NCLEX 3500 psychiatric health

After completing chemical detoxification and a 12-step program to treat crack addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future?

"I'm going to take 1 day at a time. I'm not making any promises."

A client, age 42, with antisocial personality disorder brags to the nurse about his counseling abilities. He also says he is starting a relationship with a 15-year-old girl who was recently admitted to the psychiatric unit. When the nurse expresses concern about this, he accuses the nurse of being hostile and threatens to get the nurse in trouble for interfering. Which response by the nurse would be most appropriate?

"If you continue to spend time with her, you will be restricted from the activities area."

A client tells the nurse that people from Mars are going to invade the earth. Which response by the nurse would be most therapeutic?

"That must be frightening to you. Can you tell me how you feel about it?"

A schizophrenic client with delusions tells the nurse, "There is a man wearing a red coat who's out to get me." The client exhibits increasing anxiety when focusing on the delusion. Which of the following would be the best response?

"This subject seems to be troubling you. Let's walk to the activity room."

In a group therapy setting, one member is very demanding, repeatedly interrupting others and taking most of the group time. The nurse's best response would be:

"Will you briefly summarize your point because others need time also?"

The nurse is caring for a client with antisocial personality disorder. Which statement is most appropriate for the nurse to make when explaining unit rules and expectations to the client?

"You'll be expected to attend group therapy each day."

1) A recent diagnosis of cancer has caused a client severe anxiety. The nursing care plan should include which interventions

- Maintain a calm, nonthreatening environment - Encourage the client to verbalize her concerns regarding the diagnosis - Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress

A client is prescribed sertraline (Zoloft), a selective serotonin reuptake inhibitor. Which information about this drug's adverse effects would the nurse include when creating a medication teaching plan?

Agitation Sleep disturbance Dry mouth

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

Agoraphobia

Which of the following statements describes how elderly clients react to medications?

At risk for increased adverse effects

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction?

Ataxia

A client is unable to get out of bed and get dressed unless the nurse prompts every step. This is an example of which behavior?

Avolition

The nurse is assessing a client who talks freely about feeling depressed. During the interaction, the nurse hears the client state, "Things will never change." What other indications of hopelessness would the nurse look for?

Bouts of anger, Periods of irritability , Feelings of worthlessness, Self-destructive behaviors

In the emergency department, a client with facial lacerations states that her husband beat her with a shoe. After the health care team repairs her lacerations, she waits to be seen by the crisis intake nurse, who will evaluate the continued threat of violence. Suddenly the client's husband arrives, shouting that he wants to "finish the job." What is the first priority of the health care worker who witnesses this scene?

Calling a security guard and another staff member for assistance

A physician starts a client on the antipsychotic medication haloperidol (Haldol). The nurse is aware that this medication has adverse extrapyramidal effects. Which nursing measures should be taken during haloperidol administration?

Closely monitor vital signs, especially temperature. Provide the client with the opportunity to pace. Provide the client with hard candy.

A delusional client approaches the nurse, stating, "I am the Easter bunny," and insisting that the nurse refer to him as such. The belief appears to be fixed and unchanging. Which nursing interventions should the nurse implement when working with this client?

Consistently use the client's name in interaction. Provide the client with structured activities.

A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which action?

Consulting with the physician about a care plan.

Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following?

Continuing previous use of contraception during periods of amenorrhea

During which phase of alcoholism is loss of control and physiologic dependence evident?

Crucial phase

The nurse is assigned to a client who, after a medication teaching session with the nurse, began receiving amitriptyline (Elavil) 1 week ago to treat depression. The client now refuses to take the medication, stating that it has caused blurred vision, dry mouth, and constipation, but hasn't improved the mood. Which nursing diagnosis is most appropriate for this client?

Deficient knowledge (treatment regimen) related to inadequate understanding of teaching

Which of the following medical conditions is commonly found in clients with bulimia nervosa?

Diabetes mellitus

One of the causes of schizophrenia involves an overstimulation of what neurotransmitter?

Dopamine

Yesterday, a client with schizophrenia began treatment with haloperidol (Haldol). Today, the nurse notices that the client is holding his head to one side and complaining of neck and jaw spasms. What should the nurse do?

Evaluate the client for adverse reactions to haloperidol.

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

Focusing

Sedative-hypnotic drugs are used to treat which of the following disorders?

Hallucinations and delusions

After interviewing a client diagnosed with recurrent depression, the nurse determines the client's potential to commit suicide. Which factors would the nurse consider as contributors to the client's potential for suicide?

Impulsive behaviors Overwhelming feelings of guilt Chronic, debilitating illness Repression of anger

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

Introjection

The nurse is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.

A client is admitted with a diagnosis of schizotypal personality disorder. Which signs would this client exhibit during social situations?

Paranoid thoughts

A client with catatonic schizophrenia is mute, can't perform activities of daily living, and stares out the window for hours. What is the nurse's first priority?

Reassure the client about safety.

A client is receiving chlordiazepoxide (Librium) to control the symptoms of alcohol withdrawal. The chlordiazepoxide has been ordered as needed. Which symptom may indicate the need for an additional dose of this medication?

Tachycardia Elevated blood pressure and temperature Tremors Increasing anxiety

The nurse has developed a relationship with a client who has an addiction problem. Which information would indicate that the therapeutic interaction is in the working stage?

The client addresses how the addiction has contributed to family distress. The client verbalizes difficulty identifying personal strengths. The client acknowledges the addiction's effects on the children.

A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction-formation?

The client assumes an attitude that is the opposite of an impulse that the client harbors.

A client, age 36, with paranoid schizophrenia believes the room is bugged by the Central Intelligence Agency and that his roommate is a foreign spy. The client has never had a romantic relationship, has no contact with family members, and hasn't been employed in the last 14 years. Based on Erikson's theories, the nurse should recognize that this client is in which stage of psychosocial development?

Trust versus mistrust

A client with schizophrenia hears a voice telling him he is evil and must die. The nurse understands that the client is experiencing:

a hallucination.

When teaching a group of nurses about posttraumatic stress disorder (PTSD), a nurse-educator explains that this disorder is most common in:

can occur in any age group.

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

complacency

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

dysthymic disorder.

5) A client admitted to the psychiatric unit for treatment of a panic attack comes to the nurses' station in obvious distress. After finding the client short of breath, dizzy, trembling, and nauseated, the nurse should first

escort the client to a quiet area and suggest using a relaxation exercise that he's been taught

The definition of nihilistic delusions is:

false ideas about the self, others, or the world.

A client changes topics quickly while relating past psychiatric history. This client's pattern of thinking is called:

flight of ideas.

A depressed client in the psychiatric unit hasn't been getting adequate rest and sleep. To encourage restful sleep at night, the nurse should:

gently but firmly set limits on time spent in bed during the day.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client expects the resident to prescribe:

lorazepam (Ativan).

The nurse notices that a depressed client taking amitriptyline (Elavil) for 2 weeks has become very outgoing, cheerful, and talkative. The nurse suspects that the client:

may be experiencing increased energy and is at an increased risk for suicide.

A client is in the manic phase of bipolar disorder. To help the client maintain adequate nutrition, the nurse should plan to:

offer finger foods and sandwiches.

The nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will:

participate in a daily exercise group.

The nurse who uses self-disclosure should:

refocus on the client's experience as quickly as possible.

4) A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

repetitive thoughts and recurring, irresistible impulses

A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:

severe anxiety and fear.

A client comes to the emergency department while experiencing a panic attack. The nurse can best respond to a client having a panic attack by:

staying with the client until the attack subsides.

Initial interventions for the client with acute anxiety would not include

touching the client in an attempt to comfort him

When assessing a client diagnosed with impulse control disorder, the nurse observes violent, aggressive, and assaultive behavior. Which assessment is the nurse also likely to find?

The client functions well in other areas of his life. The degree of aggressiveness is out of proportion to the stressor. The client has a history of parental alcoholism and chaotic abusive family life.