Mental Health: Midterm to Final Quizzes

Which laboratory test should the nurse monitor when taking risperidone (Risperdal)? a. Creatinine b. BUN c. Blood glucose d. Estrogen

c. Blood glucose

A child is expelled from school for repeated fighting and vandalizing school property. The school nurse and counselor meet with the parents to explain that the child may benefit from counseling and are formulating a collaborative plan. The child is experiencing signs of which disorder? a. Asperger's syndrome b. Atttention Defici Hyperactivity disorder c. Conduct disorder d. Oppositional defiant disorder

c. Conduct disorder

A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? a. Quality of the client's social support b. Client's insight into the reasons for the decision c. Lethality of the method and availability of means d. Client's educational and economic background

c. Lethality of the method and availability of means

Antabuse has a black box warning regarding how many hours after ingesting alcohol you can take this drug. How many hours is it?

> 12 hours

The nurse is caring for a client in the acute manic stage of bipolar disorder and plans to use which interventions to assist in maintaining a safe environment? Select all that apply. A. Provide high-calorie finger foods. B. Administer antidepressant medications C. Decrease the light and noise level on the unit. D. Restrict the client's access to money and other valuables. E. Apply restraints in case the patient becomes agitated

A. Provide high-calorie finger foods. C. Decrease the light and noise level on the unit. D. Restrict the client's access to money and other valuables.

The nurse is working with the client with histrionic personality disorder. Which behaviors should the nurse expect? (Select all that apply) A. Uses physical appearance to gain attention B. Shows apathy in conversations until trust is established C. Lacks close friends or companions other than first-degree relatives D. Harbors recurrent suspicions about the fidelity of his or her marital partner E. Discomfort in situations in which the client is not the center of attention

A. Uses physical appearance to gain attention E. Discomfort in situations in which the client is not the center of attention

Individuals with an eating disorder may have difficulties identifying and expressing their feelings, a condition known as _____________.

Alexithymia

A nurse learns at report that a newly admitted client experiencing mania is demonstrating grandiose delusions. The nurse should recognize that which client statement would provide supportive evidence of this symptom? A. "I can't stop my sexual urges. They have led me to numerous affairs." B. "I'm the world's most perceptive attorney." C. "My wife is distraught about my overspending." D. "The FBI has tapped my room and are out to get me.

B. "I'm the world's most perceptive attorney."

If giving propranolol to a patient with a recent MI, what education should you provide them with when they are stopping the drug?

Black Box Warning: Taper it off

_____________ nervosa is an eating disorder that is characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain such as purging, fasting, or excessive exercising.

Bulimia

A client diagnosed with bipolar disorder, who has taken lithium carbonate (Lithane) for 1 year, presents in the emergency department with severe diarrhea, blurred vision, and tinnitus. How should the nurse interpret these symptoms? A. Symptoms indicate consumption of foods high in tyramine. B. Symptoms indicate lithium carbonate discontinuation syndrome. C. Symptoms indicate the development of lithium carbonate tolerance. D. Symptoms indicate lithium carbonate toxicity.

D. Symptoms indicate lithium carbonate toxicity. Target lithium range = 0.8 - 1.2 mEq/L Serum levels below 0.5 are rarely therapeutic, above 1.5 is toxic Other tests include: Thyroid function tests (hypothyroidism is a risk of long-term lithium therapy) Creatinine & BUN (impairment of renal function is a risk of long-term lithium therapy) Na levels (dehydration can contribute to lithium toxicity)

Body image _________________ occurs when there is an extreme discrepancy between one's body image and the perceptions of others and extreme dissatisfaction with one's body image.

Disturbance

What education would you provide a patient who was just prescribed benzodiazepines?

Don't stop suddenly No EtOH Do not use for > 4 months Do not use w/ opioids Watch for rr depression

_____________ , or a lack of clearly defined role boundaries, is common in families of individuals with eating disorders

Enmeshment

What are some major Adverse effects of First Generation Antipsychotics?

Extrapyramidal symptoms, Neuroleptic malignant syndrome, Akathisia, Parkinsonism, Anticholinergic symptoms EPS- Abnormal contraction, acute dystonia Neuroleptic Malignant syndrome- Fever, stiff muscles, change in LOC, respiratory failure, liver failure.

Individuals with eating disorders are generally self-assured individuals who feel attractive and able to cope with life transitions

False

Men are more likely to seek treatment for eating disorders than are women

False

Pharmacotherapy has been found to be the most effective treatment for bulimia nervosa

False

What is the Black Box Warning for Dextroamphetamine?

High abuse potential! Misuse may cause sudden death or serious cardiovascular events. Essential to obtain baseline electrocardiogram (ECG) reading and BP reading.

What would you assess before giving a patient clonidine?

Hr, heart sounds O2 sat, rr LOC UO

Disruptions in the hypothalamus may affect an individual's sense of hunger and ________________ , or satisfaction of appetite.

Satiety

What antidepressant is considered "safe" for pregnant women?

Sertraline (SSRI) Don't forget that although this is highly recommended, it is considered safe because the benefits outweigh the consequences! There are still adverse effects associated with pregnancy.

Why are SSRIs considered first-line pharmaceutical tx for depression and anxiety?

They have the fewest and least dangerous side effects and contraindications.

Eating disorders are more common in Westernized societies

True

Individuals with anorexia nervosa often have a history of being perfectionists with above-average intelligence, who are achievement oriented, dependable, eager to please, and seeking approval before their condition began.

True

Which question best encourages the client to disclose information that the nurse must assess to provide culturally competent care? a. "How do you want to help you?" b. "Which family members do you want to receive calls from?" c. "Do you want me to contact your preacher?" d. "What special diet do you have?"

a. "How do you want to help you?" To provide culturally competent care, the nurse must find out as much as possible about a client's cultural values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to him or her. An open and objective approach to the client is essential. Clients will be more likely to share personal and cultural information if the nurse is genuinely interested in knowing and does not appear skeptical or judgmental. Assuming the client wants a preacher or has special dietary preferences is assuming the client's values. Asking about preferred family members does little to assess the nature of family relationships.

The client is brought to the clinic with dementia and is unable to recognize ordinary objects, such as a pen or notebook. The family is upset and concerned. The nurse notes that this is a symptom of which condition? a. Agnosia b. Amnesia c. Apraxia d. Aphasia

a. Agnosia

A nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? a. Bologna sandwich b. Celary sticks c. Sliced apples d. Glass of milk

a. Bologna sandwich

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? a. Decrease the client's environmental stimuli. b. Tell the client about hospital rules and policies. c. Give the client feedback about the client's behavior. d. Introduce the client to other staff on the unit.

a. Decrease the client's environmental stimuli. When the client is agitated, decreasing stimuli is the priority because it is likely to reduce the client's agitation. Giving an agitated client feedback about his or her behavior may provoke confrontation. Similarly, making reference to rules and policies may make the client reactive or defensive, exacerbating the situation. Introducing the client to other staff does nothing to address the client's agitation.

A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. The nurse evaluates that the dose is appropriate when the client reports what? a. Minimal mood swings b. Feeling sleepy and less energetic c. Increased self feelings of self-worth d. Weight gain of 7 bounds in the last 6 months

a. Minimal mood swings Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment.

During an initial interview at a clinic, a young client states that there is nothing wrong with the client. Which would indicate to the nurse that this client might have anorexia nervosa? a. Severe weight loss due to self-imposed dieting b. Flexible thought patterns and spontaneity c. Episodes of overeating and excessive weight gain d. Expressions of a positive self-concept

a. Severe weight loss due to self-imposed dieting Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

A nurse is assessing a client who has schizophrenia and has been on long-term treatment with chlorpromazine. He notes the client is experiencing some involuntary movements of the tongue and face. The nurse should suspect the client has developed which of the following adverse effects? a. Tardive dyskinesia b. Akathisia c. Parkinsonism d. Dystonia

a. Tardive dyskinesia

A nurse working in an assisted living facility is holding an inservice for the nursing assistants. The nurse reviews common behaviors associated with cognitive deterioration associated with dementia. Which would cause the nurse to know that the assistants correctly understood if it were expressed during a posttest? a. The clients may not recognize their family when they come to visit b. The clients should know when to come to the dining room for meals. c. The clients should be able to ask us for items they need. d. The clients who are ambulatory can still carry out activities of daily living independently

a. The clients may not recognize their family when they come to visit

A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) a. Use of clang associations b. Flat c. Lack of motivation d. Auditory hallucination e. Delusions persecution

a. Use of clang associations b. auditory hallucinations e. Delusions persecution

A client who is depressed states, "I think my family would be better off without me. They don't need to worry." Which would be the most appropriate response by the nurse? a. "Where are you going?" b. "Are you planning to commit suicide?" c. "You don't mean that. Your family loves you." d. "What do you think they are worried about?"

b. "Are you planning to commit suicide?" The nurse never ignores any hint of suicidal ideation regardless of how trivial or subtle it seems and the client's intent or emotional status. Asking clients directly about thoughts of suicide is important. Asking about the family's worries or their love for the client does not directly address the client's risk for suicide. Asking, "Where are you going?" is less direct and less effective than asking explicitly about suicide.

A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? a. "It is common to treat depression with ECT before trying medications." b. "I will receive a muscle relaxant to protect me from injury during ECT." c. "I can have my depression cured if I receive a series of ECT treatments." d. "I should receive ECT once a week for 6 weeks."

b. "I will receive a muscle relaxant to protect me from injury during ECT."

A 15-year-old is admitted for treatment of anorexia nervosa. Which is characteristic of anorexia nervosa? a. Absence of hunger feelings b. Body weight less than normal for age, height, and overall physical health c. Irregular menstrual circles d. Erosion of dental enamel

b. Body weight less than normal for age, height, and overall physical health Clients with anorexia nervosa have a body weight that is less than the minimum expected weight, considering their age, height, and overall physical health. Physical problems of anorexia nervosa include amenorrhea a characteristic that goes beyond simply having irregular cycles. These clients do not lose their appetites. They still experience hunger but ignore it and signs of physical weakness and fatigue. Dental erosion is characteristic of bulimia nervosa because this disorder involves vomiting of acidic stomach contents.

A client has an eating disorder characterized by consuming an amount of food much larger than a person would normally eat. Afterward, the client often purges the food or exercises excessively. Between binges, the client often eats low-calorie foods or fasts. What is the client's most likely diagnosis? a. Anorexia nervosa b. Bulimia nervosa c. Pica d. Rumanation

b. Bulimia nervosa Bulimia nervosa, often simply called bulimia, is an eating disorder characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising. The amount of food consumed during a binge episode is much larger than a person would normally eat. Between binges, the client may eat low-calorie foods or fast. Anorexia nervosa is a life-threatening eating disorder characterized by the client's refusal or inability to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists. The weight of clients with bulimia usually is in the normal range. Pica is persistent ingestion of nonfood substances. Rumination is repeated regurgitation of food that is then rechewed, reswallowed, or spit out.

When working with the family of a client with anorexia nervosa, which issue must be addressed? a. Self-discipline b. Control c. Codependence d. Sexual identity

b. Control Clients with anorexia often believe the only control they have is over their eating and weight; all other aspects of their life are controlled by their family. Codependence, self-discipline, and sexual identity may be relevant to some clients, but the presence of control issues is relevant in all clients with anorexia nervosa.

The client has been diagnosed with depression. The client asks the nurse what imbalances influence depression. Which best explains the neurochemical processes responsible for depression? a. Decreased glucocorticoid activity b. Decreased serotonin and norepinephrine activity c. Increased activity of dopamine d. Potentiating of the kindling process

b. Decreased serotonin and norepinephrine activity Deficits of serotonin, its precursor tryptophan, or a metabolite (5-hydroxyindole acetic acid, or 5-HIAA) of serotonin found in the blood or cerebrospinal fluid occur in people with depression. Norepinephrine levels may be deficient in depression and increased in mania. Elevated glucocorticoid activity is associated with the stress response, and evidence of increased cortisol secretion is apparent in about 40% of clients with depression. Kindling is the process by which seizure activity in a specific area of the brain is initially stimulated.

The client with schizophrenia believes the student nurses are there to spy on the clients. The client is suffering from which symptom? a. Ideas of reference b. Delusions c. Hallucination d. Anhedonia

b. Delusions Delusions are fixed false beliefs that have no basis in reality. Hallucinations are false sensory perceptions or perceptual experiences that do not exist in reality. Ideas of reference are false impressions that external events have special meaning for the person. Anhedonia is feeling no joy or pleasure from life or any activities or relationships.

A nurse in the emergency department tells an adult: "Your mother had a severe stroke." The adult tearfully says: "Who will take care of me now? My mother always told me what to do, what to wear, and what to eat. I need someone to reassure me when I get anxious." Which term best describes this behavior? a. Histrionic b. Dependent c. Narcissistic d. Borderline

b. Dependent

A client on the unit suddenly cries out in fear. The nurse notices that the client's head is twisted to one side, the client's back is arched, and the client's eyes have rolled back in the sockets. The client has recently begun drug therapy with haloperidol. Based on this assessment, which would be the first action of the nurse? a. Hold the client's medication until the symptoms subside b. Give a PRN dose of benztropine IM c. Get a stat order for a serum drug level d. Place an urgent call to the client's physician

b. Give a PRN dose of benztropine IM The client is having an acute dystonic reaction; the treatment is anticholinergic medication. Dystonia is most likely to occur in the first week of treatment, in clients younger than 40 years, in males, and in those receiving high-potency drugs such as haloperidol. Immediate treatment with anticholinergic drugs usually brings rapid relief.

A nurse is providing teaching for a client who has schizophrenia and a new prescription for risperidone. Which of the following statements should the nurse include in the teaching? a. Have your blood pressure checked frequently for hypertension b. Increase your fluid and fiber intake to prevent constipation c. Increase caloric intake to prevent weight loss. d. Expect to have your blood checked weekly for serum electrolyte imbalances

b. Increase your fluid and fiber intake to prevent constipation

A nurse is providing teaching for a client who has schizophrenia and a new prescription for risperidone. Which of the following statements should the nurse include in the teaching? a. Increase caloric intake to prevent weight loss. b. Increase your fluid and fiber intake to prevent constipation. c. Have your blood pressure checked frequently for hypertension. d. Expect to have your blood checked weekly for serum electrolyte imbalances.

b. Increase your fluid and fiber intake to prevent constipation.

Which is believed to be a risk factor specific to the development of delirium? a. Ineffective coping b. Increased severity of physical illness c. Gradual decline in functioning d. Baseline cognitive impairment

b. Increased severity of physical illness

A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply.) a. Hypotension b. Memory loss c. Confusion d. Polyuria e. Paralytic ileus

b. Memory loss c. Confusion

A client with schizophrenia reads the advice column in the newspaper daily. When asked why the client is so interested in the advice column, the client replies, "This person is my guide and tells me what I must do every day." The nurse would best describe this type of thinking as what? a. Personalization b. Referential delusion c. Grandiose delusion d. Thought insertion

b. Referential delusion Referential delusions or ideas of reference involve the client's belief that television broadcasts, music, or newspaper articles have special meaning for him or her. Grandiose delusions are characterized by the client's claim to association with famous people or celebrities or the client's belief that he or she is famous or capable of great feats. Thought insertion is the belief that others are placing thoughts in their mind against their will. Personalization is not a psychotic characteristic of schizophrenia.

For a client taking clozapine, which symptom should the nurse report to the health care provider immediately, as it may indicate a potentially fatal side effect? a. Inability to stand still for 1 minute b. Sore throat and malaise c. Photosensitivity reaction d. Mild rash

b. Sore throat and malaise Clozapine produces fewer traditional side effects than do most antipsychotic drugs, but it has the potentially fatal side effect of agranulocytosis. This develops suddenly and is characterized by fever, malaise, ulcerative sore throat, and leukopenia. This side effect may not be manifested immediately and can occur up to 24 weeks after the initiation of therapy. Any symptoms of infection must be investigated immediately. Agranulocytosis is characterized by fever, malaise, ulcerative sore throat, and leukopenia. Mild rash and photosensitivity reaction are not serious side effects.

A client tells the nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always yelling at me and threatening me." Which of the following actions should the nurse take? a. Keep the client's communication confidential, but talk to the client daily, using therapeutic communication to convince him to admit to hiding the knife. b. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others. c. Report the incident, but do not inform the client of the intention to do so. d. Keep the client's communication confidential but watch the client and his roommate closely.

b. Tell the client that this must be reported to health care staff because it concerns the health and safety of the client and others.

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? a. Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling. b. Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs. c. They tend to develop few relationships because they are strongly independent but generally maintain deep affection. d. They pay particular attention to details, which can interfere with the development of relationships.

b. Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs.

A delusion represents a problem in which area? a. Orientation b. Thinking c. Motivation d. Memory

b. Thinking A delusion is a fixed false idea or thought. Memory relates to the client's knowledge of past events. Motivation relates to the client's interest in doing things. Orientation relates to the client's perception of reality in terms of identity, place and time.

A student nurse is assigned to administer oral medications to a client. Which of these actions should a student nurse take if a client refuses to take prescribed oral medications? a. document the client's refusal on the medication administration record without comment b. ask the client's reason for refusing and report it to the primary care nurse c. tell the client that the nurse will receive a poor grade if he or she does not administer the medication d. tell the client that refusal is not permitted and staff will require the client to take the medication

b. ask the client's reason for refusing and report it to the primary care nurse

A client who is depressed states, "I think my family would be better off without me. They don't need to worry." Which would be the most appropriate response by the nurse? a. "Where are you going?" b. "What do you think they are worried about?" c. "Are you planning to commit suicide?" d. "You don't mean that. Your family loves you."

c. "Are you planning to commit suicide?" Response Feedback: The nurse never ignores any hint of suicidal ideation regardless of how trivial or subtle it seems and the client's intent or emotional status. Asking clients directly about thoughts of suicide is important. Asking about the family's worries or their love for the client does not directly address the client's risk for suicide. Asking, "Where are you going?" is less direct and less effective than asking explicitly about suicide.

A parent expresses concern to the nurse that the child's regularly scheduled vaccines may not be safe. The parent states hearing reports that they cause autism. Which is the most appropriate response by the nurse? a. "There are safer alternative immunizations available now." b. "It is recommended that you wait until the child is older to vaccinate." c. "There has been no research to establish a relationship between vaccines and autism." d. "The risks do not outweigh the benefits of immunization against childhood diseases."

c. "There has been no research to establish a relationship between vaccines and autism." The National Institute of Child Health and Human Development, Centers for Disease Control and Prevention (CDC) and the Academy of Pediatrics have all conducted research studies for several years and have concluded that there is no relationship between vaccines and autism and that the measles, mumps, and rubella (MMR) vaccine is safe. Consequently, there is no need for the nurse to recommend deviating from the suggested vaccination schedule. Stating, "The risks do not outweigh the benefits of immunization against childhood diseases" suggests that there are indeed risks of autism associated with vaccinations.

Which client is most likely suffering from dementia? a. A 22-year-old who was involved in a motorcycle crash without wearing a helmet now unable to remember where the client is. b. A 6-year-old who has just been administered conscious sedation for a closed reduction of a fractured wrist and says that the child's parents have three sets of eyes c. A 90-year-old who has experienced progressive mental decline that started with forgetfulness d. An 80-year-old who has been in excellent health until the client was admitted through the emergency department with a severe urinary tract infection and is now very anxious and is threatening staff

c. A 90-year-old who has experienced progressive mental decline that started with forgetfulness

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first? a. Tell the client about hospital rules and policies b. Introduce the client to other staff on the unit c. Decrease the client's environmental stimuli d. Give the client feedback about the client's behavior

c. Decrease the client's environmental stimuli When the client is agitated, decreasing stimuli is the priority because it is likely to reduce the client's agitation. Giving an agitated client feedback about his or her behavior may provoke confrontation. Similarly, making reference to rules and policies may make the client reactive or defensive, exacerbating the situation. Introducing the client to other staff does nothing to address the client's agitation.

The most important nursing intervention for serotonin syndrome is which of the following? a. Administration of an anticonvulsant. b. Administration of a muscle relaxant for myoclonus. c. Discontinuation of serotonergic drugs. d. Immediately initiate body cooling procedures.

c. Discontinuation of serotonergic drugs.

Which is likely to be most effective for adolescents with conduct disorder? a. Focusing on the parenting education b. Involvement with the legal system c. Early intervention d. Incarceration

c. Early intervention

Jamie is a 32 year old female with panic disorder who was recently prescribed Diazepam. She presents to the emergency room after being found unconscious in her kitchen by her partner. On exam, her respiratory rate is 6, she is cyanotic, cool to the touch, and A&O x0. You suspect a benzo overdose. What drug would anticipate Jamie will be given? a. Naloxone (Narcan) b. Disulfiram (Antabuse) c. Flumazenil d. Buprenorphine (Suboxone)

c. Flumazenil

Which would the nurse expect to assess in a client with narcissistic personality disorder? a. Genuine concern for others b. Dependence on others for decision making c. Grandiose and superior self-concept d. Mistrust of others

c. Grandiose and superior self-concept Clients with narcissistic personality disorder believe themselves superior to others and expect to be treated as such. They lack concern for the interests of others and tend not to seek input from others when making decision because of their perceived superiority. Mistrust is more closely associated with paranoid personality disorder than narcissistic personality disorder.

A child with attention deficit hyperactivity disorder (ADHD) reports to the child's parents that the child does not like the side effects of the child's medicine, amphetamine. The parents ask the nurse for suggestions to reduce the medication's negative side effects. The nurse can best help the parents by offering which advice? a. Let the child take daytime naps. b. Limit the number of calories the child eats each day. c. Have the child eat a good breakfast and snacks late in the day and at bedtime. d. Give the child his medicine at night.

c. Have the child eat a good breakfast and snacks late in the day and at bedtime. Stimulants should be given in daytime hours to prevent insomnia. Eating a good breakfast with the morning dose and substantial nutritious snacks late in the day and at bedtime helps the child to maintain an adequate dietary intake, which can be challenging during treatment with stimulants. Caloric intake may need to be promoted, not limited. Daytime napping for a child with ADHD is unrealistic and not developmentally necessary.

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? a. Insisting that others follow the rules of the unit b. Getting others to make decisions for the client c. Having a tantrum if not getting enough attention d. Wondering why others are being friendly to the client

c. Having a tantrum if not getting enough attention Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. These characteristics may prompt the client to act out if the client is not getting his or her own way. This disorder does not focus on monitoring others' adherence to rules and structures. A focus on others being unfriendly is suggestive of paranoia or possibly dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which may cause a desire to have others make decisions.

The nurse is assessing for negative symptoms of schizophrenia in a newly admitted client. The nurse would note which behavior as indicative of a negative symptom? a. Difficulty staying on subject when responding to assessment questions b. Belief of owning a transportation device allowing for travel to the center of the Earth c. Hesitant to answer the nurse's questions during the assessment interview d. Mimicking the postural changes made by the nurse during the assessment interview

c. Hesitant to answer the nurse's questions during the assessment interview A negative symptom of schizophrenia is alogia, or the tendency to speak very little or to convey little substance of meaning (poverty of content). Associative looseness (fragmented or poorly related thoughts and ideas), delusions (fixed false beliefs that have no basis in reality), and echopraxia (imitation of the movements and gestures of another person whom the client is observing) are all positive symptoms.

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

c. Histrionic personality disorder

A nurse is providing culturally competent care. In order to do so adequately, the nurse must do what? a. Maintain good eye contact at all times during the interview b. Engage other family members to get a broader perspective c. Inquire about client values, beliefs, and health practices d. Open all initial visits with a firm kind hand shake

c. Inquire about client values, beliefs, and health practices To provide culturally competent care, the nurse must find out as much as possible about a client's cultural values, beliefs, and health practices. Often, the client is the best source for that information, so the nurse must ask the client what is important to him or her. Due to violation of patient rights, the family is not involved unless deemed necessary and/or with permission of the client. Firm hand shakes and eye contact are taboo in some cultures.

Psychosocial theorists propose that somatic symptom illnesses are an indirect expression of stress and anxiety through physical symptoms. Which is the primary defense mechanism used in somatoform disorders? a. Identification b. Somatization c. Internalization d. Repression

c. Internalization

A client with bipolar disorder takes lithium 300 mg 3 times daily. The nurse is educating the client on its use, side effects, and need for compliance. The nurse evaluates that the dose is appropriate when the client reports what? a. Increased feelings of self-worth b. Feeling sleepy and less energetic. c. Minimal mood swings d. Weight gain of 7 pounds in the last 6 months

c. Minimal mood swings Mood-stabilizing drugs are used to treat bipolar disorder by stabilizing the client's mood, preventing or minimizing the highs and lows that characterize bipolar illness, and treating acute episodes of mania. Weight gain is a common side effect, and fatigue and lethargy may indicate mild toxicity. Inflated self-worth is a target symptom of bipolar disorder, which should diminish with effective treatment.

All are included in the plan of care for a client with schizophrenia. Which nursing intervention should the nurse perform first when caring for this client? a. Encourage client to participate in the treatment milieu b. Maintain reality through frequent contact. c. Observe for signs of fear or agitation d. Assess community support systems.

c. Observe for signs of fear or agitation Safety for both the client and the nurse is the priority when providing care for the client with schizophrenia. The nurse must observe for signs of building agitation or escalating behavior such as increased intensity of pacing, loud talking or yelling, and hitting or kicking objects. The nurse must then institute interventions to protect the client, nurse, and others in the environment.

The nurse is assessing the client who has been diagnosed with a tic disorder. Which term describes the repeating of one's own words or sounds? a. Echolalia b. Coprolalia c. Palilalia d. None of the above

c. Palilalia. Palilalia is the repeating of one's own words or sounds. Coprolalia is the use of socially unacceptable words, which are frequently obscene. Echolalia is the repeating of the last heard sound, word, or phrase.

The nurse is assessing the client who states the client is a spiritual healer. Which term describes the extent to which a person considers the self to be an integral part of the universe? a. Character b. Self-directedness c. Self-transcendence d. Cooperativeness

c. Self-transcendence Self-transcendence describes the extent to which a person considers himself or herself to be an integral part of the universe. Cooperativeness refers to the extent to which a person sees himself or herself as an integral part of human society. Self-directedness is the extent to which a person is responsible, reliable, resourceful, goal oriented, and self-confident. Character consists of concepts about the self and the external world.

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior? a. Clearing the area of all other clients b. Insisting the client take a "time-out" in the client's room c. Setting limits on aggressive and intimidating behavior d. Administering a sedative that has been prescribed to be used PRN

c. Setting limits on aggressive and intimidating behavior Because of the safety risks that clients in the manic phase take, safety plays a primary role in care, followed by issues related to self-esteem and socialization. It is necessary to set limits when clients cannot set limits on themselves. Giving the client the opportunity to exercise self-control is most therapeutic. If the client cannot control his or her behavior, then more restrictive measures can be taken, such as room restriction or sedation. Clearing the area is not necessary during limit setting and may cause excessive panic on the part of other clients. When setting limits, it is important to clearly identify the unacceptable behavior and the expected, appropriate behavior. All staff must consistently set and enforce limits for those limits to be effective.

A parent is concerned that the parent's child might suffer from attention deficit hyperactivity disorder (ADHD). The parent brings the child in to be evaluated. Which behavior reported by the parent would be consistent with this diagnosis? a. The child has been hoarding objects. b. The child is excelling academically in school. c. The child interrupts others. d. The child has lots of friends.

c. The child interrupts others. By the time the child starts school, symptoms of ADHD begin to interfere significantly with behavior and performance. He or she cannot listen to directions or complete tasks. The child interrupts and blurts out answers before questions are completed. Academic performance suffers because the child makes hurried, careless mistakes in schoolwork, often loses or forgets homework assignments, and fails to follow directions. Socially, peers may ostracize or even ridicule the child for his or her behavior. The child often loses necessary things, rather than hoarding items.

A week after beginning therapy with thiothixene, a client demonstrates muscle rigidity, a temperature of 103°F, an elevated serum creatinine phosphokinase level, stupor, and incontinence. The nurse knows that these symptoms indicate which condition? a. extrapyramidal side effects b. acute dystonic reaction c. neuroleptic malignant syndrome d. tardive dyskinesia

c. neuroleptic malignant syndrome Response Feedback: The client demonstrates all the classic signs of neuroleptic malignant syndrome. Dystonia involves acute muscular rigidity and cramping, a stiff or thick tongue with difficulty swallowing, and, in severe cases, laryngospasm and respiratory difficulties. Extrapyramidal side effects are reversible movement disorders induced by antipsychotic or neuroleptic medication. Tardive dyskinesia is a late-onset, irreversible neurologic side effect of antipsychotic medications characterized by abnormal, involuntary movements, such as blinking, chewing, and grimacing.

A patient who was admitted yesterday with an adjustment disorder and depressed mood has not left his or her room. The nurse's most appropriate approach at meal time today is to respond: a. "You will feel better if you go to the dining room and eat with the others." b. "I will bring your tray to your room, if it will make you more comfortable." c. "Where would you like to eat your meal this afternoon?" d. "I will walk with you to the dining room and sit with you while you eat."

d. "I will walk with you to the dining room and sit with you while you eat."

The adult child of a client with dementia asks the nurse if the client will ever be able to live independently again. Which would be the most appropriate response by the nurse? a. "With early treatment, mild dementia can be reversed. It may be possible." b. "You sound like you aren't ready for the client to be dependent on caregivers." c. "The client's confusion is a temporary complication of the physical illness and should subside when the illness gets better." d. "Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again."

d. "Symptoms of dementia gradually get worse. Unfortunately, the client will not be independent again."

The nurse is assisting a child with attention deficit hyperactivity disorder (ADHD) to complete the child's activities of daily living. Which is the best approach for nurse to use with this child? a. Set a time limit to complete all tasks. b. Offer rewards when all tasks are completed. c. Let the child complete tasks at the child's own pace. d. Break tasks into small steps.

d. Break tasks into small steps. Before beginning any task, adults must gain the child's full attention. The adult should tell the child what needs to be done and break the task into smaller steps if necessary. This approach prevents overwhelming the child and provides the opportunity for feedback about each set of problems he or she completes. Self-pacing would give the child freedom but make it unlikely that the child will complete the task independently; these children benefit from redirection and smaller, achievable tasks. Similarly, offering a reward will not provide the child with the continued focus necessary to complete a large task independently. Setting a time limit would be likely to frustrate the child by increasing pressure and further decreasing focus.

A nurse is modifying the diet of a client who has a depressive disorder and is prescribed selegiline, an MAOI. Which of the following foods should the nurse eliminate? a. Chicken b. Fresh fish c. Cherries d. Cheddar cheese

d. Cheddar cheese

During the change of shift report in the intensive care unit, the nurse learns that a client has developed signs of delirium over the past 8 hours. Which behavior documented in the nursing notes would be consistent with delirium? a. Unable to transfer to sitting b. Difficulty with verbal expression c. Unable to identify a water pitcher d. Disoriented to person

d. Disoriented to person

A nurse asks an assigned client diagnosed with a tic disorder, "How are you doing today?" The client responds with "doing today, doing today, doing today." Which speech pattern disturbance is this an example of? a. Reactive attachment disorder b. Selective mutism c. Stereotypic movement disorder d. Echolalia

d. Echolalia Echolalia is repeating the last heard sound, word, or phrase. Stereotypic movement disorders include waving, rocking, twirling objects, biting fingernails, handing the head, biting or hitting oneself, or picking at the skin or body orifices. Selective mutism is characterized by persistent failure to speak in social situations where speaking is expected. Reactive attachment disorder is characterized by inhibited, emotionally withdrawn behavior.

Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? a. Wondering why others are being friendly to the client b. Insisting that others follow the rules of the unit c. Getting others to make decisions for the client d. Having a tantrum if not getting enough attention

d. Having a tantrum if not getting enough attention Response Feedback: Histrionic personality disorder is characterized by a pervasive pattern of excessive emotionality and attention seeking. These characteristics may prompt the client to act out if the client is not getting his or her own way. This disorder does not focus on monitoring others' adherence to rules and structures. A focus on others being unfriendly is suggestive of paranoia or possibly dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of, which may cause a desire to have others make decisions.

During an initial interview at a clinic, a young client states that there is nothing wrong with the client. Which would indicate to the nurse that this client might have anorexia nervosa? a. Episodes of overeating and excessive weight gain b. Expressions of a positive self-concept c. Flexible thought patterns and spontaneity d. Severe weight loss due to self-imposed dieting

d. Severe weight loss due to self-imposed dieting Clients with anorexia starve themselves and lose a large proportion of body weight, yet call it dieting. In anorexia nervosa, clients do not have excessive weight gain or overeat. Clients have a negative self-concept. Clients with anorexia nervosa exhibit inflexible thinking and limited spontaneity.

Which neurochemical influences is a probable cause of substance abuse? a. Inhibition of gamma-Aminobutyric acid (GABA) in the brain b. Imbalances of serotonin and norepinephrine in the brain c. Excessive serotonin activity in the central nervous system d. Stimulation of dopamine pathways in the brain

d. Stimulation of dopamine pathways in the brain The ingestion of mood-altering substances stimulates dopamine pathways in the limbic system, which produces pleasant feelings or a "high" that is a reinforcing, or positive, experience. Euphoria and subsequent substance abuse are not attributed to alterations in the function of GABA, serotonin and norepinephrine.

A concerned family member tells the nurse, "I am concerned about my sibling. My sibling has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the sibling has bipolar disorder? a. Intense focus b. Sleeping more c. Showing low self-esteem d. Taking unnecessary risks

d. Taking unnecessary risks The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

A concerned family member tells the nurse, "I am concerned about my sibling. My sibling has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the sibling has bipolar disorder? a. Showing low self-esteem b. Intense focus c. Sleeping more d. Taking unnecessary risks

d. Taking unnecessary risks The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that the client must have a brain tumor. Which mental health diagnosis is most probable for this client? a. Pain disorder b. Brain cancer c. Conversion d. illness anxiety disorder

d. illness anxiety disorder