N4 Chapters 10, 12, 13,14, 15

Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor

d. Monoamine oxidase inhibitor

A patient is brought to the Emergency Department after a motorcycle accident. The patient is alert, responsive, and diagnosed with a broken leg. The patient's vital signs are pulse (P) 72 and respiration (R) 16. After being informed surgery is required for the broken leg, which vital sign readings would be expected? a. P 64, R 14 b. P 68, R 12 c. P 72, R 16 d. P 80, R 20

d. P 80, R 20 The patient would experience stress associated with anticipation of surgery. In times of stress, the sympathetic nervous system takes over (fight or flight response) and sends signals to the adrenal glands, thereby releasing norepinephrine. The circulating norepinephrine increases the heart rate. Respirations increase, bringing more oxygen to the lungs. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 10-3, 4 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia

d. Paranoia

. A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? a. "I do not have the ability to handle that job." b. "I can be successful if I do all the things required to learn the job." c. "I may be fired from the job but eventually I will find something else to do with my life." d. "I can never learn all there is to know for the job."

"I can be successful if I do all the things required to learn the job." Cognitive reframing changes the individual's perceptions of stress by reassessing a situation and replacing irrational beliefs with more positive self-statements. The other options are all negative cognitive distortions that would prevent the individual from success.DIF: Cognitive Level: Analyze (Analysis)REF: pages 19, 20TOP: Nursing Process: EvaluationMSC: NCLEX: Psychosocial Integrity

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes a. biofeedback. b. guided imagery. c. therapeutic touch. d. assertiveness training.

a. biofeedback. Biofeedback is a technique for gaining conscious control over unconscious processes. The scenario describes one method that might accomplish this.REF: 165

The adult child of a patient diagnosed with major depressive disorder asks, "Do you think depression and physical illness are connected? Since my father's death, my mother has had shingles and the flu, but she's usually not one who gets sick." Which answer by the nurse best reflects current knowledge? a. "It is probably a coincidence. Emotions and physical responses travel on different tracts of the nervous system." b. "You may be paying more attention to your mother since your father died and noticing more things such as minor illnesses." c. "So far, research on emotions or stress and becoming ill more easily is unclear. We do not know for sure if there is a link." d. "Negative emotions and prolonged stress interfere with the body's ability to protect itself and can increase the likelihood of illness."

ANS: D "Negative emotions and prolonged stress interfere with the body's ability to protect itself and can increase the likelihood of illness." The correct answer best explains the research. Research supports a link between negative emotions and/or prolonged stress and impaired immune system functioning. Activation of the immune system sends proinflammatory cytokines to the brain, and the brain in turn releases its own cytokines that signal the central nervous system to initiate myriad responses to stress. Prolonged stress suppresses the immune system and lowers resistance to illness. Although the adult child may be more aware of issues involving the mother, the pattern of illnesses described may be an increase from the mother's baseline. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-7, 8 TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? a. Heart rate b.Triglycerides c. Blood glucose levels d.Brain norepinephrine

C. Blood glucose levels An increase in gluconeogenesis, stimulated by the release of cortisol, ensures that increased amounts of glucose are available to the individual. Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor. None of the other options are as directly associated with the hypothalamus-pituitary-adrenal cortex.REF: 158; Fig 10-2

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? a. NANDA Handbook b. DSM-IV-TR c. Quick Mental Status Assessment d. Life-Changing Event Questionnaire

d. Life-Changing Event Questionnaire This questionnaire calls for the client to review events of the past year and score each. This is the only tool listed that assesses stress.REF: 163; Table 10-3

Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. Shortness of breath, gastrointestinal distress, chronic cough b. Ataxia, severe hypotension, large volume of dilute urine c. Gastrointestinal distress, thirst, nystagmus d. Electroencephalographic changes, chest pain, dizziness

b. Ataxia, severe hypotension, large volume of dilute urine

Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."

a. "Depression often begins after a major loss. Losing dad was a major loss."

Which comments by a nurse are likely to help a patient cope by addressing the mediators of the stress response? (Select all that apply.) a. "A divorce, while stressful, can be the beginning of a new, better phase of life." b. "You mentioned your spirituality. Are there aspects of your faith that could be helpful to you at this time?" c. "Journaling often promotes awareness of how experiences have affected people." d. "It seems to me you are overreacting to this change in your life." e. "There is a support group for newly divorced persons in your neighborhood."

a. "A divorce, while stressful, can be the beginning of a new, better phase of life." b. "You mentioned your spirituality. Are there aspects of your faith that could be helpful to you at this time?" c. "Journaling often promotes awareness of how experiences have affected people." e. "There is a support group for newly divorced persons in your neighborhood." Stress mediators are factors that can help persons cope by influencing how they perceive and respond to stressors; they include personality, social support, perceptions, and culture. Suggesting that a divorce may have positive as well as negative aspects helps the patient to alter perceptions of the stressor. Journaling increases self-awareness regarding how life experiences may have shaped how we perceive and respond to stress (or how our personality affects how we respond to stressors). A loan could help the patient by reducing the financial pressures. Participation in support groups is an excellent way to expand one's support network relative to specific issues. Many persons derive comfort and support from participation in faith-based interventions. The incorrect response demonstrates judging, which is non-therapeutic communication by the nurse and would not facilitate coping. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-9 to 11, 13, 14, 19, 37 (Box 10-1)TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I've already made arrangements for my monthly lab work."

a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." e. "I've already made arrangements for my monthly lab work."

Mary is a 39-year-old attending a psychiatric outpatient clinic. Mary believes that her husband, sister, and son cause her problems. Listening to Mary describe the problems the nurse displays therapeutic communication in which response? a. "I understand you are in a difficult situation." b. "Thinking about being wronged repeatedly does more harm than good." c. "I feel bad about your situation, and I am so sorry it is happening to you and your family." d. "It must be so difficult to live with uncaring people."

a. "I understand you are in a difficult situation."

The patient expresses sadness at "being all alone with no one to share my life with." Which response by the nurse demonstrates the existence of a therapeutic relationship? a. "Loneliness can be a very painful and difficult emotion." b. "Let's talk and see if you and I have any interests in common." c. "I use Facebook to find people who share my love of cooking." d. "Loneliness is managed by getting involved with people."

a. "Loneliness can be a very painful and difficult emotion."

Which patient statement demonstrates a value held regarding children? a. "Nothing is more important to me than the safety of my children." b. "I believe my spouse wants to leave both me and our children." c. "I don't think my child's success depends on going to college." d. "I know my children will help me through my hard times."

a. "Nothing is more important to me than the safety of my children."

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder. c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? a."Stressors are events that happen that threaten your current functioning and require you to adapt." b. "Stressors are complicated neuro stimuli that cause mental illness." c. "It's best if you ask questions like that of your provider for a complete answer." d. "Instead of focusing on what stressors are, let's explore your coping skills."

a. "Stressors are events that happen that threaten your current functioning and require you to adapt." Stressors are psychological or physical stimuli that are incompatible with current functioning and require adaptation. Stressors are not complicated neuro stimuli; telling the patient to address these questions to her provider fails to educate the patient, which is the nurse's responsibility. Exploring coping skills would be a good intervention at a later time but does not address the patient's question and changes the subject.DIF: Cognitive Level: Applying (Application)REF: page 3TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

. To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply. a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndrome

a. Alcohol use disorder b. Major depressive disorder d. Polydipsia e. Metabolic syndrome

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. Always afraid another student will steal her belongings. b. An unusual interest in numbers and specific topics. c. Demonstrates no interest in athletics or organized sports. d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

The activity of gamma-aminobutyric acid (GABA) contributes to a slowing of neural activity. Which of the following drugs facilitates the action of GABA? a. Benzodiazepines b. Antihistamines c. Anticonvulsants d. Noradrenergic

a. Benzodiazepines

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depression in a lifetime.

a. Conducting routine suicide screenings at a senior center.

Which patient has an increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply. a. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

a. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of a traumatic brain injury

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)

a. Fluoxetine (Prozac)

An individual says to the nurse, "I feel so stressed out lately. I think the stress is affecting my body also." Which somatic complaints are most likely to accompany this feeling? (Select all that apply.) a. Headache b. Neck pain c. Insomnia d. Anorexia e. Myopia

a. Headache b. Neck pain c. Insomnia d. Anorexia When individuals feel "stressed-out," they often have accompanying somatic complaints, especially associated with sleep, eating, and headache or back pain. Changes in vision, such as myopia, would not be expected. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-7, 29 (Table 10-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol. c. Administer a medication such as benztropine IM to correct this dystonic reaction. d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass.

a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol.

What would a client experience during a progressive relaxation session? a. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed. b. Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter c. Having a nurse enter the client's energy field to rebalance it and bring harmony d. Being led into a positive imaginary sensory experience

a. Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed. Instruction on sequential tensing and relaxing muscles provides a description of Benson's method of progressive relaxation. Being attached to a machine that uses sound describes biofeedback. Rebalancing an energy field describes therapeutic touch. Positive imaging describes a component of guided imagery.REF: 166

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? a. Insulin resistance b. A high resting heart rate c. Digestive problems d. Chronic muscle tension e. Obesity

a. Insulin resistance e. Obesity Insulin resistance and obesity are considered long-term sequelae of the high blood glucose levels incurred when the body responds to stress. None of the other options are related to the hypothalamus-pituitary-adrenal cortex.REF: 159

. Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

a. Monitor the patient's vital signs frequently. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

Which changes reflect short-term physiological responses to stress? (Select all that apply.) a. Muscular tension, blood pressure, and triglycerides increase. b. Epinephrine is released, increasing heart and respiratory rates. c. Corticosteroid release increases stamina and impedes digestion. d. Cortisol is released, increasing glucogenesis and reducing fluid loss. e. Immune system functioning decreases, and risk of cancer increases. f. Risk of depression, autoimmune disorders, and heart disease increases.

a. Muscular tension, blood pressure, and triglycerides increase. b. Epinephrine is released, increasing heart and respiratory rates. c. Corticosteroid release increases stamina and impedes digestion. d. Cortisol is released, increasing glucogenesis and reducing fluid loss. The correct answers are all short-term physiological responses to stress. Increased risk of immune system dysfunction, cancer, cardiovascular disease, depression, and autoimmune disease are all long-term (chronic) effects of stress. NURSINGTB.COM PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 10-3 to 5, 8 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

Which chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn's disease

a. Pain

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. Screening a group of males between the ages of 15 and 25 for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues. c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective. d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

When a patient diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The patient now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the patient? a. Sedation and muscle stiffness b. Sweating, nausea, and diarrhea c. Mild fever, sore throat, and skin rash d. Headache, watery eyes, and runny nose

a. Sedation and muscle stiffness Typical antipsychotic drugs often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the patient might describe as making him or her feel like a "robot." The side effects mentioned in the other options are usually not associated with typical antipsychotic therapy or would not have the effect described by the patient.

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? a. Social support b. Cultural support c. Life satisfaction d. Cognitive reframing

a. Social support Self-help groups often provide a high level of social support. Members meet and are encouraged and sustained by others who share the same problem. None of the other options are expected to be provided by the self-help group format.REF: 160-161

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? a. The individual's perception of the event b. The individual's degree of spirituality c. The effect of the individual's health-sustaining behaviors d. The amount of social support available to the individual

a. The individual's perception of the event Researchers have looked at the degree to which various life events upset specific individuals. They have found that the perception of a recent life event determines the person's emotional and psychological reactions to it. While the other options may be factors none contribute to the degree of stress than one's perception of the stressor.REF: 160-161

A patient who had been experiencing significant stress learned to use progressive muscle relaxation and deep breathing exercises. When the patient returns to the clinic 2 weeks later, which finding most clearly shows the patient is coping more effectively with stress? a. The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg. b. The patient reports, "I feel better, and that things are not bothering me as much." c. The patient reports, "I spend more time napping or sitting quietly at home." d . The patient's weight decreased by 3 pounds.

a. The patient's systolic blood pressure has changed from the 140s to the 120s mm Hg. Objective measures tend to be the most reliable means of gauging progress. In this case, the patient's elevated blood pressure, an indication of the body's physiological response to stress, has diminished. The patient's report regarding activity level is subjective; sitting quietly could reflect depression rather than improvement. Appetite, mood, and energy levels are also subjective reports that do not necessarily reflect physiological changes from stress and may not reflect improved coping with stress. The patient's weight change could be a positive or negative indicator; the blood pressure change is the best answer.

A nurse leads a psychoeducational group for patients experiencing depression. The nurse plans to implement an exercise regime for each patient. The rationale to use when presenting this plan to the treatment team is that exercise a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors. b. prevents damage from overstimulation of the sympathetic nervous system. c. detoxifies the body by removing metabolic wastes and other toxins. d. improves mood stability for patients with bipolar disorders.

a. has an antidepressant effect comparable to selective serotonin reuptake inhibitors. Endorphins produced during exercise result in improvement in mood and lowered anxiety. The other options are not accurate. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 10-12, 19, 37 (Box 10-1) TOP: Nursing Process: Implementation MSC: Client Needs: Physiological Integrity

What is the physiologic basis for the success of guided imagery? a. β-Endorphin release raises the pain threshold. b. Imagery raises the body level of cortisol and epinephrine. c. The sympathetic nervous system is stimulated to produce a quiet state. d. Brain catecholamines are less available to transmit pain impulses.

a. β-Endorphin release raises the pain threshold. Guided imagery stimulates release of β-endorphins, a brain chemical that raises the individual's pain threshold. In so doing, the guided imagery is responsible for making the client more comfortable. None of the other options are accurate explanations of this process. REF: 166

A patient has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this patient shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. a. "Everyone here is trying to help you. No one wants to harm you." b. "Feeling that people want to destroy you must be very frightening." c. "That is not true. People here are trying to help you if you will let them." d. "Staff members are health care professionals who are qualified to help you."

b. "Feeling that people want to destroy you must be very frightening." Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 12-45, 46, 99 (Box 12-4) TOP: Nursing Process: Implementation MSC: Client Needs: Psychosocial Integrity

A patient tells the nurse, "I will never be happy until I'm as successful as my older sister." The nurse asks the patient to reassess this statement and reframe it. Which reframed statement by the patient is most likely to promote coping? a. "People should treat me as well as they treat my sister." b. "I can find contentment in succeeding at my own job level." c. "I won't be happy until I make as much money as my sister." d. "Being as smart or clever as my sister isn't really important."

b. "I can find contentment in succeeding at my own job level." Finding contentment within one's own work, even when it does not involve success as others might define it, is likely to lead to a reduced sense of distress about achievement level. It speaks to finding satisfaction and happiness without measuring the self against another person. Focusing on salary is simply a more specific way of being as successful as the sister, which would not promote coping. Expecting others to treat her as they do her sister is beyond her control. Dismissing the sister's cleverness as unimportant indicates that the patient continues to feel inferior to the sibling. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 10-19, 20, 36 (Table 10-4) TOP: Nursing Process: Evaluation MSC: Client Needs: Psychosocial Integrity

Which statement(s) made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply. a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "You've said that going to group makes you nervous so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

A patient says, "One result of my chronic stress is that I feel so tired. I usually sleep from 11:00 PM to 6:30 AM. I started setting my alarm to give me an extra 30 minutes of sleep each morning, but I don't feel any better and I'm rushed for work." Which nursing response would best address the patient's concerns? a. "You may need to speak to your doctor about taking a sedative to help you sleep." b. "Perhaps going to bed a half-hour earlier would work better than sleeping later." c. "A glass of wine in the evening might take the edge off and help you to rest." d. "Exercising just before retiring for the night may help you to sleep better."

b. "Perhaps going to bed a half-hour earlier would work better than sleeping later." Sleeping later in the morning may disturb circadian rhythms and in this case is adding, rather than reducing, stress. Going to bed earlier and arising at the usual time alleviates fatigue more effectively. Sedatives may offer some benefit but are a short-term intervention with potential side effects, and other nonpharmacological interventions might work as well or better. Exercise earlier in the evening could induce tiredness and ease the process of falling asleep, but doing so right before bedtime would stimulate and interfere with sleep. Alcohol is sedating but potentially addictive; encouraging its use could increase the risk of using alcohol maladaptively as a response to stress in general. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Page 10-37 (Box 10-1) TOP: Nursing Process: Implementation MSC: Client Needs: Health Promotion and Maintenance

Which hallucination necessitates the nurse to implement safety measures? The patient says, a. "I hear angels playing harps." b. "The voices say everyone is trying to kill me." c. "My dead father tells me I am a good person." d. "The voices talk only at night when I'm trying to sleep."

b. "The voices say everyone is trying to kill me." The correct response indicates the patient is experiencing paranoia. Paranoia often leads to fearfulness, and the patient may attempt to strike out at others to protect self. The distracters are comforting hallucinations or do not indicate paranoia. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 12-20, 74 (Table 12-3) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"

b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"

Which statement made by either the nurse or the patient demonstrates an ineffective patient- nurse relationship? a. "I've given a lot of thought about what triggers me to be so angry." b. "Why do you think it's acceptable for you to be so disrespectful to staff?" c. "Will your spouse be available to attend tomorrow's family group session?" d. "I wanted you to know that the medication seems to be helping me fell less anxious."

b. "Why do you think it's acceptable for you to be so disrespectful to staff?"

The nurse wishes to use guided imagery to help a patient relax. Which comments would be appropriate to include in the guided imagery script? (Select all that apply.) a. "Imagine others treating you the way they should, the way you want to be treated ..." b. "With each breath, you feel calmer, more relaxed, almost as if you are floating ..." c. "You are alone on a beach, the sun is warm, and you hear only the sound of the surf ..." d. "You have taken control, nothing can hurt you now. Everything is going your way ..." e. "You have grown calm, your mind is still, there is nothing to disturb your well-being ..."f. "You will feel better as work calms down, as your boss becomes more understanding ..."

b. "With each breath, you feel calmer, more relaxed, almost as if you are floating ..." c. "You are alone on a beach, the sun is warm, and you hear only the sound of the surf ..." e. "You have grown calm, your mind is still, there is nothing to disturb your well-being ..."f. "You will feel better as work calms down, as your boss becomes more understanding ..." The intent of guided imagery to assist patients manage stress is to lead the patient to envision images that are calming and health-enhancing. Statements that involve the patient calming progressively with breathing, feeling increasingly relaxed, being in a calm and pleasant location, being away from stressors, and having a peaceful and calm mind are therapeutic and should be included in the script. However, items that raise stressful images or memories or that involve unrealistic expectations or elements beyond the patient's control (e.g., that others will treat the patient as he desires, that everything is going the patient's way, that bosses are understanding) interfere with relaxation and/or do not promote effective coping. Thus these are not health-promoting and should not be included in the script. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-16, 40 (Box 10-3) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

A patient experiencing significant stress associated with a disturbing new medical diagnosis asks the nurse, "Do you think saying a prayer would help?" Select the nurse's best answer. a. "It could be that prayer is your only hope." b. "You may find prayer gives comfort and lowers your stress." c. "I can help you feel calmer by teaching you meditation exercises." d. "We do not have evidence that prayer helps, but it wouldn't hurt."

b. "You may find prayer gives comfort and lowers your stress." Many patients find that spiritual measures, including prayer, are helpful in mediating stress. Studies have shown that spiritual practices can enhance the sense of well-being. When a patient suggests a viable means of reducing stress, it should be supported by the nurse. Indicating that prayer is the patient's only hope is pessimistic and would cause further distress. Suggesting meditation or other alternatives to prayer implies that the nurse does not think prayer would be effective. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-11, 12MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Implementation

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in school

b. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in school

Which client behavior illustrates eustress? a. A college student fails an exam. b. A bride is planning for her wedding. c. A man is laid off from his job. d. An adolescent gets into a fight at school.

b. A bride is planning for her wedding. Eustress is the result of a positive perception toward a stressor, such as having a baby, planning a wedding, or getting a new job. The other options all describe distress, or a negative energy.DIF: Cognitive Level: Analyze (Analysis)REF: page 6TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that: a. Anxiety may be present. b. Alcohol ingestion is a form of self-medication. c. The patient is lacking a sufficient number of neurotransmitters. d. The patient is using alcohol because she is depressed.

b. Alcohol ingestion is a form of self-medication.

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venlafaxine (Effexor)

c. Clonazepam (Klonopin)

. A patient diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this patient perceive the environment? a. Disorganized b. Dangerous c. Supportive d. Bizarre

b. Dangerous The patient sees the world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the patient. Data are not present to support any of the other options. PTS: 1 DIF: Cognitive Level: Understand (Comprehension)REF: Pages 12-20, 74 (Table 12-3) | Pages 12-99 (Box 12-4)TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A patient's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the patient may be hallucinating? a. Detachment and overconfidence b. Darting eyes, tilted head, mumbling to self c. Euphoric mood, hyperactivity, distractibility d. Foot tapping and repeatedly writing the same phrase

b. Darting eyes, tilted head, mumbling to self Clues to hallucinations include eyes looking around the room as though to find the speaker, tilting the head to one side as though listening intently, and grimacing, mumbling, or talking aloud as though responding conversationally to someone. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 12-21, 45, 72 (Table 12-2) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is: a. Transcranial magnetic stimulation b. Deep brain stimulation c. Vagus nerve stimulation d. Electroconvulsive therapy

b. Deep brain stimulation

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

b. Direct the patient in slow and deep breathing using abdominal muscles. The patient is responding to stress with increased arousal of the sympathetic nervous system, as evident by elevated vital signs. These will have a negative effect on his health and increase his perception of being anxious and stressed. Stimulating the parasympathetic nervous system will counter the sympathetic nervous system's arousal, normalizing these vital sign changes and reducing the physiological demands stress is placing on his body. Other options do not address his physiological response pattern as directly or immediately. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-3, 4, 15, 16, 39 (Box 10-2)TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? a. Eustress b. Fight or flight c. Resistance d. Exhaustion

b. Fight or flight The initial adaptive response of the general adaptation syndrome prepares the individual to fight or flee in the face of acute stress. None of the other options are associated with the initial stage of GAS.REF: 159

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. Reinforce that the level is considered therapeutic. b. Instruct the patient to hold the next dose of medication and contact the prescriber. c. Have the patient go to the hospital emergency room immediately. d. Alert the patient to the possibility of seizures and appropriate precautions.

b. Instruct the patient to hold the next dose of medication and contact the prescriber.

Samantha is a new patient to the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? a. Electrocardiogram b. Liver enzymes c. Glomerular filtration rate d. Complete blood count

b. Liver enzymes

The relaxation response calls upon the initiation of what process? a. Sympathetic activation b. Parasympathetic activation c. Brainstem deactivation d. Increased cortisol production by the adrenals

b. Parasympathetic activation Sympathetic activation prepares the individual for the fight-or-flight response. Parasympathetic activation has the opposite effect. None of the other options would bring about relaxation.REF: 159

Which patient outcome is directly associated with the goals of a therapeutic nurse-patient relationship? a. Patient will be respectful of other patients on the unit. b. Patient will identify suicidal feelings to staff whenever they occur. c. Patient will engage in at least one social interaction with the unit population daily. d. Patient will consume a daily diet to meet both nutritional and hydration needs.

b. Patient will identify suicidal feelings to staff whenever they occur.

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which is the best initial response by the student? a. The student requests assignment to a patient of the same gender as the student. b. She limits sharing personal information and stresses the patient-centered focus of theconversation. c. The student shares information to make the therapeutic relationship more equal. d. She explains that if he persists in focusing on her, she cannot work with him.

b. She limits sharing personal information and stresses the patient-centered focus of theconversation.

A recent immigrant from Honduras comes to the clinic with a family member who has been a U.S. resident for 10 years. The family member says, "The immigration to America has been very difficult." Considering cultural background, which expression of stress by this patient would the nurse expect? a. Motor restlessness b. Somatic complaints c. Memory deficiencies d. Sensory perceptual alterations

b. Somatic complaints Honduras is in Central America. Many people from Central American cultures express distress in somatic terms. The other options are not specific to this patient's cultural background and are less likely to be observed in persons from Central America. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 10-11 TOP: Nursing Process: AssessmentMSC: Client Needs: Psychosocial Integrity

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has been recently prescribed an antianxiety medication? a. Eating high protein foods. b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee with sugar and extra cream each morning on the way to work

b. Using acetaminophen without first discussing it with a healthcare provider

A newly admitted patient diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The patient states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior as a. echolalia. b. an idea of reference. c. a delusion of infidelity. d. an auditory hallucination.

b. an idea of reference. Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, when seeing two people talking, the individual assumes they are talking about him or her. The other terms do not correspond with the scenario. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 12-70 (Table 12-1) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? a. Guided imagery b.cognitive reframing c. wishful thinking d. confrontational assertion

b. cognitive reframing Cognitive reframing calls for changing the viewpoint of a situation and replacing it with another viewpoint that fits the facts but is less negative. That description does not apply to any of the other options.REF: 167

Which scenario best demonstrates an example of eustress? An individual a. loses a beloved family pet. b. prepares to take a vacation to a tropical island with a group of close friends. c. receives a bank notice that there were insufficient funds in his/her account for a recent rent payment. d. receives notification that his/her current employer is experiencing financial problems and some workers will be terminated.

b. prepares to take a vacation to a tropical island with a group of close friends.

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially when attempting to help the patient deescalate their anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?"

c. "Can you identify what was happening when your anxiety began to increase?"

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes effective teaching about mild anxiety when Isabel states: a. "I would like to try a benzodiazepine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay because it helps me to focus." d. "I have fear that I will fail at college."

c. "Mild anxiety is okay because it helps me to focus."

A homebound patient diagnosed with agoraphobia has been receiving therapy in the home. The nurse evaluates patient teaching is effective when the patient states: a. "I may never leave the house again." b. "Having groceries delivered is very convenient." c. "My risk for agoraphobia is increased by my family history." d. "I will go out again, someday, just not today."

c. "My risk for agoraphobia is increased by my family history."

A patient newly diagnosed as HIV-positive seeks the nurse's advice on how to reduce the risk of infections. The patient says, "I went to church years ago and I was in my best health then. Maybe I should start going to church again." Which response will the nurse offer? a. "Religion does not usually affect health, but you were younger and stronger then." b. "Contact with supportive people at a church might help, but religion itself is not especially helpful." c. "Studies show that spiritual practices can enhance immune system function and coping abilities." d. "Going to church would expose you to many potential infections. Let's think about some other options."

c. "Studies show that spiritual practices can enhance immune system function and coping abilities." Studies have shown a positive correlation between spiritual practices and enhanced immune system function and sense of well-being. The other options wrongly suggest that spiritual practices have little effect on the immune system or reject the patient's preferences regarding health management. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-11, 12MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Implementation

A patient diagnosed with schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. Which patient needs are of priority importance? a. Self-esteem b. Psychosocial c. Physiological d. Self-actualization

c. Physiological Physiological needs must be met to preserve life. A patient with waxy flexibility must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Waxy flexibility may also precipitate risk for falls; therefore, safety is a concern. Higher-level needs are of lesser concern. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 12-23, 29, 74 (Table 12-3) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

A patient reports, "I am overwhelmed by stress." Which question by the nurse would be most important to use in the initial assessment of this patient? a. "Tell me about your family history. Do you have any relatives who have problems with stress?" b. "Tell me about your exercise. How much activity do you typically get in a day?" c. "Tell me about the kinds of things you do to reduce or cope with your stress." d. "Stress can interfere with sleep. How much did you sleep last night?"

c. "Tell me about the kinds of things you do to reduce or cope with your stress." The most important data to collect during an initial assessment is that which reflects how stress is affecting the patient and how he is coping with stress at present. This data would indicate whether or not his distress is placing him in danger (e.g., by elevating his blood pressure dangerously or via maladaptive responses, such as drinking) and would help the nurse understand how he copes and how well his coping strategies and resources serve him. Of the choices presented, the highest priority would be to determine what he is doing to cope at present, preferably via an open-ended inquiry. Family history, the extent of his use of exercise, and how much sleep he is getting are all helpful but seek data that is less of a priority. Also, the manner in which such data is sought here is likely to provide only brief responses (e.g., how much sleep he got on one particular night is probably less important than how much he is sleeping in general). PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Pages 10-12 to 14MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

Morgan is a third-year nursing student in her psychiatric clinical rotation. She is assigned to an 80-year-old widow admitted for major depressive disorder. The patient describes many losses and sadness. Morgan becomes teary and says meaningfully, "I am so sorry for you." Morgan's instructor overhears the conversation and says, "I understand that getting tearful is a human response. Yet, sympathy isn't helpful in this field." The instructor urges Morgan to focus on: a. "Adopting the patient's sorrow as your own." b. "Maintaining pure objectivity." c. "Using empathy to demonstrate respect and validation of the patient's feelings." d. "Using touch to let her know that everything is going to be alright."

c. "Using empathy to demonstrate respect and validation of the patient's feelings."

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes? a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the voices, they are NOT real." c. "You say you hear voices, what are they telling you?" d. "Please tell the voices to leave you alone for now."

c. "You say you hear voices, what are they telling you?"

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing": a. A higher dosage b. Once a week dosing c. A lower dosage d. A different drug

c. A lower dosage

According to the Recent Life Changes Questionnaire, which situation would most necessitate a complete assessment of a person's stress status and coping abilities? a. A person who has been assigned more responsibility at work b. A parent whose job required relocation to a different city c. A person returning to college after an employer ceased operations d. A man who recently separated from his wife because of marital problems

c. A person returning to college after an employer ceased operations A person returning to college after losing a job is dealing with two significant stressors simultaneously. Together, these stressors total more life change units than any of the single stressors cited in the other options. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 10-12, 13, 31 (Table 10-3) TOP: Nursing Process: Assessment MSC: Client Needs: Psychosocial Integrity

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with: a. Generally good health despite the mental illness. b. An aversion to drinking fluids. c. Anxiety and depression. d. The ability to express his needs.

c. Anxiety and depression.

Emily is a 28-year-old nurse who works on a psychiatric unit. She is assigned to work with Jenna, a 27-year-old who was admitted with major depressive disorder. Emily and Jenna realize that they graduated from the same high school and each has a 2-year-old daughter. Emily and Jenna discuss getting together for a play date with their daughters after Jenna is discharged. This situation reflects: a. Successful termination b. Promoting interdependence c. Boundary blurring d. A strong therapeutic relationship

c. Boundary blurring

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) c. Electroconvulsive therapy (ECT) d. Lurasidone (Latuda)

c. Electroconvulsive therapy (ECT)

A patient diagnosed with emphysema has severe shortness of breath and needs portable oxygen when leaving home. Recently the patient has reduced activity because of fear that breathing difficulty will occur. A nurse suggests using guided imagery. Which image should the patient be encouraged to visualize? a. Engaging in activity without using any supplemental oxygen b. Sleeping comfortably and soundly, without respiratory distress c. Feeling relaxed and taking regular deep breaths when leaving home d. Having a younger, healthier body that knows no exercise limitations

c. Feeling relaxed and taking regular deep breaths when leaving home The patient has dysfunctional images of dyspnea. Guided imagery can help replace the dysfunctional image with a positive coping image. Athletes have found that picturing successful images can enhance performance. Encouraging the patient to imagine a regular breathing depth and rate will help improve oxygen-carbon dioxide exchange and help achieve further relaxation. Other options focus on unrealistic goals (being younger, not needing supplemental oxygen) or restrict her quality of life. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-16, 40 (Box 10-3) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

A person with a fear of heights drives across a high bridge. Which structure will stimulate a response from the autonomic nervous system? a. Thalamus b. Parietal lobe c. Hypothalamus d. Pituitary gland

c. Hypothalamus The individual will find this experience stressful. The hypothalamus functions as the command-and-control center when receiving stressful signals. The hypothalamus responds to signals of stress by engaging the autonomic nervous system. The parietal lobe is responsible for interpretation of other sensations. The thalamus processes messages associated with pain and wakefulness. The pituitary gland may be involved in other aspects of the person's response but would not stimulate the autonomic nervous system. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 10-4 TOP: Nursing Process: AssessmentMSC: Client Needs: Physiological Integrity

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? a. Projection b. Denial c. Perception d. Repression

c. Perception Perception, which is influenced by gender, culture, age, and life experience, plays a part in how someone will respond to a stress. The perception of a stressor determines the person's emotional and psychological reactions to it. The other options are all defense mechanisms that do not explain the difference in reactions to a stressor.DIF: Cognitive Level: Analyze (Analysis)REF: page 10TOP: Nursing Process: AssessmentMSC: NCLEX: Psychosocial Integrity

A registered nurse is caring for an older male who reports depressive symptoms since his wife of 54 years died suddenly. He cries, maintains a closed body posture, and avoids eye contact. Which nursing action describe attending behavior? a. Reminding the patient gently that he will "feel better over time" b. Using a soft tone of voice for questioning c. Sitting with the patient and taking cues for when to talk or when to remain silent d. Offering medication and bereavement services

c. Sitting with the patient and taking cues for when to talk or when to remain silent

A person with a fear of heights drives across a high bridge. Which division of the autonomic nervous system will be stimulated in response to this experience? a. Limbic system b. Peripheral nervous system c. Sympathetic nervous system d. Parasympathetic nervous system

c. Sympathetic nervous system The autonomic nervous system is comprised of the sympathetic (fight or flight response) and parasympathetic nervous system (relaxation response). In times of stress, the sympathetic nervous system is stimulated. A person fearful of heights would experience stress associated with the experience of driving across a high bridge. The peripheral nervous system responds to messages from the sympathetic nervous system. The limbic system processes emotional responses but is not specifically part of the autonomic nervous system. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Pages 10-3, 4 TOP: Nursing Process: Assessment MSC: Client Needs: Physiological Integrity

A patient tells the nurse, "My doctor thinks my problems with stress relate to the negative way I think about things and suggested I learn new ways of thinking." Which response by the nurse would support the recommendation? a. Encourage the patient to imagine being in calm circumstances. b. Provide the patient with a blank journal and guidance about journaling. c. Teach the patient to recognize, reconsider, and reframe irrational thoughts. d. Teach the patient to use instruments that give feedback about bodily functions.

c. Teach the patient to recognize, reconsider, and reframe irrational thoughts. Cognitive reframing focuses on recognizing and correcting maladaptive patterns of thinking that create stress or interfere with coping. Cognitive reframing involves recognizing the habit of thinking about a situation or issue in a fixed, irrational, and unquestioning manner. Helping the patient to recognize and reframe (reword) such thoughts so that they are realistic and accurate promotes coping and reduces stress. Thinking about being in calming circumstances is a form of guided imagery. Instruments that give feedback about bodily functions are used in biofeedback. Journaling is effective for helping to increase self-awareness. However, none of these last three interventions is likely to alter the patient's manner of thinking. PTS: 1 DIF: Cognitive Level: Apply (Application)REF: Pages 10-19, 20, 36 (Table 10-4) TOP: Nursing Process: Planning MSC: Client Needs: Psychosocial Integrity

When a nurse uses therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleep

c. Use the technique of making observations

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is a. assertiveness. b. journal keeping. c. deep breathing. d. restructuring and setting priorities.

c. deep breathing. Changing the breathing pattern can be highly effective in aborting or mitigating the high anxiety level associated with performance anxiety. None of the other options are typically associated with anxiety management.REF: 165-166

Meditation is successful in promoting stress reduction because it brings about which outcome? a. Prevents endorphin release b. changes the client's energy field c. quiets the sympathetic nervous system d. activates the parasympathetic nervous system

c. quiets the sympathetic nervous system. Sympathetic nervous system stimulation prepares the body for fight or flight in response to stress. Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system. None of the other options accurately describe the process.REF: 166

A patient diagnosed with schizophrenia tells the nurse, "I eat skiller. Tend to end. Easter. It blows away. Get it?" Select the nurse's most therapeutic response. a. "Nothing you are saying is clear." b. "Your thoughts are very disconnected." c. "Try to organize your thoughts and then tell me again." d. "I am having difficulty understanding what you are saying."

d. "I am having difficulty understanding what you are saying." When a patient's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the patient that he or she is having difficulty understanding what the patient is saying. If a theme is discernible, ask the patient to talk about the theme. The incorrect options tend to place blame for the poor communication with the patient. The correct response places the difficulty with the nurse rather than being accusatory. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 12-18, 46, 47MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Implementation

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

A patient tells the nurse, "I know that I should reduce the stress in my life, but I have no idea where to start." What would be the best initial nursing response? a. "Physical exercise works to elevate mood and reduce anxiety." b. "Reading about stress and how to manage it might be a good place to start." c. "Why not start by learning to meditate? That technique will cover everything." d. "Let's talk about what is going on in your life and then look at possible options."

d. "Let's talk about what is going on in your life and then look at possible options." In this case, the nurse lacks information about what stressors the patient is coping with or about what coping skills are already possessed. Further assessment is indicated before potential solutions can be explored. Suggesting exploration of the stress facing the patient is the only option that involves further assessment rather than suggesting a particular intervention. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-12 to 14MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Assessment

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. Increased attentiveness b. Getting up at night to urinate c. Improved vision d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

A health care provider considers which antipsychotic medication to prescribe for a patient diagnosed with schizophrenia who has auditory hallucinations and poor social function. The patient is also overweight and hypertensive. Which drug should the nurse advocate? a. Clozapine b. Ziprasidone c. Olanzapine d. Aripiprazole

d. Aripiprazole Aripiprazole is a third-generation atypical antipsychotic effective against both positive and negative symptoms of schizophrenia. It causes little or no weight gain and no increase in glucose, high- or low-density lipoprotein cholesterol, or triglycerides, making it a reasonable choice for a patient with obesity or heart disease. Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Ziprasidone may prolong the QT interval, making it a poor choice for a patient with cardiac disease. Olanzapine fosters weight gain. PTS: 1 DIF: Cognitive Level: Analyze (Analysis)REF: Pages 12-48, 54, 84 (Table 12-5) TOP: Nursing Process: Planning MSC: Client Needs: Physiological Integrity

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? a. Meditation b. Breathing exercises c. Journal keeping d.Biofeedback

d. Biofeedback Biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people with hypnotic ability, meditation, progressive muscle relaxation, and other cognitive-behavioral therapy techniques produce the most rapid reduction in clinical symptoms.REF: 165

Luc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. Hypodermic needles b. Fast food wrappers c. Empty soda cans d. Energy drink containers

d. Energy drink containers

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? a. Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over b. Antianxiety medication to help her relax c. Starting a hobby to keep her mind off the troubling event d. Talking with friends and attending a loss support group

d. Talking with friends and attending a loss support group. Social supports and support groups are two effective ways to cope with stress and stressful events. Isolation is never a healthy option; talking about feelings usually decreases stress, not increases. There is no evidence to suggest Melissa is anxious. Trying to "keep her mind off" the stressor does not develop coping mechanisms to deal with stress but rather encourages not dealing with the problem.DIF: Cognitive Level: Analyze (Analysis)REF: pages 10, 11TOP: Nursing Process: ImplementationMSC: NCLEX: Psychosocial Integrity

What is the greatest trigger for the development of a patient's nurse focused transference? a. The similarity between the nurse and someone the patient already dislikes b. The nature of the patient's diagnosed mental illness c. The history the patient has with their parents d. The degree of authority the nurse has over the patient

d. The degree of authority the nurse has over the patient

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. Medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.

d. They are not actually ill.

Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. Favorable with medication b. In the relapse stage c. Improvable with psychosocial interventions d. To have a less positive outcome

d. To have a less positive outcome

When a nurse asks a newly admitted patient to describe social supports, the patient says, "My parents died last year and I have no family. I am newly divorced, and my former in-laws blame me. I don't have many friends because most people my age just want to go out drinking." Which action will the nurse apply? a. Advise the patient that being so particular about potential friends reduces social contact. b. Suggest using the Internet as a way to find supportive others with similar values. c. Encourage the patient to begin dating again, perhaps with members of the church. d.Discuss how divorce support groups could increase coping and social support.

d.Discuss how divorce support groups could increase coping and social support. High-quality social support enhances mental and physical health and acts as a significant buffer against distress. Low-quality support relationships affect a person's coping negatively. Resuming dating soon after a divorce could place additional stress on the patient rather than helping her cope with existing stressors. Developing relationships on the Internet probably would not substitute fully for direct contact with other humans and could expose her to predators misrepresenting themselves to take advantage of vulnerable persons. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Pages 10-10, 11MSC: Client Needs: Psychosocial Integrity TOP: Nursing Process: Implementation