NSG131 UNIT 4

A client is preparing to attend a Gamblers Anonymous meeting for the first time. The nurse should tell the client that which is the first step in this 12-step program? 1. Admitting to having a problem 2. Substituting other activities for gambling 3. Stating that the gambling will be stopped 4. Discontinuing relationships with people who gamble

1. Admitting to having a problem

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." What is the most helpful response by the nurse? 1. "Why don't you tell your wife about this?" 2. "What do you find difficult about this situation?" 3. "This is not the best time to make that decision." 4. "I agree with you. You should get out of this situation."

2. "What do you find difficult about this situation?"

Before giving the client the initial dose of Disulfiram (Antabuse), what should the psychiatric home health nurse determine? 1.If there is a history of hyperthyroidism 2.When the last full meal was consumed 3.If there is a history of diabetes insipidus 4.When the last alcoholic drink was consumed

4.When the last alcoholic drink was consumed

Example of Regression

A 5 y.o. begins wetting the bed when parents divorce

Example of Undoing

A husband hits his wife and buys her a new car.

What is anxiety?

A subjective emotional response to a stressor

A client admitted voluntarily for treatment for an anxiety problem demands to be released from the hospital. Which action should the nurse take initially? A. Contact the client's HCP B. Call the client's family to arrange for transportation C. Attempt to persuade the client to stay "for only a few more days." D. Tell the client that leaving would likely result in an involuntary commitment.

A. Contact the client's HCP

The nurse is preparing to perform an admission assessment on a client with a diagnosis of bulimia nervosa. Which assessment finding should the nurse expect to note? SATA A. Dental decay B. Moist, oily skin C. Loss of tooth enamel D. Electrolyte imbalances E. Body weight well below ideal range.

A. Dental decay C. Loss of tooth enamel D. Electrolyte imbalances

Which of the following conditions increases the risk of adverse events associated with ECT? SATA A. Increased intracranial pressure B. Recent MI C. Severe underlying HTN D. Congestive heart failure E. Breast Cancer

A. Increased intracranial pressure B. Recent MI C. Severe underlying HTN D. Congestive heart failure

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? 1. Ask the client to leave the group for this session only. 2. Refer the client to another group that includes other manic clients. 3. Tell the client to stop monopolizing in a firm but compassionate manner. 4. Thank the client for the input, but inform the client that others now need a chance to contribute.

4. Thank the client for the input, but inform the client that others now need a chance to contribute.

During a home visit, the nurse suspects that a young daughter of the client is bulimic. The nurse bases this suspicion on which primary characteristics of bulimia? 1.Refusing to eat and excessive exercising 2.Eating only vegetables and fruits and fasting 3.Hoarding of food and difficulty controlling food intake 4.Eating a lot of food in a short period of time and misuse of laxatives

4.Eating a lot of food in a short period of time and misuse of laxatives

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? 1.Incessant talking and sexual innuendoes 2.Grandiose delusions and poor concentration 3.Outlandish behaviors and inappropriate dress 4.Nonstop physical activity and poor nutritional intake

4.Nonstop physical activity and poor nutritional intake

Example of Isolation

A mother relates the story of her son's fatal OD without any emotion

The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the wife make which statement? A. "I no longer feel that I deserve the beatings my husband inflicts on me." B. "My attendance at the meetings has helped me see that I provoke my husband's violence." C. "I enjoy attending the meetings because they get me out of the house and away from my husband." D. "I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics."

A. "I no longer feel that I deserve the beatings my husband inflicts on me."

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply) A. Awareness training B. Competing response training C. Social Support D. Hypnotherapy E. Aversive therapy

A. Awareness training B. Competing response training C. Social Support

A hospitalized client with a history of alcohol misuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been discharged and is scheduled for an important diagnostic test to be performed in 1 hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? A. Calling the nursing supervisor B. Call security to block all exit areas. C. Restrain the client until the primary health care provider can be reached. D. Tell the client that the client cannot return to this hospital again if the client leaves now.

A. Calling the nursing supervisor

Which interventions are most appropriate for caring for a client in alcohol withdrawal? SATA A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically D. Provide stimulation in the environment E. Provide reality orientation as appropriate F. Maintain NPO status.

A. Monitor vital signs B. Provide a safe environment C. Address hallucinations therapeutically E. Provide reality orientation as appropriate

Trauma-informed care is a philosophical approach that includes which of the following principles? SATA A. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk for revictimization or retraumatization B. Medications need to be given before any other interventions are considered. C. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. D. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide.

A. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk for revictimization or retraumatization C. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client.

A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: A. Relieves her anxiety B. Reduced her probability of infection C. Gives her a feeling of control over her life D. Increases her self-concept

A. Relieves her anxiety

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports he had been a heavy drinker for a number of years. Labs report he has a blood alcohol of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected? A. Several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink

A. Several hours after the last drink

A client who is experiencing a panic attack just arrived at the ER. Which is the priority nursing intervention for this client? A. Stay with the client and reassure safety B. Administer a dose of diazepam C. Leave the client alone in a quiet room so that she can calm down. D. Encourage the client to talk about what triggered the attack.

A. Stay with the client and reassure safety

Example of Repression

An assault victim cannot remember any details.

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to her nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she's feeling anxious." Which of the following would be an appropriate response by the nurse? A. "Xanax is not effective for generalized anxiety disorder." B. "Buspirone must be taken daily to be effective." C. "I will ask the doctor if he will change your dose of buspirone to prn so that you don't have to take it every day." D. "Your friend really should be taking the Xanax every day."

B. "Buspirone must be taken daily to be effective."

A patient has been ordered ECT and asks the nurse, "Exactly how does ECT work?" Which of the following is the most accurate response by the nurse? A. "I'm not allowed to tell you that because that would be informed consent." B. "The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects." C. "The administration of a shock to the brain induces memory loss, which will make you forget you are depressed." D. "The neuroplasticity affected by seizure activity prevents further brain damage."

B. "The exact mechanism is unknown, but there are several ways that ECT may have antidepressant effects."

The home health nurse visits a client at home and determines that the client is dependent on drugs. During the assessment, which action should the nurse take to plan appropriate nursing care? A. Ask the client why he started taking illegal drugs. B. Ask the client about the amount of drug use and its effects. C. Ask the client how long he thought that he could take drugs without someone finding out D. Do not ask any questions for fear that the client is in denial and will throw the nurse out of the home

B. Ask the client about the amount of drug use and its effects.

The nurse is caring for a client diagnosed with paranoid personality disorder who is experiencing disturbed thought processes. In formulating a nursing plan of care, which best intervention should the nurse include? A. Increase socialization of the client with peers B. Avoid using a whisper voice in front of the client C. Begin to educate the client about social supports in the community D. Have the client sign a release of information to appropriate parties for assessment purposes.

B. Avoid using a whisper voice in front of the client

A client with anorexia nervosa is a member of a pre-discharge support group. The client verbalizes that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes to the client to replace the client's old clothes. The client believes that the new clothes are much too tight and has reduced her calorie intake to 800 calories daily. How should the nurse evaluate this behavior? A. Normal behavior B. Evidence of the client's disturbed body image C. Regression as the client is moving toward the community D. Indicative of the client's ambivalence about hospital discharge.

B. Evidence of the client's disturbed body image

Which of the following best describes the average number of ECT treatments given and the timing of administration? A. One treatment per month for 6 to 12 months B. One treatment every other day, three times a week for a total of 6 to 12 treatments. C. One treatment three times per week for 6 to 12 months D. One treatment every day for a total of 10 to 20 treatments

B. One treatment every other day, three times a week for a total of 6 to 12 treatments.

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? A. Keep the client's bathroom locked so she can't wash her hands all the time. B. Structure the client's schedule so that she has plenty of time for washing her hands. C. Place the client in isolation until she promises to stop washing her hands so much. D. Explain the client's behavior to her, since she's probably unaware that it's maladaptive.

B. Structure the client's schedule so that she has plenty of time for washing her hands.

Atropine sulfate is administered to a client receiving ECT for what purpose? A. To alleviate anxiety B. To decrease secretions C. To relax muscles D. As a short-acting anesthetic

B. To decrease secretions

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? A. Chess B. Writing C. Board games D. Group exercise

B. Writing

The nurse is caring for a female client who was admitted to the mental health unit recently for anorexia nervosa. The nurse enters the client's room and notes that the client is engaged in rigorous push-ups. Which nursing action is most appropriate? A. Interrupt the client and weight her immediately. B. interrupt the client and offer to take her on a walk. C. Allow the client to complete her exercise program D. Tell the client that she is not allowed to exercise rigorously.

B. interrupt the client and offer to take her on a walk.

A client is admitted to a medical nursing unit with a diagnosis of acute blindness after being involved in a hit-and-run accident. When diagnostic testing cannot identify any organic reason why this client cannot see, a mental health consult is prescribed. The nurse plans care based on which mental health condition? A. Psychosis B. Repression C. Conversion disorder D. Dissociative disorder

C. Conversion disorder

Which of the following is the most appropriate therapy for a client with agoraphobia? A. 10 mg Valium qid B. Group therapy with other agoraphobics C. Facing her fear in gradual step progression D. Hypnosis

C. Facing her fear in gradual step progression

Joanie is a new pt at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medication is the psychiatric nurse practitioner most likely to prescribe for Joanie? A. Alprazolam (Xanax) B. Diazepam (Valium) C. Fluoxetine (Prozac) D. Olanzapine (Zyprexa)

C. Fluoxetine (Prozac)

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not at ill-at-ease with the staff or other pts anymore." In light of this change, which nursing intervention is most appropriate? A. Give attention the to ritualistic behaviors each time they occur and point out their inappropriateness. B. Ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. C. Set limits on the amount of time Sandy may engage in the ritualistic behavior. D. Continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

C. Set limits on the amount of time Sandy may engage in the ritualistic behavior.

Succinylcholine is administered to a client receiving ECT for what purpose? A. To alleviate anxiety B. To decrease secretions C. To relax muscles D. As a short-acting anesthetic

C. To relax muscles

What is the priority nursing intervention before starting ECT therapy? A. Take vital signs and record B. Have the patient void C. Administer succinylcholine D. Ensure that the consent form has been signed

D. Ensure that the consent form has been signed

When a client is admitted to an inpatient mental health unit with the diagnosis for anorexia nervosa, a cognitive behavioral approach is used as part of the treatment plan. The nurse plans care based on which purpose of this approach? A. Providing a supportive environment B. Examining intrapsychic conflicts and past issues C. Emphasizing social interaction with clients who withdraw D. Helping the client to examine dysfunctional thoughts and beliefs.

D. Helping the client to examine dysfunctional thoughts and beliefs.

A nurse is assessing a client who was admitted 24 hours ago for a fractured humerus. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? A. Hypotension, ataxia, hunger B. Stupor, lethargy, muscular rigidity C. Hypotension, coarse hand tremors, lethargy D. Hypertension, changes in level of consciousness, hallucinations

D. Hypertension, changes in level of consciousness, hallucinations

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? A. Ms. T. experiences panic anxiety when she encounters snakes B. Ms. T. refuses to fly in an airplane C. Ms. T. will not eat in a public place D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

D. Ms. T. stays in her home for fear of being in a place from which she cannot escape.

With implosion therapy, a client with phobic anxiety would be: A. Taught relaxation exercises. B. Subjected to graded intensities of the fear C. Instructed to stop the therapeutic session as soon as anxiety is experienced. D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

D. Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

GI Response to Anxiety

Decreased Gi motility, secretions, and sphincter contraction

Cognitive Response to Anxiety

Decreased concentration Poor judgment

Characteristics of Moderate Anxiety (2)

Decreased concentration and attention span Need assistance with problem solving *** Right before an exam; beneficial

Alarm stage

Fight or flight Increased HR, BP, RR Dilated pupils Muscle Tension

Trichotillomania

Hair pulling/loss Proceeded by a sense of tension resulting in a sense of release

Cardiovascular Response to Anxiety

Increased HR, BP, Force of cardiac contraction, Cardiac output

What is fear?

Purely cognitive

Characteristics of Panic Anxiety (4)

Total lack of focus Hallucinations and delusions Loss of contact with reality "Losing Control" *** Out of control, psychotic response

Neuromuscular Response to Anxiety

Tremors Restlessness

Characteristics of Severe Anxiety (2)

Unable to complete simple tasks Decreased perception *** Not coping, can't function

When is anxiety abnormal?

When the response is out of proportion to the stimulus causing it

Resistance/Recovery Stage

When thread is removed, and no physiological reactions - Things return to normal

Who is anxiety more common in?

Women (2:1 ratio)

Example of Projection

You don't love your new hair cut; you meet a friend for lunch and state: "It's horrible, right?"

Example of Intellectualization

You total your brand new car in a MVC; you decide you didn't really care for the color after all.

Sam has a diagnosis of major depression. After an unsuccessful trial of antidepressant medication, Sam's physician has hospitalized Sam for a course of ECT treatments. Sam says to the nurse on admission, "I don't want to end up like McMurphy in One Flew Over the Cuckoo's Nest! I'm scared!" Sam's priority nursing diagnosis at this time would be: a. Anxiety related to deficient knowledge about ECT b. Risk for injury related to risks associated with ECT c. Deficient knowledge related to negative media presentation of ECT d. Acute confusion related to side effects of ECT

a. Anxiety related to deficient knowledge about ECT

The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts? a. Family should be actively involved in each phase of treatment. b. Parents should be prohibited from involvement in helping their child eat more, since there are often control issues. c. Adolescents need to work on developing healthy self-identities before they can begin to gain weight. d. Individual psychotherapy is the most effective treatment for adolescents with anorexia nervosa.

a. Family should be actively involved in each phase of treatment.

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to: a. Increase energy and elevate mood. b. Stimulate the central nervous system. c. Prevent psychotic symptoms. d. Produce a calming effect.

a. Increase energy and elevate mood.

The ultimate goal of therapy for a client with DID is: a. Integration of the personalities into one b. For the client to have the ability to switch from one personality to another voluntarily c. For the client to select which personality he or she wants to be the dominant self d. For the client to recognize that the various personalities exist

a. Integration of the personalities into one

Mandy presents in the emergency department with complaints of suicidal ideation. The following data is collected by the nurse. Which of these assessment findings suggests that bulimia nervosa might be a health problem? (Select all that apply.) a. Mandy's parotid glands appear enlarged. b. Mandy's teeth has a "moth eaten" pattern of tooth decay. c. Mandy reports that she takes laxatives daily. d. Mandy's weight is within the expected range.

a. Mandy's parotid glands appear enlarged. b. Mandy's teeth has a "moth eaten" pattern of tooth decay. c. Mandy reports that she takes laxatives daily. d. Mandy's weight is within the expected range. (ALL OF THESE ANSWERS ARE CORRECT)

Lorraine has been diagnosed with Somatic Symptom Disorder. Which of the following symptom profiles would you expect when assessing Lorraine? a. Multiple somatic symptoms in several body systems b. Fear of having a serious disease c. Loss or alteration in sensorimotor functioning d. Belief that her body is deformed or defective in some way

a. Multiple somatic symptoms in several body systems

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which of the following therapy regimens would most appropriately be ordered for John? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive therapy

a. Paroxetine and group therapy

A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? a. The client abuses amphetamines and anxiolytics. b. The client abuses alcohol and cocaine. c. The client is psychotic. d. The client abuses narcotics and marijuana.

a. The client abuses amphetamines and anxiolytics.

A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. Which of the following assessment findings are consistent with long-term chronic alcohol abuse? (Select all that apply.) a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count.

a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count. (ALL OF THESE ANSWERS ARE CORRECT)

The category of adjustment disorder with disturbance of conduct identifies the individual who: a. Violates the rights of others to feel better b. Expresses symptoms that reveal a high level of anxiety c. Exhibits severe social isolation and withdrawal d. Is experiencing a complicated grieving process

a. Violates the rights of others to feel better

The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen." d. "You don't have to eat if you don't want to. It is your choice."

b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube."

Nina, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? a. "Cheer up, Nina. You have a lot to be happy about." b. "You are grieving for the marriage you did not have. It's natural for you to feel bad." c. "Try not to dwell on how you feel. If you don't think about it, you'll feel better." d. "You did the right thing, Nina. Knowing that should make you feel better."

b. "You are grieving for the marriage you did not have. It's natural for you to feel bad."

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work, Dan." c. Get real, Dan! You're a boozer and you know it!" d. Why do you think your boss sent you here, Dan?"

b. "You are here because your drinking was interfering with your work, Dan."

Marissa is hospitalized on the psychiatric unit. She has a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with Marissa's diagnosis? a. Binging, purging, obesity, hyperkalemia b. Binging, purging, normal weight, hypokalemia c. Binging, laxative abuse, amenorrhea, severe weight loss d. Binging, purging, severe weight loss, hyperkalemia

b. Binging, purging, normal weight, hypokalemia

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Phenytoin (Dilantin)

b. Chlordiazepoxide (Librium)

Nina recently left her husband of 10 years. She was very dependent on her husband and is having difficulty adjusting to an independent lifestyle. She has been hospitalized with a diagnosis of adjustment disorder with depressed mood. The priority nursing diagnosis for Nina would be: a. Risk-prone health behavior related to loss of dependency b. Complicated grieving related to breakup of marriage c. Ineffective coping related to problems with dependency d. Social isolation related to depressed mood

b. Complicated grieving related to breakup of marriage

In establishing trust with Ellen, a client with the diagnosis of DID, the nurse must: a. Try to relate to Ellen as though she did not have multiple personalities. b. Establish a relationship with each of the personalities separately. c. Ignore behaviors that Ellen attributes to other subpersonalities. d. Explain to Ellen that he or she will work with her only if she maintains the status of the primary personality.

b. Establish a relationship with each of the personalities separately.

Emma, age 14, has been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Emma? a. Complicated grieving b. Imbalanced nutrition: Less than body requirements c. Interrupted family proccesses d. Anxiety (severe)

b. Imbalanced nutrition: Less than body requirements

The ultimate goal of therapy for a client with DID is most likely achieved through: a. Crisis intervention and directed association b. Psychotherapy and hypnosis c. Psychoanalysis and free association d. Insight psychotherapy and dextroamphetamines

b. Psychotherapy and hypnosis

Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? a. Denial of depression b. Repression of anxiety c. Suppression of grief d. Displacement of anger

b. Repression of anxiety

Lorraine, a client diagnosed with somatic symptom disorder, states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the basis for Lorraine's statement?a. She thinks her doctor wants to get rid of her as a client. b. She does not understand the correlation of symptoms and stress. c. She thinks psychiatrists are only for "crazy" people. d. She thinks her doctor has made an error in diagnosis.

b. She does not understand the correlation of symptoms and stress.

John has sought help for his concern that he is binge eating and feels like it has "gotten out of control." He asks the nurse what can be done to help him. Which of these is the most accurate response? a. Nothing can be done. b. Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors. c. The primary problem is obesity. I can help you set up a calorie-restricted diet. d. Medications can help with weight loss, but there are no medications effective for reducing binge-eating.

b. Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors.

From which of the following symptoms might the nurse identify a chronic cocaine user? a. clear, constricted pupils b. red, irritated nostrils c. muscle aches d. conjunctival redness

b. red, irritated nostrils

Sam, who has been hospitalized for ECT treatments, says to the nurse on admission, "I don't want to end up like McMurphy in One Flew Over the Cuckoo's Nest! I'm scared!" Which of the following statements would be most appropriate by the nurse in response to Sam's expression of concern? a. "I guarantee you won't end up like McMurphy, Sam." b. "The doctor knows what he is doing. There's nothing to worry about." c. "I know you are scared, Sam, and we're going to talk about what you can expect from the therapy." d. "I'm going to stay with you as long as you are scared."

c. "I know you are scared, Sam, and we're going to talk about what you can expect from the therapy."

A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you."

c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment."

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. Tachycardia, hypertension, hyperthermia b. Bradycardia, hypertension, hyperthermia c. Bradycardia, hypotension, hypothermia d. Tachycardia, hypotension, hypothermia

c. Bradycardia, hypotension, hypothermia

Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belviq) b. Diazepam (Valium) c. Fluoxetine (Prozac) d. Carbamazepine (Tegretol)

c. Fluoxetine (Prozac)

Nina has been hospitalized with adjustment disorder with depressed mood following the breakup of her marriage. Which of the following is true regarding the diagnosis of adjustment disorder? a. Nina will require long-term psychotherapy to achieve relief. b. Nina likely inherited a genetic tendency for the disorder. c. Nina's symptoms will likely remit once she has accepted the change in her life. d. Nina probably would not have experienced adjustment disorder if she had a higher level of intelligence.

c. Nina's symptoms will likely remit once she has accepted the change in her life.

Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visits, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? a. Search his room for evidence b. Ask, "Have you been drinking alcohol, Dan?" c. Send a urine specimen from Dan to the lab for drug screening. d. Tell Dan, "These guys cannot come to the unit to visit you again."

c. Send a urine specimen from Dan to the lab for drug screening.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to: a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident. c. Stay with John and reassure him of his safety. d. Have John listen to a tape of relaxation exercises.

c. Stay with John and reassure him of his safety.

Symptoms of alcohol withdrawal include: a. euphoria, hyperactivity, and insomnia b. depression, suicidal ideation, and hypersomnia c. diaphoresis, nausea and vomiting, and tremors d. unsteady gait, nystagmus, and profound disorientation

c. diaphoresis, nausea and vomiting, and tremors

Lucille has a diagnosis of somatic symptom disorder, predominantly pain. Which of the following medications would the psychiatric nurse practitioner most likely prescribe for Lucille? a. Chlorpromazine (Thorazine) b. Diazepam (Valium) c. Carbamazepine (Tegretol) d. Duloxetine (Cymbalta)

d. Duloxetine (Cymbalta)

Ellen has a history of childhood physical and sexual abuse. She was diagnosed with dissociative identity disorder (DID) 6 years ago. She has been admitted to the psychiatric unit following a suicide attempt. The primary nursing diagnosis for Ellen would be: a. Disturbed personal identity related to childhood abuse b. Disturbed sensory perception related to repressed anxiety c. Impaired memory related to disturbed thought processes d. Risk for suicide related to unresolved grief

d. Risk for suicide related to unresolved grief

Carol, age 16, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed and her mother reports that Carol refuses to change her diet and often skips her medication. Carol has been hospitalized for stabilization of her blood sugar. The psychiatric nurse practitioner has been called in as a consult. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for Carol at this time? a. Anxiety related to hospitalization evidenced by noncompliance b. Low self-esteem related to feeling different from her peers evidenced by social isolation c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication

d. Risk-prone health behavior related to denial of seriousness of her illness evidenced by refusal to follow diet and take medication

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? a. increased heart rate and blood pressure b. tremors, insomnia, and seizures c. in-coordination and unsteady gate d. nausea and vomiting, diarrhea and diaphoresis

d. nausea and vomiting, diarrhea and diaphoresis

When planning the discharge of a client with chronic anxiety, which is the most appropriate maintenance goal? A. Suppressing feelings of anxiety B. Identifying anxiety-producing situations C. Continuing contact with a crisis counselor D. Eliminating all anxiety from daily situations

B. Identifying anxiety-producing situations

Electroconvulsive therapy is most commonly prescribed for which of the following? A. Bipolar disorder, manic B. Paranoid schizophrenia C. Major depression D. OCD

C. Major depression

Treatment for Hoarding?

Cognitive Behavioral Therapy (CBT) and SSRIs

Characteristics of Mild Anxiety (3)

Coping mechanisms are employed Represents anxiety experience in day-to-day life Facilitates learning and creativity *** Helps us function

Trichotillomania: Opposite side of body from....

Dominant hand

We see hoarding in more ______ and ______

Men and older adults

Exhaustion stage

Occurs if stress level persists, you can die from this

Definition of Hoarding Disorder

Persistent difficulties discarding or parting with possessions, regardless of their actual value

Behavioral Response to Anxiety

Run, Scream, Shout, Increased speech (hyperverbal, pressured)

What neurotransmitters INCREASE with Anxiety?

Serotonin and Norepinephrine

Dan begins attendance at AA meetings. Which of the following statements by Dan reflects the purpose of this organization? a. "They claim they will help me stay sober." b. "I'll dry out in AA, then I can have a social drink now and then." c. AA is only for people who have reached the bottom." d. If I lose my job, AA will help me find another."

a. "They claim they will help me stay sober."

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is: a. Denial b. Projection c. Displacement d. Rationalization

a. Denial

John, a veteran of the war in Iraq, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in John? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spiritual distress

b. Survivor's guilt

Lorraine, a client diagnosed with somatic symptom disorder, tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse? a. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." b. "Let's sit down here together and you can tell me about this new pain you are experiencing. You'll just have to miss group therapy today." c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time." d. "I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?"

c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes. You must leave now to be on time."

Nursing care for a client with somatic symptom disorder would focus on helping her to: a. Eliminate the stress in her life. b. Discontinue her numerous physical complaints. c. Take her medication only as prescribed. d. Learn more adaptive coping strategies.

d. Learn more adaptive coping strategies.

Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent/child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems

d. Severity of the stressor and availability of support systems

General Adaptation Syndrome Stages (4) ANXIETY

1. Alarm 2. Resistance/Recovery 3. Exhaustion 4. Anxiety in a continuum

During the assessment, what is the nurse's primary goal for a confused and disoriented client diagnosed with posttraumatic stress disorder? 1.Explaining the unit rules 2.Making the client feel safe 3.Orienting the client to the unit 4.Stabilizing the client's psychiatric needs

2.Making the client feel safe

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? 1. Encouraging quiet reading and writing for the first few days 2. Identification of physical activities that will provide exercise 3. No socializing activities, until the client asks to participate in milieu 4. A structured program of activities in which the client can participate

4. A structured program of activities in which the client can participate

A client's phobia is being treated with systematic desensitization. Which modality is the focus of this therapy? 1.Daily medication therapy 2.Involvement with a support group 3.Intense stress management training 4.Short exposure to the phobic object

4.Short exposure to the phobic object

Prevalence of trichotillomania

7x more prevalent in ages 4-17

Example of Denial

Alcoholic who has lost family, friend, home, and job.

Other forms of Trichotillomania

Cutting, scratching, head banging, nail biting, biting themselves

The most common side effects of ECT are: A. Permanent memory loss and brain damage B. Fractured and dislocated bones C. Myocardial infarction and cardiac arrest D. Temporary memory loss and confusion

D. Temporary memory loss and confusion

Example of Suppression

I don't want to talk about it now, maybe tomorrow.

Example of Rationalization

I lie about my experiences because it's the only way to get ahead in this world

Respiratory Response to Anxiety

Increased RR SOB

Example of Displacement

Mom has a bad day at work; she yells at kids when she gets home.

Hoarding is ______ with each decade of life

More severe

Affective Response to Anxiety

Nervous Fearful Apprehensive

Habit Reversal Therapy (HRT)

Recognize precipitating thoughts/feelings Substitute Response

Prognosis of HRT

Some will grow out of it, others will carry it into adulthood

Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? a. bradycardia b. amenorrhea c. tolerance d. convulsions

c. tolerance

Which roommate choice is least appropriate for a client diagnosed with anorexia nervosa who is in a state of starvation?1.A client with pneumonia 2.A client who had back surgery 3.A client with a fractured pelvis 4.A client who has had a myocardial infarction

1.A client with pneumonia

The nurse should be prepared to manage which occurrence unique to the abuse of hallucinogenic drugs? 1.Flashbacks 2.Amotivational syndrome 3.Enhanced physical strength 4.Absence of pain perception

1.Flashbacks

Several nurses are engaged in an assignment report when a client with a history of aggressive behavior approaches the nurses' station. The client becomes very loud and offensive, and demands to be seen by the health care provider (HCP) immediately. Which intervention will address the needs of both the client and the milieu? 1.Inform the client that the behavior is unacceptable. 2.Offer to assist the client to an examination room until the HCP is notified. 3.Assure the client that the HCP will be called as soon as the report is completed. 4.Tell the client to wait in his room, and inform him that a nurse will come when the report is finished.

2.Offer to assist the client to an examination room until the HCP is notified.

The nurse is creating a discharge plan for the family of a client diagnosed with a mood disorder. The nurse should plan to provide which priority information to the family? 1.Brain abnormalites that are responsible for this disorder 2.Signs that indicate the client may be considering suicide 3.The importance benzodiazepines play in the management of this disorder 4.The possibility that the client will experience medication-induced tinnitus

2.Signs that indicate the client may be considering suicide

A client arrives in the emergency department in a crisis state demonstrating signs of profound anxiety. What should the initial nursing assessment focus on? 1.The object of the crisis 2.The client's physical condition 3.The client's coping mechanisms 4.The presence of support systems

2.The client's physical condition

A client comes to the emergency department after an assault and is extremely agitated, trembling, and hyperventilating. What is the priority nursing action for this client? 1.Begin to teach relaxation techniques. 2.Encourage the client to discuss the assault. 3.Remain with the client until the anxiety decreases. 4.Place the client in a quiet room alone to decrease stimulation.

3.Remain with the client until the anxiety decreases.

The nurse is planning to formulate a psychotherapy group. Several clients are interested in attending the session. The nurse plans the group, based on which management principle?1.Members should be of the same gender. 2.The group will decide the focus of the sessions. 3.The group should be limited to no more than 10 members. 4.The focus of the group will determine when the group will meet.

3.The group should be limited to no more than 10 members.