance use and performing work adequately are appropriate short-term outcomes for this patient. The patient does not need to make new friends, as the patient is not reporting that there is a problem with friendships. There is no evidence the patient is unable to perform their social role well. Because the patient does not have children, improving family role does not apply. The patient did not report symptoms of anxiety or depression.

Which type of altered perception is most commonly experienced by patients with schizophrenia? a. Visual hallucinations b. Illusions c. Tactile hallucinations d. Auditory hallucinations

d. Auditory hallucinations Hallucinations, especially auditory hallucinations, are the most common example of alterations of perception in schizophrenia. Auditory hallucinations are experienced by as many as 70% of individuals with schizophrenia. Visual hallucinations are the second most common form in schizophrenia. Illusions are misinterpretations of a real experience and are considered another type of altered perception, but less prevalent than auditory hallucinations. Tactile hallucinations are unusual in mental illness.

If a patient diagnosed with a disorder resulting from trauma is within the window of tolerance, which event will occur? a. Hypervigilance related to the environment b. Avoidance of stimuli associated with the trauma c. Evidence of accurate and meaningful self-disclosure d. Balance between sympathetic and parasympathetic arousal

d. Balance between sympathetic and parasympathetic arousal Many psychiatric disorders have trauma as a precipitant. Treatment strategies are designed to modulate arousal so that the person is able to stay within a window of tolerance. Window of tolerance means there is balance between sympathetic and parasympathetic arousal. Hypervigilance is associated with dominance by the sympathetic nervous system. Avoidance of stimuli associated with the trauma is a common assessment finding for persons diagnosed with disorders resulting from trauma. Self-disclosure is a psychosocial phenomenon.

After the intravenous administration of an anxiety medication, a patient with dissociative amnesia had sudden memory retrieval and started identifying family members. Which class of medication did the nurse administer to the patient? a. Beta blockers b. Phenothiazines c. Butyrophenones d. Benzodiazepines

d. Benzodiazepines In acute settings, a patient with dissociative amnesia has sudden memory retrieval after receiving intravenously administering benzodiazepines. Research suggests that benzodiazepines help in retrieval of old memories by reducing anxiety. Beta blockers are primarily prescribed to reduce hypertension caused by anxiety and stress. Phenothiazines are an antipsychotic medication that is prescribed to cause sedation and calm the patient. Butyrophenones are prescribed to treat hallucinations and delusions in patients.

Which condition is a sign of advanced lithium toxicity? a. Sedation b. Confusion c. Mild thirst d. Blurred vision

d. Blurred vision Blurred vision is a sign of advanced lithium toxicity that is seen when the blood plasma level of lithium is 2 to 2.5 mEq/L. Sedation and confusion are early signs of lithium toxicity that are seen when the blood plasma level of lithium is 1.5 to 2 mEq/L. Mild thirst is not associated with signs of advanced toxicity.

Which toxic effect of antipsychotic medication can be avoided by ingesting foods rich in carbohydrates and protein? a. Weight gain b. Hyperpyrexia c. Agranulocytosis d. Cholestatic jaundice

d. Cholestatic jaundice Antipsychotics may cause cholestatic jaundice because of impaired liver function. Hence, a liver function test should be performed every 6 months. The patient must be given foods rich in carbohydrates and protein to enhance liver function. Weight gain is a common side effect with some antipsychotics, and the drugs may need to be changed. Hyperpyrexia is an extreme elevation of the body temperature and is a medical emergency. Agranulocytosis is caused by a reduction in white blood cell count.

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

d. Client demonstrates effective coping strategies. This is the only desirable outcome.

A child is extremely upset because they are being constantly bullied by peers for having a short stature. While giving advice to the child, the nurse states, "Your stature is not going to affect your fitness. You could always excel in other aspects like music and academics." Which defense mechanism is the nurse encouraging in the child? a. Dissociation b. Identification c. Displacement d. Compensation

d. Compensation The advice given by the nurse indicates that the nurse is trying to counterbalance the perceived deficiencies in the child and advising them to focus on other activities. The nurse is encouraging the positive use of compensation as a defense mechanism. Dissociation is a defense mechanism wherein an individual mentally separates themselves from unpleasant situations. Identification is a defense mechanism wherein an individual tries to imitate the characteristics of another person or group. Displacement is a defense mechanism wherein an individual transfers the emotions related to a particular person or situation to a nonthreatening person or object.

A patient says to the nurse, "I had my first episode of depression after I got divorced about 10 years ago. I recognized what was happening to me because both of my parents suffer from depression." Which theory regarding the etiology of depression has the patient described? a. Cognitive theory b. Biochemical factors c. Inflammation d. Diathesis-stress model

d. Diathesis-stress model The diathesis-stress model of depression takes into account the interplay between genetic and biological predisposition toward depression and life events. The physiological vulnerabilities, such as genetic predispositions, biochemical makeup, and personality structure, are referred to as a diathesis. The stress part of this model refers to the life events that affect individual vulnerabilities. Cognitive theory recognizes the role of early life experiences in the development of depression. Biochemical factors include genetic and biological variables in the etiology of depression. Inflammation may be the result of psychological, as well as physical injury, but this does not explain the patient's depression.

Which statement about dissociative disorders is true? a. Dissociative symptoms are always negative. b. Dissociative symptoms are usually a cry for attention. c. Dissociative symptoms are under the person's conscious control. d. Dissociative symptoms are not under the person's conscious control.

d. Dissociative symptoms are not under the person's conscious control. Dissociation is involuntary and results in failure of normal control over a person's mental processes and normal integration of conscious awareness. Dissociative symptoms are not a cry for attention and are not always negative.

Patients with which condition can be safely prescribed lithium therapy to treat bipolar disorder? a. Renal disease b. Thyroid disorder c. Myasthenia gravis d. Erectile dysfunction

d. Erectile dysfunction Patients with erectile dysfunction can be prescribed lithium therapy because lithium does not interfere with sexual function. Lithium causes impairment in kidney functioning. It should not be prescribed to patients with renal diseases. Lithium causes hypothyroidism by reducing the levels of thyroxine hormone. It should not be prescribed to patients with thyroid disorder. Lithium therapy must be avoided in patients with myasthenia gravis because it causes ataxia and severe muscle weakness.

The nurse is caring for a child who has witnessed a car accident and does not remember anything that took place during the accident. Which therapy would the nurse expect the advanced practice mental health clinicians to adopt to help the child regain memory of the car accident? a. Psychopharmacological therapy b. Cognitive-behavioral therapy (CBT) c. Dialectical developmental psychotherapy d. Eye movement desensitization and reprocessing therapy (EMDR)

d. Eye movement desensitization and reprocessing therapy (EMDR) EMDR is an evidence-based therapy. It is an eight-phase protocol by which the child is encouraged to recollect the traumatic event by using stimulations such as audio tones. In CBT, the nurse teaches stress management techniques to the child. In psychopharmacological therapy, medications are prescribed to the patient to treat the pathological changes caused by stress. In dialectical developmental psychotherapy, emotion regulation techniques like meditation and deep breathing are taught to the child.

Panic attacks in Latin American individuals often involve demonstration of which behavior? a. Blushing b. Repetitive involuntary actions c. Offensive verbalizations d. Fear of dying

d. Fear of dying Panic attacks in Latin Americans and Northern Europeans often involve sensations of choking, smothering, numbness or tingling, as well as fear of dying. This information directs you to the correct options.

Which medication classification is most often associated with the side effects gynecomastia, amenorrhea, and galactorrhea? a. Anticholinergic medications b. Third-generation antipsychotics c. Second-generation (atypical) antipsychotics d. First-generation (conventional) antipsychotics

d. First-generation (conventional) antipsychotics First-generation antipsychotic medications commonly have side effects that relate to sexual dysfunction. These side effects include gynecomastia (enlarged breast tissue), amenorrhea (absence of menstruation), and galactorrhea (discharge from nipples). The incidence of these side effects is much less in second- and third-generation antipsychotic medications. Anticholinergic medications have side effects of constipation and blurred vision.

Empathic listening is therapeutic because it focuses on what form of action? a. Encouraging resilience b. Enhancing self-esteem c. Reducing anxiety d. Lessening feelings of isolation

d. Lessening feelings of isolation Empathic listening can be healing because it can help minimize feelings of isolation. Empathic listening is not focused on any of the other factors suggested by the other options.

Which outcome noted in the plan of care is the most important for a patient in the manic phase of bipolar I disorder? a. Decreasing food intake b. Increasing physical activity c. Sleeping for 8 to 10 hours a night d. Maintaining a stable cardiac status

d. Maintaining a stable cardiac status During the manic phase of bipolar I disorder, the most important outcome for the patient is to maintain a stable cardiac status because cardiac problems can be life threatening. Other important outcomes include increasing food and fluid intake, ensuring at least 4 to 6 hours of sleep a night, and decreasing physical activity.

Which reason explains why the nurse caring for a patient experiencing mania is consistent in approach and expectations? a. Improves the patient's feelings of security b. Provides structure and control of the patient c. Helps the patient experience outside controls d. Minimizes the potential for the patient's manipulation of staff

d. Minimizes the potential for the patient's manipulation of staff Consistent limits and expectations minimize the potential for the patient's manipulation of staff. Using a firm, calm approach improves the patient's feelings of security and provides structure and control of the patient. Identifying expectations in simple, concrete terms with consequences helps the patient experience outside controls.

Selective inattention is first noted when experiencing which level of anxiety? a. Mild b. Panic c. Severe d. Moderate

d. Moderate When moderate anxiety is present, the individual's perceptual field is reduced, and the patient is not able to see the entire picture of events. The perceptual field is heightened with mild anxiety. Severe anxiety causes the patient to have a greatly reduced and distorted perceptual field. Panic level anxiety cause the patient to be unable to attend to the environment.

Which statement is true regarding schizophrenia, treatment, and outcomes? a. If treated quickly after diagnosis, schizophrenia can be cured. b. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. c. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms. d. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

d. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. Untrue statements about schizophrenia include that it can be cured if treated quickly; that it can be managed by receiving treatment only at the time of acute exacerbations; and that if patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Empathetic listening is therapeutic for a patient with a dissociative disorder for which reason? a. Reducing anxiety b. Encouraging resilience c. Enhancing self-esteem d. Providing support during disclosure of painful memories

d. Providing support during disclosure of painful memories Empathetic listening can be healing because it provides support during disclosure of pain memories. Empathetic listening can help reduce anxiety and encourage resilience and self-esteem, but a patient with a dissociative disorder especially needs a great deal of support during disclosure of painful memories.

A patient with depression is in the acute phase of treatment for depression. The nurse plans the patient's care, with which factor describing the goal of care? a. Phasing out medication b. Relapse prevention c. Prevention of future depression d. Reducing depressive symptoms

d. Reducing depressive symptoms The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization. Reduction or phasing out of medication does not occur during the acute phase. During the maintenance phase after a year, the goal is to prevent relapse and further episodes.

Which nursing intervention would be helpful when caring for a patient diagnosed with an anxiety disorder? a. Express mild amusement over symptoms. b. Arrange for patient to spend time away from others. c. Advise patient to minimize exercise to conserve endorphins. d. Reinforce use of positive self-talk to change negative assumptions.

d. Reinforce use of positive self-talk to change negative assumptions. This technique is a variant of cognitive restructuring. "I can't do that" is changed to "I can do it if I try." It is nontherapeutic to express amusement at a patient's symptoms. The patient should not be encouraged to stay away from other people; rather, the patient should learn to interact well with others. There is no reason for the patient to reduce exercise to conserve endorphins.

Just before the guests arrive for Thanksgiving dinner, the host discovers the turkey is burned and inedible. Which behavior by the host indicates adaptive coping? a. Going to bed and leaving the guests unattended b. Telephoning all the guests and canceling the invitation for dinner c. Telling the guests, "My oven malfunctioned. You will have to eat burned turkey." d. Saying to the guests, "We are having a vegetarian Thanksgiving dinner this year."

d. Saying to the guests, "We are having a vegetarian Thanksgiving dinner this year." Anxiety is a part of everyday life. Normal anxiety is a healthy reaction necessary for survival. It provides the energy needed to carry out the tasks involved in living and striving toward goals. Anxiety motivates people to make and survive change. It prompts constructive behaviors. In this scenario, announcing a vegetarian dinner indicates the adult has adapted to the anxiety-producing situation. Canceling the dinner and leaving guests unattended are dysfunctional responses. Saying the oven malfunctioned demonstrates maladaptive use of displacement.

Which clinical focus is appropriate when planning patient outcomes during the stabilization phase of schizophrenia? a. Acute symptom stabilization b. Safety and crisis intervention c. Stress and vulnerability assessment d. Social, vocational, and self-care skills

d. Social, vocational, and self-care skills During the stabilization phase of schizophrenia, planning is geared toward the patient and family education and skills training that will help maintain the optimal functioning of individuals with schizophrenia in the community. Acute symptom stabilization, safety and crisis intervention, and stress and vulnerability assessment are clinical focuses in other phases of schizophrenia.

Which aspect characterizes dissociative identity disorder? a. The inability to recall important information b. Recurring feelings of detachment from one's body or mental processes c. Sudden, unexpected travel away from home and inability to remember the past d. The existence of two or more personality states, each with its own patterns of thinking

d. The existence of two or more personality states, each with its own patterns of thinking The essential feature of dissociative identity disorder is the presence of two or more distinct personality states that recurrently take control of behavior. The inability to recall important information is dissociative amnesia. Depersonalization is a feeling of detachment with parts or the whole self. Sudden, unexpected travel away from home and inability to recall one's identity is dissociative fugue.

Dissociative identity disorder is characterized by what event? a. Sudden, unexpected travel away from home and inability to remember the past b. Recurring feelings of detachment from one's body or mental processes c. The inability to recall important information d. The existence of two or more subpersonalities, each with its own patterns of thinking

d. The existence of two or more subpersonalities, each with its own patterns of thinking Dissociation is an unconscious defense mechanism that protects the individual against overwhelming anxiety through an emotional separation. However, this separation results in disturbances in memory, consciousness, self-identity, and perception. None of the other options accurately characterizes this form of mental dysfunction.

A patient with mania is admitted to the unit, and the nurse sets a short-term goal of being well hydrated within 24 hours. Which cue indicates the goal has been met? a. Urine specific gravity is close to normal. b. Skin turgor has almost returned to normal. c. The patient has urinary output by 24 hours. d. The patient consumes 8 ounces of fluids per hour.

d. The patient consumes 8 ounces of fluids per hour. A patient who is to achieve hydration within 24 hours would need to consume 8 ounces of fluid per hour. At 24 hours, the urine specific gravity should be within normal limits. The patient should not go for 24 hours without urinary output. The patient's skin turgor should be normal after 24 hours.

Which statement about structural dissociation of the personality is true? a. An organic basis exists for this type of disorder. b. Nurses perceive patients with this disorder as easy to care for. c. No known link exists between this disorder and early childhood loss or trauma. d. This disorder results in a split in the personality, causing a lack of integration.

d. This disorder results in a split in the personality, causing a lack of integration. The theory of structural dissociation of the personality proposes that patients with complex trauma have different parts of their personality, the apparently normal part and the emotional part, that are not fully integrated with each other. Each part has its own responses, feelings, thoughts, perceptions, physical sensations, and behaviors. These different parts may not be aware of each other, with only one dominant personality operating depending on the situation and circumstance of the moment. There is not an organic basis for this disorder; however, genetics and early, prolonged detachment from the caretaker negatively affect the limbic system development. Patients with dissociative identity disorder are challenging to care for. There is a strong link between childhood complex trauma and dissociative identity disorder.

A child from a minority family is at greatest risk for which disorder? a. Bullying b. Homicidal thoughts c. Eating- and sleep-related disorders d. Traumatic experiences in early childhood

d. Traumatic experiences in early childhood Poverty, parental substance abuse, and exposure to violence have received increasing attention and place minority children at greater risk for trauma and stress. Bullying can affect anyone. Homicidal thoughts and eating- and sleep-related disorders are not more prominent in any particular racial or cultural group.

Which is the most likely cause of hyponatremia, increased confusion, and delirium in a patient on conventional antipsychotics? a. Dehydration b. Medication withdrawal c. Lack of response to the medication d. Water intoxication

d. Water intoxication Antipsychotics are usually prescribed in combination with anticholinergics because they cause dry mouth. The patient can feel excessive thirst and may drink lots of water, which results in water intoxication, as indicated by hyponatremia, confusion, and worsening of the psychotic symptoms. If the patient has stopped taking medication or is not responding to them, it would lead the psychotic conditions to worsen as well. It would not produce hyponatremia. In addition, mental stress would not cause hyponatremia. Fatal water intoxication occurs because of excessive water intake. The signs do not indicate that the patient is dehydrated.

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 at what level of anxiety? a. mild b. panic c. moderate d. severe

d. severe Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart. Mild anxiety involves a heightened perceptual field. In the panic state, the individual is unable to attend to the environment, and focus is lost. With moderate anxiety, the person grasps less of what is going on.