Mental Health Practice Questions

Which best describes disenfranchised grief? Grief that is accompanied with physical complaints Grief over a loss that cannot be publicly shared Grieving in a manner that does not follow normal patterns Grieving over something that has yet to happen

Grief over a loss that cannot be publicly shared Disenfranchised grief describes grief that a person feels but that cannot be shared with others. For example, a person may privately grieve over something that he feels he cannot tell anyone about. Although the grief is secretive and private, the person still feels the grief.

A nurse is assisting a client who has undergone electroconvulsive therapy for treatment of severe depression. Following the procedure, the client develops postictal agitation. Based on the nurse's knowledge of this condition, the nurse would expect to see which of the following? Limb contractures Incoherence, disorientation, and motor restlessness Coma Hyperactivity and mania

Incoherence, disorientation, and motor restlessness Electroconvulsive therapy (ECT) is a form of treatment for some severe kinds of mental illness, including depression. The client is sedated and receives a dose of electrical current in the brain. The nurse does not administer the ECT but cares for the client before, during, and after the procedure. If postictal agitation develops following the ECT, the nurse would most likely expect to see the client being incoherent, disoriented, and having motor restlessness.

A nurse is assessing a client who is being seen for malnutrition associated with a history of anorexia. Which of the following characteristics of the nervous system would the nurse expect to see in this client? Confusion and stupor Hyperactive reflexes Dilated pupils Peripheral neuropathy

Peripheral neuropathy Anorexia is the purposeful withholding of food, over for means of control over the body and for weight loss. A client with anorexia may suffer significant malnutrition from decreased intake. Malnutrition can manifest throughout different body systems. Neurological symptoms of anorexia include peripheral neuropathy, hyporeflexia, and motor weakness.

A nurse arrives at work in the psychiatric unit and is given the assignments for the day. The nurse has a client who is experiencing delirium tremens after alcohol withdrawal and needs medication, a client who will be undergoing ECT later that day, a client with obsessive-compulsive disorder who has not had breakfast yet, and a client who needs to go to eating disorder group therapy. Which client should the nurse see first? The client with delirium tremens The client going to group therapy The client receiving ECT later The client who needs breakfast

The client with delirium tremens A nurse must prioritize care to treat the clients with the highest needs first. In this situation, the client who is suffering from delirium tremens (DTs) may be hemodynamically unstable and should be seen first.

The parents of a 2-year-old child who died of leukemia are experiencing intense grief in the months following the death. Which of the following is a factor that would affect how these parents experience grief? The life history of the person who died The personality of the grieving person The illness of the person who died The gender of the deceased person

The personality of the grieving person Although everyone grieves in different ways, there are a number of factors that are common to the experience of grief and that can affect how a person grieves over a loss. Factors such as the personality of the grieving person, the age and gender of the grieving person, and the person's religious or cultural beliefs all affect how he or she will grieve over a loss as well as the time it takes to move through the grief stages.

While working with a client who is experiencing acute alcohol withdrawal, a nurse performs an assessment by asking the client to drink a glass of water. Which best explains the significance of this test? To see if the client has polydipsia To determine if the client can follow directions To check for hand tremor in the client To assess the client's cognitive ability

To check for hand tremor in the client Acute alcohol withdrawal can cause significant physical effects for the client which the nurse must assess and document. One method of assessing tremor is to ask the client to drink a glass of water. If the client's hand shakes while drinking the water, the nurse can document that the client is experiencing tremor as part of alcohol withdrawal

The nurse is working in the emergency department caring for a client with delirium tremens and severe alcohol withdrawal. Which question is the priority? When was your last drink and how much do you usually drink? Has this ever happened before when you tried to stop? Do you go to AA? Have you stopped for good?

When was your last drink and how much do you usually drink? Alcohol withdrawal syndrome typically worsens over a period of 2-3 days. The nurse must find out when the client took their last drink in order to anticipate and plan care for the client during withdrawals. These can be life-threatening with symptoms that must be managed medically.

A nurse is caring for a woman whose mother died six months ago and who is grieving over the loss. The nurse assesses the woman for any signs of complicated grief patterns. Based on the nurse's understanding of this condition, the nurse knows to look for what signs that indicate complicated grief? Select all that apply. Lack of emotion such as crying or sorrow A lack of trust in others A complete focus on the deceased person An increase in sexual activity Feelings of detachment from the world

A complete focus on the deceased person A lack of trust in others Feelings of detachment from the world Complicated grief describes a situation in which a person is not coping with grief in a normal manner. A person who is experiencing complicated grief may focus solely on the loss and on nothing else, may show a lack of trust in others and may demonstrate detachment from subjects or activities that once brought enjoyment. These symptoms are evident at least six months after the loss of the loved one, and persist for at least one month.

A client is scheduled for surgery and admits that he has never been so anxious in his life. Which of the following symptoms are common for a client in this situation? Select all that apply. Headache Blurry vision Nausea Chest pain Tachycardia

Headache Nausea Chest pain Tachycardia Symptoms of extreme anxiety include headache, GI symptoms, chest pain, trembling, trouble concentrating, and tachycardia. The nurse should maintain a calm presence for the client, and promote relaxation techniques. Blurred vision is not a common symptom experienced with extreme anxiety. Nausea often accompanies prolonged anxiety or stress. Chest pain can be a symptom of extreme anxiety. Tachycardia often described as a "racing heart", can be a symptom of extreme anxiety.

A client is undergoing acute alcohol withdrawal and is experiencing delirium tremens. Which nursing diagnosis would most likely be associated with this condition? Readiness for Enhanced Nutrition Impaired Urinary Elimination Activity Intolerance Ineffective Thermoregulation

Ineffective Thermoregulation Delirium tremens can develop as part of acute alcohol withdrawal as the body is undergoing detoxification. Symptoms include delirium, sweating, fever, restlessness, seizures, and increased pulse and breathing. The delirium usually peaks between 48 to 72 hours after the client's last drink, and can last for two to three days.

A client is being seen for care at her primary care clinic. The client tells the nurse that she has difficulty sleeping because of nightmares. Identify which description best explains the difference between night terrors and nightmares. Night terrors result in the person waking up while nightmares result in the person staying asleep Night terrors cause a person to sleep walk while nightmares usually result in thrashing in bed Night terrors are frightening but are not remembered by the client, while nightmares can be easily remembered Night terrors are the sign of a more significant mental illness while nightmares are considered benign

Night terrors are frightening but are not remembered by the client, while nightmares can be easily remembered Night terrors and nightmares are two types of sleep problems whose terms are often used interchangeably, but they are different. When a person has night terrors, he may sit up in bed and open his eyes, but is not actually awake. The next day, the person typically does not remember the episode. During a nightmare, the person may be awakened from REM sleep and is able to recall the dream. The person is typically able to remember the nightmare the next day.

A nurse has given her client a nursing diagnosis of Anxiety because of her behavior when she found out that she was pregnant. Which of the following interventions would be most appropriate for this type of nursing diagnosis? Select all that apply. Reassure the client that she is safe Assist the client with identifying coping mechanisms Assist with admitting the client to the psychiatric unit Encourage the client to talk Maintain a calm demeanor

Reassure the client that she is safe Assist the client with identifying coping mechanisms Encourage the client to talk Maintain a calm demeanor Anxiety is a state of hyperarousal that occurs in response to fear or to a threat. The client who experiences anxiety needs the nurse to remain calm and to provide reassurance. In this situation, the nurse could also help the client to assess her coping mechanisms and encourage her to calmly talk about her situation. In this situation, the nurse could also help the client to assess her coping mechanisms and encourage the client to use those coping mechanisms. Encouraging the client to talk will help the client to identify the possible sources of anxiety and available coping mechanisms. The nurse should remain calm in order to communicate therapeutically with the client experiencing anxiety.

A client is experiencing an anxiety attack. The nurse reviews the client's home medications and notes that they take an anti-anxiety medication. Which of the following medications is likely prescribed to this client? Alprazolam Alendronate Amiodarone Amitryptiline

Alprazolam This medication, also called Xanax, is a benzodiazepine that is used to relieve anxiety and calm the nerves

A client informs the nurse that he is hearing voices. What is the first action the nurse should take? Tell the client the voices are not real Distract the client with the nice weather outside Ask the client what the voices are saying Ignore the client so they know you are not going to play games

Ask the client what the voices are saying When a client is experiencing auditory hallucinations, the nurse should not reinforce the hallucination, or tell the client that there are no voices. Instead, the nurse should find out what the voices are saying to get an idea of any safety concerns.

The nurse is caring for a client admitted for alcohol addiction. Which of the following questions is the priority at this time? "Have you ever purposefully hurt yourself or tried to end your life?" "Does anyone else in your family also suffer from alcohol addiction?" "Have you ever been to treatment for this addiction?" "Have you had any legal consequences because of your addiction?"

"Have you ever purposefully hurt yourself or tried to end your life?" Self-harm and suicide assessment is critical for clients who suffer from alcohol addiction. This client may require a sitter and additional support if they have suicidal ideation

The nurse is caring for a client who presents to the ER with complaints of a fall with a laceration to the right arm. The client is slurring their speech. All vital signs are within normal limits. Which substance should be suspected in this client? Alcohol Methamphetamine Heroin Cocaine

Alcohol A client who has abused alcohol presents with slurred speech. They will have the smell of alcohol and often sustain injuries while intoxicated. Methamphetamine (meth) usage also results in dilated pupils, but this client will have dry mouth, appear thin, and malnourished. Many also pick at their skin. Usage of heroin results in a client who appears to be sleepy with very small pupils. A client who has abused cocaine will generally appear as overly energetic with an increased heart rate and dilated pupils.

A 35-year-old client is undergoing a lower limb amputation after a crushing injury. Which best describes how the nurse can support the client's anticipated grief during this time? Help the client to wrap the extremity to take care of it Have the client look at images of people who have lost a limb to get used to it Ask the provider for medications to manage anxiety Assist the client to verbalize feelings related to the loss of a body part

Assist the client to verbalize feelings related to the loss of a body part A client who has undergone an amputation may be suffering from grief and loss associated with loss of the limb. The client may need time to talk about the loss and to accept the change in body appearance, as well as the change in physical function. The nurse can help the client by facilitating conversation about the loss, helping the client to verbalize feelings and by providing information about support groups or counseling.

A 23-year-old client is being seen for treatment after purposely cutting the skin on her arm. The client has impulsive behavior, is angry, and has been losing friends because of intense and needy behavior. Which type of personality disorder does this best describe? Schizotypal personality disorder Borderline personality disorder Antisocial personality disorder Histrionic personality disorder

Borderline personality disorder A borderline personality disorder is manifested by varying degrees of moodiness, neediness, and self-image. The client with a borderline personality disorder has mood instability and is often emotionally unstable in his or her behavior and relationships. The condition can also lead to acute psychotic episodes that can be dangerous, such as when a client purposely self-mutilates.

A nurse is working with a client who has schizophrenia. The client is demonstrating clang associations. Which of the following statements by the client best displays this speech alteration? I was just flippering and flitoning today Bye, lie, die, sky, bye, bye, and rye Did you see where that blue salad orchid went? I want to see the bird jump in blue work by the ocean's pole

Bye, lie, die, sky, bye, bye, and rye Clang associations are alterations in speech patterns that are associated with schizophrenia and bipolar disorder. A client who demonstrates clang associations may use meaningless rhyming words, such as bye, lie, die, etc.

A nurse is caring for a client with bipolar disorder who is frequently manic. What describes the most appropriate psychotherapy for a client with this condition? Select all that apply. Family focused therapy Electroconvulsive therapy Interpersonal and social rhythm therapy 12-step programs Cognitive-behavior therapy

Cognitive-behavior therapy Interpersonal and social rhythm therapy Family focused therapy Bipolar disorder is a mental health condition in which a client suffers mood swings that range from mania to severe depression. There are a number of different psychotherapy treatment methods to control symptoms, cognitive-behavior therapy, psychoeducation, family-focused therapy, and interpersonal and social rhythm therapy. These methods focus on stabilization of daily rhythms, understanding the bipolar condition, sticking with the treatment plan and identifying any triggers or unhealthy beliefs that can lead to problems.

A nurse is caring for a client who is hospitalized in a very busy unit. The client complains to the nurse that it is too noisy to sleep and that he is not getting rest. Which of the following nursing interventions is most appropriate to better help this client sleep? Help the client to choose foods on the menu that promote sleep, such as broccoli Provide instructions to the client about the importance of going to bed and getting up at the same time every day Encourage the client to verbalize his sleep difficulties Evaluate for the appropriate timing of client care tasks

Evaluate for the appropriate timing of client care tasks

A nurse is helping a client who has been developing dementia. The client expresses fears about his condition to the nurse. Which nursing interventions would be most appropriate in this case? Select all that apply. Help orient the client to reality Gently provide assistance with communication when needed Use simple, short words Support and reassure the client Avoid activities that tax the client's memory

Gently provide assistance with communication when needed Support and reassure the client Avoid activities that tax the client's memory A client who is developing dementia may feel extremely fearful about his condition. The nurse can best work with this client by gently providing assistance when needed and giving support and reassurance where necessary. It is important for the nurse to avoid activities requiring excessive memory on the part of the client.

Common symptoms of impending suicide include which of the following? Select all that apply. Interacting with peers Sudden improvement in a depressed client Giving away belongings Changing a will Canceling social engagements

Giving away belongings Sudden improvement in a depressed client Changing a will Canceling social engagements Clients who are at risk for suicide have overwhelming feelings of hopelessness, guilt or worthlessness. If the nurse sees signs that a client may be suicidal, or the client says things that cause the nurse to be suspicious of suicidal intent, the provider should be notified because the client will need to be monitored closely while in the hospital.

A nurse is performing depression screenings in the community. Which question would most likely be included in this screening? Are you trying to lose weight? Do you believe that others are talking or thinking about you? Have you been having trouble sleeping? Do you hear voices or have hallucinations?

Have you been having trouble sleeping? Depression screenings are designed to assess large numbers of people for basic information that can point out whether someone is at risk of the illness. When assessing for depression, the nurse should ask broad questions to the larger group and then narrow down the questions to be more focused among those at higher risk. A broad question to ask in the beginning would include sleep difficulties, which can be a sign of depression.

A client is suffering from stress and anxiety and is being seen at a healthcare clinic for help and management. Which best describes the initial physical effects of stress and anxiety in the body? Select all that apply. Increased heart rate Pinpoint pupils Vasodilation Changes in appetite Increased respiratory rate

Increased heart rate Changes in appetite Increased respiratory rate Increased levels of stress and anxiety result in the fight or flight response. Initially, the effects of anxiety cause a stress response of a rapid heart rate and increased respiratory rate. The client may report changes in appetite, which could include overeating or undereating. The nurse should be aware of the acute effects of stress that an anxious client may demonstrate when seeking care in order to best provide a calming environment that can prevent worsening of symptoms. As a result of stress, the client may report changes in appetite, which could include overeating or undereating. Initially, the effects of anxiety cause a stress response of a rapid heart rate and increased respiratory rate.

Which medical condition has been shown to cause dementia in some adults? Lyme disease Trichomonas Varicella Tuberculosis

Lyme disease Some infectious illnesses, beyond causing certain physical symptoms, may also cause symptoms of mental illness. Infection with Lyme disease, for example, has been shown to cause cognitive changes that are similar to dementia in some adults.

The nurse is caring for a client who is an alcoholic with a history of seizures while going through withdrawals. The nurse is setting up the room and implementing seizure precautions. Which of the following does the nurse ensure is included in the client's plan of care? Call light within reach Padded side rails PRN pain medication ordered Head of bed at 45 degrees

Padded side rails Seizure precautions include padding side rails, making sure suction is set up, and anti-seizure medications are ordered in the client's MAR. For the client, make sure they wear non-constrictive clothing and to be cautious with PO intake.

A client in the psychiatric unit has been diagnosed with severe, intractable depression and is preparing to undergo electroconvulsive therapy (ECT). Which best describes the role of the nurse during ECT? Select all that apply. Note the location of resuscitative equipment on the nursing unit in case of need Prepare the client for applying EEG leads to the head Record the length of time of the client's seizure Administer oxygen as needed Notify the provider immediately if the client is confused following the procedure

Prepare the client for applying EEG leads to the head Record the length of time of the client's seizure Administer oxygen as needed

The provider has finished seeing four clients in the emergency room. The nurse should first assess the client with which condition? Fishing hook lodged in his forehead Injury to the right leg with obvious deformity Suicidal ideation Persistent back pain

Suicidal ideation A client with suicidal ideation must be in a safe environment immediately and is the priority out of the clients listed. The nurse will need to ensure that a bedside sitter or 1:1 assignment is made for this client. The client cannot be left alone.

A nurse is working with a client who suffers from depression. The client has started taking medications and is engaged in group therapy, but still tells the nurse, "I do not like myself. I am annoying, even to me." Which activities can the nurse suggest that would most likely increase this client's self-concept? Select all that apply. Remind the client not to compare self to others Teach the client how to be mindful of negative thoughts Have the client recognize personal strengths List three things that the nurse likes about the client Ask if the client has any friends

Teach the client how to be mindful of negative thoughts Have the client recognize personal strengths Remind the client not to compare self to others Some clients have a negative self-concept, in which they do not accept themselves and have difficulty even liking themselves. In this situation, the nurse can help the client with positive self-talk by teaching the patient how to think positive thoughts and notice personal positive attributes.

A client is suffering from feelings of loss after experiencing a miscarriage. Which action of the nurse would best support this client in working through her grief? Remind the client that it is important for her to be strong for her family Explain that the client will have these feelings for a time, but she will eventually forget the intense pain Tell the client that she will need time to mourn her loss, and eventually will learn to cope with it Help the client to see that hard feelings will go away sooner if she does not talk about it

Tell the client that she will need time to mourn her loss, and eventually will learn to cope with it Grief and loss are common elements, yet many people believe that there are right or wrong ways to experience grief. Normal grief may differ between people. The nurse's role in helping a client cope with loss is to facilitate the grief process. Assessing the grief and assisting the client to feel the loss are the main ways a nurse can facilitate this process. With time and by utilizing coping mechanisms, the client will eventually be able to overcome some of her intense grief, although she may never forget the loss.

A hospice nurse is helping a family whose loved one died thirty minutes ago. What kind of grief is the family experiencing? Palliative grief Dysfunctional grief Acute grief Anticipatory grief

Acute grief In the initial stages of a client's death, loved ones experience acute grief. This type of grief is a normal response to the loss of a loved one and includes feelings of disbelief, sadness, helplessness, anxiety, and shock. Anticipatory grief occurs before a loved one has passed away. The loved one may have a terminal illness or chronic condition with possible deterioration in health status. This leads to thoughts of the death of the loved one and anticipatory grief. Dysfunctional grief occurs when a person is unable to progress through the grieving process over time.

A client has orders for lorazepam administration, seizure precautions, and a banana bag. The nurse recognizes that this client is at risk for which of the following conditions? Epilepsy Sundowner's syndrome Hypoactive delirium Alcohol withdrawal

Alcohol withdrawal Therapeutic management for a client with alcohol withdrawal includes IV nutrient replacement with thiamine, sometimes called a banana bag, seizure precautions, prn ativan, and a CIWA assessment on regular intervals to assess for alcohol withdrawal.

A nurse is caring for a client who has been diagnosed with bipolar disorder, type I. Which best describes the difference between bipolar type I and type II? Bipolar I leads to extreme depression, while bipolar II causes more subdued depression Bipolar I is associated with alternating mania and depression, while bipolar II is associated with hypomania and depression Bipolar I is associated with alternating mania and depression, while bipolar II is a continuous state of hypomania Bipolar I describes mania or the high feeling of the disease, while bipolar II describes the depressed state

Bipolar I is associated with alternating mania and depression, while bipolar II is associated with hypomania and depression Bipolar disorder is classified according to a spectrum of the condition, as some clients may experience varied symptoms of the illness. Bipolar I is associated with periods of manic behavior alternating with periods of severe depression. Alternatively, bipolar II causes periods of depression and hypomania, which is a period of an emotional high that is less drastic than mania but is still noticeably 'atypical' behavior.

A client with schizoaffective disorder is being seen for recurrent swallowing issues as a result of consuming non-food items. Which of the following would this client be at highest risk for? Choking from eating non-food items Gastroesophageal reflux Injury to the muscles of the neck Breakdown of the oral mucosa

Choking from eating non-food items Some clients develop pica, which is the ingestion of non-food substances. A client with pica may crave certain items or may be unaware that he or she is eating abnormal items. The client, in this case, is at risk of choking if he tries to consume something that could become lodged in his throat

An 11-year-old boy has been diagnosed with depression after his parents' divorce. The nurse understands that depression in children of this age most commonly manifests as: Pouting Whining Low self esteem Poor blood glucose control

Low self esteem Depression often manifests differently in children than it does in adults. While there are some similarities in depression symptoms between adults and children, a depressed child may manifest symptoms in much different ways, which can be difficult to recognize. A depressed child between the ages of 9-12 may demonstrate such symptoms as talking about running away from home, having low self-esteem, displaying boredom, hopelessness or guilt.

A client is cognitively impaired. What techniques can the nurse use to facilitate communication? Select all that apply. Talking louder Maintaining eye contact Utilizing reassurance Speaking very close to them Using simple, direct wording

Maintaining eye contact Utilizing reassurance Using simple, direct wording When communicating with a cognitively impaired client, it is important to maintain eye contact with them and keep wording direct and simple. The nurse should remain reassuring to the client throughout conversation, especially if the client becomes upset. The nurse should remain reassuring to the client throughout conversation, especially if the client becomes upset.

A 29-year-old client suffered a subarachnoid hemorrhage 4 months ago and has now been diagnosed with post-traumatic stress disorder (PTSD). Based on this diagnosis, the nurse knows that the client would most likely demonstrate which of the following symptoms? Upset stomach, constipation, and difficulties eating Increased sensory perceptions Nightmares, avoidance, and numbing Fatigue, increased sleep needs, and weight gain

Nightmares, avoidance, and numbing Post-traumatic stress disorder (PTSD) can develop after a person experiences a traumatic event, such as an injury or when witnessing or experiencing a difficult or violent event. PTSD causes many physical and psychological symptoms that the client may need to manage for years after the event. The most common symptoms involve nightmares, flashbacks, sleep difficulties, hypervigilance, emotional numbing, depression, and avoidance of activities that trigger the memory of the event.

A nurse is assigned to care for a client with bulimia nervosa and assists the client to order a meal. Which of the following actions is important for the nurse to take regarding mealtime? Emphasizing that it is the client's responsibility to re-establish trust in the nurse-client relationship Allowing as much time as possible for the client to finish the meal Observing the client for 1-2 hours after the meal Allowing the client privacy during mealtime

Observing the client for 1-2 hours after the meal A client with bulimia nervosa must be monitored for a specified time period following meals, to ensure adequate time for digestion so that he or she does not purge the meal.

The nurse is caring for a client with a poor appetite. The nurse notes that the client is consuming less than 10% of meals and does not snack in between meals. Which of the following is NOT an appropriate intervention? Select all that apply. Dietary supplements Ask the client about food preferences and things the client dislikes Requesting the nutrition staff to stop bringing trays Informing the client to call when hungry rather than continuing to waste food Calorie counting

Requesting the nutrition staff to stop bringing trays. Informing the client to call when hungry rather than continuing to waste food. This is an inappropriate intervention for this client. Food delivery in the hospital is helpful for a client with a poor appetite, because it is a reminder and an opportunity for PO intake. The nurse should not take away the opportunity to eat from the client. This client will likely not call for food, which means the client will eat even less.

A 9-year-old child has been diagnosed with ADHD and is acting impulsively with hyperactivity. Which developmental activity would most likely be difficult for this child to achieve? Social interaction and making friends Performing in gym classes and at sports Talking to different groups of people Finding creative solutions to problems

Social interaction and making friends A child with ADHD and who suffers from impulsivity and hyperactivity will have difficulty settling down and being social with peers. ADHD often prevents a child from understanding social cues among peers, which normally guide social development and behavior. Instead, the child may miss cues and may become awkward around others or may have difficulty keeping friends.

A client with a history of severe depression and anxiety is in the hospital after attempting suicide. Which evidence would most likely be seen that indicates a crisis in a person with a mental illness? Select all that apply. The client has not slept for several nights in a row The client is unable to concentrate The client has increased interest in personal hygiene The client is crying The client is socially withdrawn

The client has not slept for several nights in a row The client is socially withdrawn The client is unable to concentrate The client is crying A crisis that develops because of a mental illness such as anxiety may be manifested in characteristic behaviors that demonstrate an increased level of fear or anxiety. The nurse in this situation would expect to see social withdrawal, cognitive changes or difficulties concentrating, changes in sleeping patterns, and excess emotion, such as crying.

A client is undergoing behavioral therapy through counseling for manic behaviors exhibited during episodes of bipolar disorder. Which best describes how cognitive-behavioral therapy is used as treatment for a client with bipolar disorder? The client studies a book about thoughts vs. behavior and implements the ideas The client works at changing personal thoughts to impact actions The client initiates a 12-step program to incorporate a change-through-leading approach The client meets with a group to discuss thoughts and feelings

The client works at changing personal thoughts to impact actions Cognitive-behavioral therapy (CBT) is a type of treatment in which the client meets with a therapist to discuss how his or her thoughts affect behavior. The client can learn to recognize that some cognitive thoughts directly impact how he or she behaves, and then he or she can change personal thoughts to help control some of the resulting behaviors.

A client with bipolar disorder is seeking treatment for co-occurring substance abuse disorder. During the initial assessment and treatment process, the nurse notes the development of countertransference. Which best describes an example of this response? The nurse feels irritated because the client reminds the nurse of her sister The client blames the nurse for her bipolar disorder The client determines that her substance abuse disorder was caused by the bipolar disorder The client compares the nurse to her mother

The nurse feels irritated because the client reminds the nurse of her sister Countertransference is a phenomenon in which a therapist or caregiver who is counseling a client has an unconscious response to the client, potentially because they remind the nurse of someone. In this example, the nurse is experiencing countertransference when there is a feeling of irritation with the client because she is a reminder of a sibling.

A 45-year-old client with schizophrenia has been brought to the hospital after trying to commit suicide. The client tells the nurse that the voices he hears told him to do it. He is extremely anxious and upset. Which assessment question would most likely help the nurse to assess the client's perception of this event? What happened that has made you so upset? Have you had thoughts of hurting others? Do you know what today's date is? Who do you live with?

What happened that has made you so upset? A client who is undergoing a mental health crisis may have difficulty focusing on the care and treatment needed to control his feelings and behavior. The nurse can initially assess the client's perception of the event by asking him what happened. This may motivate the client to talk about their experience and can help the nurse to better determine a reason for the behavior.

The nurse is caring for a schizophrenic client who is talking to someone who is not there. The client states, "I am talking to Cheryl. She's right here." No one is there. What is the most appropriate response for the nurse? "Hi Cheryl! How are you?" "Cheryl, go away and stop bothering him" "Are you having a hallucination? Is this person telling you to hurt yourself or anyone else?" "You're having a hallucination. No one is there"

"Are you having a hallucination? Is this person telling you to hurt yourself or anyone else?" It is important to point out hallucinations and stay in reality. Safety is always the priority, so by staying in reality, by calling it a hallucination, and asking if the hallucination is instructing them to harm themselves or another person is the priority.

Which of the following situations best describes acute grief? A client feels extreme pain over the death of a child four months earlier A client commits suicide because he can no longer handle the sadness of a break up A person is suddenly overwhelmed and starts to cry when she sees a picture of her deceased friend A nurse sits with a client while he cries over the death of his father

A client feels extreme pain over the death of a child four months earlier Acute grief is an extremely painful state of emotion following a loss. However, acute grief follows a pattern, albeit variable from person to person, of eventual healthy outcomes. The person experiencing the grieving process may still be sad over the loss, but positive emotions begin to mix with the sad feelings when the deceased person comes to mind. The positive emotions may include acceptance, joy, and understanding, to name a few.

A 58-year-old client is feeling sadness and loss after his mother died. Which best describes the difference between grief and depression? A grieving person may suffer mild delusions in their grief, but a depressed person never has this type of thought pattern A grieving person may have sadness but also some times of joy, while a depressed person's feelings are constant A grieving person experiences sadness and loss but a depressed person experiences guilt and anger A grieving person may have feelings of hopelessness but a depressed person would act on those feelings

A grieving person may have sadness but also some times of joy, while a depressed person's feelings are constant Grief and depression may seem similar because they both lead to feelings of sadness, but the two conditions are quite separate. The grieving person may have many days of sadness but may still be capable of feeling joy at times, despite the grief. Alternatively, a depressed person may feel sadness, guilt, hopelessness, and irritability that does not seem to go away and is not tied to specific thoughts or the loss of the loved one.

A nurse is counseling a client who has been diagnosed with depression to attend a support group as part of treatment. Which best describes how the nurse would explain what to expect for the client? A small group where the client may need to talk about his or her mental health issues A small group where the client will have to facilitate the discussion between members A presentation where group members watch an audiovisual demonstration A large group of up to 50 people meeting and mingling together

A small group where the client may need to talk about his or her mental health issues A support group can be a vital tool for treatment of various types of mental health issues. Many clients gain significant support, which helps them to overcome their conditions and to better manage symptoms of mental illness. A typical support group most likely includes several clients in a small group. The group is led by a facilitator who directs the conversation and engages others to talk about problems, often a specific topic for each group meeting.

After being admitted as an inpatient for treatment of substance abuse, a client becomes confused and disoriented and is demonstrating tachycardia, sweating, and tremor. Which nursing intervention is most appropriate for management of this client? Reduce fluid intake to prevent aspiration Administer benzodiazepines to control symptoms Provide warm blankets to promote client comfort Obtain an order to begin monitoring pulse oximetry

Administer benzodiazepines to control symptoms This client is displaying symptoms of Delirium Tremens, or DTs. This is a condition that develops in response to withdrawal from alcohol, usually 48 to 72 hours after cessation of alcohol intake. In the client known to be at risk for DTs, the nurse will monitor their CIWA score. Scorable items include sweating, shakiness, agitation, and hallucinations. The client may also demonstrate tachycardia, hypertension, and insomnia. Based on the information in the question, this client has a CIWA score of at least 10, and maybe more because the question does not have all the information to do a complete CIWA score. Therefore, according to most literature, the client would receive medication to control DT symptoms. The nurse should monitor the client's vital signs and provide a calm environment during this difficult transition.

A nurse is working with a client to use biofeedback as a method of controlling anxiety. Which of the following outcomes would most likely result from correct use of this mechanism? An ability to recognize and control the body's stress response A resolution of the client's anxiety symptoms The client being able to recognize that he suffers from anxiety A form of sedation that is calming when an anxiety attack occurs

An ability to recognize and control the body's stress response Biofeedback is a method of therapy in which a person can control the body's stress response by using the mind's awareness of the situation. By using awareness, the client learns to recognize symptoms of stress and to control those symptoms to achieve a focused state. Biofeedback has been used for controlling other forms of mental illness, including anxiety and depression. The client's symptoms would not go away with biofeedback but could be more well-controlled. The question states that the client is utilizing biofeedback to control anxiety, so he or she already recognizes the suffering anxiety causes. Biofeedback is a form of increased awareness and control, not sedation.

A client with obsessive-compulsive disorder (OCD) is in the hospital after having been diagnosed with a chronic illness. Which best describes what the nurse would see in this client while trying to provide care? Anxiety because they have no control over their illness Requesting help with minor tasks and portraying a helpless role Questioning so much that the nurse has difficulty leaving the room Refusing to trust the nurse and acting paranoid

Anxiety because they have no control over their illness A person with an obsessive-compulsive disorder (OCD) may feel frustrated with their diagnosis when they are unable to control their health or symptoms. The nurse can best help this client by providing many details about his treatment and helping to have a small element of control in certain areas.

A 25-year-old client with mental illness is having delusions of grandeur. Which tasks would the nurse utilize when orienting this client to reality? Select all that apply. Do not argue with the client about the delusions Continue to talk about and discuss the fine points of the delusion Provide validation for the client if part of the delusion is real Ask the client to to describe the delusion Be honest during interactions to reduce the client's suspiciousness

Ask the client to to describe the delusion Do not argue with the client about the delusions Provide validation for the client if part of the delusion is real Be honest during interactions to reduce the client's suspiciousness When working with a client who is experiencing delusions, the nurse should keep a few general rules in mind. It is important to understand the delusion, so the nurse can ask the client to describe it. The nurse focuses on reality-based topics, and sets firm limits on time spent talking about the delusion. It is not the nurse's responsibility to convince the client that the delusion is false, but it is important to validate the parts of the delusion that are real. The nurse should be open and honest during interactions with the client. The nurse should not say things that are not true, because this can cause the client to be suspicious of the nurse.

A nurse is discussing inpatient treatment options for a client who has an eating disorder. The client wants to try to manage the condition independently instead. Which response from the nurse is most appropriate? I'm sorry to tell you, but because you are seeking treatment now, I am required by law to commit you to a facility for eating disorders Ok, but you will not have a good outcome if you do that. I am only trying to help you Do you think that is a good idea? Based on your condition, I think inpatient treatment is your best chance of recovery, but I will respect your decision.

Based on your condition, I think inpatient treatment is your best chance of recovery, but I will respect your decision. A client who requires care for a mental health condition may have ideas about how to manage his or her care. The nurse may not agree with the client in this situation, but if the client is not harming other people, the nurse cannot force or coerce inpatient treatment.

A psych nurse is floated to the emergency room to help with the number of psych clients that are being triaged. The psych nurse knows to see the client with which of the following first? ETOH of 200 mg/dl Severe depression and has not eaten for a 2 days State of mania, thinks bugs are crawling all over Depression with suicidal ideation

Depression with suicidal ideation Suicidal ideation clients are priority, you want to get them back to a room for safety, remove all their belongings, put them with a sitter, and secure the area.

A nurse is caring for a client with bipolar disorder. The client has been taking antidepressants for depression but is most recently in a manic state and for the past three days has not been sleeping or eating. Which of the following questions from the nurse is correct in this assessment? What non-prescription medications are you taking? Have you been drinking alcohol? Are you still taking your mood stabilizing drugs? Did you stop taking your antidepressants? If so, let's talk about why you did this.

Did you stop taking your antidepressants? If so, let's talk about why you did this. When a client stops taking antidepressants, they do not become manic, so this is not the cause of the mania in the client. Non-prescription medications do not cause manic episodes in a person with bipolar disorder. Alcohol consumption does not cause a client to begin a manic episode. Asking a client this question may seem accusatory in nature, and is not necessary.

A 65-year-old woman has been diagnosed with Alzheimer's disease and is suffering from repeated bouts of memory loss. The client asks the nurse, "How am I supposed to handle this? I do not think I can cope with having this many memory problems." Which response from the nurse is most appropriate? Explain to the client that she needs to ask for help from others Encourage the client to keep photos of loved ones and important events nearby Advise the client to perform tasks slowly to avoid being injured Discuss the importance of taking several naps throughout the day

Encourage the client to keep photos of loved ones and important events nearby A client who is developing memory problems and is aware of cognitive changes may have difficulties with coping. The nurse can encourage the client to utilize strategies that may trigger some memories as a form of coping with the illness. The client may leave reminders around the home or place pictures of loved ones or activities nearby as regular reminders of important people and items to remember.

A client who is being prepared for surgery is experiencing severe anxiety about the procedure. Which of the following interventions could the nurse employ to decrease this client's anxiety levels? Select all that apply. Encourage the client's own coping mechanisms Employ music therapy or aromatherapy if available Provide reassurance by answering the client's questions Ask the client to help with certain tasks, such as starting an IV Administer sedative medications to help the client sleep

Encourage the client's own coping mechanisms Employ music therapy or aromatherapy if available Provide reassurance by answering the client's questions Surgery can cause severe client anxiety during the pre-op period. The nurse should display a sense of caring for the client and strive to meet his or her needs during this stressful time. The nurse should encourage the client's own coping mechanisms that have worked in the past, be present to answer any questions and reassure the client, and employ various relaxation techniques if possible. Additionally, using a nurse liaison to talk to the family members helps to calm the family, which can help calm the client. Music therapy and aromatherapy have been shown to reduce anxiety in clients. These methods could be implemented by the nurse to assist the client in reducing anxiety. The nurse should be present to answer any questions and reassure the client as needed while the client is anxious.

The parents of a 1-year-old child who has been adopted from Ethiopia ask the nurse about the child's feelings of grief. The mother tells the nurse, "I do not think the understands the loss at one year old." Which response from the nurse is correct? The child will not remember this. I would not be concerned with grief You should start counseling with the child now so that the child can talk about this grief later Even infants can feel grief and loss, even without conscious memory at this age A child does not start to feel grief until he is about 3 years old

Even infants can feel grief and loss, even without conscious memory at this age An adopted child may experience feelings of grief and loss when transitioning to the new family. These feelings are often there even if the child is leaving a negative environment or is very young. A 1-year-old child may not have much conscious memory to recall later at an older age, but they can still experience grief because of an adoption. The parents should be aware of this and continue to provide support for the grief both now and over time.

A 51-year-old client is getting ready to undergo a cardiac catheterization and is very anxious about the procedure. Which intervention can the nurse provide that will most likely help this client to remain calm? Explain what the client will see, hear, feel and experience during the procedure in terms that he can understand Give the client literature about the procedure ahead of time so that he can read about the process Tell the client that he will receive sedative medications so he will not be alert during the procedure Have the client's family sit next to him during the procedure

Explain what the client will see, hear, feel and experience during the procedure in terms that he can understand A cardiac catheterization can be frightening. In order to best reduce anxiety, the nurse should keep the client informed about what is going on, and if necessary, continue to talk during the process so that the client feels supported and knows what to expect. Giving the client information ahead of time is an excellent way to help reduce anxiety, but in this situation that is not an option because the client is about to undergo the procedure.

A 30-year-old client has been diagnosed with major depressive disorder. Which nutrition guideline should the nurse give to this client that could help with some symptoms of depression? Some free radicals in the diet combat harmful antioxidants The best diet for depression is the Western diet Fluids such as water and sugar-free juice are preferred over caffeinated beverages The client should increase carbohydrate intake and limit fats

Fluids such as water and sugar-free juice are preferred over caffeinated beverages A client who suffers from depression may benefit from dietary factors that can help to relieve symptoms. The client should be encouraged to increase intake of fluids such as water or sugar-free liquids and avoid caffeinated beverages, which can affect moods. The nurse can also help the depressed client with other food choices, such as increasing intake of antioxidants, eating more complex carbohydrates, and increasing protein intake.

A client presents to the emergency department with an anxiety attack, stating that he has had multiple attacks over the last six months. The client is hyperventilating, so the nurse administers a benzodiazepine to help with the acute attack. The nurse anticipates that the client will begin to take which of the following medications on a regular basis to help with the anxiety? Fluoxetine Fentanyl Famotidine Furosemide

Fluoxetine Antidepressant medications are the drug of choice to give to clients with anxiety disorders. Fluoxetine (Paxil) is a selective serotonin reuptake inhibitor that is given for anxiety.

A 39-year-old client has been diagnosed with schizoaffective disorder after demonstrating various changes in behavior and cognition. The nurse is educating the family about behavioral changes they can expect to see. Which of the following information should the nurse include? Severe depression and catatonia Anxiety and panic attacks Hallucinations and delusions Hyperactivity, irritability, and impulsivity

Hallucinations and delusions Schizoaffective disorder is a serious form of mental illness in which a client experiences delusions and hallucinations. The condition can be quite complicated and may also have symptoms of other types of mental health conditions. Some clients with schizoaffective disorder struggle with anxiety or depression, while others experience anxiety and panic attacks. Still others are irritable and impulsive. A client may present with most, all or just a few of the many side effects of schizophrenia and of a mood disorder, which complicates their diagnosis and treatment, but what alerts loved ones to their conditions is most often hallucinations and delusions.

A 21-year-old client with anorexia has been given the nursing diagnosis of Altered Nutrition: Less than Body Requirements related to an unwillingness to eat and demonstrated by severe weight loss to less than 100 lbs. Which nursing intervention is most appropriate that should be included as part of the client's ongoing assessment? Offer liquid nutrition supplements for added calories Encourage the client to participate in mild exercise Have the client document all food intake Consult a dietitian for nutrition recommendations

Have the client document all food intake Anorexia is a psychological condition that occurs when a person chooses not to eat and tries to lose weight. The client may lose excessive amounts of weight to a dangerous and unhealthy level. Management of the client with anorexia involves ongoing assessment and continued care, as this condition takes time to overcome. The nurse may ask the client to document all food intake to establish patterns of eating, as this helps to prevent relapses and provides a way to monitor progress.

A nurse is providing care to a client who has just witnessed a shooting at a shopping mall. Which of the following interventions would the nurse employ to help the client cope with this traumatic event? Select all that apply. Provide help with visual imaging surrounding the client's response during the event Assist the client with finding sources of support Help the client keep his usual hygienic routine Assist the client with identifying concrete needs to help Incorporate massage and therapeutic touch into treatment

Help the client keep his usual hygienic routine Assist the client with identifying concrete needs to help Assist the client with finding sources of support A client who has suffered a traumatic event may feel a range of emotions, including terror, relief, or anger. The nurse should help to stabilize the client's condition by keeping an activity of daily living routine as much as possible and helping the client to understand how he can help in his own care and treatment. A client who has suffered a traumatic event may feel a range of emotions, including terror, relief, or anger. The nurse should help to stabilize the client's condition by keeping an activity of daily living routine as much as possible and helping the client to understand how he can help in his own care and treatment. A client who has suffered a traumatic event may feel a range of emotions, including terror, relief, or anger. The nurse should help to stabilize the client's condition by keeping an activity of daily living routine as much as possible and helping the client to understand how he can help in his own care and treatment.

A client on the mental health unit has been diagnosed with cancer and is displaying a lack of healthy coping mechanisms to deal with this diagnosis. The client is unable to make any decisions for herself and has developed headaches and fatigue. Which of the following nursing interventions is most appropriate for this client? Point out the areas where the client is not taking care of herself Provide a book for the client that comprehensively describes ineffective coping Encourage the client to continue to make decisions, even when she is significantly stressed Help the client to get enough rest and to eat a healthy diet

Help the client to get enough rest and to eat a healthy diet A client who struggles to cope with a medical diagnosis can benefit by first having physical needs met. By supporting the needs for a proper diet and plenty of rest, the client may be more likely to face a diagnosis and learn to respond to it in a healthy way. Reading material is not helpful when a client is grieving over a serious medical diagnosis. Being present and assisting the client to care for their basic needs is where the nurse should start in this situation. Making decisions when stressed is not helpful. If possible, big decisions should be postponed until the client feels better.

A case management nurse is reviewing the chart for a client in a psychiatric hospital who has been diagnosed with panic disorder. The client is anxious and irritable. The nurse has done teaching on relaxation techniques, but the client requires close monitoring due to lack of adherence to the regimen. Which action of the case manager will most likely support this client best? Plan for a home health nurse to visit the client daily to watch the client perform the relaxation techniques Arrange for the client to be committed to long-term inpatient care Call to inform the provider that the client most likely needs surgery Help the client to learn about other complementary or alternative treatments available

Help the client to learn about other complementary or alternative treatments available Help the client to learn about other complementary or alternative treatments available The case manager in this situation would most likely try to help the client find a method of therapy or treatment that would work better, since the current therapy is not going well. The case management nurse may be able to help the client find a different method of management that the client finds more beneficial. Arrange for the client to be committed to long-term inpatient care It is best if the client tries multiple treatment options if the traditional types are not working well. Plan for a home health nurse to visit the client daily to watch the client perform the relaxation techniques Having someone monitor a client who is attempting to perform relaxation techniques would be counterproductive. Call to inform the provider that the client most likely needs surgery The best way to support the client would be to discuss alternative treatments if the current treatment is not working. Surgery is not a way to treat panic disorder.

A nurse is working with a client who is having sleep difficulties at night. The nurse recommends that the client keep a sleep diary and write down the times he goes to bed, the times he gets up and how many times he awakens each night. The nurse can best describe the purpose of keeping a sleep diary as which of the following? Helping the client to discover if he is a morning person Assisting the client with making up all of his lost sleep Helping the client see how to improve his sleep Determining the client's type of sleep disorder

Helping the client see how to improve his sleep Rationales: Helping the client see how to improve his sleep A sleep diary can be used to keep track of the hours of sleep a person gets at night, particularly when sleep difficulties are present, such as insomnia or frequent awakenings. The main purpose of keeping a sleep diary is to determine how much sleep a person is getting at night to see how to make improvements. Determining the client's type of sleep disorder This statement assumes the client has a sleep disorder, which may not be the case. Once a sleep disorder is diagnosed, the type can be differentiated with more detailed sleep studies. Helping the client to discover if he is a morning person The purpose of the journal is to have a starting point from which to make improvements in the quantity and quality of sleep for the client. Discovering whether they are a morning person or not is not the goal. Assisting the client with making up all of his lost sleep It is not possible to make up all the sleep a client has lost. It is possible, however, to improve sleep going forward.

A client who has been diagnosed with anxiety tells the nurse that his thoughts contribute to his problems. Which information can the nurse give the client that is true about automatic negative thoughts? How you think about the world determines how you feel and behave Persons with anxiety must accept that things are the way they are Everything happens for a reason, and good will come out of the experience When you continue to struggle with anxiety, you are not putting enough effort into changing

How you think about the world determines how you feel and behave Automatic negative thoughts are those thoughts that can be destructive and harmful to a person when they automatically enter the mind. A person may struggle as a result of a long-term pattern of negative thinking, primarily from assumptions and attitudes developed from previous experiences. This may require cognitive therapy to assist the client to overcome their negative thought pattern. The nurse can help the client to feel empowered because there are treatments and therapies available to assist them to overcome anxiety and negative thoughts. When a client struggles with a disorder such as anxiety, the nurse should encourage the client to seek treatment to overcome the disorder. The nurse should educate the client on options for support and treatment rather than place the entire burden to change on the client.

A nurse is working with a client who has schizoaffective disorder and believes that the hospital has poisoned the food. Which response from the nurse is most appropriate? I do not think the hospital has poisoned the food, but would you like to tell me why you believe this? What type of poison do you think the hospital has used? The hospital has not poisoned the food. Look at everyone else around you eating Why would the hospital want to hurt you?

I do not think the hospital has poisoned the food, but would you like to tell me why you believe this? A client with schizoaffective disorder may suffer from hallucinations and delusions of false beliefs. When this occurs, the nurse should not argue with the client but should also not encourage incorrect thinking. The nurse can tell the client that he or she does not have the same beliefs, and ask why the client feels this way.

A nurse is caring for a client with dementia as a result of progressive Alzheimer's disease. The client's family requests that the client eat fewer carbohydrates because of recent research the daughter has been studying. Which response from the nurse best indicates respect for this family's choices? I will talk to the dietitian about changing your father's menu I can help you find more journal articles that will talk about this further I have read the same information, you are right I would like a copy of the research that you found

I will talk to the dietitian about changing your father's menu The nurse acts as a client advocate when the nurse works with the client and/or family who is making a choice about healthcare decisions. Although the nurse may not agree with the family's choice of dietary factors for the client, the nurse can best act as an advocate by explaining the situation to the dietitian who develops the meal plan and menu. The nurse should also speak with the client's provider regarding dietary changes. A client with progressive Alzheimer's disease often needs all the caloric intake they can get, as they may refuse to eat, or forget to eat. Restricting carbohydrates can further reduce this client's caloric intake.

A client with schizophrenia has been non-compliant with taking his medications. The nurse understands that the most likely reason for non-compliance with the treatment regimen for the client is which of the following? Lack of insight about the diagnosis of schizophrenia Irritation with the nurse for giving the medication Anger about the diagnosis of schizophrenia The inability to remember to take the medication

Lack of insight about the diagnosis of schizophrenia Some clients with mental health diagnoses are non-compliant with taking medications and may not take them on time or may stop taking them entirely. There are numerous reasons for non-compliance. Among clients with schizophrenia who are non-compliant with their medication regimens, one of the most common reasons is a lack of insight the client has about having the disease. Other reasons a client may be non-compliant with medications include beliefs about the medications, and substance abuse.

A nurse is caring for a client has undergone ECT for the treatment of severe depression and has developed some complications afterward. Which of the following is a physical side effect that has been associated with ECT? Muscle soreness Bradycardia Peripheral edema Rash on the face and trunk

Muscle soreness Electroconvulsive therapy (ECT) is a form of treatment for some psychiatric conditions, including severe depression. ECT causes a seizure in the brain while the rest of the body is sedated with muscle relaxants. Although the client is given a relaxant and anesthetic, there may still be some physical side effects. The client may experience muscle soreness following the procedure, as well as temporary mental confusion and fatigue.

A nurse is caring for a 20-year-old client with testicular cancer. The client has expressed feelings of anxiety related to his diagnosis and appears restless and agitated every time the nurse tries to talk with him. Which intervention would be the most appropriate for the nurse to help this client with anxiety? Offer information about support groups Tell the client that he will feel better if he talks about it Offer to have the provider talk with the client about his diagnosis Explain that the client most likely needs antidepressants to get him through this time

Offer information about support groups A client who has been diagnosed with cancer may be experiencing many emotions, including anxiety, frustration, anger, and grief. A client who is anxious but who does not necessarily want to talk may benefit from information regarding support groups to meet with others who are experiencing similar situations. The client may not want to talk about the situation with the nurse, and the nurse should respect this. The client's behaviors indicate that he would benefit from a support group rather than discussing the condition with his provider again. The client may need antidepressants, but other resources should be explored first. Additionally, the provider is in a position to recommend whether the client could benefit from mood-altering medications rather than the nurse.

A 70-year-old client is worried about developing dementia because his father had Alzheimer's disease at an early age. What lifestyle interventions would the nurse recommend that would potentially reduce this client's risk of dementia? Select all that apply. Participate in social activities If drinking, only consume alcohol in moderation Control blood sugar if diabetic Play memory games Control blood pressure

Participate in social activities Control blood sugar if diabetic Play memory games If drinking, only consume alcohol in moderation Control blood pressure Studies have shown that by implementing certain preventive practices, people can reduce the risk of developing dementia, including Alzheimer's disease. The nurse may teach this client about activities that will reduce the risk of developing Alzheimer's, even though the client's father already has the disease. The person should be encouraged to maintain social relationships and participate in activities. The client should be encouraged to avoid excessive alcohol intake. The client should control blood sugar if diabetic as well as eat healthfully and stay physically active to reduce the risk of developing dementia. The client should be aware that maintaining mental activity and well-being may reduce the risk of developing dementia. Memory games, crosswords, and reading are ways to maintain mental activity. The client can reduce the risk of developing dementia by maintaining healthy blood pressure and cholesterol levels.

A client is admitted to the floor from the ER for Ulcerative Colitis complicated with infection. The client is slurring their words and stumbling. The nurse notes empty mini vodka bottles in the client belonging bag. The client reports that they drink every day and asks the nurse to get them more vodka. What is the nurse's priority at this time? Get a 12-lead EKG (ECG) Place client on a withdrawal protocol Administer IV antibiotics Apply soft wrist restraints for safety

Place client on a withdrawal protocol Any client who drinks daily and is admitted to the hospital is at risk for alcohol withdrawal (due to no longer having access to alcohol). The priority is to get this client on an alcohol withdrawal protocol as soon as possible so that the nurse can be prepared with medications. The client will need antibiotics for the infection. However, this is not a priority at this time as the antibiotics are likely on a schedule, not due STAT. There is no indication for a 12-lead EKG at this time, this is not a priority. There is no indication that the client is a danger to himself or others at this time. Placing the client in restraints would be inappropriate.

A nurse is caring for a client who is displaying symptoms of dissociative identity disorder (DID). Which of the following is an appropriate intervention for DID? Select all that apply. Focus on strengths and abilities Plan for psychotherapy Exploring methods of coping Encourage changes in lifestyle habits Provide nondemanding, simple routines

Plan for psychotherapy Exploring methods of coping Provide nondemanding, simple routines Focus on strengths and abilities Dissociative identity disorder, previously termed multiple personality disorder, describes a mental illness in which a person is disconnected from personal thoughts, feelings, and sense of identity. When working with a client who has this disorder, the goals of treatment include helping the client to function so she can integrate into society, keeping the client safe despite her behavior, and working through traumatic memories, which are thought to be the cause of the disorder.

A client was recently treated for sepsis and may have developed post-sepsis PTSD. Which information is accurate for the nurse to give the client about how this condition is treated? Exposure therapy is the most reliable form of treatment for PTSD Post-sepsis PTSD often goes away over time, so the client should wait for symptoms to resolve The client should utilize motivational interviewing to best manage his PTSD symptoms Post-sepsis PTSD can be managed through counseling or cognitive behavioral therapy

Post-sepsis PTSD can be managed through counseling or cognitive behavioral therapy Because sepsis is a life-threatening event, a person who survives the situation and who returns home may experience a myriad of psychological and physical symptoms in its aftermath, a condition known as post-sepsis syndrome. Post-traumatic stress disorder may also develop as part of this syndrome, in which the client experiences symptoms that make it difficult to function in daily life and that involve flashbacks of the time during illness. Post-sepsis PTSD is best treated through counseling, journaling, and support groups.

A client with Alzheimer's disease has had difficulties eating and is not getting enough nutrients in his diet. The client's daughter asks the nurse if there is anything that can be done to improve his nutrition intake. Which recommendation should the nurse give? Use more salt when cooking and serving food Help the client choose his own eating utensils Provide stand-by assistance when the client eats to offer support Limit calories to have better control of behavior

Provide stand-by assistance when the client eats to offer support A client with Alzheimer's disease may develop malnutrition and weight loss from difficulties with eating. The family member of the client with Alzheimer's may provide a nutritious diet with reminders about how to use utensils and how to eat food if the person forgets. Increased sodium intake can contribute to high blood pressure and should be monitored with limited salt for cooking and serving. The client should be offered the eating utensil that is appropriate for the food he is eating. If the client is not getting enough nutrients in his diet, limiting calories would be contraindicated.

A client has been brought into the emergency department under the influence of illicit drugs. The client is experiencing paranoia and yells at the nurse, "You can't hurt me! I am more powerful than you!" Which tactics would the nurse use that would help to orient this client to reality? Select all that apply. Repeat to the client that no one will hurt him or her Do not talk to the client until the client speaks normally Place the client in restraints until the client has calmed down Leave the client alone until the client asks for help Remind the client that they are in the hospital

Repeat to the client that no one will hurt him or her Remind the client that they are in the hospital Clients suffer delirium for any number of reasons. Delirium may develop due to physical or psychological factors, and it causes the client to behave abnormally and erratically. The nurse who works with a confused or delirious client should remain calm and continue to try to orient the client to reality. Restraint use is upsetting to clients and does not result in a calming effect. Ignoring can be upsetting to the client and will not yield a positive outcome or a trusting nurse-client relationship. The client is a danger to self and others in this state. Do not leave the client alone.

A nurse is working with a client who is experiencing hallucinations of water running down the walls. Which of the following intervention would be most helpful for the client? Respond verbally to anything real the client talks about Frequently reassess whether the person is experiencing hallucinations Explain that there is no water running down the walls and the client is seeing things Talk to the client in a loud, clear voice to minimize distractions

Respond verbally to anything real the client talks about Hallucinations are abnormal sensory experiences in which a person may see or hear something that is not there. The nurse's role in caring for a person who is experiencing hallucinations is to avoid playing along or arguing with the client. Instead, the nurse can support the client by responding verbally to anything the client says that is real. The nurse should avoid reacting to the hallucination as if it were real, but should not negate the client's experience. Focusing on reality-based topics in discussions with the client are helpful.

The nurse is caring for a client with generalized anxiety disorder requiring treatment. Which of the following treatments does the nurse anticipate the client will need? Select all that apply. Psychoanalysis BuSpar (buspirone) SSRI medications Cognitive behavioral therapy Antipsychotic medications

SSRI medications Cognitive behavioral therapy BuSpar (buspirone) SSRI medications Generalized anxiety disorder (GAD) is a condition in which the client has a persistent, unrealistic worry about everyday occurrences. A person would be diagnosed with GAD if they do not have another underlying medical or psychiatric disorder. The main treatments for GAD include cognitive behavioral therapy, SSRI medications, and BuSpar, an anxiolytic. Antipsychotic medications Restraints and antipsychotic medications are contraindicated for a client with GAD. Cognitive behavioral therapy Generalized anxiety disorder (GAD) is a condition in which the client has a persistent, unrealistic worry about everyday occurrences. A person would be diagnosed with GAD if they do not have another underlying medical or psychiatric disorder. The main treatments for GAD include cognitive behavioral therapy, SSRI medications, and BuSpar, an anxiolytic. Psychoanalysis Cognitive-behavioral therapy is useful to replace distorted thinking and is more effective than psychoanalysis. BuSpar (buspirone) Generalized anxiety disorder (GAD) is a condition in which the client has a persistent, unrealistic worry about everyday occurrences. A person would be diagnosed with GAD if they do not have another underlying medical or psychiatric disorder. The main treatments for GAD include cognitive behavioral therapy, SSRI medications, and BuSpar, an anxiolytic.

A nurse is caring for a 40-year-old client with post-traumatic stress disorder following a severe injury last year. The client requires a morning dose of an antidepressant medication and is scheduled for EMDR therapy in 2 hours. The provider has been in to see the client for the day and has also left new orders. Which task can the nurse delegate to the nursing assistant who is helping her? Serving the client breakfast to eat with the medication Performing the EMDR with the client Checking the provider's orders in the chart Administering the antidepressant

Serving the client breakfast to eat with the medication When delegating tasks to a nursing assistant, the nurse must carefully consider the tasks that fall within the assistant's scope of practice. In this case, the nurse can delegate the activities of daily living for the nursing assistant to help. This includes serving a client breakfast so the client can take the medication.

A nurse is caring for a client who lost her father to cancer last year. The client is demonstrating dysfunctional grief in that she has intense feelings of guilt over the situation. Which of the following factors would increase a person's risk of developing dysfunctional grief? A lack of religious beliefs Social isolation in the grieving person A prior experience with loss The age of the person when they died

Social isolation in the grieving person A person may experience dysfunctional grief over a situation when there is prolonged emotional instability and a lack of progress in developing successful ways to cope with the loss. The person may experience intense guilt over the loss and may suffer from low self-esteem or even suicidal ideation. The risk of a person developing dysfunctional grief is increased with social isolation, when the death is unexpected, with the death of a child, and when the person grieving has a history of depression, experienced trauma as a child, or had a dependent relationship with the deceased.

The nurse is preparing a presentation on stress and anxiety. Which of the following is included as part of this presentation? Select all that apply. Stress can cause anxiety Severe anxiety does not lead to psychosis Prolonged anxiety can cause illness Severe anxiety can lead to suicidal thoughts Anxiety can be motivating and increase learning

Stress can cause anxiety Prolonged anxiety can cause illness Severe anxiety can lead to suicidal thoughts Anxiety can be motivating and increase learning Stress can cause anxiety and severe anxiety can lead to depression, psychosis, and suicidal ideation. Severe anxiety can lead to panic, psychosis, exhaustion, and even death. Stress can cause anxiety and severe anxiety can lead to depression, psychosis, and suicidal ideation. Prolonged stress can cause illness. Severe anxiety and prolonged stress can cause illness and lead to suicidal ideation. Mild anxiety can be motivating. Some anxiety is normal and is associated with everyday, tense experiences. It can lead to increased creativity and learning.

A client is experiencing stress response syndrome after losing his job where he had worked for 21 years. What describes the difference between stress response syndrome and clinical depression? Stress response syndrome involves an increase in pulse, blood pressure and breathing rate, while clinical depression involves a decrease in these vital signs Stress response syndrome typically lasts for months to years, while clinical depression may last for several weeks Stress response syndrome causes hopelessness and loss of interest in activities, but not suicidal ideation such as with clinical depression Stress response syndrome often appears after a life-threatening event, while clinical depression appears after a life-changing event

Stress response syndrome causes hopelessness and loss of interest in activities, but not suicidal ideation such as with clinical depression Stress response syndrome is sometimes referred to as adjustment disorder or situational depression. It differs from clinical depression in that the affected person experiences some of the same symptoms, such as loss of interest in activities or feelings of hopelessness, but the person with stress response syndrome does not develop severe emotional effects of depression, such as suicidal ideation.

A nurse is working with a client who has paranoid thinking. The client believes that a secret chip has been implanted under the client's skin by the government. Which is the most appropriate first approach from the nurse? Talk to the client about their feelings regarding the situation Divert the client's attention to activities in the game room Touch the client gently on the arm and guide him to a place to talk Ask the client for more details about the secret chip

Talk to the client about their feelings regarding the situation When a client is experiencing paranoid delusions, the nurse should refrain from supporting inaccurate thoughts. The nurse should also avoid distracting the client or trying to get the client to talk about something else, as this is not helpful. Instead, the nurse should begin establishing a trusting relationship and focus on how the client feels at the moment. The nurse can also redirect the conversation to reality-based topics.

A client who has developed depression after experiencing chronic back pain is being seen at the acute care clinic. Which best describes how the nurse would demonstrate psychoeducation when working with this client? Teaching the client about the effects of their mental health issue so it can be better managed Administering medications that will relieve some of the back pain Providing information to the client about an upcoming research study based on the effects of pain and depression Helping the client to find a support group for people who suffer from back pain

Teaching the client about the effects of their mental health issue so it can be better managed In this question, the nurse has a client with both a physical condition and a mental health condition. The nurse would employ psychoeducation for the mental health aspect of this client,, which could also improve the client's management of chronic pain. Psychoeducation is the process of providing education to people who suffer from mental health diagnoses, specifically related to how they can best manage their physical condition. A nurse administers psychoeducation by teaching the client about the effects of depression and how they can be related to chronic pain. The purpose of psychoeducation is to empower the client to better manage their multiple health conditions.

A client who has been diagnosed with bipolar disorder is seeking treatment during the manic phase of illness. Based on the nurse's knowledge of this mental state, the nurse understands that which of the following is likely during this phase? The client is not at high risk and her safety is not threatened The client is at risk of destructive behaviors because of her manic mood The client is more likely to develop chronic illnesses, including lung disease and obesity The client is at risk of suicide during the manic phase

The client is at risk of destructive behaviors because of her manic mood Bipolar disorder is a mood disorder in which the client oscillates between periods of depression and mania. During the manic phase, the client may be at risk of being injured or harmed because of her behavior, which may include a highly elevated mood in which the client is erratic and irritable. The client may engage in unsafe activities, such as driving while intoxicated or participating in unsafe sexual practices that could harm her health.

A client with depression has been taken to the emergency department by a friend after making statements that he was contemplating suicide. The provider has ordered that the client be admitted for inpatient treatment but the client refuses. Which of the following best explains the client's rights in this situation? The client is not safe and the nurse should fill out a petition to legally keep the client The client, if competent, has the right to refuse inpatient treatment The client does not have the right to refuse treatment and should be placed in restraints The client may refuse inpatient treatment but must agree to outpatient therapy

The client is not safe and the nurse should fill out a petition to legally keep the client When a client makes threats to harm themselves or other people, it is the duty of the nurse (or anyone else) to petition that client for further evaluation. Petitions have a duration of 72 hours. A client must be seen within 72 hours by a psychiatrist or psychologist. It is illegal to hold someone against their will if they are not petitioned. A competent client has the right to refuse medical interventions, but in a situation where the client has expressed intent to commit suicide, that client becomes a danger to himself and can be involuntarily held for 72 hours. Restraints are not needed unless the client is actively attempting to kill himself. Otherwise, close monitoring by an individual may be necessary to keep the client safe. A client determined to be a danger to self forfeits the right to refuse inpatient treatment.

A 46-year-old client is experiencing symptoms of post-traumatic stress disorder after being involved in a traumatic accident. The client has symptoms of nightmares and flashbacks about the event. The nurse knows that these symptoms most likely develop because of which of the following? The client's pituitary gland works in overdrive and consistently causes flashbacks The client is no longer able to regulate levels of serotonin The client may have a hyperactive amygdala that leads to an increase in feelings of fear The body secretes too much melatonin, which leads to an increase in nightmares

The client may have a hyperactive amygdala that leads to an increase in feelings of fear Post-traumatic stress disorder is a condition that occurs following a traumatic event in which a person experiences flashbacks about the event. PTSD may also cause nightmares, irritability, intrusive thoughts, memory problems, and a sense of blame about the event. Studies have shown that clients with PTSD have a hyperactive amygdala in the brain, which is responsible for feelings of fear.

A client with anxiety disorder is in a state of panic after becoming injured while outside. The nurse caring for this client would most likely observe which behaviors? Select all that apply. The client needs direction to focus The client has a loss of rational thought The client demonstrates fear The client is moody The client is disorganized

The client needs direction to focus The client has a loss of rational thought The client is disorganized The client demonstrates fear A client who has reached a state of panic after anxiety is typically very focused on the self and the issue at hand. The nurse may be unable to maintain the client's attention or provide therapeutic communication because of their behavior. Panic is the result of fear, in which the client is hyper-aware of what happened and feels terror regarding the situation. Moodiness does not indicate a state of panic, but terror, dread and a sense of impending doom that is unmanageable indicate panic.

A client with a history of bipolar disorder has been brought in to the hospital because the client was running through a neighborhood without any clothes on. Which of the following is evidence that the client is voluntarily willing to be admitted to the hospital? Select all that apply. The situation is an emergency The client has a court order The client states that he is willing to follow the regimen of the facility The client agrees to follow orders The client is not a danger to himself or others

The client states that he is willing to follow the regimen of the facility The client agrees to follow orders A client with a mental illness can refuse care at a hospital or can voluntarily agree to be admitted. When being admitted to the hospital, a client with a mental illness demonstrates that the admission is voluntary when the client states a willingness to follow orders and the regimen of the facility.

A public health nurse is caring for a client in a psychiatric facility who has a diagnosis of bipolar disorder. Which best demonstrates that the nurse is acting as a liaison to coordinate this client's plan of care? The nurse contacts a social worker about follow-up care after the client is discharged The nurse arranges a payment plan for the client to cover the costs of medical care The nurse tells the client to participate in group therapy while in the hospital The nurse asks the client's family if the client can stay with them after discharge

The nurse contacts a social worker about follow-up care after the client is discharged A nurse often must coordinate care between several disciplines as well as with the client and family. Coordination of care may be short-term, while the client is in the hospital or care facility, or it may be long-term and may consider the ongoing needs of the client after discharge. The best example of coordinating client care is when the nurse contacts another discipline to arrange for further services after discharge.

A 44-year-old client is being seen for symptoms of bipolar disorder. After talking with the client, the provider has determined that the client should start taking medication. The client says to the nurse, "How do you know for sure? Isn't there a lab test that will tell you if I have this condition?" Which response from the nurse is accurate? There is no lab test that will identify whether you have bipolar disorder. The diagnosis is based on the provider's assessment We could perform laboratory testing, but the provider has been able to diagnose you based on your behavior You do not need lab testing. We can prescribe medication without an actual laboratory diagnosis of bipolar disorder The lab test you need will actually measure neurotransmitter levels in your blood, which will help us pinpoint how much medication to prescribe

There is no lab test that will identify whether you have bipolar disorder. The diagnosis is based on the provider's assessment Bipolar disorder is typically diagnosed after a provider has performed a psychological evaluation of the client to assess behavior and responses to certain items. While blood and urine testing may be performed to check the client's physical health and to rule out other causes of bipolar symptoms, there is no lab test that will demonstrate whether a person has bipolar disorder.

A client is undergoing a clinical interview as part of diagnostic testing for bipolar disorder. Which best describes why a clinical interview would be conducted? To assess the client's psychiatric and family background To measure the client's IQ level To test the client's memory function To determine how much the client perceives and cognitively understands

To assess the client's psychiatric and family background A clinical interview is part of an intake assessment of a client that involves talking with the client to gather important data that could later be used as part of treatment. The reason for the clinical interview is for the clinician to assess the client's current symptoms, background, including data about family, personal history, and psychological diagnoses. The clinical interview is typically performed before any other psychological testing.

A 50-year-old client with schizophrenia is being seen by the mental health nurse. The client is demonstrating signs of altered thought processes. Which communication pattern would most be associated with schizophrenia or psychosis? Select all that apply. Flight of ideas Poverty of speech Clanging Word salad Neologisms

Word salad Poverty of speech Neologisms Clanging A client with acute psychosis related to schizophrenia may develop alternative speaking habits that are characteristic to the mental illness. The client may repeat words in a nonsensical manner, substitute inappropriate words, or make up new words. Examples of communication patterns include clanging, neologisms, poverty of speech and word salad.

An emergency department nurse is working with a client who sought care for a sudden panic attack. The client tells the nurse that she feels like she is dying and is sweating and shaking. Which statement by the nurse is best? This is nothing serious and is related to stress It is time to calm down now because you are finally in the hospital I have panic attacks too, and they are terrible You are not in a medical emergency, but you are having an abnormal fight-or-flight response

You are not in a medical emergency, but you are having an abnormal fight-or-flight response The client experiencing a severe panic attack benefits from being told, reassuringly, that their symptoms are not from a psychiatric disorder, and they do not have a serious medical condition. Rather, the client has a chemical imbalance in their fight-or-flight response. Approaching the situation in this way demonstrates to the client that there IS something physiologically wrong, but it is not a serious medical condition. This acknowledges the client's situation and is effective to calm the client so that further questions can be asked. Listening and empathy are important skills for the nurse caring for the client with a panic attack.

A nurse is caring for an older adult who is experiencing wasting and malnutrition as a result of dementia. The client's daughter asks the nurse about giving her mother a nutritional shake. Which response from the nurse is accurate? You can supplement your mother's food intake with a nutritional shake to add after a meal You should substitute your mother's meals with a nutritional shake instead You should not use nutritional shakes; they do not provide enough calories or nutrients Nutritional shakes are typically only used for weight loss, which does not apply in this situation

You can supplement your mother's food intake with a nutritional shake to add after a meal While nutritional supplements are available over the counter and can be used among clients with malnutrition, they are designed to be supplements and not entire meals. The nurse should counsel the family that an older adult with malnutrition should not receive the shake in place of a meal, but should instead focus on healthy eating with a nutritional shake added afterward as a supplement.

The parents of a child with autism talk with a nurse about their feelings of being overwhelmed in caring for their child. They state that they do not get a break from their child, the child's needs are almost more than they can handle, and they are considering divorce. Which of the following initial responses from the nurse is most appropriate? You may want to talk with a respite provider who can occasionally care for your child Please do not get a divorce over this. There has to be another solution You may want to consider taking a vacation away together without your child to help with your stress levels You can look up several inpatient placement centers online for information about childcare

You may want to talk with a respite provider who can occasionally care for your child Respite care is a form of temporary caregiving in a situation that provides a break for the standard caregivers. Respite care may be provided in such situations as for special needs children, older adults, or others who require significant time and care by a relative on a regular basis. The respite care is typically provided by a trained caregiver. In this situation, the parents may consider respite care in knowing that their child will be well cared for and they can take a break from their duties. Taking a vacation or going out alone is not typically possible in these situations, and often parents have exhausted other resources for help.