Mental Health Nursing Exam 1 questions

Action of stress on the stomach

irritation causes ulcers

Action of stress on skin

vasoconstriction causes pallor

In a group therapy setting, one member is very demanding, repeatedly interrupting others and taking most of the group time. The nurse's best response would be: 1. "Will you briefly summarize your point because others need time also?" 2. "Your behavior is obnoxious and drains the group." 3. "I'm so frustrated with your behavior." 4. to ignore the behavior and allow him to vent.

1. "Will you briefly summarize your point because others need time also?" Option 1 redirects the client to focus his comments and allows him to make his point. Option 2 is judgmental, and option 3 doesn't facilitate communication. Option 4 focuses more on the nurse than on the client's need.

A client is presented with the treatment option of electroconvulsive therapy (ECT). After discussing the treatment with the staff, the client requests that a family member come in to help him decide whether or not to undergo this treatment. Which document must the client sign before undergoing ECT? 1. Informed consent 2. Durable power of attorney 3. Voluntary commitment form 4. Outpatient commitment form

1. Informed consent The client must sign the informed consent prior to ECT. The client doesn't need to appoint a durable power of attorney before treatment. Commitment isn't necessary to undergo ECT.

The American Nurses Association guidelines state that to serve as a group therapist a nurse must have what educational background? 1. Master's degree in psychiatric nursing 2. Doctorate degree in psychiatric nursing 3. Associate degree in general nursing 4. Baccalaureate degree in general nursing

1. Master's degree in psychiatric nursing A master's degree in psychiatric nursing is the standard. A doctorate degree isn't required. A nurse with a baccalaureate or associate degree may facilitate educational groups but may not serve as a group therapist.

Emergency restraints or seclusion may be implemented without a physician's order under which of the following conditions? 1. When a written order will be obtained from the primary physician within 8 hours 2. Never 3. If a voluntary client wants to leave against medical advice 4. When a minor child is out of control

1. When a written order will be obtained from the primary physician within 8 hours The primary physician in charge of a client's care must write an order for the restraint within 8 hours. In an emergency, a client who is a threat to himself or others may be restrained without an order. Voluntary clients have the right to leave against medical advice. A minor is treated the same as an adult regarding restraints.

A client with antisocial personality disorder smokes where it's prohibited and refuses to follow other unit and facility rules. The client gets others to do the laundry and other personal chores, splits the staff, and will work only with certain nurses. The care plan for this client should focus primarily on: 1. consistently enforcing unit rules and facility policy. 2. isolating the client to decrease contact with easily manipulated clients. 3. engaging in power struggles with the client to minimize manipulative behavior. 4. using behavior modification to decrease negative behavior by using negative reinforcement.

1. consistently enforcing unit rules and facility policy. Firmness and consistency regarding rules are the hallmarks of a care plan for a client with a personality disorder. Isolation is inappropriate and violates the client's rights. Power struggles should be avoided because the client may try to manipulate people through them. Behavior modification usually fails because of staff inconsistency and client manipulation.

Which statement accurately describes therapeutic communication? 1. Offering advice and your opinion 2. Not verbalizing your feelings 3. Avoiding advice, judgment, false reassurance, and approval 4. Telling the client how to cope

3. Avoiding advice, judgment, false reassurance, and approval The goal of therapeutic communication is to help the client develop insight and skills to solve his own problems. This is done by avoiding advice, judgment, false reassurance, and approval. Pointing out mistakes can make a client defensive. The client-nurse relationship isn't the place for the nurse to offer advice or an opinion. It also isn't the place for the nurse to verbalize her own feelings. The client needs assistance in developing coping skills, not someone to solve problems for him.

A client asks the nurse, "Do you think I should leave my husband?" The nurse responds, "You aren't sure if you should leave your husband?" The nurse is using which therapeutic technique? 1. Restating 2. Reframing 3. Reflecting 4. Offering a general lead

3. Reflecting Reflecting is correct because the nurse is referring feelings back to the client to explore. When restating, the nurse simply restates what the client said. Reframing is offering a new way to look at a situation. The nurse's response is specific; it isn't offering a general lead.

A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which action? 1. Administering the medication by injection 2. Omitting the dose and trying again the next day 3. Crushing the medication and putting it in his food 4. Consulting with the physician about a care plan.

4. Consulting with the physician about a care plan. To determine a care plan for clients who are noncompliant with medications, the nurse should consult with the physician. Unless the client presents a danger to himself or others, medications can't be forced on a client. Crushing the medication and putting it in food might make the client suspicious. The nurse shouldn't omit the dose and try again the next day. The nurse should instead make another attempt to administer the drug to avoid decreased drug levels.

The nurse documents, "The client described her husband's abuse in an emotionless tone and with a flat facial expression." This statement describes the client's: 1. feelings. 2. blocking. 3. mood. 4. affect.

4. affect. Affect refers to a person's emotional expression (in this case, the manner in which the client talks about her experiences). Feelings are emotional states or perceptions. Blocking is the interruption of thoughts. Moods are prolonged emotional states expressed by the affect.

Which of the following tasks may be delegated to a nursing assistant in an acute mental health setting? 1. Assessing mental status on admission 2. Checking for sharp objects 3. Administering medication 4. Discussing the treatment plan

2. Checking for sharp objects A nursing assistant may be assigned to search a client's luggage or room for potentially harmful objects, such as glass or sharp metal. A mental status assessment should be conducted by the nurse on admission. Administering medication can't be delegated to an unlicensed person. A nurse or physician must discuss the treatment plan with the client.

A client is admitted to the unit visibly anxious. When assessing the client, the nurse would expect to see which cardiovascular effect produced by the sympathetic nervous system? 1. Syncope 2. Decreased blood pressure 3. Increased heart rate 4. Decreased pulse rate

3. Increased heart rate Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction. Syncope is a response to parasympathetic stimulation.

Silence in therapeutic communication is: 1. a means of disapproval. 2. to be avoided as it indicates intolerance and anger. 3. a means of communicating patience and allowing the client space in which to respond. 4. not therapeutic.

3. a means of communicating patience and allowing the client space in which to respond. Silence conveys acceptance and gives the client an opportunity to reflect. It doesn't convey disapproval unless accompanied by hostile gestures. It's one of the most difficult therapeutic communication techniques.

A client in group therapy is restless. His face is flushed and he makes sarcastic remarks to group members. The nurse responds by saying, "You look angry." The nurse is using which technique? 1. A broad, opening statement 2. Reassurance 3. Clarifying 4. Making observations

4. Making observations The nurse is using observation to give the client feedback about his behavior and attitude. A broad statement doesn't give feedback to the client. The nurse didn't ask the client to explain his actions (clarifying) and didn't reassure the client.

Action of stress on the mouth

decreased saliva causes dry mouth

A teenager was driving a car that slipped off an icy road, killing two of his friends. He repeatedly tells the nurse that he should be dead instead of his friends. The client's behavior is an example of: 1. survivor's guilt. 2. denial. 3. anticipatory grief. 4. repression.

1. survivor's guilt. Individuals who survive a traumatic experience in which others have died commonly report powerful feelings of guilt that they survived and others didn't. This guilt is referred to as survivor's guilt. In denial, a person refuses to accept that a situation or feeling exists. Anticipatory grief occurs when an individual experiences grief before a loss occurs. In repression, an individual involuntarily blocks an unpleasant experience, memory, or feeling from consciousness.

A nurse places a client in full leather restraints. How often must the nurse check the client's circulation? 1. Once per hour 2. Once per shift 3. Every 10 to 15 minutes 4. Every 2 hours

3. Every 10 to 15 minutes Circulatory as well as skin and nerve damage can occur within 15 minutes. Checking every hour, 2 hours, or 8 hours isn't often enough and could result in permanent damage to the client's extremities. Restraints should be removed every 2 hours, and range-of-motion exercises should be performed.

An extremely agitated client is brought to the psychiatric unit by her husband. He reports that she has been hospitalized several times for treatment of bipolar disorder and has spent thousands of dollars in the past week. The psychiatrist admits her to the unit for exacerbation of the manic phase of bipolar disorder. Which approach by the nurse would best promote a therapeutic relationship with this client? 1. Confronting the client about her inappropriate behavior 2. Using reflection and open-ended questions to promote communication 3. Maintaining a firm but nonthreatening manner 4. Helping the client gain insight into her behavior

3. Maintaining a firm but nonthreatening manner The nurse must maintain a firm but nonthreatening approach to avoid provoking anger in this agitated client. Because the client can't control her behavior, confronting her would be pointless. Her agitated state makes successful communication virtually impossible; instead of using reflection and open-ended questions to try to develop a therapeutic relationship, the nurse should provide emotional support and maintain a calm environment. Also, reflective communication and open-ended questions may anger the client, who has been hospitalized before and is accustomed to "therapeutic talk." This client is too agitated to gain insight into her behavior.

A client diagnosed with depression tells the nurse that she won't allow herself to cry, "because it upsets the whole family when I cry." This is an example of: 1. manipulation. 2. insight. 3. rationalization. 4. repression.

3. rationalization. Rationalization is a defense mechanism used to justify actions or feelings with seemingly reasonable explanations. Insight is comprehension of one's own behavior, often followed by an attempt to change it. Repression is involuntary exclusion from awareness of painful and conflicting thoughts or feelings. Based on the information provided, the client doesn't seem to be manipulating those around her.

The nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include: 1. turning on the lights and opening the windows so that the client doesn't feel crowded. 2. leaving the client alone. 3. staying with the client and speaking in short sentences. 4. turning on stereo music.

3. staying with the client and speaking in short sentences. Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm, and medicating as needed. Leaving the client alone, turning on a stereo or lights, and opening windows may increase the client's anxiety.

A woman seeking help at a community mental health center complains of fatigue, sensitivity to criticism, decreased libido, and feeling self-conscious. She also has aches and pains. A nursing diagnosis for this client might include: 1. Delayed growth and development. 2. Ineffective role performance. 3. Posttrauma syndrome. 4. Situational low self-esteem.

4. Situational low self-esteem. All symptoms define a disturbance in self-esteem. There isn't enough information to determine delayed growth and development. The question doesn't describe the client's ability to perform in her roles. Posttrauma syndrome occurs after experiencing a traumatic event and doesn't coincide with the data in the scenario.

The nurse who uses self-disclosure should: 1. refocus on the client's experience as quickly as possible. 2. allow the client to ask questions about the nurse's experience. 3. discuss the nurse's experience in detail. 4. have the client explain his or her perception of what the nurse has revealed.

The nurse's self-disclosure should be brief and to the point so that the interaction can be refocused on the client's experience. Because the client is the focus of the nurse-client relationship, the discussion shouldn't dwell on the nurse's own experience.

The basis for building a strong, therapeutic nurse-client relationship begins with the nurse's: 1. sincere desire to help others. 2. acceptance of others. 3. self-awareness and understanding. 4. sound knowledge of psychiatric nursing.

3. self-awareness and understanding. Although all of the options are desirable, knowledge of self is the basis for building a strong, therapeutic nurse-client relationship. Being aware of and understanding personal feelings and behavior are prerequisites for understanding and helping clients.

Common adverse effects of electroconvulsive therapy (ECT) include: 1. cardiac arrhythmias. 2. seizure. 3. short-term memory loss. 4. brain damage.

3. short-term memory loss. Short-term memory loss is the most common adverse effect of ECT. In most cases, memory returns within 3 months. There is no effect on the heart. A seizure isn't an adverse effect; rather, it's intentionally induced. Brain damage from ECT hasn't been substantiated.

Action of stress on nerves

increased excitability cause tremors

Action of stress on the liver

increased glucose causes diabetes

A client with bipolar disorder is being treated with lithium for the first time. The nurse should observe the client for which common adverse effect of lithium? 1. Sexual dysfunction 2. Constipation 3. Polyuria 4. Seizures

3. Polyuria Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit. Sexual dysfunction isn't a common adverse effect of lithium; it's more common with sedatives and tricyclic antidepressants. Diarrhea, not constipation, occurs with lithium. Constipation can occur with other psychiatric drugs, such as antipsychotic drugs. Seizures may be a later sign of lithium toxicity.

The physician orders a tricyclic antidepressant for a client who has suffered an acute myocardial infarction (MI) within the past 6 months. The nurse should take which action? 1. Administer the medication as ordered. 2. Discontinue the medication. 3. Question the order with the physician. 4. Inform the client that he should discuss the MI with the physician.

3. Question the order with the physician. Cardiovascular toxicity is a problem with tricyclic antidepressants, and the nurse should question their use in a client with cardiac disease. Administering the medication would be an act of negligence. A nurse can't discontinue a medication without a physician's order. It's the nurse's responsibility, not the client's, to discuss questions of care with the physician.

A woman becomes increasingly afraid of riding in elevators. One morning, she experiences shortness of breath, palpitations, dizziness, and trembling while in an elevator. A physician can find no physiological basis for these symptoms and refers her to a psychiatric clinical nurse-specialist for outpatient counseling sessions. Which of the following is most likely to reduce the client's anxiety level? 1. Psychoanalytically oriented psychotherapy 2. Group psychotherapy 3. Systematic desensitization 4. Referral for evaluation for electroconvulsive therapy

3. Systematic desensitization Phobias commonly are viewed as learned responses to anxiety that can be unlearned through certain techniques such as behavior modification. Systematic desensitization, a form of behavior modification, attempts to reduce anxiety and thereby eradicate the phobia through gradual exposure to anxiety-producing stimuli. Psychoanalytically oriented therapy also may be effective in this situation but requires years of treatment. Group psychotherapy could be used as an adjunct treatment to increase the client's self-esteem and reduce generalized anxiety. Electroconvulsive therapy (ECT) is reserved primarily for clients with severe depression or psychosis who respond poorly to other treatments; it's rarely indicated for phobic disorders.

What is the nurse's most important role in caring for a client with a mental health disorder? 1. To offer advice 2. To know how to solve the client's problems 3. To establish trust and rapport 4. To set limits with the client

3. To establish trust and rapport It's extremely important that the nurse establish trust and rapport. The nurse shouldn't offer advice. Instead, she should help the client develop the coping mechanisms necessary to solve his own problems. Setting limits is also important but not as important as developing trust and rapport.

Unhealthy personal boundaries are a product of dysfunctional families and a lack of positive role models. Unhealthy boundaries may also be a result of: 1. structured limit setting. 2. supportive environment. 3. abuse and neglect. 4. direction and attention.

3. abuse and neglect. Abuse and neglect lead to poor self-concept and role confusion, the basis for unhealthy personal boundaries. Healthy boundaries are established in childhood when parents provide consistent, supportive limits and attention.

Nursing care for a client after electroconvulsive therapy (ECT) should include: 1. nothing by mouth for 24 hours after the treatment because of the anesthetic agent. 2. bed rest for the first 8 hours after a treatment. 3. assessment of short-term memory loss. 4. no special care.

3. assessment of short-term memory loss. The nurse must assess the level of short-term memory loss. The client might need to be reoriented. The client can get out of bed and eat as soon as he feels comfortable.

Which drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)? 1. benztropine (Cogentin) and diphenhydramine (Benadryl) 2. chlordiazepoxide (Librium) and diazepam (Valium) 3. fluvoxamine (Luvox) and clomipramine (Anafranil) 4. divalproex (Depakote) and lithium (Lithobid)

3. fluvoxamine (Luvox) and clomipramine (Anafranil) The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD. Librium and Valium may be helpful in treating anxiety related to OCD but aren't drugs of choice to treat the illness. The other medications mentioned aren't effective in the treatment of OCD.

A client suffers from depression after the accidental death of her daughter. After a suicide attempt, the client is admitted to the psychiatric unit. During the admission interview, the client tells the nurse that she no longer wants to die. The nurse should: 1. suggest that the client no longer requires close observation. 2. place the client in a private room, away from the nurses' station, so that she has privacy to work through the stages of the grieving process. 3. inspect the client's personal belongings for potentially dangerous objects. 4. avoid any further discussion of suicide unless the client brings up the topic.

3. inspect the client's personal belongings for potentially dangerous objects. The client must be protected from harming herself. This includes checking all personal items that the client brought to the hospital, such as a suitcase or pocketbook. The client must be closely observed until she has been evaluated and receives treatment. A client who's suicidal should be placed in a room near the nurses' station in full view of a nurse or other observer. The nurse shouldn't ignore the client's suicide attempt. The client may feel relief talking about the suicide attempt and knowing that she'll be protected from harm.

The nurse interviews the family of a client hospitalized with severe depression and suicidal ideation. What family assessment information is essential in formulating an effective care plan? 1. Physical pain 2. Personal responsibilities 3. Employment skills 4. Communication patterns 5. Role expectations 6. Current family stressors

4. Communication patterns 5. Role expectations 6. Current family stressors When working with the family of a depressed client, it's helpful for the nurse to be aware of the family's communication style, the role expectations for its members, and current family stressors. This information can help to identify family difficulties and teaching points that could benefit the client and the family. Information concerning physical pain, personal responsibilities, and employment skills wouldn't be helpful because these areas aren't directly related to their experience of having a depressed family member.

Which of the following indications is the primary use for electroconvulsive therapy (ECT)? 1. Severe agitation 2. Antisocial behavior 3. Noncompliance with treatment 4. Major depression with psychotic features

4. Major depression with psychotic features ECT is indicated for depression. ECT isn't indicated for severe agitation, antisocial behavior, or treatment noncompliance.

Assertive behavior involves which of the following elements? 1. Saying what is on your mind at the expense of others 2. Expressing an air of superiority 3. Avoiding unpleasant situations and circumstances 4. Standing up for your rights while respecting the rights of others

4. Standing up for your rights while respecting the rights of others The basic element of assertive behavior includes the ability to express your feelings and thoughts while respecting the rights of others. Options 1 and 2 describe aggressive behavior, and option 3 describes passive behavior.

When performing a physical examination on an anxious client, the nurse would expect to find which effect produced by the parasympathetic nervous system? 1. Hyperactive bowel sounds 2. Decreased urine output 3. Constipation 4. Muscle tension

1. Hyperactive bowel sounds The parasympathetic nervous system would produce increased GI motility, resulting in hyperactive bowel sounds, possibly leading to diarrhea. All of the other options would result from sympathetic nervous system stimulation.

A client, age 20, is being treated for depression. During a conversation with the nurse, she states that her father raped her when she was 7 years old. She says she has nightmares about the experience and sometimes relives it. She also reveals that she fears older men. The nurse suspects that the client has: 1. posttraumatic stress disorder (PTSD), delayed onset. 2. multiple personality disorder. 3. anxiety disorder. 4. schizophrenia.

1. posttraumatic stress disorder (PTSD), delayed onset. The client's memory of a traumatic childhood incident and her current signs and symptoms (nightmares, flashbacks, and related fears) suggest that she has PTSD with delayed onset. The client doesn't occasionally lose track of her movements and actions, as in multiple personality disorder. Her anxiety isn't primary but results from severe emotional trauma. Although she experiences flashbacks, these aren't psychotic episodes, as in schizophrenia.

The nurse's goal in crisis intervention is to provide: 1. problem-solving techniques and structured activities. 2. an insight-oriented analytic approach. 3. medication to sedate the client. 4. nondirective techniques such as free association.

1. problem-solving techniques and structured activities. Individuals in a crisis need immediate assistance. They are unable to solve problems and need structure and assistance in accessing resources. Clients in a crisis don't need lengthy explanations or have time to develop insight on their own. They might need medication but, in most cases, support and direction can be most helpful.

A client comes to the emergency department while experiencing a panic attack. The nurse can best respond to a client having a panic attack by: 1. staying with the client until the attack subsides. 2. telling the client everything is under control. 3. telling the client to lie down and rest. 4. talking continually to the client by explaining what is happening.

1. staying with the client until the attack subsides. The nurse should remain with the client until the attack subsides. If the client is left alone he may become more anxious. Giving false reassurance is inappropriate in this situation. The client should be allowed to move around and pace to help expend energy. The client may be so overwhelmed that he can't follow lengthy explanations or instructions, so the nurse should use short phrases and slowly give one direction at a time.

The nurse at a substance abuse center answers the phone. A probation officer asks if a client is in treatment. The nurse responds, "No, the client you're looking for isn't here." Which statement best describes the nurse's response? 1. Correct, because she didn't give out information about the client 2. A violation of confidentiality because she informed the officer that the client wasn't there 3. A breech of the principle of veracity because the nurse is misleading the officer 4. Illegal, because she's withholding information from law enforcement agents

2. A violation of confidentiality because she informed the officer that the client wasn't there The nurse violated confidentiality by informing the officer that the client wasn't in treatment. Even with law enforcement agents, the nurse must be a client advocate and protect the client's confidentiality. Information can be legally withheld when a court order isn't in place.

After learning that a roommate is HIV-positive, a client asks the nurse about moving to another room on the psychiatric unit because the client doesn't feel "safe" now. What should the nurse do first? 1. Move the client to another room. 2. Ask the client to describe any fears. 3. Move the client's roommate to a private room. 4. Explain that such a move wouldn't be therapeutic for the client or roommate.

2. Ask the client to describe any fears. To intervene effectively, the nurse must first understand the client's fears. After exploring the client's fears, the nurse may move the client or roommate or explain why such a move wouldn't be therapeutic, as needed.

An adolescent who is depressed and whose parents report as having difficulty in school is brought to the community mental health center to be evaluated. Which additional problem would the nurse expect the client to have? 1. Anxiety disorder 2. Behavioral difficulties 3. Cognitive impairment 4. Labile moods

2. Behavioral difficulties Adolescents with depression tend to demonstrate severe irritability and behavioral problems. Anxiety disorder is more commonly associated with small children. Cognitive impairment is typically associated with delirium and dementia. Labile mood is more characteristic of a client with bipolar disorder.

What is a generally accepted criterion of mental health? 1. Absence of anxiety 2. Self-acceptance 3. Ability to control others 4. Happiness

2. Self-acceptance Self-acceptance is a generally accepted criterion of mental health and serves as the basis for healthy relationships with others. Some degree of anxiety is necessary to stimulate growth and adaptation. Self-control and self-direction — not the ability to control others — indicate mental health. Happiness, though desirable, isn't an effective indicator of mental health because even mentally healthy people may be unhappy when faced with such events as illness, loss, and death.

The nurse is administering atropine sulfate to a client about to undergo electroconvulsive therapy (ECT). Which assessment indicates that the medication is effective? 1. The client's heart rate is 48 beats/minute. 2. The client states that his mouth is dry. 3. The client appears calm and relaxed. 4. The client falls asleep.

2. The client states that his mouth is dry. Atropine sulfate is administered approximately 30 minutes before ECT to reduce oral secretions; therefore, the client's mouth would feel dry. Atropine also blocks the vagal stimulation of the heart, causing a rise in heart rate (much higher than 48 beats/minute). Atropine sulfate isn't given to make the client feel calm and relaxed, nor does it induce sleep.

A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include: 1. insomnia and an inability to concentrate. 2. severe anxiety and fear. 3. depression and weight loss. 4. withdrawal and failure to distinguish reality from fantasy.

2. severe anxiety and fear. Phobias cause severe anxiety (such as a panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia, and elevated blood pressure. Insomnia, an inability to concentrate, and weight loss are common in depression. Withdrawal and failure to distinguish reality from fantasy occur in schizophrenia.

One day after being admitted with bipolar disorder, a client becomes verbally aggressive during a group therapy session. Which response by the nurse would be therapeutic? 1. "You're behaving in an unacceptable manner, and you need to control yourself." 2. "If you continue to talk like that, no one will want to be around you." 3. "You're disturbing the other clients. I'll walk with you around the patio to help you release some of your energy." 4. "You're scaring everyone in the group. Leave the room immediately."

3. "You're disturbing the other clients. I'll walk with you around the patio to help you release some of your energy." This response shows that the nurse finds the client's behavior unacceptable, yet still regards the client as worthy of help. The other options give the false impression that the client is in control of the behavior; the client hasn't been in treatment long enough to control the behavior.

For which adverse reaction should the nurse monitor a client during the initial phase of lithium carbonate (Lithonate) therapy? 1. Anemia 2. Dehydration 3. Nausea and vomiting 4. Decreased cerebral perfusion

3. Nausea and vomiting During the initial phase of lithium therapy, the nurse should monitor the client for GI symptoms such as nausea and vomiting, which occur most frequently in the initial stages of therapy and after dosage adjustments. GI symptoms are associated with increasing blood levels of lithium. Lithium therapy may cause leukocytosis, not anemia. The drug isn't associated with dehydration or decreased cerebral perfusion. Although lithium toxicity may cause confusion, it isn't due to decreased cerebral perfusion.

S&S of Stress

Increased heart rate Increased respiration Increased O2 to muscles Pupils dilate Decreased digestion Increased perspiration Feelings of doom

Types of Stressors

Pathophysiologic: Chemical Physical Infectious Genetic Psychosocial: Situational Maturational

Action of stress on muscles

contraction causes headache

Action of stress on the lungs

increased dilation causes tachypnea

The goal of crisis intervention is: 1. to solve the client's problems for him. 2. psychological resolution of the immediate crisis. 3. to establish a means for long-term therapy. 4. to provide a means for admission to an acute care facility.

2. psychological resolution of the immediate crisis. The goal of crisis intervention is the resolution of an immediate problem. The client must learn to solve his own issues. Although some clients do enter long-term therapy or are admitted to an acute care facility, long-term therapy isn't the goal of crisis intervention.

Which clinical condition meets the criteria for involuntary commitment? 1. A single parent who leaves her minor children unattended and stays out all night drinking 2. A person who lives alone and isn't able to care for himself and has schizophrenia with delusions of persecution 3. A man who threatens to kill his wife 4. A person with depression who says he's tired of living but doesn't have a suicide plan

3. A man who threatens to kill his wife One of the criteria for involuntary commitment is an emergency in which the client is a threat to himself or others. A parent might have a child removed from the home because of neglect, but that doesn't meet the criteria for involuntary commitment. Many individuals with schizophrenia can learn to live with hallucinations and delusions and don't require hospitalization. To meet criteria for involuntary commitment, a depressed individual must have a suicide plan and be a direct threat to himself.

Erikson described the psychosocial tasks of the developing person in his theoretical model. He proposed that the primary developmental task of the young adult (ages 18 to 25) is: 1. intimacy versus isolation. 2. industry versus inferiority. 3. generativity versus stagnation. 4. trust versus mistrust.

1. intimacy versus isolation. The primary developmental task of the young adult is to develop intimacy with another person while making choices about relationships and career. Industry, a task associated with children ages 6 to 12, involves active socialization as the child moves from the family into society; much of the child's energy is focused on acquiring competency. Generativity is associated with middle age and is characterized by parental responsibility and concern for future generations. Developing trust is the task of the infant; it's accomplished when the infant receives adequate mothering and satisfaction of oral needs.

On admission to the mental health unit, a client tells the nurse she's afraid to leave the house for fear of criticism. She informs the nurse, "My nose is so big. I know everyone is looking at me and making fun of me. I had plastic surgery and it still looks awful!" These symptoms are an indication of which disorder? 1. Paranoid personality disorder 2. Body dysmorphic disorder 3. Paranoid schizophrenia 4. Antisocial disorder

2. Body dysmorphic disorder This disorder is characterized by a belief that the body is deformed or defective in a specific way. Although elements of paranoia are evident, the focus on a defective body part is the clue. There is some evidence of a thought disorder; however, paranoid schizophrenia isn't likely. Antisocial personality is characterized by manipulative behavior.

A female client is admitted to the emergency department after being sexually assaulted. The nurse notes that the client is sitting calmly and quietly in the examination room and recognizes this behavior as a protective defense mechanism. What defense mechanism is the client exhibiting? 1. Intellectualization 2. Denial 3. Regression 4. Displacement

2. Denial Denial is a protective and adaptive reaction to increased anxiety. It involves consciously disowning intolerable thoughts and impulses. This response is often seen in victims of sexual abuse. In intellectualization, the client attempts to avoid expressing emotions associated with the stressful situation by using logic, analysis, and reasoning. When the client uses regression, he reverts to an earlier developmental level in response to stress. With displacement, the client transfers his feelings for one person toward another person who is less threatening.

Touching other people without their permission, reading someone else's mail, and using personal possessions without asking permission are all examples of: 1. antisocial behavior. 2. manipulation. 3. poor boundaries. 4. passive-aggressive behavior.

3. poor boundaries. The described behaviors indicate poor personal boundaries, which is the inability to differentiate between self and others. Poor boundaries are symptoms of antisocial and passive-aggressive behavior. Manipulation is an attempt to control another person.

In group therapy, a client angrily speaks up and responds to a peer, "You're always whining and I'm getting tired of listening to you! Here is the world's smallest violin playing for you." Which role is the client playing? 1. Blocker 2. Monopolizer 3. Recognition seeker 4. Aggressor

4. Aggressor The aggressor is negative and hostile and uses sarcasm to degrade others. The role of the blocker is to resist group efforts. The monopolizer controls the group by dominating conversations. The recognition seeker talks about accomplishments to gain attention.

A client reports losing his job, not being able to sleep at night, and feeling upset with his wife. The nurse responds to the client, "You may want to talk about your employment situation in group today." The nurse is using which therapeutic technique? 1. Restating 2. Making observations 3. Exploring 4. Focusing

4. Focusing The nurse is using focusing by suggesting that the client discuss a specific issue. She didn't restate the question (restating) or ask further questions (exploring), and didn't make an observation.

The terms "judgment" and "insight" are sometimes used incorrectly. Insight is the ability to: 1. make appropriate choices. 2. control inappropriate impulses. 3. explain one's psychiatric diagnosis. 4. understand the nature of one's problem or situation.

4. understand the nature of one's problem or situation. Insight is the ability to understand a situation or problem and its effect on one's life. Judgment is the ability to make appropriate choices and behave in an appropriate manner. A client may be able to explain the psychiatric diagnosis but may lack the insight to understand the underlying problem and how it's affecting the client's life.

A recently engaged 22-year-old woman loses her fiancé in a drunken driving accident. She complains of difficulty eating, sleeping, and working. Her reaction is considered: 1. a pathologic response to grief. 2. a crisis caused by traumatic stress. 3. a noncrisis situation. 4. a crisis of anticipated life transitions.

2. a crisis caused by traumatic stress. The scenario presents an individual in crisis. A traumatic event can create symptoms, such as difficulty eating, sleeping, and working. Individuals in crisis can experience psychological pain that isn't classified as pathologic. The sudden accident isn't an anticipated event.

The third major health problem in the United States is which disorder? 1. Cancer 2. Heart disease 3. Alcoholism 4. Bipolar Illness

3. Alcoholism Alcoholism is the third major health problem in the United States. Between 9 and 10 million people are "problem" drinkers. In addition, alcoholism adversely affects the mental health of 30 million friends and relatives of alcoholics. Alcohol also adversely affects the liver, brain, and other organs. Heart disease and cancer are the number one and two health problems, respectively, in the United States. Bipolar illness isn't considered a major illness.

Sedative-hypnotic drugs are used to treat which of the following disorders? 1. Obsessive-compulsive disorder (OCD) 2. Attention-deficit hyperactivity disorder (ADHD) 3. Hallucinations and delusions 4. Anxiety and insomnia

4. Anxiety and insomnia Sedative-hypnotic drugs aren't linked to the treatment of a specific disorder. They're used to treat anxiety and insomnia, which can occur in a range of psychiatric disorders. Antidepressants are used to treat OCD. Psychostimulants are used to treat ADHD. Hallucinations and delusions are treated with antipsychotics.

The nurse must assess a client's judgment to determine mental status. To best accomplish this, the nurse should have the client: 1. interpret proverbs. 2. spell words backward. 3. count by serial sevens. 4. discuss hypothetical ethical situations.

4. discuss hypothetical ethical situations. The best way to assess a client's judgment is to discuss hypothetical ethical situations, such as "What would you do if you found a wallet that contained several credit cards and identification?" Interpreting proverbs tests thinking. Spelling words backward and counting by serial sevens test concentration.

Critical pathways of care refer to: 1. a care plan that provides outcome-based guidelines with a designated length of stay. 2. a care plan designed for physicians to prescribe medications. 3. a design of treatment that includes approved therapies. 4. a technique in therapy to care for the client holistically.

1. a care plan that provides outcome-based guidelines with a designated length of stay. Critical pathways are defined as a provision of care in a case management system. The pathways provide outcome-based guidelines for goal achievement within a designated length of stay. Critical pathways are to be used by the treatment team, not just by the physician. Pathways are designated lengths of stay, not therapies.

A client is brought to the facility in an agitated state and is admitted to the psychiatric unit for observation and treatment. While putting personal items away, the client talks rapidly and folds and unfolds garments several times. The client can't seem to settle down. Which nursing diagnosis is most applicable at this time? 1. Disturbed personal identity 2. Anxiety 3. Compromised family coping 4. Powerlessness

2. Anxiety Anxiety is the most applicable nursing diagnosis at this time because the client's behavior mimics some of the objective signs of anxiety, which include restlessness, irritability, rapid speech, inability to complete tasks, and verbal expressions of tension. The other options would be premature diagnoses because the nurse hasn't had an opportunity to complete a thorough nursing assessment.

A client changes topics quickly while relating past psychiatric history. This client's pattern of thinking is called: 1. looseness of association. 2. flight of ideas. 3. tangential thinking. 4. circumstantial thinking.

2. flight of ideas. Flight of ideas describes a thought pattern in which a client moves rapidly from one topic to the next with some connection. Looseness of association describes a pattern in which ideas lack an apparent logical connection to one another. Tangential thoughts seem to be related but miss the point. A client who talks around the subject and includes a lot of unnecessary information is exhibiting circumstantial thinking.

The charge nurse in an acute care setting assigns a client, who is on one-on-one suicide precautions, to a psychiatric aide. This assignment is considered: 1. poor nursing practice because a registered nurse should work with this client. 2. reasonable nursing practice because one-on-one requires the total attention of a staff member. 3. outside the responsibility of an aide. 4. illegal to delegate to an aide.

2. reasonable nursing practice because one-on-one requires the total attention of a staff member. A psychiatric aide may sit with the client and ensure safety. The nurse is still responsible for assessing the client and ensuring that one-on-one supervision occurs. Aides are capable of providing one-to-one observation. It isn't illegal to delegate observation to an aide.

A client in an acute care center lacerates her wrists. She has a history of conflicts and acting out. The client tells the nurse, "I did a good job, didn't I?" Which response would be best? 1. "You sure did. You're going to have a scar now." 2. "How many times have you done this before?" 3. "What were you feeling before you hurt yourself?" 4. "It seems to me you are trying to get attention in a negative way."

3. "What were you feeling before you hurt yourself?" Self-mutilation is the client's way of defending herself against feelings she isn't able to express. It's important to shift focus from the mutilation and to help the client express feelings in a more acceptable manner. All other answers are judgmental.

Which term refers to the primary unconscious defense mechanism that keeps intense, anxiety-producing situations out of a person's conscious awareness? 1. Introjection 2. Regression 3. Repression 4. Denial

3. Repression Repression, the unconscious exclusion from awareness of painful or conflicting thoughts, impulses, or memories, is the primary ego defense. Other defense mechanisms tend to reinforce anxiety. Introjection is an intense identification in which one incorporates another person's or group's values or qualities into one's own ego structure. Regression is a retreat to an earlier level of developmental behavioral during a time of stress. Denial is the avoidance of unpleasant realities by ignoring them.

The nurse is using drawing, puppetry, and other forms of play therapy while treating a terminally ill, schoolage child. The purpose of these techniques is to help the child: 1. internalize his feelings about death and dying. 2. accept responsibility for his situation. 3. express feelings that he can't articulate. 4. have a good time while he's in the hospital.

3. express feelings that he can't articulate. Children may not have the verbal and cognitive skills to express what they feel and may benefit from alternative modes of expression. It's important for the child to find a way to express internalized feelings. The child must also know that he is not to blame for this situation. In the process of participating in play therapy, the child can also have fun, but that isn't the main goal of therapy.

Cross-tolerance to a drug is defined as: 1. one drug that can prevent withdrawal symptoms from another drug. 2. an allergic reaction to a classification of drugs. 3. one drug that results in a lessened response to another drug. 4. one drug that can increase the potency of another drug.

3. one drug that results in a lessened response to another drug. Cross-tolerance occurs when a drug with a similar action causes a decreased response to another drug. A drug that can prevent withdrawal symptoms from another drug describes cross-dependence. Cross-tolerance isn't an allergic reaction to a classification of drugs. A drug that can increase the potency of another drug describes potentiating effects.

A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique? 1. Presenting reality 2. Making observations 3. Restating 4. Exploring

4. Exploring The nurse is using the technique of exploring because she's willing to delve further into the client's concern. She isn't presenting reality or making observations or simply restating. The nurse is encouraging the client to explore his feelings.

Which of the following is an example of the role of the psychiatric nurse in primary prevention? 1. Handling crisis intervention in an outpatient setting 2. Visiting a client's home to discuss medication management 3. Conducting a postdischarge support group 4. Providing sexual education classes for adolescents

4. Providing sexual education classes for adolescents The psychiatric nurse participates in primary, secondary, and tertiary prevention activities. Primary prevention includes providing sexual education classes for adolescents, and education programs that promote mental health and prevent future psychiatric episodes. Secondary prevention involves treatment to reduce psychiatric problems (for example, handling crisis intervention in an outpatient setting, administering and supervising medication regimens, and participating in the therapeutic milieu). Tertiary prevention involves helping clients who are recovering from psychiatric illness; activities directed toward providing aftercare and rehabilitation are part of this role. Conducting a postdischarge support group is a tertiary prevention activity.

The nurse is documenting a care plan for a client who has undergone electroconvulsive therapy (ECT). The nurse should include which intervention? 1. Monitoring the client's vital signs every hour for 4 hours 2. Placing the client in Trendelenburg's position 3. Encouraging early ambulation 4. Reorienting the client to time and place

4. Reorienting the client to time and place Confusion and temporary memory loss are the most common adverse effects of ECT. The nurse should continually reorient the client to time and place as he wakes up from the procedure. Following ECT, the nurse should monitor the client's vital signs every 15 minutes for the 1st hour. The nurse should position the client on his side after the procedure to reduce the risk of aspiration. The client should remain on bed rest until he's fully awake and oriented.

When should the nurse introduce information about the end of the nurse-client relationship? 1. During the orientation phase 2. As the goals of the relationship are reached 3. At least one or two sessions before the last meeting 4. When the client can tolerate it

1. During the orientation phase Preparation for ending the nurse-client relationship should begin during the orientation phase, when realistic limits of the relationship are established. Termination should also be discussed as goals are achieved and the relationship nears an end. Although the nurse should remind the client that only one or two sessions are left, the nurse must not wait until then to prepare the client for termination. The client's ability to tolerate the end of a relationship shouldn't dictate its timing. Because many clients have had negative experiences when ending relationships, the nurse can use termination of the nurse-client relationship to prepare the client for and work the client through positive termination experiences with others.

A client is transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen (Tylenol) tablets. The client is now awake and alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to: 1. establish a rapport to foster trust. 2. place the client in full leather restraints. 3. try to communicate with the client in writing. 4. ensure safety by initiating suicide precautions.

4. ensure safety by initiating suicide precautions. The nurse's first priority is to keep a suicidal client safe and alive. Although establishing a rapport and promoting trust are important in psychiatric nursing, neither is the highest priority. Using restraints is inappropriate and could be interpreted as punishment of the client or a convenience for the nurse. Trying to communicate in writing is also inappropriate because the client can hear.

Low doses of central nervous system (CNS) depressants produce an initial excitatory response. This reaction is caused by: 1. a stimulating effect on the CNS. 2. the depression of acetylcholine. 3. the stimulation of dopamine by depressant drugs. 4. inhibitory synapses in the brain being depressed before excitatory synapses.

4. inhibitory synapses in the brain being depressed before excitatory synapses. Excitation can occur when inhibitory synapses are depressed. The other options are incorrect because depressants don't stimulate the CNS or dopamine and don't depress acetylcholine.

A client with borderline personality disorder dramatically expresses feelings about each nurse on the staff, stating that only one nurse is understanding and trustworthy — namely, the nurse the client is talking to at the time. This client is demonstrating which behavior? 1. Confidentiality 2. Splitting 3. Empathy 4. Gnawing

2. Splitting In splitting, or primitive dissociation, the client categorizes people as good or bad and tries to keep the bad from contaminating the good. Such a client may view a staff member as ideal and then devalue that person. Confidentiality is the protection of client information. Empathy is the nurse's attempt to understand and respond to a client's needs and feelings. Gnawing isn't a term used in psychiatric nursing.

Additive central nervous system (CNS) depression can occur when combining a sedative-hypnotic with which drug? 1. Methylphenidate (Ritalin) 2. Cocaine 3. Amitriptyline (Elavil) 4. Amphetamine (Adderall)

3. Amitriptyline (Elavil) Additive effects occur with concomitant use of CNS depressants, antihistamines, antidepressants, and antipsychotics. Elavil is an antidepressant and the only correct answer. All the other drugs are classified as stimulants.

Physical tolerance and withdrawal symptoms can occur with stimulants. Stimulant withdrawal is characterized by which of the following symptoms? 1. Rhinorrhea, dilated pupils, and abdominal cramps 2. Increased motor activity and tachycardia 3. Fatigue, mental depression, and confusion 4. Tremors, nausea, vomiting, and diaphoresis

3. Fatigue, mental depression, and confusion Withdrawal from stimulants results in central nervous system depression, including fatigue, depression, and confusion. Rhinorrhea, dilated pupils, and abdominal cramps are symptoms of opioid withdrawal. Increased motor activity and tachycardia are symptoms of sedative withdrawal. Tremors, nausea, vomiting, and diaphoresis are symptoms of alcohol withdrawal.

A client in the emergency department complains of suicidal ideation and feelings of worthlessness. He has a family history of suicide. The nurse is assessing the client to determine treatment recommendations. The most important factor to consider is: 1. an active suicide plan and the means to carry it out. 2. a previous suicide attempt. 3. the client's religion and social status. 4. social support and marital status.

1. an active suicide plan and the means to carry it out. The presence of an actual plan would require a restrictive environment for the client. Although a previous suicide attempt, marital status, and social support can affect the rate of suicide, a serious plan is of primary concern for the nurse.

The nurse is caring for a client diagnosed with body dysmorphic disorder. When the client verbalizes disapproval of her physical features, the nurse should: 1. encourage verbalizations about fears and stressful life situations. 2. agree with the client because she feels a specific physical feature is awful. 3. ignore the comment and talk about less threatening issues. 4. compliment the client on her appearance.

1. encourage verbalizations about fears and stressful life situations. Encouraging the client to discuss stressful life situations helps focus on the underlying issues. The client's preoccupation with a specific physical feature is a means of not coping with life. Ignoring the client or complimenting the client won't be helpful. She won't be able to accept the compliment. Agreeing with her strengthens her problem.

Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which of the following conditions? 1. Hyperpyrexia, slow pulse, and weight gain 2. Tachycardia, weight loss, and mood swings 3. Hypotension, weight gain, and listlessness 4. Increased appetite, slowing of sensorium, and arrhythmias

2. Tachycardia, weight loss, and mood swings Stimulants produce mood swings, anorexia and weight loss, and tachycardia. The other symptoms indicate CNS depression.

A client receiving morphine for long-term pain management develops tolerance. Tolerance is defined as: 1. an increased response to a medication. 2. a diminished response to a drug so that more is required to achieve the same effect. 3. an allergic reaction to a medication. 4. an ability to take the same drug for extended periods of time.

2. a diminished response to a drug so that more is required to achieve the same effect. Tolerance occurs when the body requires higher doses of substances, such as alcohol, opioids, or benzodiazepines, to achieve desired effects. Increased response indicates a need for less of a drug to achieve the same effects. Allergic reactions are autoimmune responses to a particular drug or class of drugs.

Which nursing intervention is most important when restraining a violent client? 1. Reviewing facility policy regarding how long the client can be restrained 2. Preparing an as-needed dose of the client's psychotropic medication 3. Checking that the restraints have been applied correctly 4. Asking if the client needs to use the bathroom or is thirsty

3. Checking that the restraints have been applied correctly The nurse must determine whether the restraints have been applied correctly to make sure that the client's circulation and respiration aren't restricted and that adequate padding has been used. The nurse should document the client's response and status carefully after the restraints are applied. All staff members involved in restraining clients should be aware of facility policy before using restraints. If an as needed medication is ordered, it should be given before the restraints are in place and with the assistance of other team members. The nurse should attend to the client's elimination and hydration needs after the client is properly restrained.

A client continues to stalk a man whom she met briefly 3 years ago. She believes he loves her and eventually will marry her and has been sending him cards and gifts. When she violates a restraining order he has obtained, a judge orders her to undergo a 10-day psychiatric evaluation. What is the most probable psychiatric diagnosis for this client? 1. Delusional disorder — jealous type 2. Induced psychotic disorder 3. Delusional disorder — erotomanic type 4. Schizophreniform disorder

3. Delusional disorder — erotomanic type In delusional disorder of the erotomanic type, the client has an erotic delusion of being loved by another person and tries to contact the object of the delusion through such behaviors as sending gifts, calling, and stalking. The object of the undesired attention may be a complete stranger or someone the client knows, and usually is of higher status. In a delusional disorder of the jealous type, the client has a delusion that the sexual partner is unfaithful. In a psychotic disorder, a delusion of suspicion occurs within the context of a close relationship. The individual may believe that someone has an inappropriate or sexual interest in him. Schizophreniform disorder involves bizarre delusions and hallucinations of less than 6 months' duration.

Upon returning home from work, a young man discovers that his mother has been in a serious automobile accident. Initially, he responds to the news by stating, "No, I don't believe it. It can't be true." Which defense mechanism is he using? 1. Introjection 2. Suppression 3. Denial 4. Repression

3. Denial Denial is the avoidance of reality by ignoring or refusing to acknowledge unpleasant incidents. This defense mechanism is used to allay anxiety immediately after a stressful event. Introjection is an intense form of identification in which one incorporates the values or qualities of another person or group into one's own ego structure. Suppression is the conscious analog of repression. A person intentionally uses suppression to consciously exclude material from awareness. Repression is the unconscious exclusion of painful episodes from awareness.

Which psychological or personality factor is most likely to predispose an individual to medication abuse? 1. Low self-esteem and unresolved rage 2. Desire to inflict pain upon one's self 3. Dependent personality disorder 4. Antisocial personality disorder

1. Low self-esteem and unresolved rage Low self-esteem and repressed rage as well as depression can predispose an individual to search for solace in addictive medications. Commonly, medications are used to minimize or blot out pain, rather than inflict additional pain. Personality disorders don't predispose a client to medication abuse; however, personality disorders, especially the antisocial ones, may be intensified by abuse.

Which commonly administered psychiatric medication is prescribed in individualized dosages according to the blood levels of the drug? 1. Chlorpromazine (Thorazine) 2. Alprazolam (Xanax) 3. Lithium carbonate (Lithane) 4. Thioridazine (Mellaril)

3. Lithium carbonate (Lithane) Dosages for lithium, an antimania drug, usually are individualized to achieve a maintenance blood level of 0.6 to 1.2 mEq/L. The maximum daily dosage of thioridazine, an antipsychotic agent, is 800 mg. Dosages exceeding this amount are associated with retinitis pigmentosa, an irreversible condition that can be avoided by observing dosage limits. The recommended maintenance dosage range for thioridazine is 300 to 800 mg/day. Recommended dosage ranges for chlorpromazine, an antipsychotic agent, and alprazolam, an antianxiety agent, are 300 to 1,400 mg/day and 0.5 to 4 mg/day, respectively.

During the mental status examination, a client may be asked to explain such proverbs as "Don't cry over spilled milk." The purpose is to evaluate the client's ability to think: 1. rationally. 2. concretely. 3. abstractly. 4. tangentially.

3. abstractly. Abstract thinking is the ability to conceptualize and interpret meaning. It's a higher level of intellectual functioning than concrete thinking, in which the client explains the proverb by its literal meaning. Rational thinking involves the ability to think logically, make judgments, and be goal-directed. Tangential thinking is scattered, non-goal-directed, and hard to follow. Clients with such conditions as organic brain disease and schizophrenia typically can't conceptualize and comprehend abstract meaning. They interpret such statements as "Don't cry over spilled milk" in a literal sense, such as "Even if you spill your milk, you shouldn't cry about it."

The nurse can use self-disclosure with a client if: 1. the nurse has experienced the same situation as the client. 2. the client asks the nurse directly about the experience. 3. it helps the client to talk more easily. 4. it achieves a specific therapeutic goal.

4. it achieves a specific therapeutic goal. Self-disclosure (making personal statements about oneself) can be a useful tool for the nurse. However, the nurse should use self-disclosure judiciously and with a specific therapeutic purpose in mind. The nurse should listen to the client closely and remember that experiences for different people are sometimes similar but never identical. Using too many self-disclosures is unethical and can shift the focus from the client to the nurse. Self-disclosure that distracts the client from treatment issues doesn't benefit the client and may alienate the client from the nurse.

A person loses an important advertising account and gets a flat tire while driving home. That evening, the person begins to find fault with everyone. Which defense mechanism is the person using? 1. Displacement 2. Projection 3. Regression 4. Sublimation

1. Displacement This person is using displacement, a mechanism by which feelings of anger and rejection are discharged in an indirect way that is perceived as safe (in this situation, by displacing anger related to work and car problems onto others). Projecting involves attributing one's own emotions to or blaming them on others. Regression is a retreat to an earlier level of developmental behavior in an attempt to relieve anxiety. Sublimation is the socially acceptable discharge of psychic energy or anger through such behavior as exercise or other productive activity.

During an initial assessment, a client reports the following behaviors: social inhibition, hypersensitivity to negative evaluation, fear of criticism, and social ineptitude. The nurse suspects which of the following personality disorders? 1. Narcissistic 2. Antisocial 3. Paranoid 4. Avoidant

3. Paranoid The behaviors describe avoidant behaviors. Antisocial behaviors are against society but aren't inhibited. Paranoid behaviors are those in which a client is suspicious of the actions of others, and narcissistic are self-centered behaviors.

Two nurses are discussing a client's condition in the elevator. The employer of the mentioned client overhears the conversation and fires the client. The nurses may be liable for which accusation? 1. Assault 2. Battery 3. Neglect 4. Breach of confidentiality

4. Breach of confidentiality Breach of confidentiality occurs when a nurse shares information that can cause harm to an individual. Assault is an act that results in fear that one will be touched without consent. Battery involves unconsented touching of another person. Neglect is the failure to do what is deemed reasonable in a situation.

A client becomes angry and belligerent toward the nurse after speaking on the phone with his mother. The nurse recognizes this as what defense mechanism? 1. Rationalization 2. Repression 3. Displacement 4. Suppression

3. Displacement Displacement is a defense mechanism in which the client transfers his feelings for one person toward another person who is less threatening. Rationalization is a defense mechanism in which the client makes excuses to justify unacceptable feelings or behaviors. Repression is characterized by an involuntary blocking of unpleasant experiences from one's consciousness. Suppression is the conscious blocking of unpleasant experiences from one's awareness.

On the second day of hospitalization, the client is discussing with the nurse concerns about unhealthy family relationships. During the nurse-client interaction, the client changes the subject to a job situation. The nurse responds, "Let's go back to what we were just talking about." What therapeutic communication technique did the nurse use? 1. Reflecting 2. Restating 3. Focusing 4. Summarizing

3. Focusing The therapeutic communication technique used by the nurse to direct a client back to the original topic of discussion is called focusing. Focusing fosters the client's self-control and helps avoid vague generalizations, so the client can accept responsibility for facing problems. Reflecting directs the idea back to the client. Restating involves repeating the main idea back to the client. This technique lets the client know what the nurse heard. With summarizing, the nurse gives a brief synopsis of what was covered in the conversation.

Which principle of the psychoanalytic model is particularly useful to psychiatric nurses? 1. All behavior has meaning. 2. Behavior that is reinforced will be perpetuated. 3. The first 6 years of a person's life determine personality. 4. Behavioral deviations result from an incongruence between verbal and nonverbal communication.

1. All behavior has meaning. The principle that all behavior has meaning is of particular importance to the psychiatric nurse. It serves as the basis for the nurse's assessment and analysis of the client's behavior, which reflects the client's needs. Psychoanalytic theory also proposes that the first 6 years of a person's life determine personality; these early influences are difficult, if not impossible, to counteract. However, this assumption is less useful to the nurse in planning interventions that meet the client's current needs. Reinforcement as a means of perpetuating behavior is associated with behavioral theory — not the psychoanalytic model. Incongruence between verbal and nonverbal communications is a part of communications theory.

A family member visiting on an acute care psychiatric unit approaches the nurse's station and reports that an elderly client is walking in the hall without her clothing. The nurse doesn't assist the client and suggests that the family member inform the nurse assigned to that client. Which term describes the nurse's action? 1. Negligent 2. Sensitive 3. Compassionate 4. Organized

1. Negligent The nurse has failed to respond immediately to the safety and privacy of a vulnerable client. Negligence is defined as an omission to do something a reasonable person would do. This nurse's behavior is anything but sensitive, caring, or compassionate. Organization isn't addressed in this situation.

On admission to the inpatient psychiatric unit, a client's facial expression indicates severe panic. The client repeatedly states, "I know the police are going to shoot me. They found out that I'm the child of the devil." What should the nurse say to initiate a therapeutic relationship with the client? 1. "You certainly look stressed. Can you tell me about the upsetting events that have occurred in your life recently?" 2. "Hello, my name is ___. I'm a nurse, and I'll care for you when I'm on duty. Should I call you ___, or do you prefer something else?" 3. "You're having very frightening thoughts. I'll help you find ways to cope with this scary thinking." 4. "Hello, ___. I'm going to be caring for you while I'm on duty. You look very frightened, but I'm sure you'll feel better by tomorrow."

2. "Hello, my name is ___. I'm a nurse, and I'll care for you when I'm on duty. Should I call you ___, or do you prefer something else?" The first task during the introductory, or orientation, phase of the nurse-client relationship is to formulate a contract, which begins with the exchange of names and an explanation of the roles and limits of the relationship. These tasks should precede the exploration of relevant stressors and new coping mechanisms. Offering false reassurance is never therapeutic.

An agitated client demands to see her chart so she can read what has been written about her. Which of the following statements is the nurse's best response to the client? 1. "I'm sorry. The chart is the property of the facility. We don't permit clients to read them." 2. "You have the right to see your chart. Please discuss this with your primary care provider." 3. "You may see your chart after you're discharged." 4. "Please discuss this matter with your attorney."

2. "You have the right to see your chart. Please discuss this with your primary care provider." The Bill of Rights for Psychiatric Clients includes the right for clients to access their medical records unless doing so would be detrimental to their health. To determine if information might be detrimental to the client, the primary care provider should be informed of the client's request. The client doesn't need an attorney to view her chart. She also doesn't need to wait until after discharge to view it.

The nurse is leading group therapy with psychiatric clients. During the working phase, what should the nurse do? 1. Explain the purposes and goals of the group. 2. Offer advice to help resolve conflicts. 3. Encourage group cohesiveness. 4. Encourage a discussion of feelings of loss regarding termination of the group.

3. Encourage group cohesiveness. During the working phase, or the middle phase of a group, the nurse continues to encourage cohesiveness among its members. During the orientation phase, or the initial phase, the nurse leading the group should explain the purpose and goals of the group. During the termination phase, or the final phase, the leader encourages a discussion of feelings associated with termination. When leading a group, the nurse should act as a facilitator; offering advice isn't appropriate. The group members should work together to resolve conflicts.

The nurse has been caring for a client with chronic paranoid schizophrenia for several months, including several one-on-one sessions. During one session, the client seems more anxious than usual, speaking rapidly and loudly as the session starts. This behavior indicates a possible change in which form of communication? 1. Appearance 2. Kinesics 3. Paralanguage 4. Proxemics

3. Paralanguage Paralanguage is the use of vocal effects, such as tone and tempo, to convey a message. Appearance refers to the way a person looks. Kinesics involves body language or movement. Proxemics is the use of spatial relationships (the distance between people) during interaction to communicate meaning.

A busy attorney with a successful law practice is admitted to an acute care facility with epigastric pain. Since admission, the client has called the nurse every 15 minutes with one request or another. This client is most likely exhibiting: 1. repression. 2. somatization. 3. regression. 4. conversion.

3. regression. The client is exhibiting the defense mechanism regression, a return to behavior that is characteristic of an earlier developmental level. Dependent, attention-seeking behavior is an attempt to relieve anxiety. Repression manifests as a denial of the symptoms. Somatization is the channeling of anxiety into a preoccupation with physical complaints. Conversion involves the transfer of a mental conflict into a physical symptom to relieve anxiety.

Your client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction? 1. Extrapyramidal reaction 2. Tardive dyskinesia 3. Reye's syndrome 4. Agranulocytosis

4. Agranulocytosis The complaint of a sore throat may indicate an infection caused by agranulocytosis, a depletion of white blood cells. Although extrapyramidal reaction and tardive dyskinesia may occur, a sore throat isn't an indication of these conditions. Reye's syndrome is caused by a virus unrelated to clozapine.

A man at a pizza parlor verbally confronts the waiter for lack of attentiveness. Later, in the back room, the waiter spits on the man's pizza. This is an example of a behavior typical of which disorder? 1. Obsessive-compulsive 2. Narcissistic 3. Passive-aggressive 4. Dependent

3. Passive-aggressive This is an example of a negative attitude and passive-aggressive behavior in response to word demands for adequate performance. People with this disorder won't confront or discuss issues with others but will go to great lengths to "get even." Obsessive-compulsive disorder involves rituals or rules that interfere with normal functioning. A person with a narcissistic personality has an exaggerated sense of self-worth. A person with a dependent personality is submissive and frequently apologizes and backs down when confronted.

Which of the following statements is a guideline to help nurses avoid liability? 1. Follow all physician's orders. 2. Do what the client desires even though the nurse may disagree. 3. Practice within the scope of the Nurse Practice Act. 4. Obtain malpractice insurance.

3. Practice within the scope of the Nurse Practice Act. The Nurse Practice Act outlines acceptable standards for nursing. Practicing within those guidelines will protect the nurse from liability. The client doesn't know standards of care and isn't responsible for the nurse's actions. Physicians may not be aware of guidelines for nurses and delegate inappropriate treatment or practice for the nurse. Insurance won't prevent a liability suit, but only assist the nurse if a suit would be filed.

A client is admitted to an inpatient psychiatric unit. After the assessment and admission procedures are completed, the nurse states, "I'll try to be available to talk with you when needed and will spend time with you each morning from 10:00 until 10:30 in the corner of the dayroom." What is the main rationale for communicating these planned nursing interventions? 1. To attempt to establish a trusting relationship 2. To provide a structured environment for the client 3. To instill hope in the client 4. To provide time for completing nursing responsibilities

1. To attempt to establish a trusting relationship Availability, reliability, and consistency are critical factors in establishing trust with a client. Being specific about the time and place of meetings helps establish trust, which is initially the main objective. Although important, structuring the environment and instilling hope aren't the primary tasks at this time. Arranging a regular meeting with the client allows the nurse to plan the workload but isn't the major reason for such scheduling.

An adolescent, age 17, rarely expresses feelings and usually remains passive. However, when angry, her face becomes flushed and her blood pressure rises to 170/100 mm Hg. Her parents are passive and easygoing. The adolescent may be using which defense mechanism to handle anger? 1. Displacement 2. Introjection 3. Projection 4. Sublimation

2. Introjection The adolescent may be introjecting (assuming as her own) her parents' belief that anger shouldn't be outwardly expressed. She may also be holding in and somatizing her angry feelings, as evidenced by her increased blood pressure. (A blood pressure rise is a common physiological reaction to the fight-or-flight response that may be brought on by strong emotions. Habitual failure to express anger may contribute to hypertension.) Displacement is the discharge of negative feelings onto another person or an object. Projection is the attribution of one's own thoughts or impulses to another person. Sublimation is the channeling of unbearable or socially unacceptable behaviors into more socially acceptable outlets.

What occurs during the working phase of the nurse-client relationship? 1. The nurse assesses the client's needs and develops a care plan. 2. The nurse and client evaluate and modify the goals of the relationship. 3. The nurse and client discuss their feelings about terminating the relationship. 4. The nurse and client explore each others' expectations of the relationship.

2. The nurse and client evaluate and modify the goals of the relationship. The therapeutic nurse-client relationship consists of four phases: preinteraction, introduction or orientation, working, and termination. During the working phase, the nurse and client evaluate and refine the goals established during the orientation phase. In addition, major therapeutic work takes place and insight is integrated into a plan of action. The orientation phase involves assessing the client, formulating a contract, exploring feelings, and establishing expectations about the relationship. During the termination phase, the nurse prepares the client for separation and explores feelings about the end of the relationship.

A client reports severe pain in the back and joints. Upon reviewing the client's history, the nurse notes a diagnosis of depression and frequent hospitalizations for somatic illnesses. What should the nurse encourage this client to do? 1. Tell the physician about the pain so that its cause can be determined. 2. Remember all the previous "health problems" that weren't real. 3. Try to get more rest and use relaxation techniques. 4. Ignore the pain and focus on happy things.

1. Tell the physician about the pain so that its cause can be determined. Initially, the nurse should treat all symptoms as indicators of possible pathology because a history of psychophysiologic illness doesn't rule out a purely physical illness as a cause of the client's current symptoms. The other options assume that the client has a psychophysiologic illness, which could lead to ignoring a physical illness or condition.

The nurse is explaining the Bill of Rights for psychiatric patients to a client who has voluntarily sought admission to an inpatient psychiatric facility. Which of the following rights should the nurse include in the discussion? 1. Right to select health care team members 2. Right to refuse treatment 3. Right to a written treatment plan 4. Right to obtain disability 5. Right to confidentiality 6. Right to personal mail

2. Right to refuse treatment 3. Right to a written treatment plan 5. Right to confidentiality 6. Right to personal mail An inpatient client usually receives a copy of the Bill of Rights for psychiatric patients, where they would find options 2, 3, 5, and 6 in writing. However, a client in an inpatient setting can't select health team members. A client may apply for disability as a result of a chronic, incapacitating illness; however, disability isn't a patient right, and members of a psychiatric institution don't decide who should receive it.

A client doesn't make eye contact with the nurse during an interview. The nurse suspects that the client's behavior has a cultural basis. What should the nurse do first? 1. Read several articles about the client's culture. 2. Ask staff members of a similar culture about the client's behavior. 3. Observe how the client and the client's family and friends interact with one another and with other staff members. 4. Accept the client's behavior because it's probably culturally-based.

3. Observe how the client and the client's family and friends interact with one another and with other staff members. Assessing the client's interactions with others helps to determine whether the behavior is part of a usual pattern. It also may help the nurse understand the meaning of the behavior for this particular client. Reading about a different culture, consulting other staff members, and talking with the client are helpful after the nurse has observed the client's interaction with others. The nurse must be able to accept the client as an individual but need not accept unhealthy or inappropriate behaviors. The nurse should work with the client to better understand the cultural differences.

Mental health laws in each state specify when restraints can be used and which type of restraints are allowed. Most laws stipulate that restraints can be used: 1. for a maximum of 2 hours. 2. as necessary to control the client. 3. if the client poses a present danger to himself or others. 4. only with the client's consent.

3. if the client poses a present danger to himself or others. Most states allow restraints to be used if the client presents a danger to himself or others. This danger must be reevaluated every few hours. If the client is still a danger, restraints can be used until the violent behavior abates. No standing orders for restraints are allowed, and restraints are permitted only until more "humane" methods, such as sedatives, become effective. Violent clients who are intoxicated with drugs or alcohol present a problem because they can rarely be sedated until the drug or alcohol is metabolized. In such cases, restraints may be needed for a longer period, but the client must be closely observed. Obtaining consent isn't always possible, especially when the client's violent behavior results from a psychosis such as paranoid schizophrenia.

When assessing a client's level of stress caused by significant life events, which of the following would the nurse use? 1. Holmes and Rahe's theory 2. Selye's general adaptation syndrome theory 3. The general systems theory 4. Lazarus's theory

1. Holmes and Rahe's theory Holmes and Rahe's theory suggests that all life events, whether positive or negative, cause stress. Holmes and Rahe have created a readjustment scale that ranks life events according to how much stress they cause. Selye's general adaptation syndrome theory explains a person's organized response to stress in three stages. The general systems theory takes a holistic view of the stress response, recognizing both internal and external stimuli affecting the person's health. Lazarus's theory suggests that the stress response occurs in three stages but it views each stage as a conscious evaluation of the stimulus, not an automatic reaction.

In the emergency department, a client reveals to the nurse a lethal plan for committing suicide and agrees to a voluntary admission to the psychiatric unit. Which information will the nurse discuss with the client to answer the question, "How long do I have to stay here?" 1. "You may leave the hospital at any time unless you are suicidal." 2. "Let's talk more after the health team has assessed you." 3. "Once you've signed the papers, you have no say." 4. "Because you could hurt yourself, you must be safe before being discharged." 5. "You need a lawyer to help you make that decision." 6. "There must be a court hearing before you leave the hospital."

1. "You may leave the hospital at any time unless you are suicidal." 2. "Let's talk more after the health team has assessed you." 4. "Because you could hurt yourself, you must be safe before being discharged." A person who is admitted to a psychiatric hospital on a voluntary basis may sign out of the hospital unless the health care team determines that the person is harmful to himself or others. The health care team evaluates the client's condition before discharge. If there is reason to believe that the client is harmful to himself or others, a hearing can be held to determine if the admission status should be changed from voluntary to involuntary. Option 3 is incorrect because it denies the client's rights; option 5 is incorrect because the client doesn't need a lawyer to leave the hospital; and option 6 is incorrect because a hearing isn't mandated before discharge. A hearing is held only if the client remains unsafe and requires further treatment.

The nurse has developed a relationship with a client who has an addiction problem. Which information would indicate that the therapeutic interaction is in the working stage? 1. The client addresses how the addiction has contributed to family distress. 2. The client reluctantly shares the family history of addiction. 3. The client verbalizes difficulty identifying personal strengths. 4. The client discusses the financial problems related to the addiction. 5. The client expresses uncertainty about meeting with the nurse. 6. The client acknowledges the addiction's effects on the children.

1. The client addresses how the addiction has contributed to family distress. 3. The client verbalizes difficulty identifying personal strengths. 6. The client acknowledges the addiction's effects on the children. Options 1, 3, and 6 are examples of the nurse-client working phase of an interaction. In the working phase, the client explores, evaluates, and determines solutions to identified problems. Options 2, 4 and 5 address what happens during the introductory phase of the nurse-client interaction.

The most effective way for the nurse to set limits for a newly admitted client who puts out cigarettes on the floor of the room designated for smoking is to: 1. restrict the client's smoking to times when a staff member can supervise closely. 2. encourage other clients to speak with the client about dirtying the floor. 3. ask if the client puts out cigarettes on the floor at home. 4. hand the client an ashtray and state that he must use it or he won't be allowed to smoke.

4. hand the client an ashtray and state that he must use it or he won't be allowed to smoke. Setting limits is necessary to help clients behave in socially acceptable ways. By handing the client an ashtray and stating objectively that the client must use it or he won't be allowed to smoke, the nurse is setting limits on behavior. Because this client is newly admitted, the nurse may need to restate these limits in a manner that shows disapproval of the behavior but doesn't reject the client as a person. A matter-of-fact, nonpunitive tone of voice is important. The nurse must stress that noncompliance will have consequences — in this case, a prohibition against smoking. Encouraging other clients to deal with a new client isn't advisable. Asking if the client puts out cigarettes on the floor at home has no bearing on whether this behavior is acceptable in the hospital.

The nurse notices that a client with obsessive-compulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be most therapeutic? 1. "I saw you change clothes several times today. That must be very tiring." 2. "Try to dress only once per day so you won't be so tired." 3. "It bothers me to see you always so busy." 4. "It's foolish to change clothes so many times in one day."

1. "I saw you change clothes several times today. That must be very tiring." Option 1 focuses on the client's feelings in an empathetic way, helping to reduce the intensity of the ritualistic behavior and promoting trust and rapport. Implying that the client's behavior is tiring, bothersome, or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety.

A client has been taking imipramine (Tofranil), 125 mg by mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because he still feels depressed. At this time, what is the nurse's best response? 1. "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation." 2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression." 3. "The physician may need to increase the dosage for you to get the medication's maximum benefit." 4. "Don't stop taking the medication abruptly because you may develop serious adverse effects."

2. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression." Antidepressant agents such as imipramine don't produce antidepressant effects until they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial dose. Therefore, the nurse should encourage the client to continue therapy at least until the drug reaches that level. After this time, if the client's depression doesn't abate, the nurse may use the other responses.

The physician orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate? 1. "Take this medication. It will reduce your anxiety." 2. "Do you have any concerns about taking the medication?" 3. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous." 4. "How can we help you if you won't cooperate?"

2. "Do you have any concerns about taking the medication?" Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the right to refuse the medication. Instead of simply ordering the client to take it, as in option 1, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option 3, or threatening the client, as in option 4, would increase anxiety.

A client is admitted to the hospital with severe depression after her husband left her. The nurse suspects that the client is at risk for suicide. Which of the following questions would be most appropriate and helpful for the nurse to ask during an assessment for suicide risk? 1. "Are you sure you want to kill yourself?" 2. "I know if my husband left me, I would want to kill myself. Is that what you think?" 3. "How do you think you would kill yourself?" 4. "Why don't you just look at the positives in your life?"

3. "How do you think you would kill yourself?" To determine if a client is at risk for suicide, ask, "How do you think you would kill yourself?" If the client has a plan, she may be closer to carrying out the act. Option 1 requires a yes or no response and is self-limiting. In option 2, the nurse is telling the client what to think and feel. Option 4 dismisses the client's feelings

A psychiatric nurse is trying to help a client overcome his fear of public speaking, which is preventing him from advancing in his career. He has conquered some of his other social phobias such as using public restrooms. During an interview with the nurse to evaluate his progress, he makes all of the following statements. Which statement concerns the nurse? 1. "One of my subordinates just got a promotion." 2. "I try to take deep breaths and remain calm when people talk to me." 3. "It helps me to have one or two drinks at lunch." 4. "I've met a woman whom I'd like to ask out on a date."

3. "It helps me to have one or two drinks at lunch." Clients with phobic disorders are prone to engaging in episodic alcohol or drug abuse in an attempt to overcome anxiety associated with the phobia. Therefore, a statement indicating the potential for alcohol abuse should concern the nurse. Telling the nurse that a subordinate received a promotion shows that the client trusts the nurse, who should attempt to elicit the client's feelings about this event. Using breathing and calming exercises and expressing a desire to ask someone out on a date reveal that the client is taking small steps toward overcoming his fears. In social phobias, the central fear is self-embarrassment, which compels the client to avoid scrutiny by others; asking a woman to go on a date is a progressive step toward overcoming this fear.

A 22-year-old male client diagnosed with antisocial personality disorder asks the nurse if he can have an additional smoke break because he's anxious. Which response would be best? 1. "Well okay, I have a few minutes. I'll take you." 2. "I'm sorry but I can't take you. I'm busy." 3. "Smoking is harmful to your health. I don't want to contribute to your bad habits." 4. "Clients are permitted to smoke at designated times. You'll have to follow the rules."

4. "Clients are permitted to smoke at designated times. You'll have to follow the rules." Consistency is essential when dealing with antisocial clients. They disregard social norms and don't believe the rules apply to them. Option 1 would be detrimental to the client because it reinforces the client's acting-out behaviors. Option 2 avoids the client's attempt to manipulate. Option 3 is inappropriate because the nurse is lecturing the client.

Action of stress on the heart

muscle damage causes heart attack

Physiologic stress responses

stressor --> hypothalamus --> pituitary --> ACTH ACTH --> Adrenal gland --> catecholamines, dopamine, epinephrine, norepinephrine ACTH --> Corticoids --> supress immune system and increase energy

Which of the following statements describes how elderly clients react to medications? 1. At risk for increased adverse effects 2. Tolerate medication better because they are less active 3. Metabolize medications quickly 4. Need higher doses than younger clients to respond to the same medication

1. At risk for increased adverse effects As individuals become older, their livers metabolize drugs at a slower rate. Cumulative effects can occur and increase the risk of adverse effects. Elderly clients typically need lower doses, not higher. Level of activity typically doesn't affect a person's reaction to medication.

The nurse is talking with a client who recently attempted suicide. The client asks her not to tell anyone about their conversation. How should the nurse respond? 1. "I'll need to share information with the rest of your health care team if it's important to your care." 2. "I promise I won't tell anyone about the information you share with me today." 3. "I promise I won't tell anyone about the information you share with me today unless you give me permission to do so." 4. "Please don't tell me anything that you wouldn't want others on your health care team to know."

1. "I'll need to share information with the rest of your health care team if it's important to your care." The nurse must tell the client that she'll share information if it affects his safety or his care. The nurse shouldn't promise to withhold information because she may not be able to uphold her promise if the information must be shared with others. The nurse shouldn't promise to ask permission before disclosing information to others. The nurse also shouldn't encourage the client to withhold information from her. Doing so violates the nurse's responsibility to develop a therapeutic relationship with the client. The nurse — not the client — should judge what specific information must be shared with others on the health care team.

A client, age 40, is admitted for a surgical biopsy of a suspicious lump in her left breast. When the nurse comes to take her to surgery, she is tearfully finishing a letter to her two children. She tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic? 1. "In case anything goes wrong? What are your thoughts and feelings right now?" 2. "I can understand that you're nervous, but this really is a minor procedure. You'll be back in your room before you know it." 3. "Try to take a few deep breaths and relax. I have some medication that will help." 4. "I'm sure your children know how much you love them. You'll be able to talk to them on the phone in a few hours."

1. "In case anything goes wrong? What are your thoughts and feelings right now?" By acknowledging how the client feels, this response encourages further expression of thoughts and feelings. Minimizing feelings or offering empty reassurances isn't therapeutic or helpful. Deep breathing and preoperative medication would be appropriate only after the client's fears have been expressed and dealt with.

During the admission interview, a client reports that she frequently has nightmares and memories of a rape that occurred 3 years ago. She feels depressed and asks the nurse, "Do you think I will ever get better? I don't know what is wrong with me." The nurse's most supportive response would be: 1. "It sounds like you have some unresolved pain about the trauma. Take time here to talk and allow yourself to heal." 2. "I'm not sure what is wrong, but the medication will help you soon enough." 3. "It's important to talk to your physician about an issue such as this." 4. "Don't feel bad; the treatment will help you."

1. "It sounds like you have some unresolved pain about the trauma. Take time here to talk and allow yourself to heal." Option 1 is the most supportive statement. The nurse acknowledges the client's traumatic experience and pain as well as encourages her to talk. Option 2 ignores the client's need for reassurance. Option 3 indicates that the nurse isn't capable of helping the client deal with therapeutic issues. Option 4 could make the client feel guilty for being upset about the trauma.

The nurse is caring for a Vietnam veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's best response? 1. "Many people who've been in your situation experience similar emotions and behaviors." 2. "You can change your behavior if you're motivated to do so." 3. "It isn't too late for you to make changes in your life." 4. "Weak people don't want to make changes in their lives."

1. "Many people who've been in your situation experience similar emotions and behaviors." By providing reassurance that extreme anger and other reactions are normal responses to trauma, the nurse assists the client to deal with the shame over a perceived lack of control over feelings and to gain confidence in the ability to alter behaviors. Responses such as those in options 2, 3, and 4 are clichés and don't address the client's feelings.

On admission to the psychiatric unit, a client with major depression reports that a family member is physically abusive and requests that the nurse not release any personal information to anyone. When the allegedly abusive family member calls the unit and demands information about the client's treatment, what is the nurse's best response? 1. "To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here." 2. "I can't give you any information. Goodbye." 3. "Your family member isn't accepting telephone calls." 4. "Your family member didn't sign an information release form with your name on it, so I can't give you any information."

1. "To protect clients' confidentiality, I can't give any information, including whether your relative is receiving treatment here." The client has the right to confidential treatment, and the nurse has a duty to protect the client's confidentiality. Neither option 1 nor 2 gives the caller any information, but option 1 is more diplomatic. Options 3 and 4 divulge the client's whereabouts and status, violating confidentiality.

Clients receiving monoamine oxidase inhibitor antidepressants must avoid tyramine, a compound found in which of the following foods? 1. Aged cheese and Chianti wine 2. Green leafy vegetables 3. Figs and cream cheese 4. Fruits and yellow vegetables

1. Aged cheese and Chianti wine Aged cheese and Chianti wine contain high concentrations of tyramine. The other foods listed are low in tyramine.

A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which information about this drug's adverse effects would the nurse include when creating a medication teaching plan? 1. Agitation 2. Agranulocytosis 3. Sleep disturbance 4. Intermittent tachycardia 5. Dry mouth 6. Seizures

1. Agitation 3. Sleep disturbance 5. Dry mouth Common adverse effects of sertraline are agitation, sleep disturbance, and dry mouth. Agranulocytosis, intermittent tachycardia, and seizures are adverse effects of clozapine (Clozaril).

Which medications have been found to help reduce or eliminate panic attacks? 1. Antidepressants 2. Anticholinergics 3. Antipsychotics 4. Mood stabilizers

1. Antidepressants Tricyclic and monoamine oxidase inhibitor antidepressants have been found to be effective in treating clients with panic attacks. Why these drugs help control panic attacks isn't clearly understood. Anticholinergic agents, which are smooth-muscle relaxants, relieve physical symptoms of anxiety but don't relieve the anxiety itself. Antipsychotic drugs are inappropriate because clients who experience panic attacks aren't psychotic. Mood stabilizers aren't indicated because panic attacks are rarely associated with mood changes.

During a panic attack, a client runs to the nurse and reports breathing difficulty, chest pain, and palpitations. The client is pale, with his mouth wide open and eyebrows raised. What should the nurse do first? 1. Assist the client to breathe deeply into a paper bag. 2. Orient the client to person, place, and time. 3. Set limits for acting out delusional behaviors. 4. Administer an I.M. anxiolytic agent.

1. Assist the client to breathe deeply into a paper bag. Physiological needs, particularly breathing, are the first priorities during a panic attack. Having the client breathe deeply into a paper bag corrects hyperventilation; restoring a normal breathing pattern should relieve the client's other symptoms. Orientation usually is unnecessary because most clients respond to external control and reduced stimulation. During a panic attack, the client isn't likely to act out but may strike out if he feels threatened. An anxiolytic agent may be effective but isn't the first priority.

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction? 1. Ataxia 2. Hepatomegaly 3. Urticaria 4. Rash

1. Ataxia Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, the nurse should incorporate which of the following instructions in her teaching plan? 1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants. 2. Avoid taking antianxiety drugs at bedtime. 3. Avoid taking antianxiety drugs on an empty stomach. 4. Avoid consuming aged cheese when taking antianxiety agents.

1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants. Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted with monoamine oxidase inhibitors, not Librium.

The nurse is assessing a client who talks freely about feeling depressed. During the interaction, the nurse hears the client state, "Things will never change." What other indications of hopelessness would the nurse look for? 1. Bouts of anger 2. Periods of irritability 3. Preoccupation with delusions 4. Feelings of worthlessness 5. Self-destructive behaviors 6. Auditory hallucinations

1. Bouts of anger 2. Periods of irritability 4. Feelings of worthlessness 5. Self-destructive behaviors Clients who are depressed and feeling hopeless are often irritable and express inappropriate anger and suicidal thoughts. In addition, they may have feelings of worthlessness and demonstrate self-destructive behaviors. Preoccupation with delusions and auditory hallucinations are generally seen in clients with schizophrenia or other psychotic disorders rather than in those expressing hopelessness.

The nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior? 1. By allowing times during which the client can focus on the behavior 2. By urging the client to reduce the frequency of the behavior as rapidly as possible 3. By calling attention to or attempting to prevent the behavior 4. By discouraging the client from verbalizing anxieties

1. By allowing times during which the client can focus on the behavior The nurse should allow times during which the client can focus on the compulsive behavior or obsessive thoughts. The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. She shouldn't call attention to or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror in the client. The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.

The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen on a short-term basis? 1. Diazepam (Valium), 5 mg orally three times per day 2. Benztropine (Cogentin), 2 mg orally twice per day 3. Chlorpromazine (Thorazine), 25 mg orally three times per day 4. Clozapine (Clozaril), 200 mg orally twice per day

1. Diazepam (Valium), 5 mg orally three times per day Diazepam is the most appropriate medication for this client because of its antianxiety properties. Benztropine is an antiparkinsonian agent used to control the extrapyramidal effects of such antipsychotic agents as chlorpromazine hydrochloride and thioridazine hydrochloride. Chlorpromazine is used to control the severe symptoms (hallucinations, thought disorders, and agitation) seen in clients with psychosis. Clozapine is used to manage symptoms of schizophrenia in clients who don't respond to other antipsychotic drugs.

Discharge instructions for clients receiving tricyclic antidepressants include which of following information? 1. Don't consume alcohol. 2. Discontinue if dry mouth and blurred vision occur. 3. Restrict fluid and sodium intake. 4. It's safe to continue taking during pregnancy.

1. Don't consume alcohol. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants. Fluid and sodium intake must be monitored during lithium (Lithobid) treatment. Safe use during pregnancy and breast-feeding hasn't been established.

Which of the following statements should be included when teaching clients about monoamine oxidase (MAO) inhibitor antidepressants? 1. Don't take prescribed or over-the-counter medications without consulting the physician. 2. Avoid strenuous activity because of the cardiac effects of the drug. 3. Have blood levels screened weekly for leukopenia. 4. Don't take with aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs).

1. Don't take prescribed or over-the-counter medications without consulting the physician. MAO inhibitors when combined with a number of drugs can cause life-threatening hypertensive crisis. It's imperative that a client check with his physician and pharmacist before taking any other medications. Activity doesn't need to be limited. Blood dyscrasias aren't a common problem with MAO inhibitors. Aspirin and NSAIDs are safe to take with MAO inhibitors.

A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the care plan? 1. Exercising the client's arms regularly 2. Insisting that the client eat without assistance 3. Working with the client rather than the family 4. Teaching the client how to use nonpharmacologic pain-control methods

1. Exercising the client's arms regularly To maintain the integrity of the affected areas and prevent muscle wasting and contractures, the nurse should help the client perform regular passive range-of-motion exercises with his arms. The nurse shouldn't insist that the client use the arms, such as by eating without assistance, because the client can't consciously control symptoms and move the arms; also, such insistence may anger the client and endanger the therapeutic relationship. The nurse should include family members in the client's care because they may be contributing to the client's stress or conflict and are essential in helping the client regain function of the arms. The client isn't experiencing pain and, therefore, doesn't need education regarding pain management.

After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client? 1. Exploring the meaning of the traumatic event with the client 2. Allowing the client time to heal 3. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle 4. Encouraging the client to attend a rape therapy group

1. Exploring the meaning of the traumatic event with the client The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques such as relaxation therapy may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. Attending a rape therapy group isn't indicated at this time.

The nurse is caring for a client in the manic phase of bipolar disorder who's ready for discharge from the psychiatric unit. As the nurse begins to terminate the nurse-client relationship, which client response is most appropriate? 1. Expressing feelings of anxiety 2. Displaying anger, shouting, and banging the table 3. Withdrawing from the nurse in silence 4. Rationalizing the termination, saying that "everything comes to an end"

1. Expressing feelings of anxiety Anxiety is a normal reaction to the termination of the nurse-client relationship. The nurse should help the client explore his feelings about the end of the therapeutic relationship. While anger about the termination may be a healthy response, banging the table, shouting, and other forms of acting out aren't appropriate behavior. Withdrawal isn't a healthy response to the termination of a relationship. By rationalizing the termination, the client avoids expressing his feelings and emotions.

A voluntary client in a facility decides to leave the unit before treatment is complete. To detain the client, the nurse refuses to return the client's personal effects. This is an example of which of the following? 1. False imprisonment 2. Limit setting 3. Slander 4. Violation of confidentiality

1. False imprisonment Confining a voluntary client against his will may be considered false imprisonment. Slander is oral defamation of character. The nurse hasn't given out any information about the client, so confidentiality hasn't been violated.

A client with major depression frequently is irritable, abrasive, and uncooperative and refuses to participate in group activities. When working with this client, the nurse should use which approach? 1. Firmness 2. Joyfulness 3. Humor 4. Aloofness

1. Firmness By taking a firm approach, the nurse sets limits and establishes boundaries for the client's behavior, which helps ensure safety and gives the client a sense of control. A joyful or humorous approach may make the client feel guilty about being depressed. An aloof approach doesn't enable the client to initiate interpersonal contact or encourage communication.

Which nursing action is most appropriate when trying to diffuse a client's impending violent behavior? 1. Helping the client identify and express feelings of anxiety and anger 2. Involving the client in a quiet activity to divert attention 3. Leaving the client alone until he can talk about his feelings 4. Placing the client in seclusion

1. Helping the client identify and express feelings of anxiety and anger In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client's acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security.

A recent diagnosis of cancer has caused a client severe anxiety. The nursing care plan should include which interventions? 1. Maintain a calm, nonthreatening environment. 2. Teach relevant aspects of chemotherapy. 3. Encourage the client to verbalize her concerns regarding the diagnosis. 4. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress. 5. Provide distractions for the client during periods of stress. 6. Teach the stages of grieving.

1. Maintain a calm, nonthreatening environment. 3. Encourage the client to verbalize her concerns regarding the diagnosis. 4. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress. During acute stress, interventions that help the client regain control will help the client master this new threat. Providing a calm, accepting attitude and encouraging verbalization of concerns will help the client face the unknown. Relaxation techniques have a physiologic and psychological effect in calming the client, which in turn allows further exploration of thoughts and feelings, as well as problem solving. Learning is limited during extreme stress, so teaching wouldn't be effective at this stage. Providing distractions would be ineffective at this point in the grief process. Teaching about the stages of grieving isn't appropriate at this time.

A client with the nursing diagnosis of Fear, related to being embarrassed in the presence of others, exhibits symptoms of social phobia. What should the goals be for this client? 1. Manage her fear in group situations. 2. Develop a plan to avoid situations that may cause stress. 3. Verbalize feelings that occur in stressful situations. 4. Develop a plan for responding to stressful situations. 5. Deny feelings that may contribute to irrational fears. 6. Use suppression to deal with underlying fears.

1. Manage her fear in group situations. 3. Verbalize feelings that occur in stressful situations. 4. Develop a plan for responding to stressful situations. Improving stress management skills, verbalizing feelings, and anticipating and planning for stressful situations are adaptive responses to stress. Avoidance, denial, and suppression are maladaptive defense mechanisms.

A client is brought to the crisis intervention center by his wife, who states that he has been increasingly listless and less involved with his family recently. She reports that he sleeps poorly, eats little, and can barely perform basic self-care activities. She also reveals that 3 months ago he was in a car accident in which his best friend was killed. After the physician diagnoses acute depression, the nurse should anticipate administering: 1. Paroxetine (Paxil), 20 mg by mouth (P.O.) every morning. 2. Amitriptyline (Elavil), 20 mg P.O. daily. 3. Doxepin (Sinequan), 500 mg daily. 4. Imipramine (Tofranil), 500 mg daily.

1. Paroxetine (Paxil), 20 mg by mouth (P.O.) every morning. All of the drugs listed are antidepressants that may be prescribed for this client. However, paroxetine, 20 mg P.O. every morning, is the only correct dosage. Amitriptyline is usually started at 75 to 150 mg P.O. daily in divided doses. Doxepin is started at 25 to 50 mg daily and may be titrated upward to a maximum daily dose of 300 mg. Imipramine is started at 50 to 75 mg daily and, if tolerated, titrated upward to a maximum daily dose of 300 mg.

In the community room, the nurse observes a client who suffers from depression. She sees the client pace swiftly around the room, swing both arms, and rub both hands together. What term would the nurse use to describe these behaviors to members of the health care team? 1. Psychomotor agitation 2. Tardive dyskinesia 3. Compulsions 4. Mania

1. Psychomotor agitation Psychomotor agitation is defined by constant motion, such as pacing, wringing hands, biting nails, and other types of energetic body movements. Tardive dyskinesia occurs with long-term use of antipsychotic agents. It's characterized by irregular, repetitive, involuntary movements of the mouth, face, and tongue, including chewing, tongue protrusion, lip smacking, and rapid eye blinking. Compulsions are ritualistic actions that the client feels compelled to perform. Clients with mania have inflated self-esteem, in which the client displays an abnormal and persistent elevated, expansive, and irritable mood.

The nurse is assigned to care for a recently admitted client who has attempted suicide. What should the nurse do? 1. Search the client's belongings and room carefully for items that could be used to attempt suicide. 2. Express trust that the client won't cause self-harm while in the facility. 3. Respect the client's privacy by not searching any belongings. 4. Remind all staff members to check on the client frequently.

1. Search the client's belongings and room carefully for items that could be used to attempt suicide. Because a client who has attempted suicide could try again, the nurse should search the client's belongings and room to remove any items that could be used in another suicide attempt. Expressing trust that the client won't cause self-harm may increase guilt and pain if the client can't live up to that trust. The nurse should search the client's belongings because the need to maintain a safe environment supersedes the client's right to privacy. Although frequent checks by staff members are helpful, they aren't enough because the client may attempt suicide between checks.

The nurse is caring for a client diagnosed with panic disorder. The client begins to hyperventilate. How should the nurse respond initially? 1. Stay with the client during the anxiety attack. 2. Shout for help and obtain assistance. 3. Teach the client relaxation exercises. 4. Help the client explore the reason for the anxiety.

1. Stay with the client during the anxiety attack. Because the presence of a calm nurse provides a feeling of security, the nurse should remain with a client during an anxiety attack and assure the client of his safety. Shouting for help and bringing others running to the scene can increase the client's anxiety. The nurse should keep the client's environment calm by reducing noise and limiting the number of people present. Teaching the client relaxation exercises and other methods to reduce stress and exploring the reasons underlying anxiety are important interventions but shouldn't be performed during an anxiety attack. During an attack, a client isn't capable of learning new behaviors or achieving insight.

A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction-formation? 1. The client assumes an attitude that is the opposite of an impulse that the client harbors. 2. The client believes his thoughts can control other people and events. 3. The client thinks and talks about a particular idea or subject persistently. 4. The client uses one act to negate a previous act.

1. The client assumes an attitude that is the opposite of an impulse that the client harbors. Reaction formation is a defense mechanism in which a person assumes an attitude that is the opposite of an impulse or a wish that the person harbors. The belief that one's thoughts can control other people and events is called "magical thinking." Persistent thoughts and discussion of a particular idea or subject are called "rumination." Use of an act to negate a previous act is called "undoing."

The nurse recognizes improvement in a client with the nursing diagnosis of Ineffective role performance related to the need to perform rituals. Which of the following behaviors indicates improvement? 1. The client refrains from performing rituals during stress. 2. The client verbalizes that he uses "thought stopping" when obsessive thoughts occur. 3. The client verbalizes the relationship between stress and ritualistic behaviors. 4. The client avoids stressful situations. 5. The client rationalizes ritualistic behavior. 6. The client performs ritualistic behaviors in private.

1. The client refrains from performing rituals during stress. 2. The client verbalizes that he uses "thought stopping" when obsessive thoughts occur. 3. The client verbalizes the relationship between stress and ritualistic behaviors. Refraining from rituals demonstrates that the client manages stress appropriately. Using "thought stopping" demonstrates the client's ability to employ appropriate interventions for obsessive thoughts. Verbalizing the relationship between stress and behaviors indicates that the client understands the disease process. Avoiding, rationalizing, and hiding behaviors demonstrate maladaptive methods for managing stress and anxiety.

A client has received treatment for depression for 3 weeks. Which behavior suggests that the client is recovering from depression? 1. The client talks about the difficulties of returning to college after discharge. 2. The client spends most of the day sitting alone in the corner of the room. 3. The client wears a hospital gown instead of street clothes. 4. The client shows no emotion when visitors leave.

1. The client talks about the difficulties of returning to college after discharge. By talking about returning to college, the client is demonstrating an interest in making plans for the future, which is a sign of recovery from depression. Decreased socialization, lack of interest in personal appearance, and lack of emotion are all symptoms of depression.

While in the facility, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which outcome would indicate successful treatment for this client? 1. The client throws away all disposable cups. 2. The client is discharged and takes the cups home. 3. The client keeps the cups in a bag in his room. 4. The client goes home on pass and arranges magazines.

1. The client throws away all disposable cups. With an obsessive-compulsive client, a goal of treatment is to throw away hoarded items. Moving the hoarded items or rearranging them wouldn't indicate progress because these actions allow the inappropriate behavior to continue.

A client is a Vietnam War veteran with a diagnosis of posttraumatic stress disorder. He has a history of nightmares, depression, hopelessness, and alcohol abuse. Which option offers the client the most lasting relief of his symptoms? 1. The opportunity to verbalize memories of trauma to a sympathetic listener 2. Family support 3. Prescribed medications taken as ordered 4. Alcoholics Anonymous (AA) meetings

1. The opportunity to verbalize memories of trauma to a sympathetic listener Although it's difficult, clients with posttraumatic stress disorder can obtain the most lasting relief if they verbalize memories of the trauma to a sympathetic listener. Family members are commonly frightened by the information and can't be consistently supportive. Antidepressants may help but these drugs can mask feelings and can't provide lasting relief. Treatment for alcohol abuse, including AA meetings, must be considered when planning care but alone doesn't provide lasting relief.

Lorazepam (Ativan) is often given along with a neuroleptic agent. What is the purpose of administering the drugs together? 1. To reduce anxiety and potentiate the sedative action of the neuroleptic 2. To counteract extrapyramidal effects of the neuroleptic 3. To manage depressed clients 4. To increase the client's level of awareness and concentration

1. To reduce anxiety and potentiate the sedative action of the neuroleptic Lorazepam, when given with a neuroleptic such as haloperidol (Haldol), potentiates the sedating effect and is used to treat severely agitated clients. Haloperidol places the client at risk for extrapyramidal effects and, therefore, wouldn't be used to treat extrapyramidal effects. Both drugs can cause depression, so they aren't used to treat depression. Concentration would be decreased because of the depressant effect.

A client periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, the client may experience: 1. a decreased perceptual field. 2. a decreased heart rate. 3. a decreased respiratory rate. 4. heightened concentration.

1. a decreased perceptual field. Panic is the most severe level of anxiety. During a panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings, and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and inability to concentrate. During an acute panic attack, the client may experience an increase, not a decrease, in the heart and respiratory rates, which results from stimulation of the sympathetic nervous system.

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to: 1. avoid caffeine. 2. avoid aged cheeses. 3. stay out of the sun. 4. maintain an adequate salt intake.

1. avoid caffeine. Ingesting 500 mg or more of caffeine can significantly alter the anxiolytic effects of lorazepam. Other dietary restrictions are unnecessary. Staying out of the sun or using sunscreens is required when taking phenothiazines. An adequate salt intake is necessary for clients receiving lithium.

Conditions necessary for the development of a positive sense of self-esteem include: 1. consistent limits. 2. critical environment 3. inconsistent boundaries. 4. physical discipline

1. consistent limits. A structured lifestyle demonstrates acceptance and caring and provides a sense of security. A critical environment erodes a person's esteem. Inconsistent boundaries lead to feelings of insecurity and lack of concern. Physical discipline can decrease self-esteem.

When teaching a client about lithium (Lithobid), the nurse should instruct the client to: 1. drink at least six to eight glasses of water per day and avoid caffeine. 2. limit the use of salt in his diet. 3. discontinue medicine when feeling better. 4. increase the amount of sodium in his diet.

1. drink at least six to eight glasses of water per day and avoid caffeine. Caffeine should be avoided because it increases urine output. Clients need to maintain adequate fluid intake to avoid lithium toxicity. Don't limit or increase salt intake because the kidneys will hold onto lithium or excrete it if salt intake varies. Clients should remain on medication even though they are feeling better.

Family members of a client with bipolar disorder tell the nurse that they are concerned that the client is becoming manic. The nurse knows that the manic phase is marked by: 1. flight of ideas and inflated self-esteem. 2. increased sleep and greater distractibility. 3. decreased self-esteem and increased physical restlessness. 4. obsession with following rules and maintaining order.

1. flight of ideas and inflated self-esteem. The manic phase of bipolar disorder is characterized by recurrent episodes of a persistently euphoric and expansive or irritable mood. This phase is diagnosed if the client has four of the following signs and symptoms for at least 1 week: flight of ideas; inflated self-esteem; unusual talkativeness; increased social, occupational, or sexual activity; physical restlessness; a decreased need for sleep; increased distractibility; and excessive involvement in activities with a high potential for painful but unrecognized consequences. Obsession with following rules and maintaining order characterizes obsessive-compulsive disorder.

A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, the nurse should focus on: 1. helping the client identify and verbalize feelings about the incident. 2. convincing the client that his arms aren't paralyzed. 3. developing rehabilitation strategies to help the client learn to live with the disability. 4. talking about topics other than the beating to avoid causing anxiety.

1. helping the client identify and verbalize feelings about the incident. In conversion disorder, the client represses and converts emotional conflicts into motor, sensory, or visceral symptoms with no physiologic cause. Interventions should focus on helping the client identify the underlying emotional problem. A client with conversion disorder can't be convinced that the physical problem isn't real; attempts to convince him may lead him to seek other health care providers. Treating the physical symptoms as long-term or permanent may encourage the client to maintain them. Ignoring the cause of the symptoms would prevent the client from dealing with his feelings about his wife's beating.

An elderly client's lithium (Lithobid) level is 1.4 mEq/L. She complains of diarrhea, tremors, and nausea. The nurse's first action is to: 1. hold the lithium and notify the physician. 2. reassure the client that these are normal adverse effects. 3. administer another lithium dose. 4. discontinue the lithium.

1. hold the lithium and notify the physician. The client has symptoms of lithium toxicity. Therefore, her lithium should be held and the physician notified immediately. These aren't normal adverse effects, and administering another dose would increase the toxic effects. A nurse can't discontinue a medication without a physician's order.

The nurse is caring for a client, a Vietnam veteran, who exhibits signs and symptoms of posttraumatic stress disorder. Signs and symptoms of posttraumatic stress disorder include: 1. hyperalertness and sleep disturbances. 2. memory loss of traumatic event and somatic distress. 3. feelings of hostility and violent behavior. 4. sudden behavioral changes and anorexia.

1. hyperalertness and sleep disturbances. Signs and symptoms of posttraumatic stress disorder include hyperalertness, sleep disturbances, exaggerated startle, survival guilt, and memory impairment. Also, the client relives the traumatic event through dreams and recollections. Hostility, violent behavior, and anorexia aren't usual signs or symptoms of posttraumatic stress disorder.

A client is admitted to the emergency department with chest pain, palpitations, vertigo, and diaphoresis. When initial assessment shows no physiological basis for these complaints, the client is referred to a psychiatric clinical nurse-specialist. After determining that the client has had four similar episodes in the last month, the specialist suspects that the client has: 1. panic disorder. 2. depression. 3. schizophrenia. 4. obsessive-compulsive disorder.

1. panic disorder. This client has classic signs and symptoms of panic disorder, which results from acute anxiety. Panic disorder also may cause dyspnea, choking, feelings of unreality, hot and cold flashes, and shaking or trembling. Panic disorder is confirmed by a history of three or more panic attacks within 3 weeks that are unrelated to extreme physical exertion or life-threatening situations. Depression may cause psychomotor agitation, feelings of worthlessness, difficulty concentrating, energy loss, and fatigue. Schizophrenic disorders are marked mainly by withdrawal and failure to distinguish reality from fantasy. Obsessive-compulsive disorder wouldn't cause the physiological manifestations seen in this client.

A client is receiving treatment for severe depression. When evaluating the client for suicidal ideation, the nurse checks for: 1. suicidal thoughts or plans. 2. further deterioration in self-worth. 3. hoarding of prized possessions. 4. the need for physical restraints.

1. suicidal thoughts or plans. Suicidal ideation refers to thoughts or plans of suicide. To assess for these, the nurse should ask directly if the client is thinking about or planning suicide. Common indicators of an increased risk for suicide include giving away prized possessions and lifting of depression, not further deterioration in self-worth. If the client has suicidal ideation or is at high risk for suicide, the staff should ensure a safe environment, such as by conducting frequent checks (every 15 minutes) and removing potentially dangerous objects. Continuous observation is more effective than physical restraints, which are reserved for clients who are physically violent and out of control.

An adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes, the adolescent is brought to the community mental health agency for evaluation. This adolescent is at risk for: 1. suicide. 2. anorexia nervosa. 3. school phobia. 4. psychotic break.

1. suicide. Changes in academic performance and familial communications, social withdrawal, and giving away of treasured possessions suggest that this adolescent is contemplating suicide. Anorexia nervosa would cause weight loss and other related symptoms. This adolescent's signs and symptoms don't suggest fear of school and typify depression, not psychosis.

Which statement by the client leads the nurse to suspect depression? 1. "My daughter said she's not coming to visit today because she needs to work late." 2. "I just know my daughter doesn't love me any more." 3. "I'm very sad about losing my job, but I know things will turn around for me." 4. "At least not everything in my life is bad."

2. "I just know my daughter doesn't love me any more." People who are depressed typically have cognitive distortions. They commonly jump to negative conclusions, as in option 2, without facts to validate the conclusions. They also have all-or-nothing thinking, in which they label all of life's events as "bad." They also predict negative events, and often assume that another person thinks or feels a certain way. Therefore, options 1, 3, and 4 are incorrect.

A client with borderline personality disorder tells the nurse, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond? 1. "I'll talk to the physician right away. I don't think they give you enough medicine." 2. "I'll have to discuss your request with the team. Can we talk about how you're feeling right now?" 3. "I don't want to hear you say negative things about the other nurses." 4. "You know you can't have extra medication. Why do you keep asking?"

2. "I'll have to discuss your request with the team. Can we talk about how you're feeling right now?" This response appropriately focuses on the emotional content of the client's message and helps the client identify feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly split the staff into "good guys" and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse shouldn't take the client's statements personally because this would interfere with the ability to maintain a therapeutic relationship.

During the client-teaching session, which instruction should the nurse give to a client receiving the second-generation antidepressant paroxetine (Paxetil)? 1. "Be aware that your vision may become blurred." 2. "Include high-fiber foods in your diet." 3. "Report polyuria to the physician immediately." 4. "Avoid tyramine-rich foods such as red wine."

2. "Include high-fiber foods in your diet." Because constipation may occur with paroxetine therapy, the client should eat foods rich in fiber. Blurred vision and polyuria aren't common adverse reactions to paroxetine. Avoiding tyramine-rich foods is an important instruction for a client taking a monoamine oxidase inhibitor — not a second-generation antidepressant such as paroxetine.

A depressed client tells the nurse, "I want to die. Life just isn't worth living." Which response by the nurse would be most appropriate? 1. "Of course life is worth living. You'll feel better soon." 2. "This must be a very difficult time for you." 3. "No one really wants to die." 4. "Why do you want to die?"

2. "This must be a very difficult time for you." This response is nonjudgmental and allows the client to express feelings. Options 1 and 3 are belittling and imply that the client's feelings are inappropriate or wrong. When asked a "why" question, such as option 4, a client may intellectualize or become defensive.

A client seeks care because she feels depressed and has gained weight. To treat her atypical depression, the physician prescribes tranylcypromine sulfate (Parnate), 10 mg by mouth twice per day. When this drug is used to treat atypical depression, what is its onset of action? 1. 1 to 2 days 2. 3 to 5 days 3. 6 to 8 days 4. 10 to 14 days

2. 3 to 5 days Monoamine oxidase inhibitors such as tranylcypromine have an onset of action of approximately 3 to 5 days. A full clinical response may be delayed for 3 to 4 weeks. The therapeutic effects may continue for 1 to 2 weeks after discontinuation.

Which nursing intervention would be most appropriate if a client were to develop orthostatic hypotension while taking amitriptyline (Elavil)? 1. Consulting the physician about substituting a different type of antidepressant 2. Advising the client to sit up for 1 minute before getting out of bed 3. Instructing the client to double the dosage until the problem resolves 4. Informing the client that this adverse reaction should disappear within 1 week

2. Advising the client to sit up for 1 minute before getting out of bed To minimize the effects of amitriptyline-induced orthostatic hypotension, the nurse should advise the client to sit up for 1 minute before getting out of bed. Orthostatic hypotension commonly occurs with tricyclic antidepressant therapy. In these cases, the dosage may be reduced or the physician may prescribe nortriptyline, another tricyclic antidepressant. Orthostatic hypotension disappears only when the drug is discontinued.

Which foods are contraindicated for a client taking tranylcypromine (Parnate)? 1. Whole grain cereals and bagels 2. Chicken livers, Chianti wine, and beer 3. Oranges and vodka 4. Chicken, rice, and apples

2. Chicken livers, Chianti wine, and beer A client taking a monoamine oxidase inhibitor antidepressant such as tranylcypromine (Parnate) shouldn't eat foods containing tyramine. Such foods include chicken livers, Chianti wine, beer, ale, aged game meats, broad beans, aged cheeses, sour cream, avocados, yogurt, pickled herring, yeast extract, chocolate, excessive caffeine, vanilla, and soy sauce. The client also must refrain from taking cold and hay fever preparations that contain vasoconstrictive agents.

A client on the behavioral health unit spends several hours a day organizing and reorganizing his closet. He repeatedly checks to see if his clothing is arranged in the proper order. What term is commonly used to describe this behavior? 1. Obsession 2. Compulsion 3. Exhibitionism 4. Transference

2. Compulsion Compulsion is present when a client exhibits recurrent, persistent, repetitive actions and behaviors, which he feels driven to perform. This behavior interferes with the client's activities of daily living and is disruptive to the client's lifestyle. These compulsions relieve the intense anxiety that occurs when the behavior isn't performed. Obsession is a recurrent, persistent, and intrusive thought. Exhibitionism is the compulsive need to expose a part of the body, especially the genitals, to an unsuspecting stranger. Transference is the process of placing feelings and thoughts onto the therapist, who symbolically represents a significant person in the client's past.

The nurse is assigned to a client who, after a medication teaching session with the nurse, began receiving amitriptyline (Elavil) 1 week ago to treat depression. The client now refuses to take the medication, stating that it has caused blurred vision, dry mouth, and constipation, but hasn't improved the mood. Which nursing diagnosis is most appropriate for this client? 1. Noncompliance (treatment regimen) related to treatment resistance 2. Deficient knowledge (treatment regimen) related to inadequate understanding of teaching 3. Anxiety related to unconscious conflict 4. Ineffective coping related to personal vulnerability

2. Deficient knowledge (treatment regimen) related to inadequate understanding of teaching The nurse should assume that the client doesn't have the information necessary to make an informed decision about using the medication. Therefore, Deficient knowledge related to inadequate understanding of teaching is the most appropriate nursing diagnosis. The nurse also should assume that the client wants to feel better; a nursing diagnosis of noncompliance related to treatment resistance would imply that the client is deliberately choosing to be ill. No data support a nursing diagnosis of anxiety related to unconscious conflict or ineffective coping related to personal vulnerability.

Which of the following tests are useful in diagnosing depression? 1. Coagulation profile and protein uptake test 2. Dexamethasone suppression test (DST) 3. Amitriptyline level 4. Creatinine and thyroid-stimulating hormone levels

2. Dexamethasone suppression test (DST) The DST is a blood test that determines the serum cortisol level after administration of dexamethasone (Decadron), an agent that usually suppresses the serum cortisol level. The DST has gained considerable attention in the mental health field as a diagnostic marker for endogenous depression as well as for its implications for the treatment and prognosis of this disorder. Most studies have found that 40% to 50% of clients with endogenous depression or major depression with melancholia don't have a suppressed late-afternoon serum cortisol level after dexamethasone administration. Amitriptyline levels are followed when a client is receiving the drug to treat depression. They aren't helpful in diagnosing depression. The other options aren't useful in diagnosing depression.

A client diagnosed with major depression has started taking amitriptyline (Elavil), a tricyclic antidepressant. What is a common adverse effect of this drug? 1. Weight loss 2. Dry mouth 3. Hypertension 4. Muscle spasms

2. Dry mouth Tricyclic antidepressants can have anticholinergic adverse effects, with dry mouth being the most common. Hypotension would be expected, rather than hypertension. Weight gain — not loss — is typical when taking this medication. Muscle spasms aren't an adverse effect of tricyclic antidepressants.

The nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention would best help the client achieve healthy long-term sleeping habits? 1. Administering sleeping pills 2. Encouraging the use of relaxation exercises 3. Suggesting he talk with other clients until he feels ready to sleep 4. Telling him to play ping-pong in the day room

2. Encouraging the use of relaxation exercises Relaxation exercises provide the client with a healthy way to gain control over anxiety. These exercises also produce a physiologic response opposite to that produced by stress. Giving a sleeping pill would provide short-term relief for sleeplessness but wouldn't teach healthy sleep habits. Suggesting the client stay up and talk won't help him develop healthy sleep habits or control stress and anxiety. Playing ping-pong or engaging in other exercises just prior to sleep produces a physiologic response similar to stress.

A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when developing the care plan? 1. Setting strict limits on compulsive behavior 2. Giving the client time to perform rituals 3. Increasing environmental stimulation 4. Preventing ritualistic behavior

2. Giving the client time to perform rituals The nurse should give the client time to perform rituals because this reduces anxiety. The other options would increase the client's anxiety.

A professional artist is admitted to the psychiatric unit for treatment of bipolar disorder. During the last 2 weeks, the client has created 154 paintings, slept only 2 to 3 hours every 2 days, and lost 18 lb (8.2 kg). Based on Maslow's hierarchy of needs, what should the nurse provide this client with first? 1. The opportunity to explore family dynamics 2. Help with reestablishing a normal sleep pattern 3. Experiences that build self-esteem 4. Art materials and equipment

2. Help with reestablishing a normal sleep pattern According to Abraham Maslow, the nurse first must address the client's most basic physiologic needs, such as sleep. Exploring the dynamics of relationships is a psychoanalytical task unrelated to Maslow's hierarchy. Providing experiences that build self-esteem help meet higher needs in Maslow's hierarchy. Providing art materials isn't a primary nursing intervention; it helps meet aesthetic needs, the highest in Maslow's hierarchy.

The nurse is monitoring a client receiving tranylcypromine sulfate (Parnate). Which serious adverse reaction can occur with high dosages of this monoamine oxidase (MAO) inhibitor? 1. Hypotensive episodes 2. Hypertensive crisis 3. Muscle flaccidity 4. Hypoglycemia

2. Hypertensive crisis The most serious adverse reaction associated with high doses of MAO inhibitors is hypertensive crisis, which can lead to death. Although not a crisis, orthostatic hypotension is also common and may lead to syncope with high doses. Muscle spasticity (not flaccidity) is associated with MAO inhibitor therapy. Hypoglycemia isn't an adverse reaction of MAO inhibitors.

During an interaction with the nurse, a client with bipolar disorder states that she doesn't have anything to contribute to the art therapy group. Upon exploration of the client's concerns, the nurse recognizes the client's pattern of withdrawal and nonparticipation in situations requiring communication with others. Which nursing diagnosis would be appropriate for this client? 1. Anxiety 2. Impaired social interaction 3. Defensive coping 4. Chronic low self-esteem

2. Impaired social interaction The data obtained by the nurse support the nursing diagnosis of impaired social interaction. Some defining characteristics of this diagnosis include having limited communication with others, verbalizing negative feelings, and feeling insecure around other people. The client may also have anxiety, defensive coping, and chronic low self-esteem; however, the client shows the defining characteristics of impaired social interaction.

After interviewing a client diagnosed with recurrent depression, the nurse determines the client's potential to commit suicide. Which factors would the nurse consider as contributors to the client's potential for suicide? 1. Psychomotor retardation 2. Impulsive behaviors 3. Overwhelming feelings of guilt 4. Chronic, debilitating illness 5. Decreased physical activity 6. Repression of anger

2. Impulsive behaviors 3. Overwhelming feelings of guilt 4. Chronic, debilitating illness 6. Repression of anger Impulsive behavior, overwhelming guilt, chronic illness, and anger repression are factors that contribute to suicide potential. Psychomotor retardation and decreased activity are symptoms of depression but don't typically lead to suicide because the client doesn't have the energy to harm himself.

A client is admitted to the psychiatric unit with a diagnosis of unipolar disorder. When the client doesn't respond to antidepressant drugs, the physician orders electroconvulsive therapy (ECT). What is the mechanism of action for ECT? 1. It's related to the client's perception of ECT as a well-deserved punishment. 2. It's unknown. 3. It's related to increased production of chemicals in the brain. 4. It resembles that of antidepressant drugs.

2. It's unknown. The exact mechanism of action of ECT is unknown, although various theories exist. One theory, which isn't widely accepted among medical authorities, suggests that a depressed client's underlying guilt feelings are relieved by the perception of ECT as a punishment. Another suggests that ECT increases the levels of certain chemicals in the brain, such as the neurotransmitters acetylcholine, norepinephrine, and serotonin. Although authorities agree that ECT doesn't cause permanent brain damage, they don't necessarily recognize a connection between increased chemical levels in the brain and ECT. No similarity between the action of ECT and that of antidepressant medication has been proven.

A 23-year-old client in the manic phase of bipolar disorder is admitted to the facility. Which agents would be appropriate for this client? 1. Bupropion (Wellbutrin) and lithium (Lithobid) 2. Lithium (Lithobid) and valproic acid (Depakote) 3. Haloperidol (Haldol) and fluphenazine (Prolixin) 4. Risperidone (Risperdal) and clozapine (Clozaril)

2. Lithium (Lithobid) and valproic acid (Depakote) Lithium and valproic acid are the drugs of choice for manic depression. Bupropion is an antidepressant, not an antimanic. Haloperidol, fluphenazine, clozapine, and risperidone are antipsychotic agents.

During the manic phase of bipolar disorder, a client's lithium carbonate (Lithonate) level measures 0.15 mEq/L. The client dresses flamboyantly, acts provocatively, and has seriously impaired judgment. What is the nurse's first priority when planning this client's care? 1. Administer lithium carbonate I.M. 2. Observe the client's behavior closely in the milieu. 3. Begin aversion therapy to extinguish undesirable behaviors. 4. Initiate suicide precautions because the client's judgment is impaired.

2. Observe the client's behavior closely in the milieu. Because a client with manic symptoms has impaired judgment, the nurse should observe closely to prevent the client from acting on dangerous impulses. Although lithium carbonate is used to control mania, it's available only in oral form. Aversion therapy is inappropriate because the client can't control the behavior. Suicide precautions also are inappropriate because the client hasn't displayed suicidal intentions.

The nurse is caring for a client in an acute manic state. What is the most effective nursing action for this client? 1. Assigning him to group activities 2. Reducing his stimulation 3. Assisting him with self-care 4. Helping him express his feelings

2. Reducing his stimulation Reducing stimuli helps to reduce hyperactivity during a manic state. Group activities would provide too much stimulation. Trying to assist the client with self-care could cause increased agitation. When in a manic state, these clients aren't able to express their inner feelings in a productive, introspective manner. The focus of treatment for a client in the manic state is behavior control.

The nurse is caring for an elderly client in a long-term care facility. The client has a history of attempted suicide. The nurse observes the client giving away personal belongings and has heard the client express feelings of hopelessness to other residents. Which intervention should the nurse perform first? 1. Setting time aside for listening to the client 2. Removing items that the client could use in a suicide attempt 3. Communicating a nonjudgmental attitude 4. Referring the client to a mental health professional

2. Removing items that the client could use in a suicide attempt The nurse's first responsibility is to protect the client from injuring himself. Listening and being nonjudgmental are important elements of the nurse's communication with the client. After the client's safety has been established, he would benefit from a referral to a mental health professional.

A client in the manic phase of bipolar disorder constantly belittles other clients and demands special favors from the nurses. Which nursing intervention would be most appropriate for this client? 1. Ask other clients and staff members to ignore the client's behavior. 2. Set limits with consequences for belittling or demanding behavior. 3. Offer the client an antianxiety drug when belittling or demanding behavior occurs. 4. Offer the client a variety of stimulating activities to distract him from belittling or making demands of others.

2. Set limits with consequences for belittling or demanding behavior. To protect others from a client who exhibits belittling and demanding behaviors, the nurse may need to set limits with consequences for noncompliance. Asking others to ignore the client is likely to increase those behaviors. Offering the client an antianxiety drug or stimulating activities provides no motivation for the client to change problematic behaviors.

A client with manic episodes is taking lithium. Which electrolyte level should the nurse check before administering this medication? 1. Calcium 2. Sodium 3. Chloride 4. Potassium

2. Sodium Lithium is chemically similar to sodium. If sodium levels are reduced, such as from sweating or diuresis, lithium will be reabsorbed by the kidneys, increasing the risk of toxicity. Clients taking lithium shouldn't restrict their intake of sodium and should drink adequate amounts of fluid each day. The other electrolytes are important for normal body functions but sodium is most important to the absorption of lithium.

Which statement about somatoform pain disorder is accurate? 1. The pain is intentionally fabricated by the client to receive attention. 2. The pain is real to the client, even though there may not be an organic etiology for the pain. 3. The pain is less than would be expected from what the client identifies as the underlying disorder. 4. The pain is what would be expected from what the client identifies as the underlying disorder.

2. The pain is real to the client, even though there may not be an organic etiology for the pain. In a somatoform pain disorder, the client has pain even though a thorough diagnostic workup reveals no organic cause. The nurse must recognize that the pain is real to the client. By refusing to believe that the client is in pain, the nurse impedes the development of a therapeutic relationship based on trust. While somatoform pain offers the client secondary gains, such as attention or avoidance of an unpleasant activity, the pain isn't intentionally fabricated by the client. Even if a pathologic cause of the pain can be identified, the pain is often in excess of what would normally be expected.

A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, what is the nurse's overall goal? 1. To help the client perform self-care activities 2. To help the client function effectively in her environment 3. To help control the client's symptoms 4. To help the client participate in group therapy

2. To help the client function effectively in her environment A client with panic disorder typically confines movements to increasingly smaller areas to avoid confronting fears, which may dominate the client's life and limit everyday activities. The overall goal of care is to help the client function within the environment as effectively as possible. Panic disorder with agoraphobia doesn't impair the ability to perform self-care activities. Controlling symptoms isn't the overall goal; furthermore, helping the client function effectively will help control symptoms. Although participation in group therapy may help the client control symptoms, encouraging such participation isn't the overall goal of nursing care.

The nurse is teaching a new group of mental health aides. The nurse should teach the aides that setting limits is most important for: 1. a depressed client. 2. a manic client. 3. a suicidal client. 4. an anxious client.

2. a manic client. Setting limits for unacceptable behavior is most important in a manic client. Typically, depressed, anxious, or suicidal clients don't physically or mentally test the limits of the caregiver.

During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attack. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as: 1. barbiturates. 2. antianxiety drugs. 3. depressants. 4. amphetamines.

2. antianxiety drugs. Antianxiety drugs provide symptomatic relief. Barbiturates and amphetamines can precipitate panic attacks. Depressants aren't appropriate for treating panic attacks.

The nurse is assessing a client suffering from stress and anxiety. The most common physiologic response to stress and anxiety is: 1. sedation. 2. diarrhea. 3. vertigo. 4. urticaria.

2. diarrhea. Diarrhea is the most common physiologic response to stress and anxiety. The other options could also be related to stress and anxiety but they don't occur as frequently or as commonly as diarrhea.

In a client with a conversion disorder who reports blindness, ophthalmologic examinations reveal that no physiologic disorder is causing progressive vision loss. The most likely source of this client's reported blindness is: 1. a family history of major depression. 2. having been forced to watch a loved one's torture. 3. noncompliance with a psychotropic medication regimen. 4. daily use of antianxiety agents and alcoholic beverages.

2. having been forced to watch a loved one's torture. Conversion disorder, or hysterical neurosis, is characterized by alteration or loss of physical function with no physiological basis; the client's symptoms result from psychological conflict. For example, a client may report blindness after having observed a distressing act, such as seeing a loved one tortured. None of the other options causes conversion disorder.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to prescribe: 1. haloperidol (Haldol). 2. lorazepam (Ativan). 3. bupropion (Wellbutrin). 4. paroxetine (Paxil).

2. lorazepam (Ativan). Lorazepam is a schedule IV drug used to treat anxiety. Reducing the client's anxiety will help her cope with stress. Haloperidol is an antipsychotic agent. Bupropion is an antidepressant. Paroxetine is a selective serotonin reuptake inhibitor used to treat depression.

The nurse notices that a depressed client taking amitriptyline (Elavil) for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client: 1. is responding to the antipsychotic. 2. may be experiencing increased energy and is at an increased risk for suicide. 3. is ready to be discharged from treatment. 4. is experiencing a split personality.

2. may be experiencing increased energy and is at an increased risk for suicide. As antidepressants take effect, individuals suffering from depression may begin to feel energetic enough to mobilize a suicide plan. Option 1 is incorrect because Elavil is an antidepressant, not an antipsychotic. The client shouldn't be discharged until the risk of suicide has diminished. The elevated mood is a response to the antidepressant, not a split personality.

A client is in the manic phase of bipolar disorder. To help the client maintain adequate nutrition, the nurse should plan to: 1. provide large, attractive meals. 2. offer finger foods and sandwiches. 3. provide a stimulating mealtime environment. 4. let the client choose favorite foods.

2. offer finger foods and sandwiches. Finger foods and sandwiches help maintain adequate nutrition and provide calories for this client's high energy level. During the manic phase, the client can't sit still for the large meals specified in option 1. Option 3 is incorrect because a quiet mealtime environment is more beneficial than a stimulating one. Option 4 is inappropriate because this client has a short attention span and has trouble making choices.

The nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will: 1. demonstrate decreased anxiety. 2. participate in a daily exercise group. 3. identify the underlying reasons for rituals. 4. state that the rituals are irrational.

2. participate in a daily exercise group. Participating in a daily exercise group refocuses the client's time toward adaptive activities and may reduce anxiety. Option 1 isn't stated specifically enough to allow for evaluation; for this goal to be measurable, specific objectives must be stated such as, "The client will verbalize feeling less anxious." Option 3 is incorrect because identifying the underlying reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option 4 inappropriate as well.

A client with depression doesn't respond to drug therapy. At a team conference, staff members recommend electroconvulsive therapy (ECT). The nurse knows that most people respond emotionally to the thought of an electric current passing through the brain. Therefore, when discussing ECT with the client, the nurse should: 1. use the term "shock" in a neutral, calm manner. 2. refer to the procedure as a "treatment" instead of "shock therapy." 3. refer to the procedure as ECT. 4. explain how the convulsions are artificially induced.

2. refer to the procedure as a "treatment" instead of "shock therapy." To emphasize the therapeutic value of ECT, the nurse should refer to it as a "treatment." Although ECT is medically correct terminology, this term shouldn't be used unless the client is familiar and comfortable with it. Referring to the procedure as ECT may cause the client to focus on the disturbing elements of this treatment. Such terms as "convulsions" and "shock" tend to increase a client's anxiety and should be avoided.

A client has been severely depressed since her husband died 6 months ago. Her physician prescribes amitriptyline (Elavil), 50 mg by mouth daily. Before administering amitriptyline, the nurse reviews the client's medical history. Which preexisting condition would require cautious use of this drug? 1. Hiatal hernia 2. Hypernatremia 3. Hepatic disease 4. Hypokalemia

3. Hepatic disease Conditions requiring cautious use of amitriptyline include pregnancy, breast-feeding, suicidal tendencies, cardiovascular disease, and impaired hepatic function. Hiatal hernia, hypernatremia, and hypokalemia don't affect amitriptyline therapy.

A man brings his wife to the facility. He reports that since the death of their 7-month-old daughter 8 weeks ago, his wife has been neglecting her housework and family, has lost 20 lb (9.1 kg) from not eating, and hasn't left the house. She is admitted to the psychiatric unit with a diagnosis of depression. The nurse helps the client settle in. While observing her unpack, the nurse expects her to exhibit: 1. fast movements. 2. slow movements. 3. a desire to initiate a conversation with her roommates. 4. a desire to unpack and arrange her belongings without assistance.

2. slow movements. Typically, a depressed client exhibits slow movements and fatigue. Such a client also has difficulty interacting, making decisions, and initiating independent actions. Nursing interventions should be planned to assist and support the client, as needed, to meet needs. Although a client with agitated depression (depression with frantic pacing) may exhibit increased activity, this behavior is more common in a client with mania.

A client, age 87, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find: 1. transitory short-term memory loss and permanent long-term memory loss. 2. transitory short- and long-term memory loss and confusion. 3. permanent short-term memory loss and hypertension. 4. permanent long-term memory loss and hypomania.

2. transitory short- and long-term memory loss and confusion. ECT commonly causes transitory short- and long-term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short- and long-term memory loss. ECT is more likely to lead to hypotension than hypertension and rarely causes hypomania.

When caring for an adolescent client diagnosed with depression, the nurse should remember that depression manifests differently in adolescents and adults. In an adolescent, signs and symptoms of depression are likely to include: 1. helplessness, hopelessness, hypersomnolence, and anorexia. 2. truancy, a change of friends, social withdrawal, and oppositional behavior. 3. curfew breaking, stealing from family members, truancy, and oppositional behavior. 4. hypersomnolence, obsession with body image, and valuing of peers' opinions.

2. truancy, a change of friends, social withdrawal, and oppositional behavior. In adolescents, depression typically manifests as truancy, a change of friends, social withdrawal, and oppositional behavior. In adults, it usually produces helplessness, hopelessness, hypersomnolence, and anorexia. Drug use may lead to curfew breaking, stealing, truancy, and oppositional behavior. Adolescents normally display hypersomnolence, an obsession with body image, and valuing of peers' opinions.

An adolescent, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks the nurse, "Why has this happened to me?" What is the nurse's best response? 1. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again." 2. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." 3. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened." 4. "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."

3. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened." The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is resolved, her symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict.

To treat acute mania in a client with bipolar disorder, the physician prescribes lithium. During lithium carbonate (Lithonate) therapy, this client's serum lithium level should be maintained within which range? 1. 0.2 to 1.6 mEq/L 2. 0.8 to 1.2 mEq/L 3. 1 to 1.4 mEq/L 4. 10 to 15 mEq/L

3. 1 to 1.4 mEq/L To treat acute mania, the client's serum lithium level should range from 1 to 1.4 mEq/L. To prevent or control mania, the serum lithium level should measure 0.8 to 1.2 mEq/L. The serum lithium level shouldn't exceed 2 mEq/L. The nurse must monitor the client continuously for signs and symptoms of lithium toxicity, such as diarrhea, vomiting, drowsiness, muscular weakness, ataxia, stupor, and lethargy.

A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least: 1. 2 months. 2. 12 months. 3. 6 months. 4. 4 months.

3. 6 months. For generalized anxiety disorder, the diagnostic criteria listed in the Diagnostic and Statistical Manual of Mental Disorders, 4th edition, include unrealistic or excessive anxiety and worry about two or more life circumstances for 6 months or more, during which time these concerns exist on a majority of days.

A client with a diagnosis of major depression is prescribed clonazepam (Klonopin) for agitation in addition to an antidepressant. Client teaching would include which of the following statements? 1. Clonazepam may interact with organ meats. 2. The medications shouldn't be taken together. 3. Clonazepam is a minor depressant and may aggravate symptoms of depression. 4. The order needs to be clarified; call the physician.

3. Clonazepam is a minor depressant and may aggravate symptoms of depression. Clonazepam is a central nervous system depressant and can aggravate symptoms in depressed clients. It doesn't interact with organ meats and can be taken with antidepressant medication. There is no need to call the physician; the medications can be safely taken together.

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client? 1. Providing adequate hygiene 2. Administering a sedative as prescribed 3. Decreasing environmental stimulation 4. Involving the client in unit activities

3. Decreasing environmental stimulation This client is at increased risk for injuring himself or others. Decreasing environmental stimulation is a measure the nurse can take independently that may reduce the client's hyperactivity. If this nursing intervention is ineffective, the nurse may administer a sedative, as prescribed. Providing adequate hygiene is an appropriate nursing intervention but isn't the highest priority. Because the overall goal is to reduce the client's hyperactivity, involving the client in unit activities is contraindicated.

Which of the following is the priority when assessing a suicidal client who has ingested a handful of unknown pills? 1. Determining if the client was trying to harm himself 2. Determining if the client had a support system 3. Determining if the client's physical condition is life-threatening 4. Determining if the client has a history of suicide attempts

3. Determining if the client's physical condition is life-threatening If the client's physical condition is life-threatening, the priority is to treat the medical condition. Any compromise to the client's airway, breathing, or circulation must be addressed immediately. It's also imperative to determine the time of ingestion because this may determine treatment. The psychiatric evaluation, which includes intent to harm oneself, adequate support system, and history, can be done after the client is medically stable.

A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam? 1. Levodopa (Dopar) 2. Famotidine (Pepcid) 3. Diphenhydramine (Benadryl) 4. Norgestrel (Ovrette)

3. Diphenhydramine (Benadryl) The major drug interactions relate to the use of benzodiazepines with other central nervous system depressants such as diphenhydramine, producing additive effects. Alprazolam doesn't cause clinically significant drug interactions with levodopa, famotidine, or hormonal contraceptives such as norgestrel.

The physician orders electroconvulsive therapy (ECT) for a severely depressed client who fails to respond to drug therapy. When teaching the client and family about this treatment, the nurse should include which most important point about ECT? 1. An anesthesiologist will administer ECT. 2. ECT can cure depression. 3. ECT will induce a seizure. 4. The client will remember the shock of ECT but not the pain.

3. ECT will induce a seizure. Reserved for clients with acute depression who don't respond to pharmacologic or psychiatric measures, ECT is the passage of an electrical current through the brain to induce a brief seizure. According to ECT proponents, the seizure causes desirable changes in neurotransmitters and receptor sites similar to those caused by antidepressant drugs. ECT is administered by a physician or an anesthesiologist. Although ECT may reduce the severity of depression, it doesn't necessarily cure it. Before ECT, the client receives a medication that provides short-term amnesia of the entire event.

Before the nurse administers the first dose of lithium carbonate (Lithonate) to a client, she reviews information about the drug. Which statement accurately describes the metabolism and excretion of lithium? 1. It's metabolized in the liver and excreted in the feces. 2. It's metabolized and excreted by the kidneys. 3. It isn't metabolized and is excreted unchanged by the kidneys. 4. It's metabolized in the liver and excreted by the kidneys.

3. It isn't metabolized and is excreted unchanged by the kidneys. Lithium isn't metabolized and is excreted unchanged by the kidneys.

A client with major depression sleeps 18 to 20 hours per day, shows no interest in previously enjoyed activities, and reports a 17-lb (7.7-kg) weight loss over the past month. Because this is the client's first hospitalization, the physician is most likely to prescribe: 1. Phenelzine (Nardil). 2. Thiothixene (Navane). 3. Nortriptyline (Pamelor). 4. Trifluoperazine (Stelazine).

3. Nortriptyline (Pamelor). Nortriptyline, a tricyclic antidepressant, is used in first-time drug therapy because it causes few anticholinergic and sedative adverse effects. Phenelzine isn't prescribed initially because it may cause many adverse effects and necessitates dietary restrictions. Thiothixene and trifluoperazine are antipsychotic agents and, therefore, are inappropriate for clients with uncomplicated depression.

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time? 1. Ineffective individual coping 2. Hopelessness 3. Risk for injury 4. Disturbed identity

3. Risk for injury This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury.

The nurse is administering venlafaxine (Effexor), 75 mg by mouth daily, to a client diagnosed with depression. What type of agent is venlafaxine? 1. Monoamine oxidase inhibitor 2. Tricyclic antidepressant 3. Second-generation antidepressant 4. Lithium derivative

3. Second-generation antidepressant Physicians prescribe venlafaxine to treat depressive disorders; the drug is a second-generation antidepressant agent.

Which is the most appropriate nursing diagnosis for a grieving family? 1. Interrupted family processes 2. Powerlessness 3. Spiritual distress 4. Ineffective coping

3. Spiritual distress Spiritual distress related to experienced loss most accurately describes the problem; therefore, nursing care should be based on this diagnosis. Families may not have altered family processes or suffer from ineffective coping. Although the family may feel powerless, this isn't the most accurate diagnosis.

What herbal medication for depression, widely used in Europe, is now being prescribed in the United States? 1. Ginkgo biloba 2. Echinacea 3. St. John's wort 4. Ephedra

3. St. John's wort St. John's wort has been found to have serotonin-elevating properties, similar to prescription antidepressants. Ginkgo biloba is prescribed to enhance mental acuity. Echinacea has immune-stimulating properties. Ephedra is a naturally occurring stimulant that is similar to ephedrine.

Which nursing intervention would be most helpful for a client experiencing a panic attack? 1. Encouraging the client to identify what precipitated the attack 2. Promoting the client's interaction with others to reduce anxiety through diversion 3. Staying with the client and remaining calm, confident, and reassuring 4. Reducing intolerable stimuli by encouraging the client to stay in the room alone until the anxiety abates

3. Staying with the client and remaining calm, confident, and reassuring A panic-stricken client requires the assistance of a calm person who can provide support and direction. This is particularly important because the client already feels frightened and out of control. Having someone remain with the client helps prevent feelings of isolation and desertion. Encouraging the client to identify what precipitated the attack is futile because the client is too anxious to focus on precipitating factors. Interacting with others is difficult for an extremely anxious person. Reducing stimuli may be helpful but having the client stay alone may increase anxiety.

A client with major depression must take tranylcypromine sulfate (Parnate), a monoamine oxidase inhibitor (MAOI). During medication teaching, the nurse should instruct the client to avoid consuming: 1. free-range poultry. 2. whole grain bread. 3. aged cheese. 4. fresh fish.

3. aged cheese. When taking an MAOI, the client should avoid consuming high-tyramine foods, such as aged cheese, because the interaction may cause a life-threatening hypertensive crisis. The client may safely consume low-tyramine foods, such as poultry, whole grain bread, and fresh fish.

A client admitted to the psychiatric unit for treatment of a panic attack comes to the nurses' station in obvious distress. After finding the client short of breath, dizzy, trembling, and nauseated, the nurse should first: 1. ask what the client is upset about. 2. administer an antianxiety medication, as prescribed, and instruct the client to lie down in his room. 3. escort the client to a quiet area and suggest using a relaxation exercise that he's been taught. 4. reassure the client that the symptoms will disappear after he lies down and relaxes.

3. escort the client to a quiet area and suggest using a relaxation exercise that he's been taught. Escorting the client to a quiet area and suggesting the use of a relaxation technique helps the client gain control of symptoms while providing support and feedback. Encouraging the client to discuss the cause of anxiety, as in option 1, only increases the symptoms. Option 2 isn't the best initial action because antianxiety medications don't take effect immediately. The client may become more anxious if left alone, as in option 4.

Nursing preparations for a client undergoing electroconvulsive therapy (ECT) resemble those used for: 1. physical therapy. 2. neurologic examination. 3. general anesthesia. 4. cardiac stress testing.

3. general anesthesia. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. For example, the client should receive nothing by mouth for 8 hours before ECT to reduce the risk of vomiting and aspiration. Also, the nurse should have the client void before treatment to decrease the risk of involuntary voiding during the procedure; remove any full dentures, glasses, or jewelry to prevent breakage or loss; and make sure the client is wearing a hospital gown or loose-fitting clothing to allow unrestricted movement. Usually, these preparations aren't indicated for a client undergoing physical therapy, neurologic examination, or cardiac stress testing.

A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should: 1. talk with the client for a long time at night to reduce anxiety. 2. encourage environmental stimulation during the evening. 3. gently but firmly set limits on time spent in bed during the day. 4. encourage the client to take an antianxiety agent as needed at bedtime.

3. gently but firmly set limits on time spent in bed during the day. Setting limits on how much time the client may spend in bed and what time the client must get up in the morning lets the client know what is expected while conveying genuine concern. Talking with the client for a long time at night would interfere with sleep and give the client attention for not sleeping. Encouraging environmental stimulation in the evening would discourage rest and sleep at night. While most antianxiety agents have sedative adverse effects, they aren't intended for use as sleep-inducing agents.

A client who lost her home and dog in an earthquake tells the admitting nurse at the community health center that she finds it harder and harder to "feel anything." She says she can't concentrate on the simplest tasks, fears losing control, and thinks about the earthquake incessantly. She becomes extremely anxious whenever the earthquake is mentioned and must leave the room if people talk about it. The nurse suspects that she has: 1. phobic disorder. 2. conversion disorder. 3. posttraumatic stress disorder (PTSD). 4. adjustment disorder.

3. posttraumatic stress disorder (PTSD). PTSD may occur in survivors of earthquakes and other events outside the range of usual human experience. Typically, the victim repeatedly relives the event mentally and exhibits numbed emotional responsiveness and difficulty concentrating. PTSD also may cause an inability to function in daily life, memory impairment, chronic anxiety, insomnia, and hyperalertness. In a phobic disorder, the client fears an object or situation that doesn't present any real danger. Conversion disorder typically causes changes or losses in physical function that suggest a physical disorder but actually are expressions of a psychological conflict. In adjustment disorder, the stressor usually is less severe than in PTSD and is within the range of usual experience.

A client in the manic phase of bipolar disorder arrives at the outpatient psychiatric clinic. To help the client manage a manic episode, the nurse should suggest that she: 1. go shopping with a friend. 2. read a book in a quiet room. 3. reorganize a kitchen cabinet. 4. play a game with a few friends.

3. reorganize a kitchen cabinet. Reorganizing a kitchen cabinet or painting a picture in a quiet environment are suitable outlets for this client's excess energy. By transferring inappropriate aggressive drives into a constructive activity, these activities help the client control manic behavior. Going shopping is much too tempting for this client, who can't control her behavior and is likely to overspend. During the manic phase, a client with bipolar disorder lacks the concentration needed to read a book. Playing a competitive game may be overly stimulating and may make the client more agitated.

A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. The nurse notices that the client's hair is thinning and the skin on his forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to: 1. helping the client identify how the ritualistic behavior interferes with daily activities. 2. exploring the purpose of the ritualistic behavior. 3. setting consistent limits on the ritualistic behavior if it harms the client or others. 4. using problem solving to help the client manage anxiety more effectively.

3. setting consistent limits on the ritualistic behavior if it harms the client or others. Client safety is the paramount concern and must be maintained. Therefore, setting consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the other options are important, they take lower priority. For instance, helping the client identify how the ritualistic behavior interferes with daily activities increases the client's motivation for using more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client see this behavior as an attempt to control anxiety. As the client learns new ways to manage anxiety, the ritualistic behavior is likely to decrease.

When preparing a client for electroconvulsive therapy (ECT), the nurse should make sure that: 1. the client sees family members immediately before the procedure. 2. the client is scheduled for a brain scan immediately after the procedure. 3. the client has undergone a thorough medical evaluation. 4. the client has received lithium carbonate (Lithonate).

3. the client has undergone a thorough medical evaluation. Before an ECT treatment, the nurse should ensure that the client has had a medical evaluation that includes an ECG, a chest X-ray, neurologic and laboratory tests, and spinal X-rays, if indicated. Although making sure that the client sees family members immediately before the procedure would be appropriate, it's unnecessary (unless the client requests this). A brain scan isn't required after ECT because it can't evaluate the therapeutic effects of this treatment. Lithium must be discontinued before ECT because it prolongs the effects of succinylcholine chloride (Anectine), a muscle relaxant given just before the shock is delivered.

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)? 1. "Discontinue the medication immediately if you experience nausea." 2. "Notify the physician if you experience urine retention." 3. "Apply sunscreen to prevent photosensitivity." 4. "Inform the physician if you become pregnant or intend to do so."

4. "Inform the physician if you become pregnant or intend to do so." Because alprazolam is contraindicated during pregnancy, the client should be instructed to inform the physician if she becomes pregnant. Nausea, urine retention, and photosensitivity are adverse reactions that may occur, but aren't contraindications.

During the admission assessment, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response? 1. "Just calm down. You're getting overly anxious." 2. "What do you think is causing your panic attack?" 3. "You can rest alone in your room until you feel better." 4. "You're having a panic attack. I'll stay here with you."

4. "You're having a panic attack. I'll stay here with you." During a panic attack, the nurse's best approach is to orient the client to what is happening and provide reassurance that the client won't be left alone. The anxiety level is likely to increase and the panic attack is likely to continue if the client is told to calm down (as in option 1), asked the reasons for the attack (as in option 2), or left alone (as in option 3).

How long after amitriptyline (Elavil) therapy begins can the nurse expect the client to show improved psychological symptoms? 1. 2 to 4 days 2. 4 to 6 days 3. 6 to 8 days 4. 10 to 14 days

4. 10 to 14 days Because tricyclic antidepressants have long half-lives, a noticeable response may not occur for 10 to 14 days; a full response may take up to 30 days.

A client diagnosed with anxiety disorder is prescribed buspirone (BuSpar). Teaching instructions for newly prescribed buspirone should include which of the following? 1. A warning that immediate sedation can occur with a resultant drop in pulse 2. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug 3. A warning about the incidence of neuroleptic malignant syndrome (NMS) 4. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days

4. A warning about the drug's delayed therapeutic effect, which occurs in 14 to 30 days The client should be informed that the drug's therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Blood level checks aren't necessary. NMS hasn't been reported with this drug, but tachycardia is frequently reported.

During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention would be best? 1. Encourage participation in milieu activities. 2. Encourage work on a craft project in the client's room. 3. Encourage the client to lie down on the bed; then turn off the lights and leave the room. 4. Accompany the client to his room; remain there and provide instructions in short, simple statements.

4. Accompany the client to his room; remain there and provide instructions in short, simple statements. During a panic attack, interventions should focus on decreasing anxiety. Therefore, the best nursing intervention is to stay with the client in a less stimulating environment, such as the client's room, and maintain a calm but direct and professional manner. Because the client feels flooded with stimuli during a panic attack, the nurse should remove the client from the milieu. The client also may tremble and have difficulty concentrating, so working on a craft project would be impossible. Being left alone could exacerbate panic symptoms.

A client on the behavioral health unit tells the nurse that she experiences palpitations, trembling, and nausea while traveling alone, outside her home. These symptoms have severely limited her ability to function and have caused her to avoid leaving home whenever possible. The nurse recognizes that this client has symptoms of what disorder? 1. Thanatophobia 2. Aerophobia 3. Hodophobia 4. Agoraphobia

4. Agoraphobia Agoraphobia is a phobia, or fear, and avoidance of open spaces accompanied by the concern that escape to safety would be difficult or embarrassing. It's commonly accompanied by physical symptoms, such as palpitations, trembling, nausea, and shortness of breath. It's also commonly accompanied or preceded by panic attacks. Thanatophobia is the fear of death; aerophobia, the fear of air; and hodophobia, the fear of traveling.

Which characteristic is most common among suicidal clients? 1. Psychosis 2. Remorse 3. Anger 4. Ambivalence

4. Ambivalence One of the most common features shared by most suicidal persons is ambivalence, an internal struggle between self-preserving and self-destructive forces. These doubts are expressed when a person threatens or attempts suicide and then tries to get help to be saved. When the possible consequences of suicide are discussed with such persons, they commonly describe life-related outcomes such as relief from an unhappy situation. Many people consider suicide an alternative to present circumstances, but they may not have considered the implications of no longer living. A psychotic person may or may not have suicidal tendencies. Remorse and anger may be associated with depression but aren't universally present in suicidal persons.

A 54-year-old female was found unconscious on the floor of her bathroom with self-inflicted wrist lacerations. An ambulance was called and the client was taken to the emergency department. When she was stable, the client was transferred to the inpatient psychiatric unit for observation and treatment with antidepressants. Now that the client is feeling better, which nursing intervention is most appropriate? 1. Observe for extrapyramidal symptoms. 2. Begin a therapeutic relationship. 3. Cancel any no-suicide contracts. 4. Continue suicide precautions.

4. Continue suicide precautions. As antidepressants begin to take effect and the client feels better, she may have the energy to initiate and complete another suicide attempt. As the client's energy level increases, the nurse must continue to be vigilant to the risk of suicide. Extrapyramidal symptoms may occur with antipsychotics and aren't adverse effects of antidepressants. A therapeutic relationship should be initiated upon admission to the psychiatric unit, after suicide precautions have been instituted. It's through this relationship that the client develops feelings of self-worth and trust and problem solving takes place. In a no-suicide contract, the client states verbally or in writing that she won't attempt suicide and will seek out staff if she has suicidal thoughts. When the time period for a contract has expired, a new contract should be obtained from the client.

A client is admitted to the local psychiatric facility with bipolar disorder in the manic phase. The physician decides to start the client on lithium carbonate (Lithonate) therapy. One week after this therapy starts, the nurse notes that the client's serum lithium level is 1 mEq/L. What should the nurse do? 1. Call the physician immediately to report the laboratory result. 2. Observe the client closely for signs and symptoms of lithium toxicity. 3. Withhold the next dose and repeat the laboratory test. 4. Continue to administer the medication as ordered.

4. Continue to administer the medication as ordered. The serum lithium level should be maintained between 1 and 1.4 mEq/L during the acute manic phase; therefore, the nurse should continue to administer the medication as ordered. Unless the client has signs or symptoms of lithium toxicity, the nurse has no need to call the physician, withhold the medication, or repeat the laboratory test. Nonetheless, the nurse should continue to monitor the client's serum lithium level and watch for indications of toxicity if the level begins to rise.

Victims of sexual assault can experience posttraumatic stress reactions after the attack. Which statement best describes symptoms associated with posttraumatic stress disorder (PTSD)? 1. Denial of the event 2. Anger, guilt, and humiliation 3. Fatigue and self-blame 4. Flashbacks, recurring dreams, and numbness

4. Flashbacks, recurring dreams, and numbness Posttraumatic stress involves recurring dreams about the event or flashbacks to the event. The victims feel a general sense of numbness and estrangement from others. Emotional reactions such as denial of the event, anger, guilt, humiliation, fatigue, and self-blame are all normal feelings after rape but aren't consistent with PTSD.

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs? 1. Beta-adrenergic blockers 2. Antineoplastic drugs 3. Antiparkinsonian drugs 4. Monoamine oxidase (MAO) inhibitors

4. Monoamine oxidase (MAO) inhibitors Buspirone interacts only with MAO inhibitors, producing a hypertensive reaction. Administration of beta-adrenergic blockers, antineoplastic drugs, or antiparkinsonian drugs wouldn't cause an interaction, so they can be administered simultaneously with buspirone.

The physician orders lithium carbonate (Lithonate) for a client who's in the manic phase of bipolar disorder. During lithium therapy, the nurse should watch for which adverse reactions? 1. Weakness, tremor, and urine retention 2. Anxiety, restlessness, and sleep disturbance 3. Constipation, lethargy, and ataxia 4. Nausea, diarrhea, tremor, and lethargy

4. Nausea, diarrhea, tremor, and lethargy The most common adverse effects of lithium are nausea, diarrhea, tremor, and lethargy. Lithium doesn't cause weakness, tremor, urine retention, anxiety, restlessness, sleep disturbance, constipation, or ataxia.

Which adverse reaction to lithium should the client with bipolar disorder report? 1. Black tongue 2. Increased tearing 3. Periods of disorientation 4. Persistent GI upset

4. Persistent GI upset Persistent GI upset indicates a mild to moderate toxic reaction that should be reported. Black tongue is an adverse reaction to mirtazapine (Ramaron), not lithium. Increased tearing isn't an adverse reaction to lithium. Periods of disorientation don't occur with lithium use.

A client on the behavioral health unit confides in a nurse that she was raped 5 months before. During the nurse's assessment of her sleep patterns, the client complains of having difficulty falling and staying asleep. She attributes her irritability to sleep deprivation. Further questioning reveals that the client can't recall details of the rape, and feels detached when she has sex with her husband. The nurse recognizes that this client is experiencing symptoms of what disorder? 1. Antisocial personality disorder 2. Cypridophobia 3. Anhedonia 4. Posttraumatic stress disorder (PTSD)

4. Posttraumatic stress disorder (PTSD) PTSD is characterized by a pattern of symptoms resulting from exposure to a traumatic event. These symptoms last more than a month, distinguishing this client's disorder from acute stress disorder, which resolves within a month. Common symptoms of PTSD include intense fear, helplessness, or horror related to the trauma; recurrent and disturbing recollections or dreams of the trauma; avoidance of situations related to the trauma; symptoms of arousal such as difficulty falling or staying asleep; irritability; and an exaggerated startle response. Clients with antisocial personality disorder show little concern for others and no moral standards. Cypridophobia is an anxiety disorder in which the client has an overwhelming fear of sexual intercourse. Anhedonia is defined as the absence of pleasure from acts that ordinarily produce pleasure. Anhedonia is typically a symptom of depression.

After an upsetting divorce, a client threatens to commit suicide with a handgun and is involuntarily admitted to the psychiatric unit with major depression. Which nursing diagnosis takes highest priority for this client? 1. Hopelessness related to recent divorce 2. Ineffective coping related to inadequate stress management 3. Spiritual distress related to conflicting thoughts about suicide and sin 4. Risk for self-directed violence related to planning to commit suicide with a handgun

4. Risk for self-directed violence related to planning to commit suicide with a handgun Although all of these options may apply to this client, safety is the nurse's first priority in caring for any suicidal client. The nurse can address the client's hopelessness, ineffective coping, and spiritual distress later in therapy.

Before eating a meal, a client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom light on and off 44 times. What is the most appropriate goal of care for this client? 1. Omit one unacceptable behavior each day. 2. Increase the client's acceptance of therapeutic drug use. 3. Allow ample time for the client to complete all rituals before each meal. 4. Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.

4. Systematically decrease the number of repetitions of rituals and the amount of time spent performing them. When caring for a client with OCD, the goal is to systematically decrease the undesirable behavior. (Therapy may not completely extinguish certain behaviors.) Expecting to omit one behavior each day is unrealistic because the client may have used ritualistic behaviors to reduce anxiety for a long time. Drugs may become a source of obsession and must be used with caution. Allowing time for rituals would perpetuate the undesirable behaviors.

A client with bipolar disorder has been taking lithium carbonate (Lithonate), as prescribed, for the past 3 years. Today, family members brought this client to the hospital. The client hasn't slept, bathed, or changed clothes for 4 days; has lost 10 lb (4.5 kg) in the last month; and woke the entire family at 4 a.m. with plans to fly them to Hawaii for a vacation. Based on this information, what can the nurse assume? 1. The family isn't supportive of the client. 2. The client has stopped taking the prescribed medication. 3. The client hasn't accepted the diagnosis of bipolar disorder. 4. The lithium level should be measured before the client receives the next lithium dose.

4. The lithium level should be measured before the client receives the next lithium dose Measuring the lithium level is the best way to evaluate the effectiveness of lithium therapy and begin to assess the client's current status. The other options may contribute to the client's manic episode, but the nurse can't assume them to be true until after assessing the client and family more fully.

Which classification of drugs is the most potentially fatal if the client takes an overdose? 1. Antihistamines 2. Dopaminergics 3. Phenothiazine antipsychotics 4. Tricyclic antidepressants

4. Tricyclic antidepressants Tricyclic antidepressants can create fatal cardiac arrhythmias. Overdose of the other medications is rarely fatal.

When teaching a group of nurses about posttraumatic stress disorder (PTSD), a nurse-educator explains that this disorder is most common in: 1. is most common in men ages 30 to 40. 2. is most common in women ages 30 to 40. 3. is most common in men ages 20 to 30. 4. can occur in any age group.

4. can occur in any age group. PTSD, the psychological consequence of a traumatic event outside the range of usual human experience, can occur in persons of any age, including children.

A young man brought to the emergency department by a police officer states, "I don't know who or where I am." He has no identification but appears to be in good physical health. Physical examination reveals no evidence of trauma or other abnormal findings. He is admitted to the psychiatric unit for further evaluation and treatment. The nurse anticipates that the client will react to his inability to recall his identity by exhibiting: 1. an intense preoccupation with discovering who he is. 2. depression. 3. anger and frustration. 4. complacency.

4. complacency. Because a client with psychogenic amnesia is successfully blocking a traumatic or severe anxiety-producing event, he is likely to react to his inability to recall his identity with complacency. He won't have an intense desire to discover who he is because learning his identity would force him to remember the event and confront the anxiety. For the same reason, he won't exhibit depression or anger, both of which are associated with anxiety-producing events.

A client visits the physician's office to seek treatment for depression, feelings of hopelessness, poor appetite, insomnia, fatigue, low self-esteem, poor concentration, and difficulty making decisions. The client states that these symptoms began at least 2 years ago. Based on this report, the nurse suspects: 1. cyclothymic disorder. 2. atypical affective disorder. 3. major depression. 4. dysthymic disorder.

4. dysthymic disorder. Dysthymic disorder is marked by feelings of depression lasting at least 2 years, accompanied by at least two of the following symptoms: sleep disturbance, appetite disturbance, low energy or fatigue, low self-esteem, poor concentration, difficulty making decisions, and hopelessness. These symptoms may be relatively continuous or separated by intervening periods of normal mood that last a few days to a few weeks. Cyclothymic disorder is a chronic mood disturbance of at least 2 years' duration marked by numerous periods of depression and hypomania. Atypical affective disorder is characterized by manic signs and symptoms. Major depression is a recurring, persistent sadness or loss of interest or pleasure in almost all activities, with signs and symptoms recurring for at least 2 weeks.

The nurse discovers that a client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. Based on this finding, the nurse should assess the client for: 1. feelings of failure. 2. depression. 3. excessive fear. 4. increased anxiety.

4. increased anxiety. An obsessive-compulsive client who attempts to resist the compulsion must be evaluated for increased anxiety. A compulsion is a repetitive, intentional behavior that the client performs in response to a certain obsession; it's aimed at neutralizing or decreasing anxiety. Resisting the compulsion may increase the client's anxiety. Although a client with OCD may have feelings of failure, depression, and excessive fear, these aren't responses to resisting the compulsion.

The physician prescribes lithium carbonate (Eskalith) for a client who has just been diagnosed with bipolar disorder. Now the nurse is teaching the client about signs and symptoms of lithium toxicity, which include: 1. skeletal muscle contractions, cogwheel rigidity, and a thick tongue. 2. dry mouth, blurred vision, and urine retention. 3. edema, orthostatic hypotension, and rash. 4. lethargy, vomiting, and diarrhea.

4. lethargy, vomiting, and diarrhea. Lethargy is an early sign of lithium toxicity; if it goes undetected, vomiting and diarrhea soon develop. Lithium doesn't cause extrapyramidal effects, such as skeletal muscle contractions, cogwheel rigidity, and a thick tongue, or cholinergic effects, such as dry mouth, blurred vision, and urine retention. The drug also doesn't cause edema, orthostatic hypotension, or rash.

The nurse is caring for a client with manic depression. The care plan for a client in a manic state would include: 1. offering high-calorie meals and strongly encouraging the client to finish all food. 2. insisting that the client remain active through the day so that he'll sleep at night. 3. allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits. 4. listening attentively with a neutral attitude and avoiding power struggles.

4. listening attentively with a neutral attitude and avoiding power struggles. The nurse should listen to the client's requests, express willingness to seriously consider the request, and respond later. The nurse should encourage the client to take short daytime naps because he expends so much energy. The nurse shouldn't try to restrain the client when he feels the need to move around as long as his activity isn't harmful. High-calorie finger foods should be offered to supplement the client's diet if he can't remain seated long enough to eat a complete meal. The client shouldn't be forced to stay seated at the table to finish a meal. The nurse should set limits in a calm, clear, and self-confident tone of voice.

The nurse is caring for a client who's suicidal. When accompanying the client to the bathroom, the nurse should: 1. give him privacy in the bathroom. 2. allow him to shave. 3. open the window and allow him to get some fresh air. 4. observe him.

4. observe him. The nurse has a responsibility to observe continuously the acutely suicidal client — not provide privacy. The nurse should watch for clues, such as communicating suicidal thoughts, threats, and messages; hoarding medications; and talking about death. By accompanying the client to the bathroom, the nurse will naturally prevent hanging or other injury. The nurse will check the client's area and fix dangerous conditions, such as exposed pipes and windows without safety glass. The nurse will also remove potentially dangerous objects, such as belts, razors, suspenders, glass, and knives.

A client with obsessive-compulsive disorder tells the nurse that he must check the lock on his apartment door 25 times before leaving for an appointment. The nurse knows that this behavior represents the client's attempt to: 1. call attention to himself. 2. control his thoughts. 3. maintain the safety of his home. 4. reduce anxiety.

4. reduce anxiety. A compulsion is a repetitive act or impulse. Carrying out a compulsion helps a person reduce anxiety unconsciously. An obsessive-compulsive client doesn't want to call attention to himself and can't control his thoughts. This client's priority is to reduce anxiety — not maintain the safety of the home.

A client refuses his evening dose of haloperidol (Haldol), then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is to: 1. check the client's medical record for an order for an I.M. as needed dose of medication for agitation. 2. place the client in full leather restraints. 3. call the physician and report the behavior. 4. remove all other clients from the day room.

4. remove all other clients from the day room. The nurse's first priority is to consider the safety of the clients in the therapeutic setting. The other actions are appropriate responses after ensuring the safety of other individuals.

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with: 1. physical signs and symptoms with no physiologic cause. 2. apprehension. 3. inability to concentrate. 4. repetitive thoughts and recurring, irresistible impulses.

4. repetitive thoughts and recurring, irresistible impulses. OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders.

A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium (Seconal), 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that: 1. sedatives cause predictable responses; hypnotics cause unpredictable ones. 2. sedatives interact with few drugs; hypnotics interact with many. 3. sedatives don't depress respirations; hypnotics do. 4. sedatives reduce excitement; hypnotics induce sleep.

4. sedatives reduce excitement; hypnotics induce sleep. Sedatives are drugs that act to reduce activity or excitement, calming a client. Hypnotics induce a state resembling natural sleep.

According to Freud's psychosexual theory, the ego has several functions. The primary function of the ego is to: 1. serve as the source of instinctual drives. 2. stimulate psychic energy. 3. operate as a conscience that controls unacceptable drives. 4. test reality and direct behavior.

4. test reality and direct behavior. The ego tests reality and directs behavior by mediating between the pleasure-seeking instinctual drives of the id and the restrictiveness of the superego. The superego also is called the conscience. The id is the source of psychic energy.

A client with a diagnosis of depression is started on imipramine (Tofranil), 75 mg by mouth at bedtime. The nurse should tell the client that: 1. this medication may be habit forming and will be discontinued as soon as the client feels better. 2. this medication has no serious adverse effects. 3. the client should avoid eating such foods as aged cheeses, yogurt, and chicken livers while taking the medication. 4. this medication may initially cause tiredness, which should become less bothersome over time.

4. this medication may initially cause tiredness, which should become less bothersome over time. Sedation is a common early adverse effect of imipramine, a tricyclic antidepressant, and usually decreases as tolerance develops. Antidepressants aren't habit forming and don't cause physical or psychological dependence. However, after a long course of high-dose therapy, the dosage should be decreased gradually to avoid mild withdrawal symptoms. Serious adverse effects, although rare, include myocardial infarction, heart failure, and tachycardia. Dietary restrictions, such as avoiding aged cheeses, yogurt, and chicken livers, are necessary for a client taking a monoamine oxidase inhibitor, not a tricyclic antidepressant.

Initial interventions for the client with acute anxiety would not include: 1. providing the client with a safe, quiet, and private place 2. encouraging the client to verbalize feelings and concerns 3. approaching the client in a calm, confident manner 4. touching the client in an attempt to comfort him

4. touching the client in an attempt to comfort him The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Trust can be established by approaching the client in a calm and confident manner; providing a place that is quiet, safe, and private; and encouraging the client to verbalize feelings and concerns.