NUR326 Combined NCLEX psych exams

Which patient statement indicates learned helplessness? 1. "I am a horrible person." 2. "Everyone in the world is just out to get me." 3. "It's all my fault that my husband left me for another woman." 4. "I hate myself."

"It's all my fault that my husband left me for another woman."

What is Divalproex/valproate. Depakote?

-Increase levels of GABA, an inhibitory neurotransmitter in the CNS. -anticonvulsants. -Decreases manic episodes.

What are the major adverse effects of Lamotrigine/Lamictal?

-Life-threatening rash. - Septic meningitis

ECT is indicated if

-Patient is suicidal or homicidal. -Agitation or stupor is extreme. -Life-threatening illness is a result of the refusal of foods or fluids. -History includes a poor drug response or a good ECT response. -Standard medical treatment has no effect. -Major depression with psychotic symptoms

What is Lamotrigine/Lamictal?

-Stabilizes neuronal membranes by inhibiting sodium transport. - Anticonvulsants. - first line treatment for bipolar depression, and acute/maintenance therapy.

What are some key points with bipolar disorder in the young?

-Young S&S irritable, impulsive, aggressive, risk taker & hostile -Approx 1% lifetime prevalence -Frequently have rapid cycling -Thinking usually grandiose & illogical -Treatment: many require long-term or lifelong psychopharmacology

cyclothymic disorder

-alternating hypo-mania and depressive episodes - involves cycling between highs and lows, but it never reaches full mania or major depression

What are side effects of SSRIs?

-anticholinergic effects, but less than those of tricyclic agents -nausea and vomiting

Bipolar I disorder

-at least one episode of mania alternating with major depression -psychosis may accompany manic episode

What is Lorazepam/Ativan?

-benzodiazepines -antianxiety agents -sedative/hypnotics -Depresses the CNS, probably by potentiating GABA, an inhibitory neurotransmitter.

What symptoms would you expect to find in someone suffering from major depression?

-depressed mood and anhedonia -substantial pain and suffering: psychologic, social, and occupational disability -history of one or more depressive episodes -possible psychotic features

Dysthymic Disorder (dysthymia)

-early and insidious onset -chronic depressive syndrome (chronic sadness) -present most of the day, more days than not, for at least 2 years and one year for children

Bipolar II disorder

-hypomanic episode(s) alternating with major depression -not accompanied by psychosis

serotonin syndrome

-idiosyncratic medication reaction due to accumulation of serotonin -rare and life-threatening -risk is greatest when SSRI is administered in combination with monoamine oxidase inhibitor (MAOI)

What do tricyclic antidepressants do?

-increase norepinephrine

Bipolar spectrum disorders are characterized by what two opposite poles?

-mania (euphoria) and depression

What are MAOIs? What do they do?

-monoamine oxidase inhibitors -prevent the breakdown of norepinephrine, serotonin, and dopamine

signs and symptoms of serotonin symdrome

-musculoskeletal changes -fever -elevated BP -severe could result in death

6 subtypes observed in major depressive disorder

-psychotic features -melancholic features -atypical features -catatonic features -postpartum onset -seasonal affective disorder

specifiers?

-rapid-cycling bipolar disorder -mania or hypomania with mixed features The distinction between bipolar I and bipolar II diagnoses and rapid-cycling or mixed mania specifiers is crucial. Each dictates specific treatment implications and appropriate medical interventions. ??

What are SSRIs? What do they do?

-selective serotonin reuptake inhibitors -increases serotnin

toxic effects of lithium

-tremor, ataxia, confusion, convulsions, and N/V

3 most common antidepressant drugs

-tricyclics (TCAs) -SSRIs -SNRIs

Maintenance Level of Lithium

0.4 to 1.3 mEq/L

Lomotrigine

(Lamictal) Anticonvulsant

Maprotiline

(Ludiomil) Antidepressant

Thioridazine

(Mellaril) First generation antipsychotic

Gabapentin

(Neurotin) Anticonvulsant

Risperidone

(Risperdal) Second generation antipsychotic

Carbamazepine

(Tegretol, Carbatrol, Equetro) Anticonvulsant

Chlorpromazine

(Thorazine) First generation antipsychotic

Topiramate

(Topamax) Anticonvulsant

Oxcarbazepine

(Trileptal) Anticonvulsant

You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn't want to ask her patient about suicidal ideation because "It might put ideas in her head about suicide." Your best response would be: "I'm glad you are thinking that way. She may not have thought of suicide before, and we don't want to introduce that." "You are right; however, because of professional liability, we have to ask that question." "Actually, it's a myth that asking about suicide puts ideas into someone's head." "If I were you, I'd ask Dr. Carmichael to talk to the patient about that subject."

"Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

grandiosity

(inflated self-regard) apparent in both ideas expressed and the person's behavior. People w/ mania may exaggerate their achievements or importance.

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies prevalence is A. "That is a good observation. Depression does mostly strike people older than 50 years." B. "Depression is seen in people of all ages, from childhood to old age." C. "Depression is most often seen among the middle adult age group." D. "The age of onset for most depressive episodes is given as 18 years."

"Depression is seen in people of all ages, from childhood to old age."

A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is "That is a good observation. Depression does mostly strike people older than 50 years." "Depression is seen in people of all ages, from childhood to old age." "Depression is most often seen among the middle adult age group." "The age of onset for most depressive episodes is given as 18 years."

"Depression is seen in people of all ages, from childhood to old age." Depression can occur at any age. Children, adolescents, adults, and the elderly may all experience depression.

Sasha is a 38-year-old patient admitted with major depression. Which of the following statements Sasha makes alerts you to a common accompaniment to depression? "I still pray and read my Bible every day." "My mother wants to move in with me, but I want to independent." "I still feel bad about my sister dying of cancer. I should have done more for her!" "I've heard others say that depression is a sign of weakness."

"I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided? "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction." "I will not take any over-the-counter medication while on the fluoxetine." "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." "I will report increased thirst and urination to my provider."

"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the patient should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be "That will be fine. I'll have you sign our hospital release form." "Because we do not have a copy of durable power of attorney, we cannot release them to you." "Don't worry. You can leave them at her bedside. We are insured for losses of this sort." "I would like to have your mother wear them. It will help her to be less confused."

"I would like to have your mother wear them. It will help her to be less confused." Clients with cognitive disorders usually profit from being able to see and hear clearly. Confusion is reduced through the use of glasses and hearing aids.

A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be A. "What an offensive thing to suggest!" B. "I don't have sex with clients." C. "It's time to work on your art project." D. "Let's walk down to the seclusion room."

"It's time to work on your art project."

A female patient tells the nurse that she would like to begin taking St. John's Wort for depression. What teaching should the nurse provide? 1. "St. John's wort should be taken several hours after your other antidepressant." 2. "St. John's wort has generally been shown to be effective in treating depression." 3. "This supplement is safe to take if you are pregnant." 4. "St. John's wort is regulated by the FDA, so you can be assured of its safety."

"St. John's wort has generally been shown to be effective in treating depression."

Lorazopam

(Ativan) Antianxiety

Valproate sodium

(Depacon) Anticonvulsant

Valproic acid

(Depakene, Stavzor) Anticonvulsant

Divalproex sodium

(Depakote) Anticonvulsant

Lithium

(Eskalith, Eskalith CR, Lithobid) First line treamtment

Haloperidol

(Haldol) First generation antipsychotic

Clonazepam

(Klonopin) Antianxiety

Patient and Family Teaching

*Know about the disease and it's processes *Alcohol, drugs, caffeine, and OTC's can cause relapse *Good sleep and hygiene is important *Psychosocial strategies *Group and individual psychotherapy for relapse prevention *Increased risk for diabetes, high blood pressure, dyslipidemia, cardiac problems

What are the levels of lithium?

- <.4 to 1mEq/L. therapeutic level. may see tremors, polyuria, and mild thirst, mild nausea, and wt gain. - <1.5 mEq/L. Early signs of toxicity. may see nausea, vomiting, diarrhea, thirst, polyuria, slurred speech, and muscle weakness. - 1.5 to 2 mEq/L Advanced signs of toxicity. will see coarse hand tremor, GI upset, mental confusion, muscle hyperirritability, EEG changes, and incoordination. 2 to 2.5 mEq/L Sever Toxicity. will see Ataxia, EEG changes, blurred vision, clonic movements, large output of dilute urine, tinnitus, blurred vision, seizures, stupor, severe hypotension, coma and death. >2.5 coma and death

What are the major Adverse effects of Divalproex/valproate. Depakote?

- Base liver function test should be performed and results monitored regular intervals. Hepatitis has been reported. -Fever, chills, right upper quadrant pain, dark urine, malaise, jaundice/confusion, significant drowsiness.

What are some benefits of Lithium carbonate?

- Reduces elation, grandiosity, and expansiveness. - Reduces flight of ideas. - Reduces irritability and manipulativeness. - reduces anxiety. - Controls Insomnia, psychomotor agitation, threatening or assaultive behavior, distractibility, hypersexuality, and paranoia.

What are some goals of Seclusion and restraints?

- decrease overwhelming stimuli. - protect patient and others from injury. - prevent destruction of personal property or property of others.

what are some guidelines for patients with Bipolar Disorder?

- use firm, calm approach. - use short, concise statements. - Remain neutral; avoid power struggles - be consistent. - firmly redirect energy into appropriate channels.

Maintenance Therapy for Lithium

--not addictive --eat a normal diet with normal salt and fluid intake (1500-3000 mL/day or six 12 oz glasses of fluid) --take with meals --stop taking if you have excessive diarrhea, vomiting, or sweating --do not take diuretics -- have your kidneys and thyroid checked for hypothyroidism and inability to make urine -- do not take over the counter medications --talk about weight gain with doctor -- self help groups -- taper dose to discontinue to prevent relapse of mania

What are the major adverse effects of Carbamazepine/Tegretol?

-Agranulocytosis and aplastic anemia. -Blood levels should be monitored throughout first 8 weeks because drug induces liver enzymes that speed its own metabolism. Dosage may need to be adjusted to maintain serum levels of 6-8 mg/L. -Severe: confusion, difficulty breathing, irregular heartbeat, skin rash or hives, jaundice.

what is Clonazepam/Klonopin?

-Anticonvulsant effects may be due to presynaptic inhibition. -Produces sedative effects in the CNS, probably by stimulating inhibitory GABA receptors. -anticonvulsants. -benzodiazepines. used for prevention of seizures and decreased manifestations of panic disorder.

4 types of bipolar spectrum disorders

-Bipolar I -Bipolar II -cyclothymia -Bipolar disorder - not otherwise specified

What are some key points with depression in the young?

-Children as young as 3 years of age have been diagnosed with depression. -MDD may occur in 18% of preadolescents. -MDD among adolescents is often associated with substance abuse and antisocial behavior.

what is Carbamazepine/Tegretol?

-Decreases synaptic transmission in the CNS by affecting sodium channels in neurons. -anticonvulsant -mood stabilizer. -Works better in patients with rapid cycling, severely paranoid and angry patients with mania.

Some other common diagnoses for individuals with depression

-Disturbed thought processes -Chronic low self-esteem -Imbalanced nutrition -Constipation -Disturbed sleep pattern -Ineffective coping -Spiritual distress -Disabled family coping

When teaching parents about childhood depression the nurse should say that it: 1 May appear as acting-out behavior 2 Does not respond to conventional treatment 3 Looks almost identical to adult depression 4 Is short in duration and has an early resolution

1 Children have difficulty verbally expressing their feelings; acting-out behaviors, such as temper tantrums, may indicate an underlying depression. Adult and childhood depression may be manifested in different ways. Childhood depression is not necessarily short and requires treatment. Many conventional therapies for adults with depression, including medication, are effective for children with depression.

A nurse in the mental health clinic is counseling a client with the diagnosis of depression. During the counseling session the client says, "Things always seem the same. They never change." The nurse suspects that the client is feeling hopeless. For what indication of hopelessness should the nurse assess the client? 1 Outbursts of anger 2 Focused concentration 3 Preoccupation with delusions 4 Intense interpersonal relationships

1 Clients who are depressed and feeling hopeless also tend to have inappropriate expressions of anger. Depressed clients frequently have a diminished ability to think or concentrate. Preoccupation with delusions is usually associated with clients who have schizophrenia rather than with clients experiencing depression and hopelessness. Clients who are depressed and feeling hopeless tend to be socially withdrawn and do not have the physical or emotional energy for intense interpersonal relationships.

A 25-year-old woman with the diagnosis of bipolar disorder, manic episode, is admitted to the psychiatric unit. A nurse on the unit reviews the admission information provided by the client's husband and assesses the client. In light of the information in the chart, what is an appropriate nursing intervention? 1 Assigning the client to a private room 2 Suggesting that the client play cards with several other clients 3 Encouraging the development of insight through introspection 4 Having the client sit at the communal dining table during meals

1 During the acute phase of mania, care should be focused on maintaining the safety of the client and others and decreasing the client's energy expenditure. Hypersexuality is often associated with the manic episode of bipolar disorder. Obtaining sexual pleasure by exposing the genitals (exhibitionism) is a paraphilia. A private room protects the other clients and provides privacy for the client. The client is too hyperactive to engage in group activities, and hypersexual behavior may precipitate anxiety in the other clients. Also, manic clients can be overly competitive, which may disturb the other clients. Activities at this time should be solitary or one-on-one with the nurse or nursing assistant. Manic clients have flight of ideas (rapid racing thoughts) and are easily distracted. Introspection and the development of insight cannot occur during this phase of the illness. The hyperactive client will not have the self-control to sit long enough to eat a meal. The nurse should provide finger foods and other portable foods (e.g., sandwich, fruit, milkshake) and encourage the intake of food with short declarative statements that direct the client to eat (e.g., "Finish your sandwich," "Eat this banana").

A client with major depression that includes psychotic features tells the nurse, "All of my relatives have been killed because I've been sinful and need to be punished." What is the primary focus of nursing interventions? 1 Protecting the client against any suicidal impulses 2 Supporting the client's interest in the outside world 3 Helping the client manage the concern for family members 4 Reassuring the client that past behaviors are not being punished

1 Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions. Supporting the client's interest in the outside world is of very low priority. The client is focusing on the current personal situation, not the outside world. Helping the client manage the concern for family members is a secondary concern. Reassurance will not change the client's belief.

A client experiencing lower extremity paralysis is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder? 1) Conversion disorder 2) Factitious disorder 3) Illness anxiety disorder 4) Somatic symptom disorder

1) Conversion disorder

Sally was admitted to the hospital with paralysis of her right arm. Medical tests reveal the absence of physiological explanations for her symptom. Her family reports that Sally struck her infant son last week, shortly before the symptom developed, but that she sees no connection between the two events. Which of the following would be appropriate nursing interventions in Sally's plan of care? Select all that apply. 1) Ensure that children's services agencies are involved to evaluate the child's safety in the home. 2) Assist Sally with all activities of daily living, since the paralysis is real to her. 3) Encourage Sally to discuss her fears and anxieties. 4) Monitor ongoing physical assessment to ensure that organic pathology is clearly ruled out. 5) Confront Sally with the evidence that she is intentionally feigning her paralysis.

1) Ensure that children's services agencies are involved to evaluate the child's safety in the home. 3) Encourage Sally to discuss her fears and anxieties. 4) Monitor ongoing physical assessment to ensure that organic pathology is clearly ruled out.

Gertrude has been admitted to the hospital for depression and concurrent alcohol abuse. During the assessment, Gertrude gives the nurse detailed accounts about several somatic symptoms she has had that "they've never been able to find a medical reason for." Based on the data provided, which of the following would be an appropriate nursing diagnosis? 1) Ineffective coping 2) Knowledge deficit 3) Impaired memory 4) Risk for suicide

1) Ineffective coping

Flo has been seeing the nurse at the mental health center because she has been struggling with intense fear of becoming ill. She spends much of her day checking her temperature and palpating lymph nodes for signs of a lump even though there have never been positive findings of illness. Which of the following are appropriate nursing interventions in response to Flo's concerns? Select all that apply. 1) Refer all new physical complaints to the physician. 2) Help the client explore thoughts and feelings associated with her excessive fears. 3) Gently but firmly tell the client from the outset that you will not permit discussion of illnesses. 4) Help the client identify coping strategies she thinks will be useful during times when anxiety and fear are exacerbated.

1) Refer all new physical complaints to the physician.

A 30-year-old law school graduate is to take the bar examination tomorrow and is suddenly paralyzed but expresses no distress. History reveals no recent injury or neurological impairment. What data presented in the question reflect a conversion disorder? Select all that apply. 1) Sudden onset 2) Age of the graduate 3) Negative neurological findings 4) Upcoming bar examination 5) Lack of concern

1) Sudden onset 3) Negative neurological findings 4) Upcoming bar examination 5) Lack of concern

During a home visit the nurse obtains information about a postpartum client's behavior and suspects that she is experiencing postpartum depression. Which assessments support this conclusion? Select all that apply. 1 Lethargy 2 Ambivalence 3 Emotional lability 4 Increased appetite 5 Long periods of sleep

1,2,3 Lethargy reflects the lack of physical and emotional energy that is associated with depression. Ambivalence, the coexistence of contradictory feelings about an object, person, or idea, is associated with postpartum depression. Emotional lability is associated with postpartum depression. Anorexia, rather than increased appetite, is associated with postpartum depression; the client lacks the physical and emotional energy to eat. Insomnia, rather than long periods of sleep, is associated with depression.

A nurse is planning an educational program for family members of clients with bipolar disorder. What clinical manifestations indicating the beginning of an episode of mania should the nurse include? Select all that apply. 1 Insomnia 2 Irritability 3 Excessive eating 4 Decreased libido 5 Financial irresponsibility

1,2,5 During a manic episode there is a decreased need for sleep and clients do not feel tired. During a manic episode the primary mood is irritability; the emotions often fluctuate between euphoria and anger. During a manic episode there is a decrease in appetite. The client's increased activity and inability to sit still interfere with the ability to eat and drink. Hypersexuality, rather than decreased libido, is common during a manic episode. During a manic episode impulsivity, impaired judgment, and involvement in pleasurable activities may result in spending sprees that can have negative consequences.

A client with paranoid personality disorder works toward the goal of increasing social interaction. Which behavior indicates that the client is meeting this goal? 1. The client develops and follows a schedule of group activities. 2. The client verbalizes aggressive feelings to the nurse. 3. The client visits the consumer center to use the Internet. 4. The client explores somatic complaints with the staff.

1. The client develops and follows a schedule of group activities.

A client diagnosed with generalized anxiety disorder complains of feeling out of con- trol and states, "I just can't do this anymore." Which nursing action takes priority at this time? 1. Ask the client, "Are you thinking about harming yourself?" 2. Remove all potentially harmful objects from the milieu. 3. Place the client on a one-to-one observation status. 4. Encourage the client to verbalize feelings during the next group.

1. Ask the client, "Are you thinking about harming yourself?"

The nurse on the in-patient psychiatric unit should include which of the following interventions when working with a newly admitted client diagnosed with obsessive- compulsive disorder? Select all that apply. 1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 3. With the client's input, set limits on ritualistic behaviors. 4. Present the reality of the impact the compulsions have on the client's life. 5. Discuss client feelings surrounding the obsessions and compulsions.

1. Assess previously used coping mechanisms and their effects on anxiety. 2. Allow time for the client to complete compulsions. 5. Discuss client feelings surrounding the obsessions and compulsions.

vegetative signs of depression

1. Change in bowel movement pattern (constipation) 2. Eating habits (anorexia) 3. Sleep 4. Disinterest in sex

What is the most appropriate goal for a client with antisocial personality disorder with a high risk for violence directed at others? 1. The client will discuss the desire to hurt others rather than act. 2. The client will be given something to destroy to displace the anger. 3. The client will develop a list of resources to use when anger escalates. 4. The client will understand the difference between anger and physical symptoms.

1. The client will discuss the desire to hurt others rather than act.

What would be an important guideline for nurses working with clients with borderline personality disorder? 1. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment. 2. Try to prevent or reduce untoward effects of manipulation. 3. Remain neutral and avoid engaging in power struggles. 4. Respect a client's need for social isolation.

1. When behavioral problems emerge, calmly review the therapeutic goals and boundaries of treatment.

What are the assessment guidelines for bipolar disorder?

1. assess patient for danger to self or others. 2. assess for need for control. patient may be giving away all personal items including money. need someone to stop behavior. 3. assess need to be hospitalized. 4. assess medical status. ex: dehydration, exhaustion. 5. assess for any coexisting medical or other conditions that warrant special interventions. 6. assess patients and family's understanding of disorder, medication and knowledge of disorder.

Which nursing intervention is of highest priority for L, a client with bulimia nervosa? 1. assist client to identify triggers to binge eating 2. communicate empathy and focusing on feelings 3. assess for signs of anxiety and depression 4. explore alternative coping strategies

1. assist client to identify triggers to binge eating

Martha, a 93-year-old woman who is being cared for by her daughter, is hospitalized for the third time in a month with complaints of nausea and vomiting. Medical tests have been unable to identify a physical cause. When the daughter is witnessed putting syrup of ipecac in her mother's coffee, which of the following diagnoses is likely to be made? 1) Factitious disorder 2) Factitious disorder by proxy 3) Malingering 4) Conversion disorder

2) Factitious disorder by proxy

A client is admitted with the diagnosis of borderline personality disorder/possible depression. The client has a history of abusive acting-out behavior. What is most important to assess when caring for this client? 1 Degree of anger 2 Potential for suicide 3 Level of intelligence 4 Ability to test reality

2 Depressed clients may use suicide as the ultimate escape from feelings; ensuring safety by protecting the client from self-harm is the priority. Although degree of anger is important, it is not the priority. Assessment of the level of intelligence is unnecessary; clients with a diagnosis of borderline personality disorder are usually of average intelligence. Clients with a diagnosis of borderline personality disorder are more concerned with satisfying their needs than testing reality; they are more concerned about themselves than others or the environment.

Nurses on a psychiatric unit have secluded a client who has the diagnosis of bipolar I disorder, manic episode, and who has been losing control and throwing objects while in the dayroom. The most important intervention for the client who is given a PRN medication and confined to involuntary seclusion is to: 1 Continue intensive nursing interactions. 2 Evaluate the client's progress toward self-control. 3 Determine whether any staff member has been injured. 4 Observe the client for side effects of the medication given to the client.

2 For the safety of the client and everyone on the unit, improvement in a client's level of self-control is essential before the degree of restraint and seclusion is progressively reduced. Continuing intensive interaction at this time would not be productive and could cause the client's behavior to escalate. The nurse's prime responsibility should be the client; staff members can assess other staff members. Observing the client for side effects of medications is only one of the many factors in determining the client's level of self-control.

Two weeks after a client has been admitted to the mental health hospital, the client's depression begins to lift. The nurse encourages involvement with unit activities, primarily because this type of activity: 1 Supports self-confidence 2 Provides for group interaction 3 Limits opportunities for suicide 4 Allows verbalization of repressed feelings of hostility

2 Group interaction provides a sense of belonging and fosters the assumption of responsibility. The group is not the best arena for the expression of repressed hostility. Support of self-confidence and limitation of opportunities for suicide are not ensured by group interaction.

A nurse is caring for a client who is experiencing a major depression. What feeling should the nurse anticipate that the client will likely have difficulty expressing? 1 Need for comforting 2 Anger toward others 3 Remorse for past behaviors 4 Feelings of low self-esteem

2 The client is dependent, and such individuals can never get enough attention to meet their dependent needs. This unfulfilled need causes anger, which the client has problems expressing for fear of losing the people on whom the client is dependent. The client is expressing the need for comfort. The client is able to express remorse and guilt. The client is able to express feelings of low self-esteem.

A nurse is caring for depressed older adults. What precipitating factors for depression are most common in the older adult without cognitive problems? Select all that apply. 1 Dementia 2 Multiple losses 3 Declines in health 4 A milestone birthday 5 An injury requiring hospitalization

2 & 3 Depression in the older adult is most often associated with the loss of family members and friends (e.g., death, relocation) and declines in mobility, health, and income. A decline in health, particularly when associated with a chronic illness, frequently precipitates depression in older adults. Dementia is a cognitive problem. Research does not correlate the onset of depression with a milestone birthday in older adults. A traumatic injury does not precipitate the onset of depression in the older adult as often as does a chronic illness.

A client with depression has not responded to a tricyclic antidepressant and outpatient electroconvulsive therapy (ECT). The health care provider prescribes selegiline (Eldepryl), and the nurse teaches the client about food to be avoided while taking this medication. Which foods identified by the client allow the nurse to conclude that the instructions have been understood? Select all that apply. 1 Fresh fish 2 Aged cheese 3 Fried chicken 4 Chocolate drinks 5 Leafy vegetables

2 & 4 Foods containing tyramine can cause hypertensive crisis and should be eliminated from the diet. These foods include pickled herring, beer, wine, chicken livers, aged or natural cheese, caffeine, cola, licorice, avocados, bananas, and bologna. Chocolate in moderation is safe for some patients, but it does contain caffeine. Overripe fruits and caffeine have high levels of tyramine, which can cause dangerous hypertension in clients taking monoamine oxidase inhibitors (MAOIs). Also, large amounts of caffeine can increase blood pressure and should be avoided. There is no need to limit the intake of fish, chicken, or leafy vegetables while taking an MAOI.

Clients diagnosed with illness anxiety disorder often "doctor shop." Which defense mechanism is at the root of this behavior? 1) Suppression 2) Denial 3) Projection 4) Rationalization

2) Denial

A nursing diagnosis formulated for L, a client with bulimia nervosa, was Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating as a comfort measure followed by self-induced vomiting. Which short-term goal is related to this nursing diagnosis? 1. Client will verbalize the importance of eating a balanced diet within 2 weeks. 2. Client will identify two alternative methods of coping with loneliness and isolation within 2 weeks. 3. Client will verbalize two positive things about herself within 2 weeks. 4. Client will appropriately express angry feelings within 2 weeks.

2. Client will identify two alternative methods of coping with loneliness and isolation within 2 weeks.

A client with antisocial personality disorder says, "I always want to blow things off." Which response by the nurse is most appropriate? 1. " Try to focus on what needs to be done and just do it." 2. " Let's work on considering some options and strategies." 3. " Procrastinating is a part of your illness that we'll work on." 4. " The best thing to do is decide on some useful goals to accomplish."

2. " Let's work on considering some options and strategies."

Which teaching need is important when a client is newly prescribed buspirone (BuSpar) 5 mg tid? 1. Encourage the client to avoid drinking alcohol while taking this medication because of the additive central nervous system depressant effects. 2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks. 3. Encourage the client to monitor for signs and symptoms of anxiety to determine need for additional buspirone (BuSpar) PRN. 4. Encourage the client to be compliant with monthly lab tests to monitor for medica- tion toxicity.

2. Encourage the client to take the medication continually as prescribed because onset of action is delayed 2 to 3 weeks.

A client is admitted to the hospital with a diagnosis of depression. What clinical manifestations of depression does the nurse expect when assessing this client? 1 Flight of ideas 2 Suspicion of others 3 Psychomotor retardation 4 Intrusive social behaviors

3 Both thought and motor activity, which require physical and psychic energy, are commonly slowed when someone is depressed. Flight of ideas is associated with manic behavior because it requires psychic energy. Suspicion is associated with paranoid ideation and is less common with depression. Intrusive social behaviors are associated with manic behavior.

A client is admitted to the mental health hospital with the diagnosis of major depression. What is a common problem that clients experience with this diagnosis? 1 Loss of faith in God 2 Visual hallucinations 3 Decreased social interaction 4 Ambivalent feelings about the future

3 Depressed clients demonstrate decreased social interaction because of a lack of psychic or physical energy. They tend to withdraw, speak in monosyllables, and avoid contact with others. Depressed clients are commonly negative and pessimistic, especially regarding their future. Loss of faith and visual hallucinations are not commonly associated with the diagnosis of major depression. Hallucinations are associated with schizophrenic disorders.

A client is experiencing feelings of sadness and is having difficulty concentrating and sleeping. What are additional common signs and symptoms of depression that the nurse should expect when performing an assessment of this client? 1 Rigidity and a narrowing of perception 2 Alternating episodes of fatigue and high energy 3 Diminished pleasure in activities and alteration in appetite 4 Excessive socialization and interest in activities of daily living

3 Depression is characterized by feelings of hopelessness, helplessness, and despair, leaving little room for any pleasure; alteration in appetite (either decreased or increased) is common in depressed clients. Although there is a narrowing of perception, rigidity is uncommon with depression. Fatigue is continually present and does not alternate with a high energy level. There is a loss of interest in socialization and little participation in activities of daily living.

A client with depression is to be given fluoxetine (Prozac). What precaution should the nurse consider when initiating treatment with this drug? 1 It must be given with milk and crackers to avoid hyperacidity and discomfort. 2 Eating cheese or pickled herring or drinking wine may cause a hypertensive crisis. 3 The blood level may not be sufficient to cause noticeable improvement for 2 to 4 weeks. 4 The blood level should be checked weekly for 3 months to monitor for an appropriate level.

3 Fluoxetine (Prozac) does not produce an immediate effect; nursing measures must be continued to reduce the risk for suicide. Consuming milk and crackers to help prevent hyperacidity and discomfort is not necessary. Avoiding cheese, pickled herring, and wine is a precaution taken with the monoamine oxidase inhibitors. Weekly blood level checks are not necessary with fluoxetine.

A client is not responding to antidepressant medications for treatment of major depression with suicidal ideation. After learning about electroconvulsive therapy (ECT), the client discusses the advantages and disadvantages with the primary nurse. The nurse concludes that the client understands the disadvantages of ECT when he states that one major disadvantage of ECT is that: 1 The seizures may cause bone fractures. 2 Relief of symptoms requires many weeks of treatment. 3 Memory is impaired just before and after the treatment. 4 Loss of mental function occurs and continues for a long time.

3 Impaired memory is an expected side effect of the therapy. Succinylcholine (Anectine) prevents the external manifestations of a tonic-clonic seizure, thereby minimizing fractures and dislocations. The therapy begins to elicit results in two or three treatments. There is no substantial loss of mental function after the treatment is completed.

A nurse is discharging a client from the mental health unit who has been treated for major depression. Which statement is most therapeutic at this time? 1 "I'm going to miss you; we've become good friends." 2 "I know that you're going to be all right when you go home." 3 "Call the contact number we gave you if you have an emergency." 4 "This is my phone number; call and let me know how you're doing."

3 Instructing the client to call the contact number that was provided in case of emergency demonstrates an understanding that the newly discharged client needs to have a support system. Clients need to feel that in a crisis there will be someone there for them. The role of the nurse is not to become a good friend but instead to help the client become a functioning being again. "I know you're going to be all right when you go home" provides false reassurance; the nurse does not know this. "This is my phone number; call and let me know how you're doing" is unprofessional and blurs the roles of nurse and client.

The nurse notices that one of her clients, who has depression, is sitting by the window crying. The most appropriate response by the nurse is: 1 "It's OK. No need to cry or worry while you're here. We all feel down now and then." 2 "Please don't consider suicide. It really isn't an appropriate way out of your troubles." 3 "You seem to be experiencing a sad moment. I'll sit here with you for a while and talk if you would like." 4 "Why don't you go into the dayroom and join the card game going on? That'll take your mind off of your problems for a while."

3 The nurse is acknowledging that the client is feeling especially down and offering to be available for discussion or just to provide a presence. The response regarding suicide is judgmental and may discourage any effort by the client to initiate a discussion. Telling the client not to cry and suggesting a card game do not acknowledge the client's feelings and appear to trivialize the situation.

A client with the diagnosis of manic episode of bipolar disorder attends a mental health day treatment program. What supervised activity will be most therapeutic for this client during the early phase of treatment? 1 Doing a needlepoint project 2 Joining a brief swimming competition 3 Walking around the facility with a nurse 4 Playing a board game with another client

3 Walking around the facility with a nurse does not involve an element of competition and still allows the client to channel excess energy safely. A needlepoint project requires fine motor skills of a client who is hyperactive and whose attention span is limited. The sense of competition and added stimulation provided by a swimming competition may increase the client's anxiety. The client is too hyperactive to play a board game and may respond with distractibility or aggressiveness toward others.

A client has a history of multiple somatic complaints involving several organ systems. Diagnostic studies revealed no physiological cause. Which diagnosis would the nurse expect the physician to assign this client? 1) Thought disorder 2) Bipolar disorder 3) Somatic symptom disorder 4) Depersonalization-derealization disorder

3) Somatic symptom disorder

A nurse tells a client with a personality disorder that he must clean his room before he can go to the dayroom. The client asks if he can play one game of pool first. What is the most appropriate response by the nurse? 1. " You can play one quick game. Then you have to clean your room." 2. " No, you may not." 3. " No, you may not play pool first. The rules were explained to you." 4. " Yes, you may play a quick game. But don't tell the other clients about this."

3. " No, you may not play pool first. The rules were explained to you."

A client with antisocial personality disorder is trying to convince a nurse that he deserves special privileges and that an exception to the rules should be made for him. What is the best response by the nurse? 1. " I believe we need to sit down and talk about this." 2. " Don't you know better than to try to bend the rules?" 3. " What you're asking me to do for you is unacceptable." 4. " Why don't you bring this request to the community meeting?"

3. " What you're asking me to do for you is unacceptable."

S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss. To assess S's eating patterns, what questions might the nurse ask? 1. "Do you often feel fat?" 2. "Who plans the family meals?" 3. "What do you eat in a typical day?" 4. "What do you think about your present weight?"

3. "What do you eat in a typical day?"

C is admitted to the eating disorders unit. As she undresses, she removes layer after layer of clothing. The nurse realizes that she is extremely thin. Her skin has a yellow cast, her hair is limp and dry, and her body is covered by fine downy hair. Her weight is 70 pounds and her height is 5 feet 4 inches. C remains quiet and sullen during the physical assessment. In the nurse's written assessment of C's physical condition, which of the following should be recorded? 1. amenorrhea 2. alopecia 3. lanugo 4. Stupor

3. lanugo

A patient has a lithium level of 1.1 mEq/L. This level is 1. below the therapeutic level 2. above the therapeutic level 3. within the therapeutic range 4. not needed as lithium does not require blood levels

3. within the therapeutic range.

A client with a diagnosis of bipolar I disorder with rapid cycling is readmitted 4 months after discharge. On the first day on the unit the client continually interrupts the nurse and is increasingly talkative and loud. What is the most therapeutic response by the nurse? 1 "You seem to have a need to interrupt me." 2 "How's your relationship with your spouse?" 3 "Do you realize that you're talking loud and fast?" 4 "Tell me about the medication you've been taking."

4 Antidepressants can induce rapidly cycling behavior, or the client may not be taking medications as prescribed; asking the client to talk about the medication will elicit information in a nonchallenging, nonthreatening manner. Observing that the client seems to have a need to interrupt the nurse is challenging and is not focused on assessing the problem. The question "How is your relationship with your spouse?" is not focused on the behavior being manifested. Asking the client whether he realizes that he is speaking loudly and quickly does little to promote discussion.

Which food selection best meets the needs of the manic patient? 1. Pineapple, bananas, popcorn 2. Chicken and Mashed potatoes 3. Corn chowder and spinach 4. Peanut butter sandwich and carrots

4. peanut butter sandwich and carrots

A client is admitted with a bipolar disorder, depressed episode. The nursing history indicates a progressive increase in depression over the past month. What should the nurse expect the client to display? 1 Elated affect related to reaction formation 2 Loose associations related to a thought disorder 3 Physical exhaustion related to decreased physical activity 4 Paucity of verbal expression related to slowed thought processes

4 As depression increases, thought processes become slower and verbal expression decreases due to lack of emotional energy. Elation is associated with bipolar disorder, manic episode; the affect of a depressed person is usually one of sadness, or it may be blank. Loose associations are related to schizophrenia, not depression. Physical exhaustion is associated with bipolar disorder, manic episode; decreased physical activity does not produce physical exhaustion.

A client whose depression is beginning to lift remains aloof from the other clients on the mental health unit. How can a nurse help the client participate in an activity? 1 Find solitary pursuits that the client can enjoy. 2 Speak to the client about the importance of entering into activities. 3 Ask the health care provider to speak to the client about participating. 4 Invite another client to take part in a joint activity with the nurse and the client.

4 Bringing another client into a set situation is the most therapeutic, least threatening approach. At this point in time it is not therapeutic to allow the client to follow solitary pursuits; it will promote isolation. Explanations will not necessarily change behavior. Asking the health care provider to speak to the client about participating transfers the nurse's responsibility to the health care provider.

A client with major depression is admitted to the hospital. What is the most therapeutic initial nursing intervention? 1 Introducing the client to one other client 2 Requiring participation in therapy sessions 3 Encouraging interaction with others in small groups 4 Conveying an attitude of concern that is not intrusive

4 Conveying concern without being intrusive will allow the client to control the pace of development of the nurse-client relationship. Depressed clients are unable to move into relationships with other clients or group situations. It is too early for therapy sessions; the first thing that must be established is a trusting nurse-client relationship.

Which of the following personality disorders fall under cluster A (select all that apply) A. Paranoid personality disorder B. Schizoid personality disorder C. Schizotypal personality disorder D. Antisocial personality disorder E. Borderline personality disorder F. Histrionic personality disorder

A. Paranoid personality disorder B. Schizoid personality disorder C. Schizotypal personality disorder

An effective mood-stabilizing drug used in clients with bipolar disorder in the acute treatment of mania and prevention of recurrent mania and depressive episodes is: 1 Doxepin (Sinequan) 2 Clozapine (Clozaril) 3 Amitriptyline (Elavil) 4 Lithium carbonate (Lithium)

4 Lithium carbonate is often the first choice of treatment, once primary acute mania has been diagnosed, to calm acute manic symptoms and relieve recurrent mania. Doxepin and amitriptyline are antidepressants used to treat depression but not mania. Clozaril is an antipsychotic medication used to control hallucinations and delusions in patients with psychosis but is not a first-line drug because of its side effects, which include seizures and significant weight gain.

When a nurse is working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action? 1) Avoid discussing social and personal problems. 2) Focus on the physical symptoms. 3) Always meet the client's dependency needs. 4) Gradually minimize time spent focusing on physical symptoms.

4) Gradually minimize time spent focusing on physical symptoms.

It has been determined that Susan, who thought she was pregnant, is experiencing a conversion disorder. The nurse correctly documents this conversion symptom as which of the following? 1) Aphonia 2) Anosognosia 3) Anosmia 4) Pseudocyesis

4) Pseudocyesis

A client is experiencing pain that has no organic etiology. This pain allows the client to avoid an unpleasant activity. What best describes what this client is experiencing? 1) The client is experiencing altered social interaction. 2) The client is experiencing disturbed thought processes. 3) The client is experiencing secondary gain. 4) The client is experiencing primary gain.

4) The client is experiencing primary gain.

Which characteristic does the nurse understand is central in somatic symptom disorders? 1) The presence of delusions 2) The presence of pain 3) The presence of paranoia 4) The presence of physical symptoms

4) The presence of physical symptoms

A client is receiving carbamazepine (Tegretol) for the treatment of a manic episode of bipolar disorder. What should the nurse include when planning client teaching about this medication? Select all that apply. 1 "You have to eat a low-sodium diet every day." 2 "You'll have to take a diuretic with this medication." 3 "You'll have to take this medication for the rest of your life." 4 "You may want to suck on hard candy when you get a dry mouth." 5 "We'll need to test your blood often during the first few weeks of therapy."

4,5 Sucking on hard candy or frequent rinsing may relieve a dry mouth, a side effect of carbamazepine. Carbamazepine can cause severe bone marrow depression in the early phase of therapy. Also, the drug level needs to be checked frequently to ensure a therapeutic level. A low-sodium diet is not required; nor is a diuretic. The client may or may not have to take the medication for life.

The nurse assesses a client with the diagnosis of bipolar disorder, manic episode. Which clinical findings support the diagnosis? Select all that apply. 1 Passivity 2 Dysphoria 3 Anhedonia 4 Grandiosity 5 Talkativeness 6 Distractibility

4,5,6 Grandiosity, manifested by extravagant, pompous, flamboyant beliefs about the self, frequently occurs during the manic phase of bipolar disorder. As mania increases, the client's rate of speech increases, and speech is delivered with urgency (pressured speech). Clients experiencing manic episodes have difficulty blocking out incoming stimuli, which results in distractibility and responses to irrelevant stimuli. Passiveness is exhibited when clients turn anger inward and show little emotion. It frequently occurs during the depressive stage of bipolar disorder. Dysphoria, a depressed, sad mood, is associated with the depressive stage of bipolar disorder. Anhedonia, an inability to feel pleasure, is associated with the depressive stage of bipolar disorder.

A client with antisocial personality disorder talks about personal life changes that need to occur. Which client statement shows group therapy is having a positive therapeutic effect? 1. " I'm not doing as bad as I thought I was." 2. " I wish I could believe I can change, but it's probably too late." 3. " I see all the problems, but I'm not sure there are good solutions." 4. " I'm finally learning how to live my life without living on the edge."

4. " I'm finally learning how to live my life without living on the edge."

A positive characteristic that assists the nurse in the care of the manic patient is 1. flight of ideas 2. racing thoughts 3. taunting behavior 4. distractibility

4. Distratibility

S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss and cessation of menses. The nurse ascertains that S perceives herself as grossly overweight and needing to lose more weight. Based on what is currently known about S, what nursing diagnosis can be established? Imbalanced nutrition: less than body requirements related to: 1. abuse of laxatives, as evidenced by electrolyte imbalances 2. physical exertion in excess of energy produced through caloric intake, as evidenced by weight loss 3. self-induced vomiting, as evidenced by swollen parotid glands 4. refusal to eat, as evidenced by loss of more than 15% of body weight

4. refusal to eat, as evidenced by loss of more than 15% of body weight

Which activity has a calming effect on the manic patient? 1. writing on a notepad 2. reading a book 3. discussion of current events 4. watching a movie

4. watching a movie

rapid cycling

4> mood episodes in a 12-month period. Used to indicate more severe symptoms, such as poorer global functioning, high risk recurrence risk, and resistances to conventional somatic treatments

MDD Signs and Symptoms

5 or more s/s must also be present one of which must be either a depressed mood or loss of interest in previously enjoyed activities At least 4 or more s/s which include: changes in appetite or weight, sleep disturbances, fatigue or loss of energy, feelings of worthlessness or guilt, difficulty concentrating, thinking, or making decisions, or recurrent thoughts of death or suicide. Additional s/s may be: bodily aches and pains, irritability, or crankiness rather than sadness, social withdrawal, and neglect of activities that previously brought pleasure. Many times begins in childhood

Teamwork and Safety

Protect against self harm control hyperactivity seclusion or restraints may be needed Seclusion for: reducing overwhelming stimuli protect from self harm and injuring others prevents destruction of personal property

Client Needs: Psychosocial Integrity 2. A patient became depressed after the last of the family's six children moved out of the home 4 months ago. Select the best initial outcome for the nursing diagnosis Situational low self-esteem related to feelings of abandonment. The patient will: a. verbalize realistic positive characteristics about self by (date). b. agree to take an antidepressant medication regularly by (date). c. initiate social interaction with another person daily by (date). d. identify two personal behaviors that alienate others by (date).

A Low self-esteem is reflected by making consistently negative statements about self and self-worth. Replacing negative cognitions with more realistic appraisals of self is an appropriate intermediate outcome. The incorrect options are not as clearly related to the nursing diagnosis. Outcomes are best when framed positively; identifying two personal behaviors that might alienate others is a negative concept. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 259 | Page 261 (Table 14-2) | Page 256 (Case Study and Nursing Care Plan 14-1) | Page 274 TOP: Nursing Process: Outcomes Identification

Client Needs: Psychosocial Integrity 17. A patient diagnosed with major depression does not interact with others except when addressed, and then only in monosyllables. The nurse wants to show nonjudgmental acceptance and support for the patient. Which communication technique will be effective? a. Make observations. b. Ask the patient direct questions. c. Phrase questions to require yes or no answers. d. Frequently reassure the patient to reduce guilt feelings.

A Making observations about neutral topics such as the environment draws the patient into the reality around him or her but places no burdensome expectations for answers on the patient. Acceptance and support are shown by the nurse's presence. Direct questions may make the patient feel that the encounter is an interrogation. Open-ended questions are preferable if the patient is able to participate in dialogue. Platitudes are never acceptable. They minimize patient feelings and can increase feelings of worthlessness. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 261-263 (Table 14-3) TOP: Nursing Process: Implementation

Client Needs: Physiological Integrity 19. Which documentation for a patient diagnosed with major depression indicates the treatment plan was effective? a. Slept 6 hours uninterrupted. Sang with activity group. Anticipates seeing grandchild. b. Slept 10 hours uninterrupted. Attended craft group; stated "project was a failure, just like me." c. Slept 5 hours with brief interruptions. Personal hygiene adequate with assistance. Weight loss of 1 pound. d. Slept 7 hours uninterrupted. Preoccupied with perceived inadequacies. States, "I feel tired all the time."

A Sleeping 6 hours, participating with a group, and anticipating an event are all positive events. All the other options show at least one negative finding. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 256 (Case Study and Nursing Care Plan 14-1) | Page 274-275 TOP: Nursing Process: Evaluation

Which is the greatest protective factor against the risk of suicide? One or more previous suicide attempts A sense of responsibility to family, including spouse and children Fear of dying A cultural belief that suicide is a shameful resolution for a dilemma

A sense of responsibility to family, including spouse and children Having family responsibilities makes a client less likely to commit suicide. Hopelessness is the greatest risk factor.

Which room placement would be best for a client experiencing a manic episode? A. A shared room with a client with dementia B. A single room near the unit activities area C. A single room near the nurse's station D. A shared room away from the unit entrance

A single room near the nurse's station

Depression

A state wherein the person experiences profound sadness.

A client complaining of leg paralysis is admitted to a medical unit. Extensive tests and workups confirm the client's disability but fail to indicate any underlying organic pathological condition. This is most suggestive of which disorder? A) Conversion disorder B) Hypochondriasis C) Malingering D) Somatization disorder

A) Conversion disorder

Personality disorders differ from personality traits in that personality disorders: A. Interfere with role functioning B. Remain stable over time C. Assist clinicians in predicting behavior D. May cause distress in other people

A. Interfere with role functioning

Client Needs: Psychosocial Integrity 2. A student nurse caring for a patient diagnosed with depression reads in the patient's medical record, "This patient shows vegetative signs of depression." Which nursing diagnoses most clearly relate to the vegetative signs? Select all that apply. a. Imbalanced nutrition: less than body requirements b. Chronic low self-esteem c. Sexual dysfunction d. Self-care deficit e. Powerlessness f. Insomnia

A, C, D, F Vegetative signs of depression are alterations in body processes necessary to support life and growth, such as eating, sleeping, elimination, and sexual activity. These diagnoses are more closely related to vegetative signs than diagnoses associated with feelings about self. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 257-261 (Table 14-2) | Page 264 (Table 14-5) TOP: Nursing Process: Diagnosis/Analysis

Client Needs: Psychosocial Integrity 4. A patient being treated with paroxetine (Paxil) 50 mg po daily for depression reports to the clinic nurse, "I took a few extra tablets earlier today and now I feel bad." Which assessments are most critical? Select all that apply. a. Vital signs b. Urinary frequency c. Psychomotor retardation d. Presence of abdominal pain and diarrhea e. Hyperactivity or feelings of restlessness

A, D, E The patient is taking the maximum dose of this SSRI and has ingested an additional unknown amount of the drug. Central serotonin syndrome must be considered. Symptoms include abdominal pain, diarrhea, tachycardia, elevated blood pressure, hyperpyrexia, increased motor activity, and muscle spasms. Central serotonin syndrome may progress to a full medical emergency if not treated early. The patient may have urinary retention, but frequency would not be expected. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 265-268 (Box 14-2) TOP: Nursing Process: Assessment

A nursing instructor is teaching students about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia nervosa. Which student statement indicates that learning has occurred? A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not." B. "Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not." C. "Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not." D. "Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not."

A. "Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not."

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

The nurse can anticipate a prescription for what medication for the client who was just diagnosed with obsessive compulsive disorder? A. Clomipramine B. Clonidine C. Clonazepam D. Propranolol

A. Clomipramine

When a client on an acute care psychiatric unit demonstrates behaviors and verbalizations indicating a lack of guilt feelings, which nursing intervention would help the client to meet desired outcomes? A. Provide external limits on client behavior. B. Foster discussions of rationales for behavioral change. C. Implement interventions consistently by only one staff member. D. Encourage the client to involve self in care.

A. Provide external limits on client behavior.

The mental health nurse practitioner would include what initial intervention in the care of the client with hoarding disorder: A. Psychoeducation about their disorder B. Ordering neuroimaging to determine activity in the cingulate cortex. C. Psychopharmacology including an SSRI D. Cognitive-behavioral therapy

A. Psychoeducation about their disorder

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

Which nursing diagnosis should be prioritized when providing care to a client diagnosed with paranoid personality disorder? A. Risk for violence: directed toward others R/T suspicious thoughts B. Risk for suicide R/T altered thought C. Altered sensory perception R/T increased levels of anxiety D. Social isolation R/T inability to relate to others

A. Risk for violence: directed toward others R/T suspicious thoughts

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

A nursing diagnosis of ineffective coping R/T feelings of loneliness AEB bingeing then purging when alone, is assigned to a client diagnosed with bulimia nervosa. Which is an appropriate outcome related to this nursing diagnosis? A. The client will identify two alternative methods of dealing with isolation by day 3. B. The client will appropriately express angry feelings about lack of control by week 2. C. The client will verbalize two positive self attributes by day 3. D. The client will list five ways that the body reacts to bingeing and purging.

A. The client will identify two alternative methods of dealing with isolation by day 3.

A nurse observes dental deterioration when assessing a client diagnosed with bulimia nervosa. What explains this assessment finding? A. The emesis produced during purging is acidic and corrodes the tooth enamel. B. Purging causes the depletion of dietary calcium. C. Food is rapidly ingested without proper mastication. D. Poor dental and oral hygiene leads to dental caries.

A. The emesis produced during purging is acidic and corrodes the tooth enamel.

A physician describes a client as "malingering." The nurse knows this means the client A. is falsely claiming to have the symptoms. B. experiences symptoms that cannot be explained medically. C. experiences symptoms that have a physiological basis. D. is seeking medication to ease pain of psychological origin

A. is falsely claiming to have the symptoms.

Select the outcomes most appropriate for a client in phase III of treatment of schizophrenia who displays many negative symptoms of the disorder. The client will (more than one answer may be correct) A. take medication as ordered. B. maintain a regular sleep pattern. C. use alcohol and caffeine as desired. D. participate in self-care skills training.

ANS: A, B, D Rationale: The stabilization phase of schizophrenia is seen when the client is well enough to be maintained in the community. It is a time for consolidating gains, learning relapse prevention (options A and B), and promoting adaptation to deficits that still exist (option D). Option C: Use of alcohol, caffeine, and other recreational drugs should be discouraged because these substances interfere with therapeutic medication effects. DIF: Cognitive Level: Application REF: Text Page: 398 TOP: Nursing Process: Planning (Outcome Identification) MSC: NCLEX: Psychosocial Integrity

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would a nurse expect to observe during assessment? (Select all that apply.) 1. Apathy 2. Social withdrawal 3. Anhedonia 4. Auditory hallucinations 5. Delusions

ANS: 1, 2, 3 Rationale: The nurse should expect that a client with decreased levels of prolactin may experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression, which could result in these symptoms.

A client with schizophrenia begins to talk about "volmers" hiding in the warehouse where he works and undoing his work each night. The term "volmers" should be assessed as a. a neologism. b. concrete thinking. c. thought insertion. d. an idea of reference.

ANS: A A neologism is a newly coined word having special meaning to the client. "Volmer" is not a known word. Option B: Concrete thinking refers to the inability to think abstractly. Option C: Thought insertion refers to the idea that the thoughts of others are being planted in one's mind. Option D: Ideas of reference are a type of delusion in which trivial events are given personal significance. DIF: Cognitive Level: Application REF: Text Page: 392, Text Page: 393 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A client with many positive symptoms of schizophrenia whose behavior is disorganized and who is highly anxious tells the nurse in the psychiatric emergency department "You have got to help me. I do not know what is going on. I think someone is trying to wipe me out. I have to get a gun." The client, a college student, lives alone and has no family or support system in the immediate area. He has not left his room in 2 weeks, has not eaten in several days, and is unkempt. Of the available treatment settings, the nurse should recommend a. acute hospitalization for 4 to 5 days. b. partial hospitalization for 2 weeks. c. day treatment for 4 weeks. d. home treatment for 6 weeks.

ANS: A A short-term hospital stay would probably serve the client best. Medication can be started, the inpatient milieu can provide structure, observation can be ongoing, interpersonal support can be provided, physical needs can be met, and the safety of client and others preserved. The client has no support system to provide care at home, and both partial hospitalization and day treatment would leave the client without structure and support for at least 12 hours daily. DIF: Cognitive Level: Analysis REF: Text Page: 399, Text Page: 400 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment

A client with schizophrenia is admitted to the psychiatric unit in an acutely disturbed, violent state. He is given several doses of haloperidol (Haldol) and becomes calm and approachable. During rounds, the nurse notices the client has his head rotated to one side in a stiffly fixed position. His lower jaw is thrust forward and he is drooling. He appears severely anxious. The client has a. a dystonic reaction. b. tardive dyskinesia. c. waxy flexibility. d. akathisia.

ANS: A Acute dystonic reactions involve painful contractions of the tongue, face, neck, and back. Opisthotonos and oculogyric crisis may be observed. Dystonic reactions are considered emergencies requiring immediate intervention. Option B: Tardive dyskinesia involves involuntary spasmodic muscular contractions that involve the tongue, fingers, toes, neck, trunk, or pelvis. It appears after prolonged treatment. Option C: Waxy flexibility is a symptom seen in catatonic schizophrenia. Option D: Akathisia is evidenced by internal and external restlessness, pacing, and fidgeting. DIF: Cognitive Level: Analysis REF: Text Page: 405, Text Page: 406, Text Page: 407, Text Page: 408, Text Page: 409, Text Page: 410, Text Page: 411 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

A client is admitted to the in-patient unit in the withdrawn phase of catatonic schizophrenia. He is completely stuporous. While giving care to the client, the nurse must a. explain care activities in simple, explicit terms as though expecting a response. b. maintain a quiet, nonstimulating atmosphere, speaking as little as possible to the client. c. provide high levels of sensory stimulation by using conversation, the radio, and television. d. address negativism by asking the client to do exactly the opposite of what is desired.

ANS: A Although the withdrawn, catatonic client may appear stuporous, he may be aware of everything going on around him. The client should be treated as though he can see and hear and as though he will respond normally. Option B: The client needs contact with the nurse on a frequent basis. Option C: Excessive auditory stimulation can be a disorganizing influence. Option D: This is nontherapeutic. DIF: Cognitive Level: Application REF: Text Page: 414 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment;

Family members of a client newly diagnosed with paranoid schizophrenia state that they do not understand what caused the client's illness. The nurse's response should be predicated on the a. neurobiological-genetic model. b. stress model. c. family theory model. d. developmental model.

ANS: A Compelling evidence exists that schizophrenia is a neurological disorder probably related to neurochemical abnormalities, neuroanatomical disruption of brain circuits, and genetic vulnerability. Options B, C, and D: Stress, family disruption, and developmental influences may contribute but are not considered single etiologies. DIF: Cognitive Level: Application REF: Text Page: 386, Text Page: 387 TOP: Nursing Process: Implementation MSC: NCLEX: Physiologic Integrity

A client was admitted to the mental health unit after arguing with co-workers and threatening to kill them. He is diagnosed with paranoid schizophrenia. On the unit he is aloof and suspicious. He mentioned that two physicians he saw talking were plotting to kill him. On the basis of data gathered at this point, two nursing diagnoses the nurse should consider are a. disturbed thought processes and risk for other-directed violence. b. spiritual distress and social isolation. c. risk for loneliness and deficient knowledge. d. disturbed personal identity and noncompliance.

ANS: A Delusions of persecution and ideas of reference support a nursing diagnosis of disturbed thought processes. Risk for other-directed violence is substantiated by the client's feeling endangered by persecutors. Fearful individuals may strike out at perceived persecutors or may attempt self-harm to get away from persecutors. Data are not present to support the diagnoses in the other options. DIF: Cognitive Level: Analysis REF: Text Page: 396, Text Page: 397 TOP: Nursing Process: Nursing Diagnosis MSC: NCLEX: Psychosocial Integrity

The nurse who observes a client prescribed haloperidol who has his head rotated to one side in a stiff, fixed position with his lower jaw thrust forward and drool coming from his mouth should intervene by a. obtaining an order to administer diphenhydramine (Benadryl) 50 mg IM. b. reassuring the client that the symptoms will subside if he relaxes. c. administering trihexyphenidyl (Artane) 5 mg orally. d. administering atropine 2 mg subcutaneously.

ANS: A Diphenhydramine, trihexyphenidyl, benztropine, and other anticholinergic medications may be used to treat dystonias, but because the client is drooling the nurse must assume swallowing is difficult, if not impossible. Therefore oral medication is not an option. Medication should be administered intramuscularly. In this case the option given is diphenhydramine. DIF: Cognitive Level: Application REF: Text Page: 409 TOP: Nursing Process: Implementation MSC: NCLEX: Physiologic Integrity

A newly admitted client diagnosed with paranoid schizophrenia is hypervigilant and constantly scans the environment. He states that he saw two doctors talking in the hall and knows they were plotting to kill him. The nurse may correctly assess this behavior as a. an idea of reference. b. a delusion of infidelity. c. an auditory hallucination. d. echolalia.

ANS: A Ideas of reference are misinterpretations of the verbalizations or actions of others that give special personal meanings to these behaviors; for example, seeing two people talking, the individual assumes they are talking about him or her. The other behaviors do not correspond with the scenario. DIF: Cognitive Level: Application REF: Text Page: 392 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

The nurse spends several sessions with a client with paranoid schizophrenia and the client's family to help them understand the importance of the client regularly taking antipsychotic medication. The client repeatedly states he does not like taking pills, and family members say they feel helpless to foster his compliance. The treatment strategy the nurse should discuss with the physician is a. use of an antipsychotic decanoate preparation. b. adjunctive use of amitriptyline (Elavil). c. use of benzodiazepines such as diazepam (Valium). d. use of chlordiazepoxide (Librium).

ANS: A Medications such as fluphenazine decanoate and haloperidol decanoate are long-acting forms of antipsychotic medication. They are given by depot injection every 2 to 4 weeks, thus reducing daily opportunities for noncompliance. The other options do not address the client's dislike of taking pills. DIF: Cognitive Level: Application REF: Text Page: 407 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment;

The wife of a client with schizophrenia is worried about her 17-year-old daughter and asks the nurse what symptoms mark the prodromal stage of schizophrenia. The nurse should respond by listing behaviors such as a. withdrawal, misinterpreting, poor concentration, and preoccupation with religion. b. auditory hallucinations, ideas of reference, thought insertion, and broadcasting. c. stereotyped behavior, echopraxia, echolalia, and waxy flexibility. d. loose associations, concrete thinking, and echolalia neologisms.

ANS: A Options B, C, and D each list the positive symptoms of schizophrenia that might be apparent during the acute stage of the illness. Prodromal symptoms, the symptoms that are present before the development of florid symptoms, are listed in option 1. DIF: Cognitive Level: Application REF: Text Page: 389 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

Personality disorders differ from personality traits in that personality disorders a. May cause distress in other people b. Assist nurse in predicting behavior c. Remains stable over time d. Interfere with role functioning.

d. Interfere with role functioning.

A client with catatonic schizophrenia exhibits little spontaneous movement and demonstrates waxy flexibility. The client's needs of priority importance are a. physical. b. psychosocial. c. safety and security. d. self-actualization.

ANS: A Physical needs must be met to preserve life. A client who is semistuporous must be fed by hand or tube, toileted, given range-of-motion exercises, and so forth to preserve physiological integrity. Safety needs rank second to physical needs. Higher level needs are of lesser concern. DIF: Cognitive Level: Analysis REF: Text Page: 414 TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment

Which event would a client with early stage 4 Alzheimer's disease have greatest difficulty remembering? His or her high school graduation The births of his or her children The story of a teenage escapade What he or she ate for breakfast

What he or she ate for breakfast Initially, recent memory is impaired, and remote memory remains intact.

A client is prescribed alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order? A. History of alcohol use disorder B. History of personality disorder C. History of schizophrenia D. History of hypertension

ANS: A Rationale: The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances.

To establish a relationship with a severely withdrawn schizophrenic client being cared for at home by a supportive family, the most realistic plan would be for the community mental health nurse to a. visit daily for 4 days, then every other day for 1 week; stay with client for 20 minutes, accept silence; state when the nurse will return. b. arrange to spend 1 hour each day with the client, with the focus on asking questions about what the client is thinking or experiencing; avoid silences. c. visit twice daily; sit beside the client with hand on the client's arm; leave if the client does not respond within 10 minutes. d. visit every other day; remind the client of the nurse's identity; tell the client he may use the time to talk or the nurse will work on reports.

ANS: A Severe constraints on the community mental health nurse's time will probably not allow more time than what is mentioned in option A, yet important principles can be used. A severely withdrawn client should be met "at the client's own level," with silence accepted. Short periods of contact are helpful to minimize both the client's and the nurse's anxiety. Predictability in returning as stated will help build trust. Option B: An hour may be too long to sustain a home visit with a withdrawn client, especially if the nurse persists in leveling a barrage of questions at the client. Option C: Twice-daily visits are probably not possible, and leaving after 10 minutes would be premature. Touch may be threatening. Option D: Working on reports suggests the nurse is not interested in the client. DIF: Cognitive Level: Application REF: Text Page: 399, Text Page: 400 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment

An insurance agent who is sitting in his office after returning from a physical examination in which he was pronounced "in good health" suddenly experiences a feeling of terror. His heart pounds, he feels as though he cannot breathe, and he cannot focus on what is being said to him. Several earlier episodes and the fear of their repetition had prompted the visit to the doctor. This experience should be assessed as a possible a. panic attack. b. phobic reaction. c. dissociative reaction. d. obsessive-compulsive crisis.

ANS: A According to the DSM-IV-TR, panic attacks cause symptoms of sympathetic nervous system arousal and occur without warning, as described in the scenario. Option B: A phobic reaction involves excessive fear. Option C: A dissociative reaction involves separation of an event from conscious awareness. Option D: No disorder is known as an obsessive-compulsive crisis.

A client tells the nurse he cannot go out on a date because he might have to eat something in front of others. He reveals that he is afraid that someone will laugh at the way he eats or that he will spill food and be laughed at. The nurse can assess this behavior as being consistent with a. social phobia. b. specific phobia. c. agoraphobia. d. posttraumatic stress disorder.

ANS: A Fear of a potentially embarrassing situation is called a social phobia. Option B: Specific phobias are fears of specific objects, such as dogs. Option C: Agoraphobia is fear of a place in the environment. Option D: Posttraumatic stress disorder is associated with a major traumatic event.

Which piece of subjective data obtained during the nurse's psychosocial assessment of a client experiencing severe anxiety would indicate the possibility of obsessive-compulsive disorder? a. "I have to keep checking to see where my car keys are." b. "My legs feel weak most of the time." c. "I'm afraid to go out in public." d. "I keep reliving the rape."

ANS: A Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Option B is more in keeping with a somatoform disorder. Option C is associated with agoraphobia and option D with posttraumatic stress disorder.

A client who is a recovering alcoholic has been diagnosed as having panic attacks. The psychiatrist mentions plans to treat the client with daily doses of medication. Of the medications listed below, for which drug should the nurse plan client teaching? a. Paroxetine (Paxil) b. Alprazolam (Xanax) c. Chlorpromazine (Thorazine) d. Propranolol (Inderal)

ANS: A Selective serotonin reuptake inhibitors are first-line drugs for the treatment of panic disorder. Both paroxetine and sertraline are approved by the Food and Drug Administration for treatment of panic disorder. Selective serotonin reuptake inhibitors are nonaddicting and have a relatively low incidence of unpleasant side effects. Also useful are tricyclic antidepressants, such as imipramine, which are more useful than the benzodiazepines because they are nonaddicting. Option B: Alprazolam is a benzodiazepine and would not be the drug of choice for a client who has a problem of chemical dependency. Option C: Chlorpromazine is a neuroleptic and not useful for treating panic disorder. Propranolol is more often used in the treatment of social phobias.

A client who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse "I know it's probably crazy, but I just can't bring myself to leave my apartment alone. And I can't expect somebody to take me to work every day." The nurse can make the assessment that the client a. knows his symptom is unrealistic. b. is misinterpreting reality. c. is seeking sympathy. d. is depersonalizing.

ANS: A Symptoms of anxiety disorders are often recognized by the client as strange and nonadaptive and are sources of dissatisfaction to the client. Options B and C: The client is interpreting reality appropriately and does not seem to be attempting to elicit sympathy from the nurse. Option D: The scenario does not give evidence of depersonalization (experiencing feelings of unreality or alienation).

2. Which assessment findings would the nurse expect in a patient experiencing delirium? Select all that apply. a. Impaired level of consciousness b. Disorientation to place, time c. Wandering attention d. Apathy e. Agnosia

ANS: A, B, C Disorientation to place and time is an expected finding. Orientation to person (self) usually remains intact. Attention span is short, and difficulty focusing or shifting attention as directed is often noted. Patients with delirium commonly experience illusions and hallucinations. Fluctuating levels of consciousness are expected. Agnosia occurs with dementia. Apathy is associated with depression.

1. A patient diagnosed with moderately severe Alzheimer's disease has a self-care deficit of dressing and grooming. Designate appropriate interventions to include in the patient's plan of care. Select all that apply. a. Provide clothing with elastic and hook-and-loop closures. b. Label clothing with the patient's name and name of the item. c. Administer anti-anxiety medication before bathing and dressing. d. Provide necessary items and direct the patient to proceed independently. e. If the patient resists dressing, use distraction and try again after a short interval.

ANS: A, B, E Providing clothing with elastic and hook-and-loop closures facilitates patient independence. Labeling clothing with the patient's name and the name of the item maintains patient identity and dignity (provides information if the patient has agnosia). When a patient resists, it is appropriate to use distraction and try again after a short interval because patient moods are often labile. The patient may be willing to cooperate given a later opportunity. Providing the necessary items for grooming and directing the patient to proceed independently are inappropriate. Be prepared to coach by giving step-by-step directions for each task as it occurs. Administering anxiolytic medication before bathing and dressing is inappropriate. This measure would result in unnecessary overmedication.

27. An elderly patient is admitted with delirium secondary to a urinary tract infection. The family asks whether the patient will ever recover. Select the nurse's best response. a. "The health care provider is the best person to answer your question." b. "The confusion will probably get better as we treat the infection." c. "Unfortunately, delirium is a progressively disabling disorder." d. "I will be glad to contact the chaplain to talk with you."

ANS: B Usually, as the underlying cause of the delirium is treated, the symptoms of delirium clear. The distracters mislead the family.

7. Which assessment finding would be likely for a patient experiencing a hallucination? The patient: a. looks at shadows on a wall and says, "I see scary faces." b. states, "I feel bugs crawling on my legs and biting me." c. reports telepathic messages from the television. d. speaks in rhymes.

ANS: B A hallucination is a false sensory perception occurring without a corresponding sensory stimulus. Feeling bugs on the body when none are present is a tactile hallucination. Misinterpreting shadows as faces is an illusion. An illusion is a misinterpreted sensory perception. The other incorrect options apply to thought insertion and clang associations.

8. Consider these health problems: Lewy body disease, frontal-temporal lobar degeneration, and Huntington's disease. Which term unifies these problems? a. Cyclothymia b. Dementia c. Delirium d. Amnesia

ANS: B The listed health problems are all forms of dementia.

The family of a client with acute symptoms of schizophrenia knows nothing about the client's illness and the role the family can play in his recovery. The nurse should recommend that they attend a. psychoanalytic group therapy. b. a psychoeducational group. c. transactional therapy. d. family therapy.

ANS: B A psychoeducational group explores the causes of schizophrenia, the role of medication, the importance of medication compliance, support for the ill member, and hints for living with a schizophrenic person. Such a group can be of immeasurable practical assistance to the family. The other types of therapy do not focus on psychoeducation. DIF: Cognitive Level: Application REF: Text Page: 402, Text Page: 403 TOP: Nursing Process: Implementation MSC: NCLEX: Health Promotion and Maintenance

Which client with schizophrenia would be expected to have the lowest score in global assessment of functioning? a. Client A, aged 39 years, who had paranoid ideation develop at age 35 years b. Client B, aged 40 years, who has had disorganized schizophrenia since age 18 years c. Client C, diagnosed as catatonic at age 24 years, who has been stable for 3 years d. Client D, aged 19 years, diagnosed with undifferentiated schizophrenia at age 17 years

ANS: B Disorganized schizophrenia represents the most regressed and socially impaired of all the schizophrenias. Client B could logically be expected to have the lowest global assessment of functioning. In addition, the client has been ill for a number of years. Option A: Client A could be expected to have the highest score because paranoid schizophrenia of short duration may be less impairing than other types. Option C: Client C has been stable more than 3 years, suggesting higher functional ability. Option D: Client D has been ill only 2 years, and disability in undifferentiated schizophrenia remains fairly stable over time. DIF: Cognitive Level: Application REF: Text Page: 412, Text Page: 414, Text Page: 415, Text Page: 416 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A client with schizophrenia has received standard antipsychotics for a year. His hallucinations are less intrusive, but the client remains apathetic, has poverty of thought, cannot work, and is socially isolated. To address these symptoms, the nurse might expect the psychiatrist to prescribe a. haloperidol (Haldol). b. olanzapine (Zyprexa). c. diphenhydramine (Benadryl). d. chlorpromazine (Thorazine).

ANS: B Olanzapine is an atypical antipsychotic that targets both positive and negative symptoms of schizophrenia. Options A and D are standard antipsychotics that target only positive symptoms. Option C is an antihistamine. DIF: Cognitive Level: Application REF: Text Page: 405 TOP: Nursing Process: Planning MSC: NCLEX: Physiologic Integrity

Which findings listed in the medical record of a client with schizophrenia indicate a neurological origin for schizophrenia? a. A hostile, overinvolved parent and a weak, uninvolved parent b. Enlarged or asymmetrical ventricles, cortical atrophy c. Presence of ambivalence and flattened affect d. Presence of delusions and hallucinations

ANS: B Only option B relates to neurological findings. Options C and D refer to symptoms. Option A refers to family dynamics. DIF: Cognitive Level: Analysis REF: Text Page: 387 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

A client with catatonic schizophrenia is semistuporous, demonstrating little spontaneous movement and waxy flexibility. The client's self-care activities of daily living have been assessed as severely compromised. An appropriate outcome would be that the client will a. demonstrate increased interest in the environment by the end of week 1. b. perform self-care activities with coaching by the end of week 1. c. gradually assume the initiative in self-care by the end of week 2. d. accept tube feeding without objection by day 2.

ANS: B Outcomes related to self-care deficit nursing diagnoses should deal with increasing ability to perform self-care tasks independently, such as feeding, bathing, dressing, and toileting. Performing the tasks with coaching by nursing staff denotes improvement over the complete inability to perform the tasks. Option A is not directly related to self-care activities. Option C is difficult to measure. Option D is related to maintenance of nutrition. DIF: Cognitive Level: Application REF: Text Page: 414 TOP: Nursing Process: Planning (Outcome Identification) MSC: NCLEX: Psychosocial Integrity

When a client diagnosed with paranoid schizophrenia was discharged from the unit 6 months ago, the plan was for him to take chlorpromazine (Thorazine) 300 mg po daily. He tells the nurse he stopped taking his pills after a few months because they made him feel like a "zombie." The common side effects the nurse should validate with the client include a. sweating, nausea, and diarrhea. b. sedation and muscle stiffness. c. headache, watery eyes, and runny nose. d. mild fever, sore throat, and skin rash.

ANS: B Phenothiazines often produce sedation and extrapyramidal side effects such as stiffness and gait disturbance, effects the client might describe as making him feel like a "zombie." The side effects mentioned in the other options are usually not associated with phenothiazine therapy or would not have the effect described by the client. DIF: Cognitive Level: Application REF: Text Page: 405, Text Page: 407 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

A client with schizophrenia who has received chlorpromazine (Thorazine) 200 mg po 4 times daily for 3 weeks has symptoms of a shuffling, propulsive gait, a masklike face, and drooling. These symptoms should be assessed as a. hepatocellular effects. b. pseudoparkinsonism. c. tardive dyskinesia. d. akathisia.

ANS: B Pseudoparkinsonism induced by antipsychotic medication mimics the symptoms of Parkinson's disease. It frequently appears within the first month of treatment. Hepatocellular effects would produce abnormal liver test results. Tardive dyskinesia produces involuntary tonic muscular spasms. Akathisia produces symptoms of motor restlessness. DIF: Cognitive Level: Application REF: Text Page: 405, Text Page: 406, Text Page: 407, Text Page: 408, Text Page: 409, Text Page: 410, Text Page: 411 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

A client received maintenance doses of trifluoperazine (Stelazine) 30 mg po daily for 1.5 years. The clinic nurse notes the client is grimacing and seems to be constantly smacking her lips. Her neck and shoulders twist in a slow, snakelike motion. The nurse should suspect the presence of a. agranulocytosis. b. tardive dyskinesia. c. Tourette's syndrome. d. anticholinergic effects.

ANS: B Tardive dyskinesia is a neuroleptic-induced condition involving the face, trunk, and limbs. Involuntary movements such as tongue thrusting; licking; blowing; irregular movements of the arms, neck, and shoulders; rocking; hip jerks; and pelvic thrusts are seen. These symptoms are frequently not reversible even when the drug is discontinued. The scenario does not present evidence consistent with the other disorders mentioned. Option A: Agranulocytosis is a blood disorder. Option C: Tourette's syndrome is a condition in which tics are present. Option D: Anticholinergic effects include dry mouth, blurred vision, flushing, constipation, and dry eyes. DIF: Cognitive Level: Application REF: Text Page: 409 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

A newly admitted client diagnosed with paranoid schizophrenia believes co-workers are "out to get" him and has stated he thinks two doctors on the unit are plotting to kill him. How does the client perceive the environment? a. Supportive b. Dangerous c. Disorganized d. Bizarre

ANS: B The client sees his world as hostile and dangerous. This assessment is important because the nurse can be more effective by using empathy to respond to the client. Data are not present to support any of the other options. DIF: Cognitive Level: Analysis REF: Text Page: 392 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

Which diagnosis is associated with worry?

GAD

A catatonic client admitted in a stuporous condition begins to demonstrate increased motor activity. He sometimes walks slowly around the unit without interacting. One day the nurse observes him standing immobile, facing the wall with one arm bent behind his back and the other extended in a Nazi-like salute. He remains immobile in that position for 15 minutes, moving only when the nurse gently lowers his arm. This phenomenon is termed a. echolalia. b. waxy flexibility. c. depersonalization. d. thought withdrawal.

ANS: B Waxy flexibility is the ability to hold distorted postures for extended periods of time, as though the client were molded in wax. Option A: Echolalia is a speech pattern. Option C: Depersonalization refers to a feeling state. Option D: Thought withdrawal refers to an alteration in thinking. DIF: Cognitive Level: Application REF: Text Page: 394 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

For the client with ritualistic hand washing and an identified outcome of the use of more effective coping patterns, the nurse should use the intervention of a. allowing the client to set own hand-washing schedule. b. encouraging the client to participate in unit activities. c. encouraging the client to discuss hand washing in all groups. d. focusing on the client's symptoms rather than on the client.

ANS: B Because obsessive-compulsive clients become overly involved in the rituals, promotion of involvement with other people and activities is necessary to improve coping. Daily activities prevent constant focus on anxiety and symptoms. The other interventions focus on the compulsive symptom.

A client reveals that he becomes panic stricken when he sees a dog. The nurse can assess this behavior as being consistent with a. social phobia. b. specific phobia. c. agoraphobia. d. generalized anxiety disorder.

ANS: B Intense, persistent fear of an object is a clinical manifestation of a specific phobia. Option A: Social phobias involve fear of a social situation. Option C: Agoraphobia involves fear of an environment from which escape would be difficult. Option D: Generalized anxiety disorder involves generalized anxiety rather than a specific fear

When interviewing and planning care for a client with fear of public speaking, the nurse must be aware that social phobias are often treatable with a. neuroleptics. b. ß-blockers. c. tricyclic antidepressants. d. monoamine oxidase inhibitors.

ANS: B ß-Blockers such as propranolol are often effective in preventing symptoms of anxiety associated with social phobias. Option A: Neuroleptics are major tranquilizers and not useful in treating social phobias. Option C: Tricyclic antidepressants are rarely used because of their side-effect profile. Option D: Monoamine oxidase inhibitors are used for depression and only by individuals who can observe the special diet required.

10. An older adult was stopped by police for driving through a red light. When asked for a driver's license, the adult hands the police officer a pair of sunglasses. What sign of dementia is evident? a. Aphasia b. Apraxia c. Agnosia d. Anhedonia

ANS: C Agnosia refers to the loss of sensory ability to recognize objects. Aphasia refers to the loss of language ability. Apraxia refers to the loss of purposeful movement. Anhedonia refers to a loss of joy in life.

29. A nurse gives anticipatory guidance to the family of a patient diagnosed with stage 3, mild cognitive decline Alzheimer's disease. Which problem common to that stage should the nurse address? a. Violent outbursts b. Emotional disinhibition c. Communication deficits d. Inability to feed or bathe self

ANS: C Families should be made aware that the patient will have difficulty concentrating and following or carrying on in-depth or lengthy conversations. The other symptoms are usually seen at later stages of the disease.

11. An older adult drove to a nearby store but was unable to remember how to get home or state an address. When police intervened, they found that this adult was wearing a heavy coat and hat, even though it was July. Which stage of Alzheimer's disease is evident? a. Preclinical Alzheimer's disease b. Mild cognitive decline c. Moderately severe cognitive decline d. Severe cognitive decline

ANS: C In the moderately severe stage, deterioration is evident. Memory loss may include the inability to remember addresses or the date. Activities such as driving may become hazardous, and frustration by the increasing difficulty of performing ordinary tasks may be experienced. The individual has difficulty with clothing selection. Mild cognitive decline (early-stage) Alzheimer's can be diagnosed in some, but not all, individuals. Symptoms include misplacing items and misuse of words. In the stage of severe cognitive decline, personality changes may take place, and the patient needs extensive help with daily activities. This patient has symptoms, so the preclinical stage does not apply.

9. Which medication prescribed to patients diagnosed with Alzheimer's disease antagonizes N-Methyl-D-Aspartate (NMDA) channels rather than cholinesterase? a. Donepezil (Aricept) b. Rivastigmine (Exelon) c. Memantine (Namenda) d. Galantamine (Razadyne)

ANS: C Memantine blocks the NMDA channels and is used in moderate-to-late stages of the disease. Donepezil, rivastigmine, and galantamine are all cholinesterace inhibitors. These drugs increase the availability of acetylcholine and are most often used to treat mild-to-moderate Alzheimer's disease.

15. Two patients in a residential care facility have dementia. One shouts to the other, "Move along, you're blocking the road." The other patient turns, shakes a fist, and shouts, "You're trying to steal my car." What is the nurse's best action? a. Administer one dose of an antipsychotic medication to both patients. b. Reinforce reality. Say to the patients, "Walk along in the hall. This is not a traffic intersection." c. Separate and distract the patients. Take one to the day room and the other to an activities area. d. Step between the two patients and say, "Please quiet down. We do not allow violence here."

ANS: C Separating and distracting prevents escalation from verbal to physical acting out. Neither patient loses self-esteem during this intervention. Medication probably is not necessary. Stepping between two angry, threatening patients is an unsafe action, and trying to reinforce reality during an angry outburst will probably not be successful when the patients are cognitively impaired.

The nurse is told that a client with disorganized schizophrenia is being admitted to the unit. The nurse should expect the client to demonstrate a. highly suspicious, delusional behavior. b. extremes of motor activity and excitement to stupor. c. social withdrawal and ineffective communication. d. severe anxiety and ritualistic behavior.

ANS: C Clients with disorganized schizophrenia demonstrate the most regressed and socially impaired behaviors of the schizophrenias. Communication is often incoherent, with silly giggling and loose associations predominating. Option A relates more to paranoid schizophrenia. Option B relates to catatonic schizophrenia. Option D is seen with obsessive-compulsive disorder. DIF: Cognitive Level: Application REF: Text Page: 413 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

The physician is considering changing the antipsychotic medication for a client with schizophrenia who is troubled by the extrapyramidal symptoms of his current medication, haloperidol, and who seems to be becoming less motivated and more withdrawn. For planning purposes the nurse can assume that the physician will probably choose a. chlorpromazine (Thorazine). b. clozapine (Clozaril). c. olanzapine (Zyprexa). d. fluoxetine (Prozac).

ANS: C Olanzapine is an atypical antipsychotic that produces few extrapyramidal side effects and is effective in treating both positive and negative symptoms of schizophrenia. Option A: This drug often produces EPS. It is not effective in treating negative symptoms. Option B: Clozapine would not be the drug of choice because of the danger of agranulocytosis. Option D: Fluoxetine is a selective serotonin reuptake inhibitor antidepressant. DIF: Cognitive Level: Application REF: Text Page: 412 TOP: Nursing Process: Planning MSC: NCLEX: Physiologic Integrity

A client who is 5 foot 6 inches tall and weighs 98 pounds is admitted with a medical diagnosis of anorexia nervosa. Which nursing diagnosis would take priority at this time? A. Ineffective coping R/T food obsession B. Altered nutrition: less than body requirements R/T inadequate food intake C. Risk for injury R/T suicidal tendencies D. Altered body image R/T perceived obesity

B. Altered nutrition: less than body requirements R/T inadequate food intake

During her aunt's wake, a four-year-old child runs up to the casket before a mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? A. Complicated grieving B. Altered family processes C. Ineffective coping D. Body image disturbance

ANS: C Rationale: Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a diagnosis of hair-pulling disorder, or trichotillomania, may be assigned

A college student is unable to take a final exam owing to severe test anxiety. Instead of studying, the student relieves stress by attending a movie. Which priority nursing diagnosis should a campus nurse assign for this client? A. Non-adherence R/T test taking B. Ineffective role performance R/T helplessness C. Altered coping R/T anxiety D. Powerlessness R/T fear

ANS: C Rationale: The priority nursing diagnosis for this client is altered coping R/T anxiety. The nurse should assist in implementing interventions that will improve the client's healthy coping skills and reduce anxiety.

A salesman has had difficulty holding a job because he accuses co-workers of conspiring to take his sales. Today, he argued with several office mates and threatened to kill one of them. The police were called, and he was brought to the mental health center for evaluation. He has had previous admissions to the unit for stabilization of symptoms of paranoid schizophrenia. When the nurse meets him, he points at staff in the nursing station and states loudly "They're all plotting to destroy me. Isn't that true?" An appropriate response for the nurse would be a. "No, that is not true. People here are trying to help you if you will let them." b. "Everyone here is trying to help you. No one wants to harm you." c. "Thinking that people want to destroy you must be very frightening." d. "That is absurd. Staff are health care workers, not members of the mob."

ANS: C Resist focusing on content; instead, focus on the feelings the client is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase client anxiety and the tenacity with which the client holds to the delusion. The other options focus on content and provide opportunity for argument. DIF: Cognitive Level: Application REF: Text Page: 401 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A client, newly diagnosed with paranoid schizophrenia, is delusional, withdrawn, and aloof. One of her nursing diagnoses is deficient diversional activity. An activity that would be appropriate to plan for the client early in the course of her hospital stay is a. a basketball game. b. ping-pong with another client. c. a paint-by-number project. d. a card game with three other clients.

ANS: C Solitary, noncompetitive activities that require concentration are best while the client is overtly psychotic. Having to concentrate minimizes hallucinatory and delusional preoccupation. Options A, B, and D are all competitive. DIF: Cognitive Level: Application REF: Text Page: 400 TOP: Nursing Process: Planning MSC: NCLEX: Safe, Effective Care Environment;

A newly admitted client with schizophrenia approaches the unit nurse and says "The voices are bothering me. They are yelling and telling me I am bad. I have got to get away from them." The most helpful reply for the nurse to make would be a. "Do you hear the voices often?" b. "Do you have a plan for getting away from the voices?" c. "I'll stay with you. Focus on what we are talking about, not the voices. " d. "Forget the voices and ask some other clients to play cards with you."

ANS: C Staying with a distraught client who is hearing voices serves several purposes: ongoing observation, the opportunity to provide reality orientation, a means of helping dismiss the voices, the opportunity of forestalling an action that would result in self-injury, and general support to reduce anxiety. Option A is not particularly relevant at this point. Option B is relevant for assessment purposes but is less helpful than option C. Option D shifts responsibility for intervention from the nurse to the client and other clients. DIF: Cognitive Level: Application REF: Text Page: 401 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A highly suspicious client who has delusions of persecution about being poisoned has refused all hospital meals for 3 days. Assuming all interventions listed are possible, the one likely to be most acceptable to the client is a. allowing the client to contact a local restaurant to deliver his meals. b. offering to taste each portion on the tray for the client. c. allowing the client supervised access to lobby food machines. d. providing tube feedings or total parenteral nutrition.

ANS: C The client who is delusional about his food being poisoned is likely to believe restaurant food might still be poisoned and to say that the staff member tasting the food has taken an antidote to the poison before tasting. Attempts to tube feed or give nutrition intravenously are seen as aggressive and usually promote violence. Clients perceive foods in sealed containers, packages, or natural shells as being safer. DIF: Cognitive Level: Application REF: Text Page: 414 TOP: Nursing Process: Planning MSC: NCLEX: Psychosocial Integrity

Which behavior exhibited by a patient with mania should the nurse choose to address first? 1. Indiscriminate sexual relations 2. Excessive spending of money 3. Declaration of "being at one with the world" 4. Demonstration of flight of ideas

Indiscriminate sexual relations

A client with schizophrenia tells the nurse "Everyone must listen to me. I am the redeemer. I will bring peace to the world." From this the nurse can determine that an appropriate nursing diagnosis to be completed is a. disturbed sensory perception: auditory. b. risk for other-directed violence. c. chronic low self-esteem. d. noncompliance: medication.

ANS: C The client's grandiose delusion is based on reaction formation to actual feelings of low self-esteem. The scenario does not provide sufficient data to support the other diagnoses. DIF: Cognitive Level: Analysis REF: Text Page: 391, Text Page: 392, Text Page: 396, Text Page: 397 TOP: Nursing Process: Nursing Diagnosis MSC: NCLEX: Psychosocial Integrity

A frightened, delusional client tells the nurse "I can't go to activities. When I am in a room with a lot of people I can feel them sucking my thoughts out of my head." The nurse can correctly assess this as a. anhedonia. b. concrete thinking. c. thought withdrawal. d. associative looseness.

ANS: C Thought withdrawal is defined as a delusional belief that someone or something is removing thoughts from the client's mind. Option A: Anhedonia is the inability to experience pleasure. Option B: Concrete thinking refers to the inability to use abstraction. Option D: Associative looseness refers to a lack of ties between thoughts, leading to jumbled thinking.

The nurse caring for a client who has been diagnosed as having generalized anxiety disorder tells a preceptor "I find myself feeling uncomfortable and anxious around the client. When he starts trembling and perspiring and pacing, I find myself with cold, clammy hands and my pulse races. I start worrying whether I will be able to help him stay in control." In such an interaction the client will most likely experience a. fatigue. b. claustrophobia. c. increased anxiety. d. improved self-esteem.

ANS: C Anxiety is transmissible interpersonally. The client who "tunes in" to the nurse's anxiety usually experiences heightening of his or her own anxiety. Option A: The client's immediate reaction would be heightened anxiety rather than fatigue. Option B: Claustrophobia is rarely the outcome of empathized anxiety. Option D: Improved self-esteem would not result from empathic anxiety.

When a client asks what causes his panic attacks, the nurse should reply that research gives evidence to support the theory that panic disorders have their etiology in a. faulty learning. b. traumatic events. c. genetic-biological factors. d. developmental fixations.

ANS: C Panic attacks can be caused by the introduction of various chemicals into the body, thus supporting a biological theory of etiology. Clients experiencing panic attacks frequently have close relatives who experience panic attacks, a finding that suggests a genetic tie.

A client who has been unable to leave his home for more than a month because of symptoms of severe anxiety asks the nurse "Don't you agree that not being able to go out is pretty stupid?" The most therapeutic reply is a. "No, I do not think it's stupid." b. "Many individuals share this situation with you." c. "You feel stupid because you're afraid to leave home?" d. "I guess some people might say that being housebound is pretty strange."

ANS: C This response will allow the nurse to validate the possibility that the client is dissatisfied with being unable to control his symptom and suggests openness to listening to feelings of powerlessness. The nurse should neither agree nor disagree with the client. Clarifying his own thinking is more important for the client.

3. Which nursing diagnoses are most applicable for a patient diagnosed with severe Alzheimer's disease? Select all that apply. a. Acute confusion b. Anticipatory grieving c. Urinary incontinence d. Disturbed sleep pattern e. Risk for caregiver role strain

ANS: C, D, E The correct answers are consistent with problems frequently identified for patients with late-stage Alzheimer's disease. Confusion is chronic, not acute. The patient's cognition is too impaired to grieve.

17. A patient diagnosed with Alzheimer's disease calls the fire department saying, "My smoke detectors are going off." Firefighters investigate and discover that the patient misinterpreted the telephone ringing. Which problem is this patient experiencing? a. Hyperorality b. Aphasia c. Apraxia d. Agnosia

ANS: D Agnosia is the inability to recognize familiar objects, parts of one's body, or one's own reflection in a mirror. Hyperorality refers to placing objects in the mouth. Aphasia refers to the loss of language ability. Apraxia refers to the loss of purposeful movements, such as being unable to dress.

24. What is the priority need for a patient with late-stage dementia? a. Promotion of self-care activities b. Meaningful verbal communication c. Preventing the patient from wandering d. Maintenance of nutrition and hydration

ANS: D In late-stage dementia, the patient often seems to have forgotten how to eat, chew, and swallow. Nutrition and hydration needs must be met if the patient is to live. The patient is incapable of self-care, ambulation, or verbal communication.

22. A older patient diagnosed with severe, late-stage dementia no longer recognizes family members. The family asks how long it will be before this patient recognizes them when they visit. What is the nurse's best reply? a. "Your family member will never again be able to identify you." b. "I think that is a question the health care provider should answer." c. "One never knows. Consciousness fluctuates in persons with dementia." d. "It is disappointing when someone you love no longer recognizes you."

ANS: D Therapeutic communication techniques can assist the family to come to terms with the losses and irreversibility dementia imposes on both the loved one and themselves. Two incorrect responses close communication. The nurse should take the opportunity to foster communication. Consciousness does not fluctuate in patients with dementia.

3. A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response? a. "No bugs are on your legs. You are having hallucinations." b. "I will have someone stay here and brush off the bugs for you." c. "Try to relax. The crawling sensation will go away sooner if you can relax." d. "I don't see any bugs, but I can tell you are frightened. I will stay with you."

ANS: D When hallucinations are present, the nurse should acknowledge the patient's feelings and state the nurse's perception of reality, but not argue. Staying with the patient increases feelings of security, reduces anxiety, offers the opportunity for reinforcing reality, and provides a measure of physical safety. Denying the patient's perception without offering help does not support the patient emotionally. Telling the patient to relax makes the patient responsible for self-soothing. Telling the patient that someone will brush the bugs away supports the perceptual distortions.

The physician and advanced practice nurse are considering which antipsychotic medication to prescribe for a client with schizophrenia who demonstrates auditory hallucinations, apathy, anhedonia, and poor social functioning. The client is overweight and has hypertension. Bearing these facts in mind, the drug the nurse should advocate would be a. clozapine (Clozaril). b. ziprasidone (Geodon). c. olanzapine (Zyprexa). d. aripiprazole (Abilify).

ANS: D Aripiprazole is a new 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 client with obesity or heart disease. Option A: Clozapine may produce agranulocytosis, making it a poor choice as a first-line agent. Option B: Ziprasidone may prolong the QT interval, making it a poor choice for a client with cardiac disease. Option C: Olanzapine fosters weight gain. DIF: Cognitive Level: Analysis REF: Text Page: 406 TOP: Nursing Process: Planning MSC: NCLEX: Physiologic Integrity

A male client diagnosed with paranoid schizophrenia angrily tells the male nurse "You act like a homosexual. None of the men trust you or want to be around you." The nurse, who is heterosexual, is perplexed by the client's statements and discusses the event with his mentor. The most likely analysis of the event is a. the client was unleashing unconscious, hostile feelings toward the nurse. b. the client was demonstrating reaction formation in response to feelings of abandonment. c. dwelling on others' shortcomings puts them on the defensive. d. the client was projecting homosexual urges.

ANS: D Clients with paranoid ideation unconsciously use the defense mechanism projection to deal with unacceptable, anxiety-producing ideas and impulses, in this case homosexual urges. Option A: Although the behavior seems hostile, the projection is homosexual urges rather than hostility. Option B: Clients who exhibit paranoid ideation usually fear abandonment, but this situation does not represent reaction formation to abandonment feelings. Option C: Although this statement about defensive behavior is true, it is not the correct analysis of the behavior described in the scenario. DIF: Cognitive Level: Analysis REF: Text Page: 414 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A client's nursing care plan includes assessment for auditory hallucinations. Indicators that suggest the client may be hallucinating include a. aloofness, haughtiness, and suspicion. b. elevated mood, hyperactivity, and distractibility. c. performing rituals and avoiding open places. d. darting eyes, tilted head, and mumbling to self.

ANS: D 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. DIF: Cognitive Level: Application REF: Text Page: 393 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

A client tends to be deceitful and irresponsible, engages in abusive behaviors, is easily irritable, and does not have a sense of remorse for others. When bored, the client acts out in aggression towards staff and other clients on the unit. Which personality disorder will the nurse suggest that the client may have? A. Narcissistic B. Antisocial C. Paranoid D. Histrionic

B. Antisocial

A client with schizophrenia who admits to auditory hallucinations anxiously tells the nurse "The voice is telling me to do things." The priority assessment question the nurse should ask is a. "Do you recognize the voice speaking to you?' b. "How long has the voice been directing your behavior?" c. "Does what the voice tell you to do frighten you?" d. "What is the voice telling you to do?"

ANS: D Learning what a command hallucination is telling the client to do is important because the command often places the client or others at risk for harm. Command hallucinations can be terrifying and may pose a psychiatric emergency. The other queries are of lesser importance than identifying the command. DIF: Cognitive Level: Application REF: Text Page: 393 TOP: Nursing Process: Assessment MSC: NCLEX: Safe, Effective Care Environment;

A client with the diagnosis of schizophrenia, disorganized type, approaches the nurse and says "It's beat, it's eat. No room. The cat." The nurse can correctly assess this verbalization as a. neologisms. b. ideas of reference. c. thought broadcasting. d. associative looseness.

ANS: D Looseness of association refers to jumbled thoughts that are often incoherently expressed to the listener. Option A: Neologisms are newly coined words. Option B: Ideas of reference are a type of delusion. Option C: Thought broadcasting is the belief that others can hear one's thoughts. DIF: Cognitive Level: Application REF: Text Page: 392, Text Page: 393 TOP: Nursing Process: Assessment MSC: NCLEX: Psychosocial Integrity

When a client with paranoid schizophrenia has a recurrence of positive symptoms after stopping his antipsychotic medication to be free of its orthostatic side effect, he is readmitted to the mental health unit. The physician orders the resumption of medication. The nurse adds the nursing diagnosis of "noncompliance with antipsychotic medication regimen related to side effects" to the client's care plan. What measure should the nurse suggest to the client? a. Ask the physician about prescribing an anticholinergic drug such as trihexyphenidyl (Artane). b. Chew sugarless gum or use sugarless hard candy to moisten oral mucous membranes. c. Reduce dosage by 5 mg daily if side effects recur. d. Wear elastic support hose, stay hydrated, and rise slowly from the lying or sitting position.

ANS: D Orthostasis produces dizziness or fainting when moving from a lying or seated position to a standing position. This can be effectively combated by rising slowly. The use of support hose may also be helpful to prevent pooling of blood in the lower extremities. Options A and B are unnecessary. Anticholinergic side effects are not the problem. Option C The client should be taught not to discontinue or adjust the dose of the medication, but rather to report annoying side effects to the physician or nurse. DIF: Cognitive Level: Application REF: Text Page: 409 TOP: Nursing Process: Implementation MSC: NCLEX: Physiologic Integrity

Antianxiety drugs are also called ______________________ and minor tranquilizers.

ANS: anxiolytics Rationale: Antianxiety drugs are also called anxiolytics and minor tranquilizers. Antianxiety agents are used in the treatment of anxiety disorders, anxiety symptoms, acute alcohol withdrawal, skeletal muscle spasms, convulsive disorders, status epilepticus, and preoperative sedation.

The family of a client with schizophrenia who has been stable for a year reports to the community mental health nurse that the client reports feeling tense and having difficulty concentrating. He sleeps only 3 to 4 hours nightly and has begun to talk about "volmers" hiding in the warehouse where he works and undoing his work each night. The nurse can correctly assess this information as an indication of a. medication noncompliance. b. the need for psychoeducation. c. chronic deterioration. d. relapse.

ANS: D Signs of potential relapse include feeling tense, difficulty concentrating, trouble sleeping, increased withdrawal, and increased bizarre or magical thinking. Option A: Medication noncompliance may not be implicated. Relapse can occur even when the client is taking medication regularly. Option B: Psychoeducation is better delivered when the client's symptoms are stable. Option C: Chronic deterioration is not the most viable explanation. DIF: Cognitive Level: Application REF: Text Page: 399, Text Page: 400 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

Traits associated with schizoid, obsessive-compulsive, and _____________________ personality disorders are commonly seen in clients with the diagnosis of body dysmorphic disorder.

ANS: narcissistic Rationale: Traits associated with schizoid, obsessive-compulsive, and narcissistic personality disorders are not uncommon in clients with the diagnosis of BDD

A client receiving risperidone (Risperdal) reports severe muscle stiffness mid-morning. During lunch he has difficulty swallowing food and is noted to drool. When vital signs are taken at 4 PM he is noted to be diaphoretic, with a temperature elevation of 38.4° C, pulse of 110 beats/min, and blood pressure of 150/90 mm Hg. The nurse should suspect a. agranulocytosis and institute reverse isolation. b. cholestatic jaundice and begin a high-protein, high-cholesterol diet. c. tardive dyskinesia and withhold the next dose of medication. d. neuroleptic malignant syndrome and notify physician stat.

ANS: D Taking an antipsychotic medication coupled with the presence of extrapyramidal symptoms such severe muscle stiffness and difficulty swallowing, hyperpyrexia, and autonomic symptoms (pulse elevation) suggest neuroleptic malignant syndrome, a medical emergency. The symptoms given in the scenario are not consistent with the medical problems listed in options A, B, or C. DIF: Cognitive Level: Analysis REF: Text Page: 409 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

ANS: B Only option B relates to neurological findings. Options C and D refer to symptoms. Option A refers to family dynamics. DIF: Cognitive Level: Analysis REF: Text Page: 387 TOP: Nursing Process: Assessment MSC: NCLEX: Physiologic Integrity

ANS: D The atypical antipsychotic medications target both the negative and positive symptoms of schizophrenia, an obvious advantage over the standard antipsychotics; thus both sets of symptoms should be the foci of evaluation. No specific subset of disorganized symptoms is available. DIF: Cognitive Level: Analysis REF: Text Page: 405 TOP: Nursing Process: Evaluation MSC: NCLEX: Psychosocial Integrity

A client with schizophrenia anxiously describes seeing the left side of her body merge with the wall as she walked down the corridor and of seeing her face appear and disappear in the bathroom mirror. As the nurse listens she should a. sit close to the client on the bed. b. place an arm protectively around the client's shoulders. c. place a hand on the client's arm and exert light pressure. d. maintain the normal social interaction distance from the client.

ANS: D The client is describing phenomena that indicate personal boundary difficulties. The nurse should maintain appropriate social distance from the client and not touch her because the client is anxious about her inability to maintain ego boundaries and merging or being swallowed by the environment. Physical closeness or touch could precipitate panic. DIF: Cognitive Level: Application REF: Text Page: 393, Text Page: 394 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

The nurse is sitting with a client diagnosed as having schizophrenia, disorganized type, who starts to laugh uncontrollably, although the nurse has not said anything funny. The nurse should say a. "Please share the joke with me." b. "Why are you laughing?" c. "I don't think I said anything funny." d. "You're laughing. Tell me what's happening."

ANS: D The client is likely laughing in response to inner stimuli such as hallucinations or fantasy. Moller suggests focusing on the hallucinatory clue (the client's laughter) and eliciting the client's observation. The other options are less useful in eliciting a response. Option A: No joke may be involved. Option B: "Why" questions are difficult to answer. Option C: The client is probably not focusing on what the nurse said in the first place. DIF: Cognitive Level: Application REF: Text Page: 393, Text Page: 401 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

A client with schizophrenia tells the nurse "I eat skiller. Tend to end. Easter. It blows away. Get it?" The best response for the nurse to make would be 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."

ANS: D When a client's speech is loosely associated, confused, and disorganized, pretending to understand is useless. The nurse should tell the client that she is having difficulty understanding what the client is saying. If a theme is discernable, ask the client to talk about the theme. The other options tend to place blame for the poor communication with the client. Option D places the difficulty with the nurse rather than being accusatory. DIF: Cognitive Level: Application REF: Text Page: 401, Text Page: 402 TOP: Nursing Process: Implementation MSC: NCLEX: Psychosocial Integrity

The nurse attempting to establish a relationship with a severely withdrawn schizophrenic client tells a preceptor that her frustration level is rising daily because the client turns his head away each time she sits down near him. The nurse states "I am beginning to wonder what is wrong with me as a nurse." The preceptor could be most helpful by explaining that withdrawn clients with schizophrenia a. universally fear sexual involvement with therapists. b. are socially disabled by the positive symptoms of schizophrenia. c. exhibit a high degree of hostility by demonstrating rejecting behavior. d. avoid relationships because they become anxious with emotional closeness.

ANS: D When an individual is suspicious and distrustful and perceives the world and the people in it as potentially dangerous, withdrawal into an inner world can be a defense against uncomfortable levels of anxiety. When someone attempts to establish a relationship with such a client, the client's anxiety rises until trust is established. The truth of option A is not borne out by the evidence. Options B and C: These options are not considered true in most cases. DIF: Cognitive Level: Application REF: Text Page: 394, Text Page: 395 TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment

A client has generalized anxiety disorder but is otherwise healthy. He is receiving buspirone daily. The topic that would be excluded from the health teaching plan is a. the importance of daily aerobic exercise. b. avoidance of foods and drinks containing caffeine. c. effects and side effects of buspirone. d. how to prevent the occurrence of flashbacks.

ANS: D Flashbacks are not part of the symptom picture of generalized anxiety disorder. All other topics are appropriate health teaching for this client.

The nurse teaches a client to snap a rubber band on her wrist whenever an obsessive thought enters her mind. This technique, designed to interrupt obsessive thinking, can be identified as a. modeling. b. flooding. c. desensitization. d. thought stopping.

ANS: D Thought stopping uses techniques such as rubber band snapping, saying "stop" aloud, and stomping one's foot to interrupt obsessive thinking. Option A: Modeling involves the therapist acting as a role model to demonstrate an appropriate behavior. Option B: Flooding exposes a client to a large amount of a feared stimulus in an effort to extinguish the anxiety response. Option C: Desensitization involves gradual exposure to a feared stimulus.

A client is seeking treatment for a specific phobia: fear of cats. The nurse in the anxiety disorders clinic has established the nursing diagnosis of anxiety related to exposure to phobic object (cats). A realistic indicator for the outcome anxiety self-control would be that within 10 days, the client will a. avoid the feared object whenever possible. b. face the feared object without supportive assistance. c. state that the fear of cats is unrealistic and inappropriate. d. practice relaxation techniques and report decreased physiological sensations associated with thoughts of the feared object.

ANS: D When the client is able to relax in the presence of thoughts, pictures, or the phobic object, the client will begin to experience a sense of control over the phobia. Option A is unrelated to anxiety self-control. Option B probably cannot be achieved within 10 days. Option C: Intellectual understanding does not automatically convey behavioral change associated with anxiety self-control.

. ___________________________ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses.

ANS: Hallucinations Rationale: Hallucinations are false sensory perceptions not associated with real external stimuli and may involve any of the five senses. Types of hallucinations include auditory, visual, tactile, gustatory, and olfactory.

Therapeutic Levels of Lithium

Active Phase= 300 mg to 600 mg 2-3 times a day by mouth Therapeutic level= 0.8 to 1.4 mEq/L Maintenance Levels= 0.4 to 1.3 mEq/L Lithium should be measured at least 5 days after starting and after dose changes until therapeutic levels have been reached Once reached, levels are checked every month; after 6 months they are checked every year Blood is drawn in the morning 8-12 hours after dose

what are the 3 phases in planning?

Acute phase: up to first 2 months, planning focuses on medically stabilizing the patient while maintaining safety. Hospital usually safest place. Continuation phase: 2 to 6 months. planning focuses on maintaining compliance with medication regimen and preventing relapse. Maintenance phase: begins at about 6 months and planning focuses on relapse and limiting the severity and duration of episodes.

What are the 4 A's associated with negative symptoms;

Affect- nonverbal expression of emotion. Person may have blunt or absence of nonverbal emotion called flat affect. No facial expressions are shown or other body language to indicate feelings. Alogia- decreased amount and richness of speech. Often called poverty of speech. A person with Alogia often has brief verbal responses, with little emotional expression. Avolition- lack of motivation. Patients with avolition often have difficulty initiating and persisting in goal directed behavior. As a result, these inidviduals often don't work. Anhedonia- is a lack of the ability to feel pleasure.

Which symptom would NOT be assessed as a positive symptom of schizophrenia? Delusion of persecution Auditory hallucinations Affective flattening Idea of reference

Affective flattening Positive symptoms are those symptoms that should not be present, but are. They include hallucinations, delusions, bizarre behavior, and paranoia and are referred to as florid symptoms. Affective flattening is one of the negative symptoms that contribute to rendering the person inert and unmotivated.

Which type of dementia has a clear genetic link? Alcohol-induced dementia Multi-infarct dementia Creutzfeldt-Jakob disease Alzheimer's disease

Alzheimer's disease Family members of people with Alzheimer's disease have a higher risk of developing the disease than does the general population.

A patient suffering from Bipolar I Disorder is admitted in a manic episode to the Mental Health Inpatient Unit. What should be included in your assessment in addition to suicide?

Amount of sleep, nutritional status, history of aggression, a/v hallucinations, etc...

The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? 1. A low starting dose of a tricyclic antidepressant 2. An SSRI given initially with an MAOI 3. Electroconvulsive therapy to treat suicidal thoughts 4. Elavil to address the patient's agitation

An SSRI given initially with an MAOI

Which of the following would be assessed as a negative symptom of schizophrenia? Anhedonia Hostility Agitation Hallucinations

Anhedonia Negative symptoms refer to deficits that characterize schizophrenia. They include the crippling symptoms of affective blunting (lack of facial expression), anergia (lack of energy), anhedonia (inability to experience happiness), avolition (lack of motivation), poverty of content of speech, poverty of speech, and thought blocking.

Which problem is NOT considered a causative agent in delirium? Elevated blood urea nitrogen levels Infection Anticholinergic drugs Antibiotic therapy

Antibiotic therapy Although delirium may be a result of an infection, antibiotic therapy is not known to cause cognitive disorders.

lamotrigine (Lamictal)

Anticonvulsant First line treatment for bipolar depression and is approved for acute and maintenance therapy. A potential life-threatening rash may occur.

carbamazepine (Tegretol)

Anticonvulsant that works better in patients w/ rapid cycling and severely paranoid, angry, patients experiencing manias than euphoric, overactive, over-friendly patients experiencing manias.

valproate (depakote)

Anticonvulsant useful in treatment in lithium non-responders who are in acute mania, experience rapid cycles, are in dysphoric mania, or have not responded to cabamazepine; also helpful in prevention of future manic episodes

Severe signs of Lithium Toxicity

Ataxia, confusion, large output of dilute urine, serious electroencephalographic changes, blurred vision, clonic movements, seizures, stupor, severe hypotension, coma; death is usually secondary to pulmonary complications.

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with A. senile dementia. B. hypertensive crisis. C. psychomotor agitation. D. central serotonin syndrome.

psychomotor agitation.

co-morbidity

co-occurance

What type of medical problems put people at a higher risk for depression?

co-occurring CHRONIC medical problems (hypertension, backache, deiabetes, heart problems, arthritis, etc)

Client Needs: Psychosocial Integrity 3. A patient diagnosed with major depression says, "No one cares about me anymore. I'm not worth anything." Today the patient is wearing a new shirt and has neat, clean hair. Which remark by the nurse supports building a positive self-esteem for this patient? a. "You look nice this morning." c. "I like the shirt you are wearing." b. "You're wearing a new shirt." d. "You must be feeling better today."

B Patients with depression usually see the negative side of things. The meaning of compliments may be altered to "I didn't look nice yesterday" or "They didn't like my other shirt." Neutral comments such as making an observation avoid negative interpretations. Saying, "You look nice" or "I like your shirt" gives approval (non-therapeutic techniques). Saying "You must be feeling better today" is an assumption, which is non-therapeutic. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 259 | Page 261 (Table 14-2) | Page 256 (Case Study and Nursing Care Plan 14-1) | Page 274 TOP: Nursing Process: Implementation

All of the following are considered Cluster B personality disorders, EXCEPT: A) Antisocial personality disorder B) Avoidant personality disorder C) Histrionic personality disorder D) Narcissistic personality disorder

B) Avoidant personality disorder

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

The family of a client diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting. Which is the appropriate nursing reply? A. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve." C. "Family dynamics are not linked to eating disorders. The meeting is to provide your child with family support." D. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

B. "Eating disorders have been correlated to certain familial patterns; without addressing these, your child's condition will not improve."

Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? A. A client diagnosed with antisocial personality disorder B. A client diagnosed with borderline personality disorder C. A client diagnosed with schizoid personality disorder D. A client diagnosed with paranoid personality disorder

B. A client diagnosed with borderline personality disorder

Which nursing intervention is appropriate when caring for clients diagnosed with either anorexia nervosa or bulimia nervosa? A. Provide privacy during meals. B. Remain with the client for at least 1 hour after the meal. C. Encourage the client to keep a journal to document types of food consumed. D. Restrict client privileges when provided food is not completely consumed.

B. Remain with the client for at least 1 hour after the meal.

Which nursing diagnosis should be investigated for clients with somatoform disorders? A. Deficient fluid volume B. Self-care deficit C. Disturbed personal identity D. Delayed growth and development

B. Self-care deficit

Which neurotransmitter has been implicated as a possible causative factor in both pain disorder and body dysmorphic disorder? A. Dopamine B. Serotonin C. Norepinephrine D. Acetylcholine

B. Serotonin

The physician tells the nurse "Mrs. G's appearance is that of a typical manic client." The nurse can expect Mrs. G to be attired in clothing that is A. dark colored and modest. B. colorful and outlandish. C. compulsively neat and clean. D. ill-fitted and ragged.

colorful and outlandish.

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 ct's bathroom locked so she can't wash her hands all the time. B. Structure the ct's schedule so that she has plenty of time for washing her hands. C. Place the ct in isolation until she promises to stop washing her hands so much. D. Explain the ct's behavior to her, since she's probably unaware that it's maladaptive.

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

A nurse working with a client diagnosed with bulimia nervosa asks the client to recall a time in life when food could be consumed without purging. Which is the purpose of this nursing intervention? A. To gain additional information about the progression of the disease process B. To emphasize that the client is capable of consuming food without purging C. To incorporate specific foods into the meal plan to reflect pleasant memories D. To assist the client to become more compliant with the treatment plan

B. To emphasize that the client is capable of consuming food without purging

Therapeutic intervention for a client with a somatoform disorder would include A. steering conversation away from client feelings. B. conveying interest in the client rather than in symptoms. C. encouraging the client in liberal use of benzodiazepines. D. encouraging the client to refer to the nurse for meeting client needs.

B. conveying interest in the client rather than in symptoms.

If a patient has EPS what would you find in your prn orders?

Benadryl or cogentin

Theories of Depression

Biological: genetic, biochemical factors, alterations in hormonal regulation Psychodynamic: exaggerated stress response Cognitive: Beck's cognitive triad: 1. a negative self deprecating view of self 2. a pessimistic view of the world 3. no validation for self will continue

What are the types of bipolar disorders?

Bipolar I, Bipolar II, and Cyclothymia

Serotonin Norepinephrine Reuptake Inhibitors (SNRIs)

Block the reuptake of serotonin and norepinephrine; often used as 2nd line treatment if pt does not respond to SSRIs; similar side effect profile as SSRIs; need to monitor BP and HR

Norepinephrine Dopamine Reuptake Inhibitor (NDRI)

Bupropion (Wellbutrin) Blocks the reuptake of norepinephrine and dopamine; Stimulant action may reduce appetite; May increase sexual desire; Used as an aid to quit smoking Contraindicated in pt with seizure and eating disorders

A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with senile dementia. hypertensive crisis. psychomotor agitation. central serotonin syndrome.

psychomotor agitation. These behaviors describe the psychomotor agitation sometimes seen in clients with the agitated type of depression.

When a community health nurse arrives at the home of a client diagnosed with bulimia nervosa, the nurse finds the client on the floor unconscious. The client has a history of using laxatives for purging. To what would the nurse attribute this client's symptoms? A. Increased creatinine and blood urea nitrogen (BUN) levels B. Abnormal electroencephalogram (EEG) C. Metabolic acidosis D. Metabolic alkalosis

C. Metabolic acidosis

Client Needs: Safe, Effective Care Environment 6. When counseling patients diagnosed with major depression, an advanced practice nurse will address the negative thought patterns by using: a. psychoanalytic therapy. b. desensitization therapy. c. cognitive behavioral therapy. d. alternative and complementary therapies.

C Cognitive behavioral therapy attempts to alter the patient's dysfunctional beliefs by focusing on positive outcomes rather than negative attributions. The patient is also taught the connection between thoughts and resultant feelings. Research shows that cognitive behavioral therapy involves the formation of new connections between nerve cells in the brain and that it is at least as effective as medication. Evidence is not present to support superior outcomes for the other psychotherapeutic modalities mentioned. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 274 TOP: Nursing Process: Planning

Client Needs: Psychosocial Integrity 8. A patient diagnosed with major depression began taking a tricyclic antidepressant 1 week ago. Today the patient says, "I don't think I can keep taking these pills. They make me so dizzy, especially when I stand up." The nurse will: a. limit the patient's activities to those that can be performed in a sitting position. b. withhold the drug, force oral fluids, and notify the health care provider. c. teach the patient strategies to manage postural hypotension. d. update the patient's mental status examination.

C Drowsiness, dizziness, and postural hypotension usually subside after the first few weeks of therapy with tricyclic antidepressants. Postural hypotension can be managed by teaching the patient to stay well hydrated and rise slowly. Knowing this information may convince the patient to continue the medication. Activity is an important aspect of the patient's treatment plan and should not be limited to activities that can be done in a sitting position. Withholding the drug, forcing oral fluids, and notifying the health care provider are unnecessary actions. Independent nursing action is called for. Updating a mental status examination is unnecessary. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 266-267 (Table 14-6) | Page 269 (Box 14-4) TOP: Nursing Process: Implementation

When a client experiences 4 or more mood episodes in a 12 month period, the client is said to be: A. dysynchronous. B. incongruent. C. cyclothymic. D. rapid cycling.

rapid cycling.

Client Needs: Health Promotion and Maintenance 25. A patient diagnosed with major depression began taking escitalopram (Lexapro) 5 days ago. The patient now says, "This medicine isn't working." The nurse's best intervention would be to: a. discuss with the health care provider the need to increase the dose. b. reassure the patient that the medication will be effective soon. c. explain the time lag before antidepressants relieve symptoms. d. critically assess the patient for symptoms of improvement.

C Escitalopram is an SSRI antidepressant. One to three weeks of treatment is usually necessary before symptom relief occurs. This information is important to share with patients. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 266 (Table 14-6) | Page 268 (Box 14-3) TOP: Nursing Process: Implementation

Client Needs: Physiological Integrity MULTIPLE RESPONSE 1. The admission note indicates a patient diagnosed with major depression has anergia and anhedonia. For which measures should the nurse plan? Select all that apply. a. Channeling excessive energy b. Reducing guilty ruminations c. Instilling a sense of hopefulness d. Assisting with self-care activities e. Accommodating psychomotor retardation

C, D, E Anergia refers to a lack of energy. Anhedonia refers to the inability to find pleasure or meaning in life; thus, planning should include measures to accommodate psychomotor retardation, assist with activities of daily living, and instill hopefulness. Anergia is lack of energy, not excessive energy. Anhedonia does not necessarily imply the presence of guilty ruminations. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 256 (Case Study and Nursing Care Plan 14-1) | Page 257 | Page 261 TOP: Nursing Process: Planning

The nurse would expect the chief complaint of the client with hypochondriasis to be A. "I feel confused and disoriented." B. "I feel spaced out, as though I'm outside my body watching what is happening." C. "I know I have cancer, but the doctors just cannot find it." D. "I woke up one morning and my left leg was paralyzed from the knee down."

C. "I know I have cancer, but the doctors just cannot find it."

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)

The nurse places highest priority on which of the following nursing interventions when caring for a client diagnosed with antisocial personality disorder? A. Supporting the development of insight B. Encouraging socialization C. Maintaining consistent limits D. Monitoring for suicidal ideations

C. Maintaining consistent limits

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.

A client diagnosed with bulimia nervosa has been attending a mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? A. The client gains 2 pounds in 1 week. B. The client focuses conversations on nutritious food. C. The client demonstrates healthy coping mechanisms that decrease anxiety. D. The client verbalizes an understanding of the etiology of the disorder.

C. The client demonstrates healthy coping mechanisms that decrease anxiety.

A nurse is seeing a client in an outpatient clinic for treatment of anorexia nervosa. Which is the most appropriate, correctly written short-term outcome for this client? A. The client will use stress-reducing techniques to avoid purging. B. The client will discuss chaos in personal life and be able to verbalize a link to purging. C. The client will gain 2 pounds prior to the next weekly appointment. D. The client will remain free of signs and symptoms of malnutrition and dehydration.

C. The client will gain 2 pounds prior to the next weekly appointment.

A high school senior is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. The treatment team is planning to use behavior modification. What rationale should a nurse identify as the reasoning behind this therapy choice? A. This therapy will increase the client's motivation to gain weight. B. This therapy will reward the client for perfectionist achievements. C. This therapy will provide the client with control over behavioral choices. D. This therapy will protect the client from parental overindulgence.

C. This therapy will provide the client with control over behavioral choices.

A nurse responsible for conducting group therapy on an eating disorder unit schedules the sessions immediately after meals. Which is the rationale for scheduling group therapy at this time? A. To shift the clients' focus from food to psychotherapy B. To prevent the use of maladaptive defense mechanisms C. To promote the processing of anxiety associated with eating D. To focus on weight control mechanisms and food preparation

C. To promote the processing of anxiety associated with eating

An example of a somatoform disorder is A. depersonalization. B. dissociative fugue. C. conversion disorder. D. dissociative identity disorder.

C. conversion disorder.

A woman has to take her real estate examination tomorrow but suddenly finds she cannot see. She seems unconcerned about her symptom and tells her husband "Don't worry, dear. Things will all work out." Her attitude is an example of A. regression. B. depersonalization. C. la belle indifference. D. dissociative amnesia.

C. la belle indifference.

Ativan why should you IV push per policy?

Cardiac arrest, Do not push over 4 mg Must be mixed with equal volume of NS or D5W Each 0.05mg/kg over 2-5 minutes NTE (not to exceed 2mg/minute)

Advanced signs of Lithium Toxicity

Coarse hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritability, electroencephalographic changes, incoordination, sedation

Integrative Therapy

Cod liver oil- omega 3 good for mood stabilization and depression Eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) important in CNS functioning and mood stabilization

A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted? Constant 24-hour, one-to-one observation at arm's length One-to-one observation while client is awake Every 15-minute observation around the clock Seclusion with 15-minute observation

Constant 24-hour, one-to-one observation at arm's length A client who will not enter into a no-suicide contract should be placed on the highest level of suicide watch.

Learned helplessness

this has been used to explain the development of depression in certain social groups, such as the aged, people in ghettos, and women.

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation? A. Constipation B. Death anxiety C. Activity intolerance D. Self-care deficit: bathing/hygiene

Death anxiety

Client Needs: Physiological Integrity 9. A patient diagnosed with depression is receiving imipramine (Tofranil) 200 mg qhs. Which assessment finding would prompt the nurse to collaborate with the health care provider regarding potentially hazardous side effects of this drug? a. Dry mouth c. Nasal congestion b. Blurred vision d. Urinary retention

D All the side effects mentioned are the result of the anticholinergic effects of the drug. Only urinary retention and severe constipation warrant immediate medical attention. Dry mouth, blurred vision, and nasal congestion may be less troublesome as therapy continues. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 266-267 (Table 14-6) | Page 269 (Box 14-4) TOP: Nursing Process: Assessment

Client Needs: Psychosocial Integrity 22. A patient diagnosed with major depression refuses solid foods. In order to meet nutritional needs, which beverage will the nurse offer to this patient? a. Tomato juice c. Hot tea b. Orange juice d. Milk

D Milk is the only beverage listed that provides protein, fat, and carbohydrates. In addition, milk is fortified with vitamins. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 264 (Table 14-5) TOP: Nursing Process: Implementation

Client Needs: Physiological Integrity 26. A nurse is caring for a patient with low self-esteem. Which nonverbal communication should the nurse anticipate from this patient? a. Arms crossed c. Smiling inappropriately b. Staring at the nurse d. Eyes pointed downward

D Nonverbal communication is usually considered more powerful than verbal communication. Downward casted eyes suggest feelings of worthlessness or hopelessness. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 256 (Case Study and Nursing Care Plan 14-1) | Page 260 TOP: Nursing Process: Assessment

Client Needs: Psychosocial Integrity 24. A disheveled patient with severe depression and psychomotor retardation has not showered for several days. The nurse will: a. bring up the issue at the community meeting. b. calmly tell the patient, "You must bathe daily." c. avoid forcing the issue in order to minimize stress. d. firmly and neutrally assist the patient with showering.

D When patients are unable to perform self-care activities, staff must assist them rather than ignore the issue. Better grooming increases self-esteem. Calmly telling the patient to bathe daily and bringing up the issue at a community meeting are punitive. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 259 | Page 261 (Table 14-2) | Page 256 (Case Study/Nursing Care Plan 14-1) TOP: Nursing Process: Implementation

9. Somatization disorders are most often linked with which emotion? A) Euphoria B) Guilt C) Anger D) Anxiety

D) Anxiety

A potential Olympic figure skater collapses during practice and is hospitalized for severe malnutrition. Anorexia nervosa is diagnosed. Which client statement best reflects the underlying etiology of this disorder? A. "Skaters need to be thin to improve their daily performance." B. "All the skaters on the team are following an approved 1,200-calorie diet." C. "When I lose skating competitions, I also lose my appetite." D. "I am angry at my mother. I can only get her approval when I win competitions."

D. "I am angry at my mother. I can only get her approval when I win competitions."

Neurotransmitters have been implicated in the pathophysiology of anxiety disorders. Select the disturbances that are associated with anxiety disorders: A. Increased seratonin, decreased norepinephrine, and decreased GABA. B. Increased seratonin, decreased norepinephrine, and increased GABA. C. Decreased seratonin, decreased norepinephrine, and decreased GABA. D. Decreased seratonin, increased norepinephrine, and decreased GABA.

D. Decreased seratonin, increased norepinephrine, and decreased GABA.

Client exhibits dependency on staff and peers and expresses fear of abandonment. Using Mahler's theory of object relations, which should the nurse expect to note in this client's childhood? A. Lack of fulfillment of basic needs by parental figures B. Absence of the client's maternal figure during symbiosis C. Difficulty establishing trust with the maternal figure D. Inconsistency by the maternal figure during individuation

D. Inconsistency by the maternal figure during individuation

What symptom characterizes body dysmorphic disorder? A. Severe pain with psychological origins B. Fear of having a life-threatening illness C. Multiple physical symptoms spanning many years D. Preoccupation with an imagined defect in appearance

D. Preoccupation with an imagined defect in appearance

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.

Why are behavior modification programs the treatment of choice for clients diagnosed with eating disorders? A. These programs help clients correct distorted body image. B. These programs address underlying client anger. C. These programs help clients manage uncontrollable behaviors. D. These programs allow clients to maintain control.

D. These programs allow clients to maintain control.

Which of the following is not a common traits/symptom of hoarding disorder? A. Perfectionism B. Indecisiveness C. Distractibility D. narcissistic personality disorder

D. narcissistic personality disorder

Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation? Constipation Death anxiety Activity intolerance Self-care deficit: bathing/hygiene

Death anxiety A client with psychomotor retardation has vegetative signs of depression and is often constipated, too tired to engage in activities, and lacks the energy to attend to personal hygiene. Depressed clients usually do not have death anxiety. They are more likely to welcome the idea of dying.

What is a fixed, false belief?

Delusion

stages of grieving:

Denial Anger Bargaining Depression/resignation Acceptance

Anticonvulsant for mood disorders

Depakote tegretol lamictal

What statement about the comorbidity of depression is accurate? A. Depression most often exists in an individual as a single entity. B. Depression is commonly seen among individuals with medical disorders. C. Substance abuse and depression are seldom seen as comorbid disorders. D. Depression may coexist with other disorders but is rarely seen with schizophrenia.

Depression is commonly seen among individuals with medical disorders.

Psychological Factors

Diathesis-stress model

psychomotor agitation

Excessive motor and cognitive activity

What neurotransmitters are affected with S?

Dopamine, Glutamate and Serotonin

mood stabilizers

Drugs used to control mood swings in patients with bipolar mood disorders.

Assessment

Early diagnosis and treatment can prevent suicide attempts, alcohol or substance abuse, marital or work problems, development of medical comorbidity; can use Mood Disorder Questionnaire

What is echolalia?

Echolalia is the automatic repetition of vocalizations made by another person. It is closely related to echopraxia, the automatic repetition of movements made by another person.

Monoamine Oxidase Inhibitors (MAOIs)

Efficacy similar to other antidepressants, but dietary restrictions and potential drug interactions make this drug less desirable Contraindicated in people taking other antidepressants Tyramine-rich food could bring about a hypertensive crisis

Toxic Levels of Lithium

Expected side effects= 0.4-1.0 mEq/L (hand tremor, polyuria, mild thirst, mild nausea, weight gain) Early signs of toxicity= 1.5 mEq/L (nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, fine hand tremor) Advanced signs of toxicity= 1.5-2.0 mEq/L (course hand tremor, persistent gastrointestinal upset, mental confusion, muscle hyperirritabliliy, electroencephalographic changes, incoordination, sedation) Severe toxicity= 2.0-2.5 mEq/L (ataxia, giddiness, blurred vision, clonic movements, large output of dilute urine, seizures, stupor, severe hypotension, coma, death > 2.5 mEq/L= (convulsions, oliguria, death)

Mania

Extreme drive and energy Inflated sense of self-importance Drastically reduced sleep requirements Excessive talking combined with pressured speech Personal feeling of racing thoughts Distraction by environmental events Unusually obsessed with and over focused on goals Purposeless arousal and movement Dangerous activities: indiscriminate spending, reckless sexual encounters, risky investments Euphoric or Dysphoric

Predisposing Factors

Family hx of depression Having experienced recent negative stressors Having childhood experiences in a negative home environment Lacking a social support system Having significant physical disease

affect

Feeling, mood, or emotional tone; objective

Which side effects of lithium can be expected at therapeutic levels? A. Fine hand tremor and polyuria B. Nausea and thirst C. Coarse hand tremor and gastrointestinal upset D. Ataxia and hypotension

Fine hand tremor and polyuria

Thought Process and Speech Patterns

Flight of Ideas rapid, verbose, and circumstantial may be disorganized and incoherent sexually explicit and vulgar loud or screaming Clang Associations Grandiosity (inflated self-regard) Grandiose persecutory delusions Sensory perceptions may become altered Hallucinations may occur Delusions and hallucinations are not present with hypomania

Planning for Continuation Phase

Focus on maintaining adherence to meds and prevent relapse Psychoeducational teaching necessary for patient and family Referrals to community programs, groups, and support for co-occuring disorders or problems Community and problem solving skills training Cognitive behavioral therapy

Planning for Maintenance Phase

Focus on preventing relapse and limiting severity and duration of future episodes Require medication for life Need support groups and periodic evaluations

Which behavior would be most characteristic of a client during a manic episode? A. Going rapidly from one activity to another B. Taking frequent rest periods and naps during the day C. Being unwilling to leave home to see other people D. Watching others intently and talking little

Going rapidly from one activity to another

What is a sensory perception that do not have an apparent stimuli?;

Hallucination

What is bipolar I?

Has at least 1 episode of "persistent or elevated expansive or irritable mood. Mania." causing marked impairment in social and occupational functioning.

If a suicidal client is to be treated outside the hospital, which intervention would be of high priority? Have the client identify three people to call if he is overwhelmed by hopelessness. Make sure the client has food enough to last for 2 to 3 days. Arrange for a police visit every 24 hours. Provide a 1-week supply of antidepressant medication.

Have the client identify three people to call if he is overwhelmed by hopelessness. For suicidal clients treated in the community, establishing a network of individuals to whom the client may turn if the suicidal urge becomes great is important.

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with postpartum depression. A. Impaired parenting B. Ineffective role performance C. Health-seeking behaviors D. Risk for impaired parent/infant/child attachment

Health-seeking behaviors

Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with post-partum depression. Impaired parenting Ineffective role performance Health-seeking behaviors Risk for impaired parent/infant/child attachment

Health-seeking behaviors A client with severe depression of any etiology will not have the mental or physical energy to engage in health-seeking behaviors. Further, her negative view of self and the world would preclude such thinking.

Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia? Excessive sleeping with disturbing dreams Hearing voices telling him to hurt his roommate Withdrawal from college because of failing grades Chaotic and dysfunctional relationships with his family and peers

Hearing voices telling him to hurt his roommate People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken? Closely follow up; consider hospitalization. Hospitalize or commit. Send home with follow-up. Strongly consider hospitalization.

Hospitalize or commit. A score of 7 to 10 on the SAD PERSONS scale indicates hospitalization or commitment because the person would be considered high risk for suicide. Closely follow up refers to a score of 3 to 4. Send home with follow-up refers to a score of 0 to 2. Strongly consider hospitalization refers to a score of 5 to 6.

Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment? How long the client has been suicidal Whether the plan has specific details Whether the method is one that causes death quickly Whether the client has the means to implement the plan

How long the client has been suicidal Lethality refers to how deadly a plan is. The length of time a client has been suicidal has nothing to do with the lethality of the plan.

what is Bipolar II?

Hypomanic episodes with alternating with at least 1 major depressive disorder. has increased suicide risk.

What is important to remember of Lamictal?

If you see a rash, STOP THE MEDS!

anhedonia

Inability or decreased ability to experience pleasure, joy, intimacy, and closeness.

Postpartum onset.

Indicates onset within 4 weeks after childbirth. It is common for psychotic features to accompany this depression. Severe ruminations or delusional thoughts about the infant signify increased risk of harm to the infant.

Seasonal features (seasonal affective disorder, [SAD]).

Indicates that episodes mostly begin in fall or winter and remit in spring. These patients have reduced cerebral metabolic activity. SAD is characterized by anergia, hypersomnia, overeating, weight gain, and a craving for carbohydrates; it responds to light therapy

Psychotic features

Indicates the presence of disorganized thinking, delusions or hallucinations

First breaks for men are what age

Late teens to early twenties

A manic client in the acute phase is verbally and physically aggressive to himself. The nursing diagnosis Defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors has been identified. A desirable short-term goal would be that the client will A. Making no attempts at self harm within 12 hrs of admission. B. sleep soundly for 12 of the next 24 hours. C. willingly take prescribed medication as offered by staff within 24 hours of admission. D. develop psychomotor retardation associated with sedation from prescribed medication within 6 hours of admission.

Making no attempts at self harm within 12 hrs of admission.

Catatonic features

Marked by nonresponsiveness, extreme psychomotor retardation (may seem paralyzed), withdrawal, and negativity.

Planning for Acute Phase

Medically stabilizing the patient while maintaining safety (usually in the hospital) Nurses should: manage meds decrease physical activity increase food and fluid intake ensure at least 4-6 hours of sleep per night alleviate bowl or bladder problems make sure self-care needs are met Some may require seclusion or electroconvulsive therapy

Based on current research, which of the following patients is most likely to develop dementia? Karen, who works as an office manager in a high-stress environment Milo, who is a former boxer and is now a trainer Lilly, who works in a factory where asbestos is found Justin, who is a bartender in a dark underground club/bar

Milo, who is a former boxer and is now a trainer Brain injury and trauma are associated with a greater risk of developing Alzheimer's disease and other dementias. People who suffer repeated head trauma, such as boxers and football players, may be at greater risk. The other options do not specifically represent known risk.

What are the 2 most common psychiatric presentations? Why?

Mixed anxiety and depression because the 2 areas of the brain having to do with these systems are closely related

what are some common symptoms of bipolar disorder?

Mood symptoms. unstable euphoric mood and intense feeling of well being. Behavioral symptoms. excessive hyperactivity, involved in pleasurable activities with painful consequences Physical symptoms. nonstop activity, minimal food intake, little or no sleep. can lead to exhaustion and even death. Cognitive symptoms. poor concentration and problems with verbal memory. flight of ideas.

What is an emergency/crisis related to s/s from antipsychotic meds?

NMS and anticholinergic crisis

Early sign of Lithium Toxicity

Nausea, vomiting, diarrhea, thirst, polyuria, lethargy, slurred speech, muscle weakness, and fine hand tremor

Self Assessment

Nurses can experience feelings of frustration, hopelessness, and annoyance. They can alter these responses by: Recognizing any unrealistic expectations they have of themselves or the client Identify feelings they are experiencing that originate with the client Understanding the part that neurotransmitters play in the client with depressed mood.

What are some key points with mood disorders in the elderly?

Older adults (65 years and older) with an MDD or a DD are often -underdiagnosed or misdiagnosed -Diagnosed with types of dementia

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? A. Onset of action is from 1 to 6 weeks. B. They tend to be more effective for men. C. They may cause recent memory impairment. D. They often cause the client to have diurnal variation.

Onset of action is from 1 to 6 weeks.

Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching? Onset of action is from 1 to 6 weeks. They tend to be more effective for men. Recent memory impairment is commonly observed. They often cause the client to have diurnal variation.

Onset of action is from 1 to 6 weeks. People are accustomed to fast results from medication: thirty minutes for aspirin, 24 hours for antibiotics. Information is necessary to prevent discouragement and maintain compliance.

What are some s/s of panic attack?

Palpitations Shortness of breath Choking or smothering sensation Chest pain Nausea Feelings of depersonalization Fear of dying or insanity, doom, losing control Chills or hot flashes

what are the 3 phases of outcomes identification?

Phase 1. acute phase: goal is preventing physical harm or injury. stabilizing body. rehydration, assessments, cardiac and sleep. phase 2. continuation of treatment phase: goal is relapse prevention. Last about 2 to 6 months. knowledge of disease is key. education on s/s of relapse. knowledge of medication. phase 3. Maintenance phase: goal is relapse prevention and limiting severity of future episodes. medication, therapy compliance. support groups established

The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? 1. Provide consistency among staff members when working with the patient. 2. Negotiate limits so the patient has a voice in the plan of care. 3. Allow only certain staff members to interact with the patient. 4. Attempt to control the patient's emotions.

Provide consistency among staff members when working with the patient.

Claire is a student nurse working with Carl, an 82-year-old patient with dementia. She finds herself frustrated at times by not knowing how best to care for or communicate with Carl. Which of the following statements she could make to Carl illustrates best care practice? Lighthearted banter: "Carl, you look great today in your new sweater, you handsome devil!" Limit setting: "Carl, you cannot yell out in your room. You are upsetting other patients." Firm direction: "You will take a shower this morning; there is no debating about it so don't try to argue." Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."

Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day." Positive regard implies respect. It is the ability to view another person as being worthy of caring about and as someone who has strengths. The attitude of unconditional positive regard is the nurse's single most effective tool in caring for people with dementia. It induces people to cooperate with care and increases family members' satisfaction with care. Although the patient may not be able to verbalize plans for his day, this response conveys belief that the patient has something to offer and treats him with respect. It also shows that the nurse wants to care for the patient and conveys commitment to the relationship. Limit-setting may be necessary at times; however it is not the most effective care tool. The other responses are nontherapeutic.

The nurse is planning care for a patient experiencing the acute phase of mania. Which is the priority intervention? 1. Prevent injury. 2. Maintain stable cardiac status. 3. Get the patient to demonstrate thought self-control. 4. Ensure that the patient gets sufficient sleep and rest.

Prevent injury.

Interventions for Maintenance Phase

Prevent reoccurrence of episodes Community resources

What is the usual progression of Alzheimer's disease? A single, short episode followed by years of normal function Recurring remissions and exacerbations Progressive deterioration There is no usual progression

Progressive deterioration The usual progression of Alzheimer's disease is steadily downward.

Individuals with depression are always evaluated for what?

RISK OF SUICIDE

Which of the following statements is true regarding culture and protective factors against suicide? Asian Americans have the highest rates of suicide. Religion and the importance of family are protective factors for Hispanic Americans. Older women have the highest risk for suicide among African Americans. American Indians and Pacific Islanders have the lowest rates of suicide.

Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is true.

Psychopharmacological Interventions

Require multiple medications Severe manic episodes: Lithium or Valproate and a second generation antipsychotic such as Olanzapine (Zyprexa) or Risperidone (Risperdal) Less severe: only one Benzodiazepines may be used at times

The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled for upon returning to the unit? Rest Group therapy A protein-based snack Unstructured private time

Rest A depressed client usually has little energy. After even a short exercise period, the client may feel exhausted and need rest.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. The initial nursing intervention of highest priority is to: a. provide for the patient's safety. b. encourage clarification of feelings. c. respect the patient's personal space. d. offer an outlet for the patient's energy.

a. provide for the patient's safety.

Depression Nursing Diagnosis

Risk for suicide Hopelessness Ineffective coping Social isolation Spiritual distress Self care deficit

Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan's mother's question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone? All antipsychotic medications have an equal chance of producing EPSs. Newer antipsychotic medications have a higher risk for EPSs. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Advise Declan's mother to ask the provider to change the medication to clozapine instead of risperidone.

Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

what are some major adverse effects of Clonazepam/Klonopin?

SUICIDAL THOUGHTS, behavioral changes, drowsiness, fatigue, slurred speech, ataxia, sedation, abnormal eye movements, diplopia, nystagmus

An assessment tool that is useful to nurses in rating suicide risk is the AIMS scale. Sad Persons scale. CAGE questionnaire. Mini-Mental Status Examination.

Sad Persons scale. Evaluation of a suicide plan is extremely important in determining the degree of suicidal risk. The Sad Persons scale is short and easy to use. It thoroughly covers major risk factors and gives guidelines for action to meet the client's needs.

The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be the priority on the nurse's discharge plan of care? 1. Pharmacological teaching 2. Safety risk 3. Awareness of symptoms increasing depression 4. The need for interpersonal contact

Safety risk

Sasha has been having angry outbursts with staff and peers on the unit. You are talking with Sasha on her third day of admission. You ask whether she is having any thoughts of suicide. Sasha becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" Your response is based on the knowledge that: Sasha is getting better because she is able to be assertive. Sasha may be at high risk for self-harm. Sasha is probably experiencing transference. Sasha may be angry at someone else and projecting that anger to staff.

Sasha may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

Second Generation Antipsychotics

Sedative properties mood stabilizing properties

Which neurotransmitter has been implicated as playing a part in the decision to commit suicide? γ-Aminobutyric acid Dopamine Serotonin Acetylcholine

Serotonin Low serotonin levels have been noted among individuals who have committed suicide.

What is the difference between social phobia, agoraphobia and specific phobia?

Social phobia The client has a fear of embarrassment, is unable to perform in front of others, has a dread of social situations, believes that others are judging him negatively, & has impaired relationships Agoraphobia The client avoids being outside & has an impaired ability to work to work or perform duties Specific phobia Fear of specific objects ( spiders, snakes) Fear of specific experiences (flying, being in the dark)

What exacerbates the symptoms of anxiety?

Stress

What are two of the highest co-morbidities you see with Schizophrenia

Substance Abuse, Smoking

Anticonvulsant Drugs

Superior for rapid cycling patients* more effective when there is no family history dampening affective swings in schizoaffective patients diminish impulsive and aggressive behavior alcohol and bento withdrawal controlling mania and depression* slows inference of sodium and calcium back into the neuron makes GABA more inhibitory inhibits glutamate and suppresses the CNS --ADVERSE EFFECTS-- *CNS effects: (Nystagmus, Double vison, Vertigo, Staggering gait, Headache) *Blood dycrasias: (Leukopenia, Anemia, Thrombocytopenia) *Teratogenesis *Hypo-osmolarity *Skin disorders (Dermatitis, Stevens-Johnson Syndrome) *nausea *vomiting *hepatotoxicity *pancreatitis --DONT USE IF-- *pregnant *bone marrow suppression or bleeding disorders *liver disorders --DONT USE WITH-- *oral contraceptives *warfarin *grapefruit juice *Phenytoin, phenobarbital *Each other*

What is the duration for PTSD?

Symptoms last more than month. In acute, duration < less than 3 months. In chronic, duration > more than 3 months

MOOD stabilizers

TEGRETOL-carbamazepine DEPAKOTE-valproic acid NEUROTINE-gabapentin LAMICTAL-topiramate TRILEPTAL-oxcarbazepine LITHIUM-(Eskalith, lithobid)

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true? Tara and Aaron have the same expectation of a poor long-term prognosis. Tara will experience more positive signs of schizophrenia such as hallucinations. Aaron will be more likely to hold a job and live a productive life. Tara has a better chance for positive outcomes because of later onset.

Tara has a better chance for positive outcomes because of later onset. Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis.

Which side effect of antipsychotic medication is generally nonreversible? Anticholinergic effects Pseudoparkinsonism Dystonic reaction Tardive dyskinesia

Tardive dyskinesia Tardive dyskinesia is not always reversible with discontinuation of the medication and has no proven cure. The side effects in A, B, and C often appear early in therapy and can be minimized with treatment.

may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance? A. The side-effects are unpleasant B. The voices tell the client to stop taking it C. The client prefers to feel "high" and energetic D. The client feels well and denies the possibility of recurrence

The voices tell the client to stop taking it

Mood Swings

They are a normal part of everyone's life. There are days when we feel up and days we feel down. That is normal. We get into trouble when: The mood is down for several days The longer we stay down the more likely it is depression Usually depression is associated with a significant loss.

Melancholic features

This outdated term indicates a severe form of endogenous depression (not attributable to environmental stressors) characterized by severe apathy, weight loss, profound guilt, symptoms that are worse in the morning, early morning awakening, and often suicidal ideation.

light therapy

Treats seasonal affective disorder (SAD); scientifically proven to be effective, exposure to daily doses of intense light. Increases activity in the adrenal gland and the superchiasmatic nucleus.

Risk Factors for developing Bipolar disorder

Twins-more on mother's side unstable levels of norepinepherine, epinepherine and serotonin Stressful life events loss events Children who have mother or father with depression

Nursing Diagnoses for Bipolar Disorder

Wandering Risk for injury Risk for other-directed violence Sleep deprivation Defense coping Ineffective coping Self-care deficit Interrupted family processes Caregiver role strain Impaired verbal communication Impaired social interaction

What are the common side effects of antipsychotic medications?;

Weight gain and orthostatic hypotension

The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 2 Alzheimer's disease? (Select all that apply) Willingness to respond directly to questions posed by nurse Charming behavior designed to hide memory deficit Confabulation to compensate for forgotten information Avoidance of questions by subject changing

Willingness to respond directly to questions posed by nurse During stage 1 Alzheimer's disease the client is aware of memory impairment and may attempt to disguise it or cover it by being evasive or using confabulation.

The causation of schizophrenia is currently understood to be a combination of inherited and non-genetic factors. deficient amounts of the neurotransmitter dopamine. excessive amounts of the neurotransmitter serotonin. stress related and ineffective stress management skills.

a combination of inherited and non-genetic factors. Causation is a complicated matter. Schizophrenia most likely occurs as a result of a combination of inherited genetic factors and extreme non-genetic factors (e.g., viral infection, birth injuries, nutritional factors) that can affect the genes governing the brain or directly injure the brain.

mood

a feeling state reported by the client that can vary with internal and external changes

psychomotor retardation

a generalized slowing of physical and mental reactions; seen frequently in depression, intoxications, and other conditions

mania

a mood disorder marked by a hyperactive, wildly optimistic state; decreased need for sleep

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as a neologism. clang association. blocking. a delusion.

a neologism. A neologism is a newly coined word that has meaning only for the client.

A patient says, "I know I have a brain tumor despite the results of the magnetic resonance image (MRI). The radiologist is wrong. People who have brain tumors vomit, and yesterday I vomited all day." Which response by the nurse fosters cognitive restructuring? a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking." b. "Let's see whether any other explanations for your vomiting are possible." c. "You seem so worried. Let's talk about how you're feeling." d. "We'll talk about something else."

a. "You do not have a brain tumor. The more you talk about it, the more it reinforces your illogical thinking."

In planning care for a client with borderline personality disorder, a nurse must be aware that this client is prone to develop which of the following conditions? a. Binge eating b. Memory loss c. Cult membership d. Delusional thinking

a. Binge eating

A nurse plans health teaching for a patient with generalized anxiety disorder who begins a new prescription for lorazepam (Ativan). What information should be included? Select all that apply. a. Caution in use of machinery b. Foods allowed on a tyramine-free diet c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives e. Take the medication on an empty stomach

a. Caution in use of machinery c. The importance of caffeine restriction d. Avoidance of alcohol and other sedatives

A student says, "Before taking a test, I feel very alert and a little restless." Which nursing intervention is most appropriate to assist the student? a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects. b. Advise the student to discuss this experience with a health care provider. c. Encourage the student to begin antioxidant vitamin supplements. d. Listen attentively, using silence in a therapeutic way.

a. Explain that the symptoms result from mild anxiety and discuss the helpful aspects.

A 20-year old college student has been brought to the psychiatric hospital by her parents. Her admitting diagnosis is borderline personality disorder. When talking with the parents, which information would the nurse expect to be included in the client's history? Select all that apply. a. Impulsiveness b. Lability of mood c. Ritualistic behavior d. psychomotor retardation e. self-destructive behavior

a. Impulsiveness b. Lability of mood e. self-destructive behavior

The nurse assesses an adult who is socially withdrawn and hoards. Which nursing diagnoses most likely apply to this individual? Select all that apply. a. Ineffective home maintenance b. Situational low self-esteem c. Chronic low self-esteem d. Disturbed body image e. Risk for injury

a. Ineffective home maintenance c. Chronic low self-esteem e. Risk for injury

Which of the following nursing interventions has priority for a client with borderline personality disorder? a. Maintain consistent and realistic limits b. Give instructions for meeting basic self-care needs c. Engage in daytime activities to stimulate wakefulness d. Have the client attend group therapy on a daily basis

a. Maintain consistent and realistic limits

13. When assessing a patient with Alzheimer's disease (AD) who is being admitted to a long-term care facility, the nurse learns that the patient has had several episodes of wandering away from home. Which nursing action will the nurse include in the plan of care? a. Place the patient in a room close to the nurses' station. b. Ask the patient why the wandering episodes have occurred. c. Have the family bring in familiar items from the patient's home. d. Reorient the patient to the new living situation several times daily.

a. Place the patient in a room close to the nurses' station. Patients at risk for problems with safety require close supervision. Placing the patient near the nurse's station will allow nursing staff to observe the patient more closely. The use of "why" questions is frustrating for patients with AD because they are unable to understand clearly or verbalize the reason for wandering behaviors. Because of the patient's short-term memory loss, reorientation will not help prevent wandering behavior. Because the patient had wandering behavior at home, familiar objects will not prevent wandering.

3. A home care nurse is visiting an 88-year-old client who has moderate cognitive impairment resulting from Alzheimer's disease. His partner expresses concern that he is experiencing difficulty getting the client "to eat properly." The nurse suggests which of the following? Select all that apply. a. Serving meals at the same time each day b. Offering liquids in place of solid foods when possible c. Offering a calorie-dense snack at bedtime d. Cutting food into bite size pieces he can hold in his hand e. Asking him to identify his favorite foods

a. Serving meals at the same time each day c. Offering a calorie-dense snack at bedtime d. Cutting food into bite size pieces he can hold in his hand It is important to support the ongoing nutrition of individuals with dementia because they may experience decreased hunger and ability to taste food. People who demonstrate symptoms of moderate to severe cognitive impairment may benefit from having meals in the same place at the same time each day. Small, frequent, nutritionally dense meals and snacks should be provided. During later stages of dementia, individuals may need to be reminded to open the mouth and chew. Food should be soft and cut in small pieces.

1. A patient who is hospitalized with pneumonia is disoriented and confused 2 days after admission. Which information obtained by the nurse about the patient indicates that the patient is experiencing delirium rather than dementia? a. The patient was oriented and alert when admitted. b. The patient's speech is fragmented and incoherent. c. The patient is disoriented to place and time but oriented to person. d. The patient has a history of increasing confusion over several years.

a. The patient was oriented and alert when admitted. The onset of delirium occurs acutely. The degree of disorientation does not differentiate between delirium and dementia. Increasing confusion for several years is consistent with dementia. Fragmented and incoherent speech may occur with either delirium or dementia.

A child was placed in a foster home after being removed from abusive parents. The child is apprehensive and overreacts to environmental stimuli. The foster parents ask the nurse how to help the child. Which interventions should the nurse suggest? Select all that apply. a. Use a calm manner and low voice. b. Maintain simplicity in the environment. c. Avoid repetition in what is said to the child. d. Minimize opportunities for exercise and play. e. Explain and reinforce reality to avoid distortions.

a. Use a calm manner and low voice. b. Maintain simplicity in the environment. e. Explain and reinforce reality to avoid distortions.

A 16-year-old has stolen money from his invalid grandmother, uses drugs and alcohol, and frequently beats up acquaintances who disagree with him. Arrested for an assault in which he beat a classmate and caused brain damage, he stated in court "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of a. antisocial personality disorder. b. borderline personality disorder. c. schizotypal personality disorder. d. narcissistic personality disorder.

a. antisocial personality disorder.

Characteristics the nurse will assess in the client with antisocial personality disorder are a. deceitfulness, impulsiveness, and lack of empathy. b. perfectionism, preoccupation with detail, and verbosity. c. avoidance of interpersonal contact and preoccupation with being criticized. d. need for others to assume responsibility for decision-making and seeks nurture.

a. deceitfulness, impulsiveness, and lack of empathy.

The causes of somatic system disorders may be related to: a. faulty perceptions of body sensations. b. traumatic childhood events. c. culture-bound phenomena. d. depressive equivalents.

a. faulty perceptions of body sensations.

2. The nurse educates the older client on the possible risks for injury related to the common age-related changes to the senses by stressing the importance of: a. installing auditory smoke alarms. b. having regular eye checkups. c. being aware that hearing acuity decreases with age. d. checking the expiration dates on foods such as dairy.

a. installing auditory smoke alarms. Aging adults are also less likely to detect the bad taste smells. Their reduced ability to smell makes them unable to rapidly detect smoke, gas leaks, or other toxic fumes.

2. The nurse caring for an older adult client admitted to the hospital documents that the client is at risk for developing delirium when it is determined that he (select all that apply): a. is receiving medications to manage several chronic illnesses. b. has a history of urinary tract infections. c. is in cancer remission. d. has recently been eating poorly. e. experienced a mild heart attack 2 years ago.

a. is receiving medications to manage several chronic illnesses. b. has a history of urinary tract infections. d. has recently been eating poorly. The risk factors for delirium include advanced age, CNS diseases, infection, polypharmacy, hypoalbuminemia, electrolyte imbalances, trauma history, gastrointestinal or genitourinary disorders, cardiopulmonary disorders, and sensory changes. These factors can lead to physiologic imbalances increasing the risk for confusion.

A client tells the nurse, "You are so much nicer than that mean nurse on the nightshift." This statement would be associated with which personality disorder? a.) Borderline b.) Histrionic c.) Schizoid d.) Avoidant

a.) Borderline

The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with antihypertensives. benzodiazepines. immunosuppressants. acetylcholinesterase inhibitors.

acetylcholinesterase inhibitors. Memory deficit is thought to be related to a lack of acetylcholine at the synaptic level. Acetylcholinesterase inhibitor drugs prevent the chemical that destroys acetylcholine from acting, thus leaving more available acetylcholine.

A desired outcome for the maintenance phase of treatment for a manic client would be that the client will A. exhibit optimistic, energetic, playful behavior. B. adhere to follow-up medical appointments. C. take medication more than 50% of the time. D. use alcohol to moderate occasional mood "highs."

adhere to follow-up medical appointments.

The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly agitation. lethargy. depression. mania.

agitation. Sundowning involves increased disorientation and agitation occurring at night.

manic episode

an elevated expanisve or irritable mood accompanies by hyperactivity, grandiosity, and loss of reality

lithium and lamotrigine (Lamictal)

are the first line therapy for bipolar disorder.

Bipolar I Disorder

at least 1 week long manic episode that results in excessive activity and energy and alternate with depression or mixed state of agitation and depression; may be symptom free at times; difficulty maintaining social connections and employment and may experience psychosis during manic episodes; more common in males

Dysthymia cannot be diagnosed unless it has existed for A. at least 3 months. B. at least 6 months. C. at least 1 year. D. at least 2 years.

at least 2 years.

Dysthymia cannot be diagnosed unless it has existed for at least 3 months. at least 6 months. at least 1 year. at least 2 years.

at least 2 years. Dysthymia is a chronic condition that by definition has to have existed for longer than 2 years.

Rapid Cycling

at least 4 mood episodes in a 12 month period; can occur within a month period or throughout a 24 hour period; associated with more severe symptoms

bipolar 1 disorder

at least one episode of mania alternates w/ major depression. Psychosis may accompany the manic episode.

olanzapine (Zyprexa) and risperidone (Risperdal)

atypical antipsychotics that help w/ insomnia, anxiety, agitation and mood stabilizing properties. At times may be more effective in treatment than lithium.

The type of altered perception most commonly experienced by clients with schizophrenia is delusions. illusions. tactile hallucinations. auditory hallucinations.

auditory hallucinations. Hallucinations, especially auditory hallucinations, are the major example of alterations of perception in schizophrenia. They are experienced by as many as 90% of individuals with schizophrenia.

Which is characteristic of the diagnosis of anorexia nervosa? a) Obsession with weight gain b) Body image disturbance c) Disregard for the feelings of others d) Healthy family relationships

b) Body image disturbance

Which of the following statements is expected from a client with borderline personality disorder with a history of dysfunctional relationships? a. "I won't get involved in another relationship." b. "I'm determined to look for the perfect partner." c. "I've decided to use better communication skills." d. "I'm going to be an equal partner in a relationship."

b. "I'm determined to look for the perfect partner."

9. Which of the following statements, when made by family members caring for an older client with dementia, indicates peaceful acceptance of the situation? a. "I'm so pleased that Mother had a good day today. I'm really very hopeful." b. "The hospice nurses are so helpful when I needed time for myself." c. "I promised Mother I would take care of her and I'll never leave her." d. "It's the least I can do for Mother since she cared for us all these years."

b. "The hospice nurses are so helpful when I needed time for myself." Adjusting to the fact that dementia is irreversible and prolonged places families in situations of dealing with grief over a long period. Nurses need to encourage caregivers to take time out from their task and participate in self-care and health promotion activities.

A medical-surgical nurse works with a patient diagnosed with a somatic system disorder. Care planning is facilitated by understanding that the patient will probably: a. Readily seek psychiatric counseling. b. Be resistant to accepting psychiatric help. c. Attend psychotherapy sessions without encouragement. d. Be eager to discover the true reasons for physical symptoms.

b. Be resistant to accepting psychiatric help.

A woman is 5'7", 160 lbs, and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? a. Social anxiety disorder b. Body dysmorphic disorder c. Separation anxiety disorder d. Obsessive-compulsive disorder due to a medical condition

b. Body dysmorphic disorder

A patient with blindness related to a functional neurological (conversion) disorder says, "All the doctors and nurses in this hospital stop by often to check on me. Too bad people outside the hospital don't find me interesting." Which nursing diagnosis is most relevant? a. Social isolation b. Chronic low self-esteem c. Interrupted family processes d. Ineffective health maintenance

b. Chronic low self-esteem

A patient is experiencing moderate anxiety. The nurse encourages the patient to talk about feelings and concerns. What is the rationale for this intervention? a. Offering hope allays and defuses the patient's anxiety. b. Concerns stated aloud become less overwhelming and help problem solving begin. c. Anxiety is reduced by focusing on and validating what is occurring in the environment. d. Encouraging patients to explore alternatives increases the sense of control and lessens anxiety.

b. Concerns stated aloud become less overwhelming and help problem solving begin.

A patient preparing for surgery has moderate anxiety and is unable to understand preoperative information. Which nursing intervention is most appropriate? a. Reassure the patient that all nurses are skilled in providing postoperative care. b. Present the information again in a calm manner using simple language. c. Tell the patient that staff is prepared to promote recovery. d. Encourage the patient to express feelings to family.

b. Present the information again in a calm manner using simple language.

A patient reports fears of having cervical cancer and says to the nurse, "I've had Pap smears by six different doctors. The results are normal, but I'm sure that's because of errors in the laboratory." Which disorder would the nurse suspect? a. Functional neurologic (conversion) disorder b. Prominent health anxiety (hypochondriasis) c. Predominant (pain) disorder d. Dissociative fugue

b. Prominent health anxiety (hypochondriasis)

Which treatment modality should a nurse recommend to help a patient with pain disorder cope more effectively? a. Flooding b. Relaxation c. Response prevention d. Systematic desensitization

b. Relaxation

2. When developing a plan of care for a hospitalized patient with moderate dementia, which intervention will the nurse include? a. Provide complete personal hygiene care for the patient. b. Remind the patient frequently about being in the hospital. c. Reposition the patient frequently to avoid skin breakdown. d. Place suction at the bedside to decrease the risk for aspiration.

b. Remind the patient frequently about being in the hospital. The patient with moderate dementia will have problems with short- and long-term memory and will need reminding about the hospitalization. The other interventions would be used for a patient with severe dementia, who would have difficulty with swallowing, self-care, and immobility.

A patient fearfully runs from chair to chair crying, "They're coming! They're coming!" The patient does not follow the staff's directions or respond to verbal interventions. Which nursing diagnosis has the highest priority? a. Fear b. Risk for injury c. Self-care deficit d. Disturbed thought processes

b. Risk for injury

A nurse counsels a patient diagnosed with body dysmorphic disorder. Which nursing diagnosis would be a priority for the plan of care? a. Anxiety b. Risk for suicide c. Disturbed body image d. Ineffective role performance

b. Risk for suicide

A patient has blindness related to a functional neurological (conversion) disorder. To help the patient eat, the nurse should: a. establish a "buddy" system with other patients who can feed the patient at each meal. b. expect the patient to feed him- or herself after explaining the arrangement of the food on the tray. c. direct the patient to locate items on the tray independently and feed self unassisted. d. address the needs of other patients in the dining room, and then feed this patient.

b. expect the patient to feed him- or herself after explaining the arrangement of the food on the tray.

A patient experiences a sudden episode of severe anxiety. Of these medications in the patient's medical record, which is most appropriate to give as a prn anxiolytic? a. buspirone (BuSpar) b. lorazepam (Ativan) c. amitriptyline (Elavil) d. desipramine (Norpramin)

b. lorazepam (Ativan)

4. A nurse caring for an older client diagnosed with acute depression shows an understanding of the client's risk for developing delirium when: a. frequently reorienting the client to the day, time and place. b. physically being present to help the client with eating meals. c. providing the client with opportunities to discuss the cause of the depression. d. administering antidepressive medication as prescribed.

b. physically being present to help the client with eating meals. Depressed older adults may neglect eating or caring for a chronic medical condition, predisposing them to the development of delirium.

A patient has blindness related to a functional neurological (conversion) disorder but is unconcerned about this problem. Which understanding should guide the nurse's planning for this patient? The patient is: a. suppressing accurate feelings regarding the problem. b. relieving anxiety through the physical symptom. c. meeting needs through hospitalization. d. refusing to disclose genuine fears.

b. relieving anxiety through the physical symptom.

which statement indicates that a patient has successfully mourned a loss in his or her life? a. she was so strong after her husband died. She never cried the whole time. She kept a stiff upper lip. b. she was a wreck when her sister died. She cried and cried. It took her about a year before she resumed her usual activities with any zest. c. you know, he still talks about his mother as if she were alive today, and she's been dead for 4 years. d. He never talked about his wife after she died. He just picked up and went on life's way.

b. she was a wreck for about a year

Playing one staff member against another is an example of a. devaluation. b. splitting. c. impulsiveness. d. social ineptitude.

b. splitting.

What is rapid cycling?

bipolar disorder with 4 or more episodes in a 12 month period. can occur with either bipolar I or bipolar II.

Ron has been having serious issues with his mother, not wanting to leave her side, fear of being abandoned. As a young child he was raped and has recently been having suicidal ideations, yet he calls his mother before he decides to take his medication. Which disorder is this most likely conveying? a)Antisocial b)Schizoid c)Borderline d)Schizotypal

c)Borderline

A young, handsome man with a diagnosis of antisocial personality disorder is being discharged from the hospital next week. He asks the nurse for her phone number so that he can call her for a date. The nurse's best response would be: a. "We are not permitted to date clients." b. "No, you are a client and I am a nurse." c. "I like you, but our relationship is professional." d. "It's against my professional ethics to date clients."

c. "I like you, but our relationship is professional."

A patient experiencing moderate anxiety says, "I feel undone." An appropriate response for the nurse would be: a. "What would you like me to do to help you?" b. "Why do you suppose you are feeling anxious?" c. "I'm not sure I understand. Give me an example." d. "You must get your feelings under control before we can continue."

c. "I'm not sure I understand. Give me an example."

hypomanic episode

clients may appear happy, agreeable, humorous, and agreeable: not sever enough to cause significant impairment

9. A 62-year-old patient is brought to the clinic by a family member who is concerned about the patient's inability to solve common problems. To obtain information about the patient's current mental status, which question should the nurse ask the patient? a. "Where were you were born?" b. "Do you have any feelings of sadness?" c. "What did you have for breakfast?" d. "How positive is your self-image?"

c. "What did you have for breakfast?" This question tests the patient's recent memory, which is decreased early in Alzheimer's disease (AD) or dementia. Asking the patient about birthplace tests for remote memory, which is intact in the early stages. Questions about the patient's emotions and self-image are helpful in assessing emotional status, but they are not as helpful in assessing mental state.

A woman is 5'7" tall, weighs 160 pounds, and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." The patient tries to buy shoes to make her feet look smaller, and in social settings conceals both feet under a table or chair. Which health problem is likely? a. Dissociative fugue b. Prominent pain disorder c. Body dysmorphic disorder d. Depersonalization disorder

c. Body dysmorphic disorder

Which of the following interventions is important for a client with paranoid personality disorder taking olanzapine (Zyprexa)? a. Explain effects of serotonin syndrome b. Teach the client to watch for extrapyramidal adverse reactions c. Explain that the drug is less effective if the client smokes d. Discuss the need to report paradoxical effects such as euphoria.

c. Explain that the drug is less effective if the client smokes

Which of the following characteristics or situations is indicated when a client with borderline personality disorder has a crisis? a. Antisocial behavior b. Suspicious behavior c. Relationship problems d. Auditory hallucinations

c. Relationship problems

A 19 y/o F client with a dx of anorexia nervosa wants to help serve dinner trays to other clients on a psychiatric unit. What action should the nurse take? a. Encourage the client's participation in unit activities by asking her to pass trays for the rest of the week. b. Provide an additional challenge by asking the client to also help feed the older clients. c. Suggest another way for this client to participate in unit activities. d. Tell the client that the hospital policy doesn't permit her to pass trays.

c. Suggest another way for this client to participate in unit activities.

A patient experiencing panic suddenly began running and shouting, "I'm going to explode!" Select the nurse's best action. a. Ask, "I'm not sure what you mean. Give me an example." b. Capture the patient in a basket-hold to increase feelings of control. c. Tell the patient, "Stop running and take a deep breath. I will help you." d. Assemble several staff members and say, "We will take you to seclusion to help you regain control."

c. Tell the patient, "Stop running and take a deep breath. I will help you."

Which of the following characteristics is expected for a client with paranoid personality disorder who receives bad news? a. The client is overly dramatic after hearing the facts b. The client focuses on self to not become over-anxious c. The client responds from a rational, objective point of view d. The client doesn't spend time thinking about the information.

c. The client responds from a rational, objective point of view

5. When assessing an older client displaying symptoms reflective of delirium, the nurse focuses the assessment on: a. the degree and duration of the symptoms. b. the amount of self-care deficiency the symptoms cause. c. identifying processes that commonly result in the symptoms. d. physiological dysfunction resulting from the symptoms.

c. identifying processes that commonly result in the symptoms. The treatment of delirium entails the identification and treatment of the underlying cause.

8. A 73-year-old client diagnosed with vascular dementia is admitted for exacerbation of asthma. The nursing history determines that has been treated for 2 years with benzodiazepines to manage her increasingly aggressive behavior. The nurse's initial responds is to: a. identify the client as being at high risk for falls. b. monitor the client for signs of benzodiazepine withdrawal. c. notify the admitting physician immediately. d. place the client on strict intake and output.

c. notify the admitting physician immediately. Benzodiazepines should be reserved for acute situations and not used for the long-term management of troubling behaviors.

A patient diagnosed with obsessive-compulsive disorder has this nursing diagnosis: Anxiety related to __________ as evidenced by inability to control compulsive cleaning. Which phrase correctly completes the etiological portion of the diagnosis? a. feelings of responsibility for the health of family members b. approval-seeking behavior from friends and family c. persistent thoughts about bacteria, germs, and dirt d. needs to avoid interactions with others

c. persistent thoughts about bacteria, germs, and dirt

To assist a patient with a somatic system disorder, a nursing intervention of high priority is to: a. imply that somatic symptoms are not real. b. help the patient suppress feelings of anger. c. shift the focus from somatic symptoms to feelings. d. investigate each physical symptom as it is offered.

c. shift the focus from somatic symptoms to feelings.

full-blown mania

constantly go from one activity, place, or project to another; many projects may be started, but few if any are finished.

maintenance phase

continued focus on prevention of relapse and limitation of the severity and duration of future episodes.

A person who has numerous hypomanic and dysthymic episodes can be assessed as having A. bipolar II disorder. B. bipolar I disorder. C. cyclothymia. D. seasonal affective disorder.

cyclothymia.

A client is 5'8'' tall and weighs 105 pounds. The client has been taking laxatives daily, and self-induces vomiting after eating. Which is the priority nursing diagnosis for this client? a) Ineffective denial b) Disturbed body image c) Low self-esteem d) Imbalanced nutrition, less than body requirements

d) Imbalanced nutrition, less than body requirements

Which assessment finding would the nurse expect in clients diagnosed with bulimia? a) They are below normal weight. b) They binge when they experience hunger. c) They will be highly motivated to seek help. d) They are within their normal weight range.

d) They are within their normal weight range.

A nurse assesses a patient with a tentative diagnosis of generalized anxiety disorder. Which question would be most appropriate for the nurse to ask? a. "Have you been a victim of a crime or seen someone badly injured or killed?" b. "Do you feel especially uncomfortable in social situations involving people?" c. "Do you repeatedly do certain things over and over again?" d. "Do you find it difficult to control your worrying?"

d. "Do you find it difficult to control your worrying?"

A patient who fears serious heart disease was referred to the mental health center by a cardiologist after extensive diagnostic evaluation showed no physical illness. The patient says, "I have tightness in my chest and my heart misses beats. I'm frequently absent from work. I don't go out much because I need to rest." Which health problem is most likely? a. Dysthymic disorder b. Antisocial personality disorder c. Simple somatic symptom disorder d. Prominent health anxiety (hypochondriasis)

d. Prominent health anxiety (hypochondriasis)

For a patient experiencing panic, which nursing intervention should be implemented first? a. Teach relaxation techniques. b. Administer an anxiolytic medication. c. Prepare to implement physical controls. d. Provide calm, brief, directive communication.

d. Provide calm, brief, directive communication.

To plan effective care for patients with somatic system disorders, the nurse should understand that patients have difficulty giving up the symptoms because the symptoms: a. Are generally chronic. b. Have a physiological basis. c. Can be voluntarily controlled. d. Provide relief from health anxiety.

d. Provide relief from health anxiety.

When working with the nurse during the orientation phase of the relationship, a client with a borderline personality disorder would probably have the most difficulty in: a. Controlling anxiety b. terminating the session on time c. Accepting the psychiatric diagnosis d. Setting mutual goals for the relationship

d. Setting mutual goals for the relationship

6. An 80-year-old client exhibiting signs of dementia representative of Alzheimer's disease (AD). The nurse supports that possibility when determining that the client: a. experienced a gastric resection several years ago. b. traveled often to third world countries. c. was employed as a steelworker for 40 years. d. has a history of viral encephalitis.

d. has a history of viral encephalitis. Viral illness such as herpes zoster, herpes simplex, or viral encephalitis is believed to be a possible risk factor for AD.

7. A 72-year-old patient is diagnosed with moderate dementia as a result of multiple strokes. During assessment of the patient, the nurse would expect to find a. excessive nighttime sleepiness. b. difficulty eating and swallowing. c. variable ability to perform simple tasks. d. loss of both recent and long-term memory.

d. loss of both recent and long-term memory. Loss of both recent and long-term memory is characteristic of moderate dementia. Patients with dementia have frequent nighttime awakening. Dementia is progressive, and the patient's ability to perform tasks would not have periods of improvement. Difficulty eating and swallowing is characteristic of severe dementia.

A student says, "Before taking a test, I feel very alert and a little restless." The nurse can correctly assess the student's experience as: a. culturally influenced. b. displacement. c. trait anxiety. d. mild anxiety.

d. mild anxiety.

The nurse is talking to an adolescent about the death of his father 2 years ago. Which statement indicates a healthy progression in resolving this loss? a. I never really had any feelings about his death. b. I drive my father's old car which is nearly broken down, but I cannot give it up as it reminds me of him. c. I still can barely make it through the day without sobbing d. Of course I loved my father, but he was not perfect.

d. of course i loved my father, but he was not perfect

When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse will include information related to local: (select all that apply): day care centers legal professionals home health services family support groups professional counseling

day care centers home health services family support groups professional counseling Most importantly, families need to know where to get help. Help includes professional counseling and education regarding the process and progression of the disease. Families especially need to know about and be referred to community-based groups that can help shoulder this tremendous burden (e.g., day care centers, senior citizen groups, organizations providing home visits and respite care, and family support groups). While legal professionals may be of interest to the family, client and family education does not include such services.

Antidepressants

depression

Etiology

early onset is more severe; young people have more mood switches, mixed episodes, sick more often, and greater risk of suicide attempts; theories of development are focused on biological, psychological, and environmental factors

Euphoric Mania

euphoria turns into confusion and loss of control

major depressive disorder (MDD)

experience substantial pain and suffering. at least one depressive episode. Lasts at least two weeks. Represents a change from previous functioning. Causes some impairment in social or occupationals functioning.

A client with severe depression has been regulated on a monamine oxidase inhibitor because trials of other antidepressants proved unsuccessful. She has a pass to go out to lunch with her husband. Given a choice of the following entrees, which can she safely eat? A. avocado salad plate. B. fruit and cottage cheese plate. C. kielbasa and sauerkraut. D. liver and bacon plate.

fruit and cottage cheese plate.

A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying A. flight of ideas. B. distractibility. C. limit testing. D. grandiosity.

grandiosity.

bipolar 2 disorder

hypomanic episodes alternate w/ major depression. No psychosis. euphoric w/ increase functioning. depression puts people at risk for suicide.

apathy

indifference

An initial intervention the nurse might suggest to the family members of a client diagnosed with Alzheimer's disease who has begun incontinence would be to label the bathroom door with a picture. provide toileting on an as-needed basis. apply disposable diapers. encourage hourly toileting.

label the bathroom door with a picture. Labeling doors and various items with pictures can be helpful for a client who has forgotten where things are and what certain items are.

anergia

lack of energy; passivity

continuation phase

last 4-9 months. Relapse prevention. psychoeducational classes for patients and family, knowing their disease process, know medications, early s/s of relapse.

Continuation Phase Outcomes

lasts for 4-9 months 1.) Relapse prevention** 2.) Knowledge of disease 3.) Knowledge of medication 4.) Consequences of substance addictions 5.) Knowledge of early signs and symptoms of relapse 6.) Support groups 7.) Communication and problem solving

what is the main theme to keep the patient from staff splitting?

limit-setting (consistency among staff is imperative if the limit setting is to be carried out effectively)

Comorbidity

more than half have another psychiatric disorder; panic attacks, alcohol abuse, social phobia, oppositional defiant disorder, specific phobia, and seasonal affective disorder; substance abuse is more common in bipolar I and should be treated at the same time; borderline personality disorder is high; physical disorders associated: chronic fatigue, asthma, migraine, chemical sensitivity, hypertension, bronchitis, and gastric ulcers

When the clinician mentions that a client has anhedonia, the nurse can expect that the client A. has poor retention of recent events. B. has weight loss of 10 lb or more from anorexia. C. obtains no pleasure from previously enjoyed activities. D. has difficulty with tasks requiring fine motor skills.

obtains no pleasure from previously enjoyed activities.

When the clinician mentions that a client has anhedonia, the nurse can expect that the client has poor retention of recent events. experienced a weight loss from anorexia. obtains no pleasure from previously enjoyed activities. has difficulty with tasks requiring fine motor skills.

obtains no pleasure from previously enjoyed activities. Anhedonia is the term for the lack of ability to experience pleasure.

Cognitive Function

often preceded by high cognitive functioning cognitive impairment is more common in bipolar I but is also present in bipolar II Potential cognitive dysfunction implications: affects overall function correlate with greater number of manic episodes, psychosis, chronic illness, and poor functional outcomes Early diagnosis and treatment are crucial Medication selection should consider not only efficacy in reducing symptoms but cognitive impact of the drug

Bipolar disorders type 1

one or more manic episodes hx of depressive disorder hyperverbal, animated, grandeous, belief they have abilities they don't really have

The suicide intervention that has the greatest impact on a client's safety is educating visitors about potentially dangerous gifts. restricting the client from potentially dangerous areas of the unit. one-on-one observation by the staff. removal of personal items that might prove harmful.

one-on-one observation by the staff. One-on-one observation allows for constant supervision, which minimizes the client's opportunities to cause self-harm.

The most common course of schizophrenia is an initial episode followed by recurrent acute exacerbations and deterioration. recurrent acute exacerbations. continuous deterioration. complete recovery.

recurrent acute exacerbations and deterioration. Schizophrenia is usually a disorder marked by an initial episode followed by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

A client has a severe sleep pattern disturbance and psychomotor retardation. The nurse has developed a plan for him to spend 20 minutes in the gym at 1 PM. The hour immediately after the exercise period should be scheduled for A. rest. B. group therapy. C. individual therapy. D. occupational therapy.

rest.

The priority nursing diagnosis for a hyperactive manic client during the acute phase is A. risk for injury. B. ineffective role performance. C. risk for other-directed violence. D. impaired verbal communication.

risk for injury.

Major depression disorder

serotonin and norepinepherine decreased levels > 8 weeks

clang associations

stringing together words that sounds alike or rhyming without regard to their meaning.

Electroconvulsive Therapy

subdue severe manic behavior for treatment resistant people and rapid cyclers Monitor vitals every 15 minutes for 1 hour; they will have high blood pressure cause short term memory loss

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of acute dystonia. tardive dyskinesia. cholestatic jaundice. pseudoparkinsonism.

tardive dyskinesia. An AIMS assessment should be performed periodically on clients who are being treated with antipsychotic medication known to cause tardive dyskinesia.

A nursing intervention designed to help a schizophrenic client manage relapse is to schedule the client to attend group therapy that includes those who have relapsed. teach the client and family about behaviors associated with relapse. remind the client of the need to return for periodic blood draws to minimize the risk for relapse. help the client and family adapt to the stigma of chronic mental illness and periodic relapses.

teach the client and family about behaviors associated with relapse By knowing what behaviors signal impending relapse, interventions can be quickly invoked when the behaviors occur. The earlier the intervention, the greater the likelihood that a recurrence can be averted.

kindling

the creation of electrostress in the brain from stress that results in alteration of neural functioning

A depressed client tells the nurse he is in the 'acute phase' of his treatment for depression. The nurse recognizes that the client has been in treatment: A. for more than 4 months B. that is directed toward relapse prevention C. that focuses on prevention of future depression D. to reduce depressive symptoms

to reduce depressive symptoms

A depressed client tells the nurse he is in the "acute phase" of his treatment for depression. The nurse recognizes that the client has been in treatment for more than 4 months. that is directed toward relapse prevention. that focuses on prevention of future depression. to reduce depressive symptoms.

to reduce depressive symptoms. The acute phase of depression therapy (6-12 weeks) is directed toward the reduction of symptoms and restoration of psychosocial and work function and may require some hospitalization.

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client's energy level. weekly weights. observed eating patterns. statement of appetite.

weekly weights. The client's body weight is the most reliable and objective evaluation of success in treating this nursing diagnosis.

Physical (vegetative) symptoms

weight change-loss or gain sleep disturbance-loss or gain low energy and sex drive constipation psychomotor disturbances-agitation or retardation

An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to A. write. B. exercise. C. direct unit activities. D. orient a new client to the unit.

write.

seclusion protocol

written order, restraints used, reviewed and rewritten every 24 hr. Used to reduce stimuli, protection of client from self/others, protects destruction of personal property. Only used when other measures have failed

What is Schizoaffective d/o?

•Patient has schizophrenia, along with an affective disorder such as depression, mania or mixed

Schizophrenia affects thinking, emotions and.......;

•Thinking •Emotions •Behavior •Ability to perceive reality

You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment? "I know a lot of people care about me and want me to get better." "I have suicidal thoughts at times, but I don't have any plan and don't think I would ever actually hurt myself." "I don't have a good support system, but I am planning on joining a recovery group." "I think things will be better soon."

"I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be "You are safe here in the hospital; nothing bad will happen to you." "The voices are wrong about the hospital food. It is not contaminated." "I understand that the voices are very real to you, but I do not hear them." "Other people are eating the food, and nothing is happening to them."

"I understand that the voices are very real to you, but I do not hear them." This reply acknowledges the client's reality but offers the nurse's perception that he or she is not experiencing the same thing.

A nurse caring for a nearly mute depressed client wishes to show acceptance of the client. An intervention that would meet this objective would be to say A. "I will be spending time with you each day to try to improve your mood." B. "I would like to sit with you for 15 minutes now and again this afternoon." C. "Each day we will spend time together to talk about things that are bothering you." D. "It is important for you to share your thoughts with someone who can help you evaluate whether your thinking is realistic."

"I would like to sit with you for 15 minutes now and again this afternoon."

An statement that would show acceptance of a depressed, mute client would be "I will be spending time with you each day to try to improve your mood." "I would like to sit with you for 15 minutes now and again this afternoon." "Each day we will spend time together to talk about things that are bothering you." "It is important for you to share your thoughts with someone who can help you evaluate your thinking."

"I would like to sit with you for 15 minutes now and again this afternoon." Spending time with the client without making demands is a good way to show acceptance.

Declan is a 26-year-old patient with schizophrenia. He states to you, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be: "You are having problems with your speech. You need to try harder to be clear." "You are confused. I will take you to your room to rest a while." "I will get you a prn medication for agitation." "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

"I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on yourself, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes.

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be "You are safe here. This is a locked unit, and no one can get in." "I do not believe I understand the word volmers. Tell me more about them." "Why do you think someone or something is going to harm you?" "It must be frightening to think something is going to harm you."

"It must be frightening to think something is going to harm you." This response focuses on the client's feelings and neither directly supports the delusion nor denies the client's experience. Option A gives global reassurance. Option B encourages elaboration about the delusion. Option C asks for information that the client will likely be unable to answer.

What critical information should the nurse provide about the use of lithium? 1. "You will still have hypersexual tendencies, so be certain to use protection when engaging in intercourse." 2. "Lithium will help you to only feel the euphoria of mania but not the anxiety." 3. "It will take 1 to 2 weeks and maybe longer for this medication to start working fully." 4. "This medication is a cure for bipolar disorder."

"It will take 1 to 2 weeks and maybe longer for this medication to start working fully."

Trifluoperazine

(Stelazine) First generation antipsychotic

Olanzapine

(Zyprexa) Second generation antipsychotic

what are some common diagnosis?

- risk for injury. - risk for self or other directed violence. - risk for suicide. - ineffective coping. - disturbed thought process. - interrupted family processes. - impaired verbal communication -imbalanced nutrition: less than body requirements.

4 other antidepressant drugs that are not used as commonly

-bupropion (Wellbutrin) -Zyban -trazodone -MAOIs

Lithium Carbonate

-treats bipolar I acute and recurrent manic and depressive episodes - takes about 7-14 days to reach therapeutic levels -less effective with mixed mania, rapid cycling, and atypical features -Particularly effective for: --elation, grandiosity --flight of ideas -- irritability --anxiety -Less effective for: --insomnia --psychomotor agitation --assaultive behavior --distractibility --hypersexuality --paranoia -Is not a cure -Must stay on it for life

What is a key dietary restriction while taking MAOIs? What can happen if not followed?

-tyramine. Hypertensive crisis can occur if tyramine is taken with MAOIs. **dietary restriction of tyramine must be maintained for 2 weeks after stoping MAOIs

anticonvulsant drugs

-valproate (depakote/depakene) -carbamazepine (Tegretol) -lamotrogine (Lamictal)

Therapeutic Level of Lithium

0.8 to 1.4 mEq/L

Patients with personality disorders are grouped into three categories depending on the disorder. Cluster b patients most often described as: (select all that apply) A) Withdrawn B) Expansive C) Anxious D) Odd/eccentric E) Emotional

B) Expansive E) Emotional

What contributes to the difficulty in creating a therapeutic alliance with clients with personality disorders? Select all that apply. 1. Client's suspiciousness 2. Aloofness from clients 3. Secretive style and hostility of clients 4. Transference from the nurse 5. Setting limits

1. Client's suspiciousness 2. Aloofness from clients 3. Secretive style and hostility of clients

Which nursing intervention has priority in the plan of care for a client with antisocial personality disorder who shows defensive behaviors? 1. Help the client accept responsibility for his own decisions and behaviors. 2. Work with the client to feel better about himself by taking care of basic needs. 3. Teach the client to identify the defense mechanisms used to cope with distress. 4. Confront the client about the disregard of social rules and the feelings of others.

1. Help the client accept responsibility for his own decisions and behaviors.

Which nursing intervention has priority for a client with borderline personality disorder? 1. Maintain consistent, realistic limits. 2. Give instructions for meeting basic self-care needs. 3. Engage in daytime activities to stimulate wakefulness. 4. Have the client attend group therapy on a daily basis.

1. Maintain consistent, realistic limits.

S, age 18, has been diagnosed with anorexia nervosa. A short-term goal related to the nursing diagnosis: Imbalanced nutrition: less than body requirements would be: client will 1. gain 1 to 2 pounds each week 2. state she feels better about her situation within 2 weeks 3. identify two emotional supports within 3 weeks 4. identify an alternative coping skill prior to discharge

1. gain 1 to 2 pounds each week

In communicating with a patient who is experienceing an elated mood, which of the following interventions by the nurse is most approptriate: 1. use a calm, firm approach 2. Give expanded explanations 3. Make use of abstract concepts 4. Encourage lighthearted optimisim

1. use a calm, firm approach

Assessment Guidelines

1.) Danger to self or others 2.) Need for protection from uninhibited behaviors 3.) Need for hospitalization 4.) Medical Status- is mania primary or secondary to another disorder 5.) Coexisting medical condition 6.) Patient and family understanding of the illness

Acute Phase Outcomes

1.) Injury prevention** 2.) Hydrated 3.) Stable cardiac status 4.) Tissue integrity 5.) Sleep and Rest 6.) Thought self-control 7.) No attempt at self-harm

Maintenance Phase Outcomes

1.) Prevention of relapse** 2.) Limitation of severity and duration of future episodes 3.) Learning interpersonal strategies 4.) Participation in psychotherapy, group, or other supportive therapy

Early Toxic Level of Lithium

1.5 to 2.0 mEq/L

What is some criteria that must be met for a patient to meet GAD?

1.Feeling wound-up, tense, or restless 2. Easily becoming fatigued or worn-out 3.Concentration problems 4.Irritability 5.Significant tension in muscles 6.Difficulty with sleep

How long does a panic attack usually last?

15-30

A depressed client has been prescribed a tricyclic antidepressant. How long should the nurse inform the client that it will take before the client notices a significant change in the depression? 1 4 to 6 days 2 2 to 4 weeks 3 5 to 6 weeks 4 12 to 16 hours

2 It takes 2 to 4 weeks for the tricyclic antidepressant to reach a therapeutic blood level. Four to 6 days and 12 to 16 hours are both too short of time spans for a therapeutic blood level of the drug to be achieved. Improvement in depression should be demonstrated earlier than 5 to 6 weeks.

When used in combination with certain foods and drugs, monoamine oxidase inhibitors (MAOIs) can cause serious side effects. Which condition could occur in clients treated with MAOIs for depression? 1 A serious drop in blood pressure 2 A serious increase in blood pressure 3 A significant increase in liver enzymes 4 A significant increase in cholesterol levels

2 MAOIs, when taken with foods high in tyramine (e.g., pickled foods, beer, wine, aged cheeses) and drugs such as antidepressants, certain pain medications, and decongestants, can cause a life-threatening increase in blood pressure. For this reason they are seldom used to treat symptoms of depression. MAOIs do not increase liver enzymes or cholesterol levels.

A client has been found to have bipolar disorder and is being prescribed lithium carbonate (Lithium). In light of the information shown, the nurse provides teaching to the client. Select all that apply. TSH (10) Sodium (132) 1 Lithium can affect WBC production and therefore increases her risk for infection. 2 Her current thyroid function will require frequent assessments while she takes lithium. 3 Hyponatrium could lead to lithium toxicity, so the healthcare provider must first be notified of the level. 4 Because of the platelet count, neutropenic precautions will be initiated once the client starts lithium therapy. 5 The current hemoglobin and hematocrit call for regular monitoring is needed once the lithium level is stabilized.

2,3 Lithium carbonate therapy can negatively affect thyroid function; the client's current TSH is at the high normal level and so frequent checks are appropriate. Low serum sodium levels would result in the kidneys' reabsorbing the lithium; this situation would lead to lithium toxicity. The health care provider must first be notified of the lab result. Lithium is not known to have a negative effect on WBC, platelet, or RBC production. Test-Taking Tip: Chart/exhibit items present a situation and ask a question. A variety of objective and subjective information is presented about the client in formats such as the hospital record (e.g., laboratory test results, results of diagnostic procedures, progress notes, health care provider orders, medication administration record, health history), physical assessment data, and nurse/client interactions. After analyzing the information presented, the test taker answers the question. These questions usually reflect the analyzing level of cognitive thinking.

A nurse is caring for a client with bipolar I disorder. What should the plan of care for this client include? Select all that apply. 1 Touching the client to provide reassurance 2 Providing a structured environment for the client 3 Ensuring that the client's nutritional needs are met 4 Engaging the client in conversation about current affairs 5 Designing activities that require the client to maintain contact with reality

2,3 Structure tends to decrease agitation and anxiety and to increase the client's feelings of security. Whether the individual is experiencing mania or depression, nutritional needs must be met. The hyperactivity associated with mania interferes with the ability to sit still long enough to eat; hyperactivity requires an increase in the intake of calories for the energy expended. Touching can be threatening for many clients and should not be used indiscriminately. Conversations should be kept simple. The client with a bipolar disorder, either depressed or manic phase, may have difficulty following involved conversations about current affairs. Clients with bipolar disorders are in contact with reality, so designing activities that require the client to maintain such contact will serve little purpose.

Which of the following responses from the nurse would enhance a therapeutic relationship with a client with a personality disorder? 1. " What would you like to do today?" 2. " After you attend the morning community meeting, you may work on your homework." 3. " You remind me of a friend of mine." 4. " We will have you get comfortable on the unit first before we have you work on any homework."

2. " After you attend the morning community meeting, you may work on your homework."

Which statement made by a client with paranoid personality disorder shows that teaching about social relationships is effective? 1. " As long as I live, I won't abide by social rules." 2. " Sometimes, I can see what causes relationship problems." 3. " I'll find out what problems others have so I won't repeat them." 4. " I don't have problems in social relationships; I never really did."

2. " Sometimes, I can see what causes relationship problems."

The psychiatric clinical nurse specialist decides to use cognitive therapy techniques as she works with S, a client with anorexia nervosa. Which statement by the nurse is consistent with the use of cognitive therapy principles? 1. "You seem to feel much better about yourself when you eat something." 2. "Being thin doesn't seem to solve your problems, since you're thin, now, and still unhappy." 3. "It must be difficult to talk about private matters to someone you just met." 4. "What are your feelings about not eating the food that you prepare?"

2. "Being thin doesn't seem to solve your problems, since you're thin, now, and still unhappy."

The nurse is using a cognitive intervention to decrease anxiety during a client's panic attack. Which statement by the client would indicate that the intervention has been successful? 1. "I reminded myself that the panic attack would end soon, and it helped." 2. "I paced the halls until I felt my anxiety was under control." 3. "I felt my anxiety increase, so I took lorazepam (Ativan) to decrease it." 4. "Thank you for staying with me. It helped to know staff was there."

2. "I paced the halls until I felt my anxiety was under control."

During an intake assessment, a client diagnosed with generalized anxiety disorder rates mood at 3/10, rates anxiety at 8/10, and states, "I'm thinking about suicide." Which nursing intervention takes priority? 1. Teach the client relaxation techniques. 2. Ask the client, "Do you have a plan to commit suicide?" 3. Call the physician to obtain a PRN order for an anxiolytic medication. 4. Encourage the client to participate in group activities.

2. Ask the client, "Do you have a plan to commit suicide?"

Which statement from a depressed patient might recede a suicide attempt? 1. I want to be the best I can be 2. I have decided to solve all my problems 3. I have the most horrendous family 4. I will try and work with the staff

2. I have decided to solve all my problems

A client diagnosed with obsessive-compulsive disorder has been hospitalized for the last 4 days. Which intervention would be a priority at this time? 1. Notify the client of the expected limitations on compulsive behaviors. 2. Reinforce the use of learned relaxation techniques. 3. Allow the client the time needed to complete the compulsive behaviors. 4. Say "stop" to the client as a thought-stopping technique.

2. Reinforce the use of learned relaxation techniques.

The nurse is expecting the psychiatrist to order an antidepressant for a client with borderline personality disorder. Which of the following would be best for this client? 1. Monoamine oxidase inhibitors (MAOIs) work best for those with a borderline personality disorder because the effects are felt very quickly. 2. Selective serotonin reuptake inhibitors (SSRIs) in addition to an atypical antipsychotic treat dysphoria, mood instability, and impulsivity in clients with borderline personality disorder. 3. Antipsychotics treat illusions, ideas of reference, paranoid thinking, anxiety, and hostility in clients. 4. Anxiolytics will reduce the anxiety seen in borderline personality disorder clients.

2. Selective serotonin reuptake inhibitors (SSRIs) in addition to an atypical antipsychotic treat dysphoria, mood instability, and impulsivity in clients with borderline personality disorder.

Which of the following behaviors can a nurse expect to see in a client with a personality disorder? Select all that apply. 1. Compliance with the rules of the unit 2. Tendency to provoke interpersonal conflict 3. Inflexibility 4. Maladaptive responses to stress 5. Trouble in social and professional relationships 6. Personal boundaries are blurred

2. Tendency to provoke interpersonal conflict 3. Inflexibility 4. Maladaptive responses to stress 5. Trouble in social and professional relationships 6. Personal boundaries are blurred

A client with paranoid personality disorder responds aggressively during a psychoeducational group therapy session to something another client said about him. The nurse interprets this behavior as indicating which of the following? 1. The client doesn't want to participate in the group. 2. The client took the statement as a personal criticism. 3. The client is impulsive and was acting out of frustration. 4. The client was attempting to handle emotional distress.

2. The client took the statement as a personal criticism.

What nursing intervention would relate to a client goal that S, a client with anorexia nervosa, will gain 1 to 2 pounds per week? 1. assessing for depression and suicidal ideation 2. observing for adverse side effects of refeeding 3. communicating empathy for S's feelings 4. focusing with client on objective facts comparing energy expenditure and caloric intake

2. observing for adverse side effects of refeeding

S, a client with anorexia nervosa, is particularly resistant to the idea of weight gain. The nurse decides to encourage S to agree to a treatment contract. What is the rationale for establishing a contract with S in which she agrees to participate in measures designed to produce a specified weekly weight gain? 1. Because severe anxiety concerning eating is to be expected, objective and subjective data must be routinely collected. 2. A team approach to planning diet ensures that physical and emotional needs will be met. 3. Client involvement in decision making increases sense of control and promotes compliance with treatment. 4. Because there is increased risk of physical problems with refeeding, client permission is essential.

3. Client involvement in decision making increases sense of control and promotes compliance with treatment.

A client with antisocial personality disorder is trying to manipulate the health care team. What is the best strategy for the staff to implement? 1. Focus on how to teach the client more effective behaviors for meeting basic needs. 2. Help the client verbalize underlying feelings of hopelessness and learn coping skills. 3. Remain calm and don't emotionally respond to the client's manipulative actions. 4. Help the client eliminate the intense desire to have everything in life turn out perfectly.

3. Remain calm and don't emotionally respond to the client's manipulative actions.

A client with borderline personality disorder states that he doesn't know how to deal with his impulsive behavior. Which intervention should the nurse implement? 1. Teach the client that impulsive behavior is part of his illness. 2. Explore how depression influences impulsive situations. 3. Select an example of an impulsive situation and explore it. 4. Decrease interactions in which impulsive behavior occurs.

3. Select an example of an impulsive situation and explore it.

"Client, age 28, admitted to unit with diagnosis of antisocial personality disorder and suicide attempt after cutting his right wrist. Right wrist dressing appears dry and intact. Client states, "I don't want to be here and I'm not following your treatment plan or any of your rules. I'm going to tell everyone here not to follow your rules" 1. The client requires psychotropic drugs to treat his condition, which he refuses. 2. The client manipulates other clients but not his family. 3. The client may not be motivated to change his behavior or his lifestyle. 4. The client could quickly make behavior changes if motivated.

3. The client may not be motivated to change his behavior or his lifestyle.

When caring for a client with major depression, nurses usually have the most difficulty dealing with the: 1 Client's lack of energy 2 Negative nonverbal responses 3 Client's psychomotor retardation 4 Pervasive quality of the depression

4 Depression is "contagious"; it affects the nurse as well as the client. The client's lack of energy should not make nursing care difficult. These clients usually do not offer negative responses; they offer no response.

A client with paranoid personality disorder is discussing current problems with a nurse. What is the most important intervention for the nurse to implement? 1. Have the client look at sources of frustration. 2. Have the client focus on ways to interact with others. 3. Have the client discuss the use of defense mechanisms. 4. Have the client clarify thoughts and beliefs about an event.

4. Have the client clarify thoughts and beliefs about an event.

A client with borderline personality disorder is learning how to verbalize, rather than act on, the desire to hurt himself. What is the most appropriate nursing intervention? 1. Explain how pain triggers intense anger and causes the client to act out. 2. Determine how problems with the client's family cause him to act aggressively. 3. Teach the client that being volatile is a normal reaction to unfair events. 4. Have the client work on identifying speech and behavior that accompany anger.

4. Have the client work on identifying speech and behavior that accompany anger.

What is the most appropriate short-term goal for a client with paranoid personality disorder and impaired social skills? 1. Obtain feedback from other people. 2. Discuss anxiety-provoking situations. 3. Address positive and negative feelings about self. 4. Identify personal feelings that hinder social

4. Identify personal feelings that hinder social

A client with a paranoid personality disorder makes an inappropriate and unreasonable report to a nurse. What is the most appropriate intervention by the nurse? 1. Use logic to address the client's concern. 2. Confront the client about the stated misperception. 3. Use nonverbal communication to address the issue. 4. Tell the client matter-of-factly that you don't share his interpretation.

4. Tell the client matter-of-factly that you don't share his interpretation.

The nurse is developing long-term goals for a client with paranoid personality disorder who is trying to improve peer relationships. What is the most appropriate goal? 1. The client will verbalize a realistic view of self. 2. The client will take steps to address disorganized thinking. 3. The client will become appropriately interdependent on others. 4. The client will become involved in activities that foster social relationships.

4. The client will become involved in activities that foster social relationships.

What behavior on the part of the nurse caring for a client with anorexia nervosa would indicate a need for supervision? 1. being consistent and reliable 2. using an accepting, nonjudgmental manner 3. being matter-of-fact and neutral 4. being flexible about limits for the client

4. being flexible about limits for the client

This diagnosis is characterized by _______months of worry and tension?

6

What percentage of people can expect to have a 2nd episode of MDD or DD after 5 years?

70%

Genetics

80%-90% heritable; polygenetic disease; connection between diacylglycerol kinase eta (DGKH); lithium if first line therapy because DGKH is crucial part of lithium-sensitive pathway; abnormal circadian genes which leads to insomnia; Circadian clock gene (CRY2) associated with rapid cycling; bipolar and schizophrenia exhibit irregularities on chromosomes 13 and 15

Client Needs: Psychosocial Integrity 4. An adult diagnosed with major depression was treated with medication and cognitive behavioral therapy. The patient now recognizes how passivity contributed to the depression. Which intervention should the nurse suggest? a. Social skills training c. Desensitization techniques b. Relaxation training classes d. Use of complementary therapy

A Social skill training is helpful in treating and preventing the recurrence of depression. Training focuses on assertiveness and coping skills that lead to positive reinforcement from others and development of a patient's support system. Use of complementary therapy refers to adjunctive therapies such as herbals, which would be less helpful than social skill training. Assertiveness would be of greater value than relaxation training because passivity was a concern. Desensitization is used in treatment of phobias. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 256 (Case Study and Nursing Care Plan 14-1) | Page 259 TOP: Nursing Process: Planning

Client Needs: Psychosocial Integrity 20. A patient was diagnosed with seasonal affective disorder (SAD). During which month would this patient's symptoms be most acute? a. January c. June b. April d. September

A The days are short in January, so the patient would have the least exposure to sunlight. Seasonal affective disorder is associated with disturbances in circadian rhythm. Days are longer in spring, summer, and fall. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 271-272 TOP: Nursing Process: Assessment

dysthymic disorder (DD)

A chronically depressed mood that is present for more than 2 yrs in an adult or 1 yr in a child or adolescent. Affected persons describe themselves as being chronically "down in the dumps".

Which statement is a fact about suicide? More women than men commit suicide. Suicide is the tenth leading cause of death in the United States. Native Americans and Alaskan Natives have low suicide rates. A client with schizophrenia is at great risk for attempting suicide.

A client with schizophrenia is at great risk for attempting suicide. Individuals with schizophrenia are 50 times more likely to attempt suicide than is the general public. Suicide is the eleventh leading cause of death in the United States. Native Americans and Alaskan Natives have high suicide rates. More women attempt suicide, but more men are successful.

hypomania

A mild manic state in which the individual seems infectiously merry, extremely talkative, charming, and tireless.

How should a nurse psychotherapist who is operating from a psychoanalytic paradigm explain the presence of hypochondriasis to a client? A) "Physical complaints are the expression of low self-esteem and feelings of worthlessness because it is easier to believe that something is wrong with the body than to believe that something is wrong with the self." B) "Somatic complaints are often reinforced when the sick role relieves the individual from the need to deal with a stressful situation, whether it is within society or within the family." C) "When emotional arousal precipitates somatic symptoms, the symptoms are incorrectly assessed and misinterpreted and negative cognitive meanings are attached to them." D) "Evidence indicates an increased prevalence of hypochondriasis among identical twins and other first-degree relatives."

A) "Physical complaints are the expression of low self-esteem and feelings of worthlessness because it is easier to believe that something is wrong with the body than to believe that something is wrong with the self."

Client Needs: Psychosocial Integrity 3. A patient diagnosed with major depression shows vegetative signs of depression. Which nursing actions should be implemented? Select all that apply. a. Offer laxatives if needed. b. Monitor food and fluid intake. c. Provide a quiet sleep environment. d. Eliminate all daily caffeine intake. e. Restrict intake of processed foods.

A, B, C The correct options promote a normal elimination pattern. Although excessive intake of stimulants such as caffeine may make the patient feel jittery and anxious, small amounts may provide useful stimulation. No indication exists that processed foods should be restricted. See relationship to audience response question. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 257 | Page 260-261 (Table 14-2) | Page 264 (Table 14-5) TOP: Nursing Process: Implementation

A client standing in the dining room is experiencing auditory hallucinations commanding him to strangle someone. His behavior and verbalizations indicate he is experiencing severe to panic level anxiety. Put each of the nursing interventions in the order they should be undertaken. A. Send another staff member to report the situation and obtain a prn medication. B. Assure the client that staff will help him resist the command. C. Take the client to a quiet, secure environment. D. Clear the dining room of other clients. E. Explain that the medication will stop the voices, then administer the drug.

ANS: B, D, A, C, E Rationale: This sequence supports client self-control to resist the command, protects other clients from potential harm, secures help from another while allowing the nurse to remain with the client to provide structure and set limits, removes client to a safer, less confusing environment, explains therapeutic use of medication, and limits the possibility of the client perceiving the medication as punishment. DIF: Cognitive Level: Analysis REF: Text Page: N/A TOP: Nursing Process: Implementation MSC: NCLEX: Safe, Effective Care Environment;

A client with obsessive-compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work, then comes home on the lunch hour and spends more than an hour rechecking faucets, stove burners, appliances, window and door locks, and so forth. The checking continues after work and during the evening. The client spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent. Indicators for measuring progress should include (more than one answer may be correct) A. adequate grooming achieved daily. B. participation in a social activity 30 minutes per day. C. refraining from checking more than once when leaving home. D. calling to request that a neighbor to check the home in her absence.

ANS: A, B, C Rationale: Individualized indicators that show the client is spending less time in checking rituals and using more time for activities of daily living and social/recreational activities indicate progress toward the outcome of symptom control. Option D suggests symptom control is still tenuous.

A client with severe obsessive-compulsive symptoms will be admitted to the hospital for a short stay for assessment and initiation of therapy with a selective serotonin reuptake inhibitor. The assessments of critical importance include (more than one answer may be correct) A. anxiety level. B. sleep pattern. C. elimination. D. nutritional status. E. hygiene and grooming. F. presence of delusions and hallucinations

ANS: A, B, C, D, E Rationale: Options B through E are important because each may be adversely affected by the client's excessive use of ritualistic behaviors. A baseline anxiety level must be established for later comparison. When the drug therapy is initiated, the anxiety level may rise before the desired effect of anxiety reduction is accomplished. Option F: The client is not expected to demonstrate either delusions or hallucinations.

The nurse interviewing a client with suspected posttraumatic stress disorder should be alert to findings indicating the client (more than one answer may be correct) A. experiences flashbacks. B. demonstrates hypervigilance. C. feels detached, estranged, or empty inside. D. feels driven to repeat ritualistic behaviors. E. avoids people and places that arouse painful memories. F. experiences sympathetic nervous system symptoms suggestive of a heart attack.

ANS: A, B, C, E Rationale: These assessment findings are consistent with the symptoms of posttraumatic stress disorder according to the DSM-IV-TR. Option D is consistent with obsessive-compulsive disorder and option F with panic attack.

The plan of care for a client with obsessive-compulsive disorder relative to self-esteem enhancement should include (more than one answer may be correct) A. encouraging the client to identify and reinforce strengths. B. encouraging the client to examine negative self-perceptions. C. encouraging the use of as-needed anxiolytic medication. D. assisting the client to identify positive responses from others. E. refraining from giving praise to the client for accomplishments. F. discouraging experiences that increase client autonomy.

ANS: A, B, D Rationale: Self-identification of strengths that can subsequently be reinforced by the nurse builds esteem and promotes self-acceptance. Examining negative self-perceptions permits reframing in positive ways. Identifying positive responses from others helps the client see self in a more positive light. Option C: This intervention is not directly related to self-esteem enhancement. Option E: Clients should receive realistic praise. Option F: Realistic levels of client autonomy should be encouraged because autonomy can be esteem enhancing.

The nurse planning health teaching for a client with generalized anxiety disorder who is taking lorazepam (Ativan) should include information about the need for (more than one answer may be correct) A. a tyramine-free diet. B. caffeine restriction. C. use of care with machinery. D. avoidance of alcohol and other sedatives.

ANS: B, C, D Rationale: Caffeine is a central nervous system stimulant that acts as an antagonist to the benzodiazepine lorazepam. Daily caffeine intake should be reduced to the amount contained in one cup of coffee. Benzodiazepines are sedatives, thus the importance of exercising caution when driving or using machinery and the importance of not using other central nervous system depressants such as alcohol or sedatives to avoid potentiation. Option A: Benzodiazepines do not require a special diet.

When working with a client with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal, effective nursing interventions would include (more than one answer may be correct) A. encouraging repression of memories associated with the traumatic event. B. explaining that physical symptoms are related to the psychological state. C. teaching stress management techniques. D. discussing possible meanings of the event. E. advising the use of alcohol as adjunctive sedation.

ANS: B, C, D Rationale: The goal of treatment for posttraumatic stress disorder is to come to terms with the event rather than repress it; thus option D is correct and option A is incorrect. Option B will help the client understand the mind-body relation and the fact that relaxation, breathing exercises, and imagery can be helpful in symptom reduction (option C). Option E is inadvisable. Substance abuse is often a comorbidity with posttraumatic stress disorder because the client seeks to self-medicate.

A client with obsessive-compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work, then comes home on the lunch hour and spends more than an hour rechecking faucets, stove burners, appliances, window and door locks, and so forth. The checking continues after work and during the evening. The client spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent. Nursing diagnoses the nurse can immediately rule out include (more than one answer may be correct) A. ineffective role performance relative to time spent in rituals. B. impaired environmental interpretation syndrome relative to confusion. C. ineffective coping relative to use of compulsive behavior. D. social isolation relative to excessive use of time to perform rituals. E. defensive coping relative to feelings of superiority to others. F. dressing/grooming self-care deficit relative to time spent in rituals.

ANS: B, E Rationale: Impaired environmental interpretation syndrome refers to consistent lack of orientation to person, place, time. Defensive coping is defined as repeated projection of falsely positive self-evaluation based on a self-protective pattern that defends against underlying perceived threats to positive self-regard. The other options are relevant to the scenario.

Assessment questions that would be highly appropriate to ask a client with possible obsessive-compulsive disorder would be (more than one answer may be correct) A. "Have you been a victim of a crime or seen someone badly injured or killed?" B. "Do you feel especially uncomfortable in social situations involving people?" C. "Do you do certain things over and over again?" D. "Do you find it difficult to keep certain thoughts out of awareness?" E. "Do you have to do things in a certain way to feel comfortable?"

ANS: C, D, E Rationale: These questions refer to obsessive thinking and compulsive behaviors. Option A is more pertinent to a client with suspected posttraumatic stress disorder. Option B is more relevant for a client with suspected social phobia.

Which symptoms should a nurse recognize that differentiate a client diagnosed with obsessive-compulsive disorder (OCD) from a client diagnosed with obsessive-compulsive personality disorder? 1. Clients diagnosed with OCD experience both obsessions and compulsions, and clients diagnosed with obsessive-compulsive personality disorder do not. 2. Clients diagnosed with obsessive-compulsive personality disorder experience both obsessions and compulsions, and clients diagnosed with OCD do not. 3. Clients diagnosed with obsessive-compulsive personality disorder experience only obsessions, and clients diagnosed with OCD experience only compulsions. 4. Clients diagnosed with OCD experience only obsessions, and clients diagnosed with obsessive-compulsive personality disorder experience only compulsions.

ANS: 1 Rationale: A client diagnosed with OCD experiences both obsessions and compulsions. Clients with obsessive-compulsive personality disorder exhibit a pervasive pattern of preoccupation with orderliness, perfectionism, mental and interpersonal control, but do not experience obsessions and compulsions

A nurse is providing discharge teaching to a client taking a benzodiazepine. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

ANS: 1 Rationale: The client indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. This intervention is used when taking lithium (Eskalith) for the treatment of bipolar disorder. The client should understand that taking extra doses of a benzodiazepine may result in addiction and that the drug should not be taken in conjunction with alcohol.

A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

ANS: 1 Rationale: The most appropriate nursing response to the client's concerns is to empathize with the client and provide encouragement that panic attacks only last a short period. Panic attacks usually last minutes but can, rarely, last hours. When the nurse states that "Most people who experience panic attacks..." the nurse depersonalizes and belittles the client's feeling

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an ED with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. Neuroleptic malignant syndrome treated by discontinuing Thorazine and administering dantrolene (Dantrium) 2. Neuroleptic malignant syndrome treated by increasing Thorazine dosage and administering an antianxiety medication 3. Dystonia treated by administering trihexyphenidyl (Artane) 4. Dystonia treated by administering bromocriptine (Parlodel)

ANS: 1 Rationale: The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine and administering dantrolene. Neuroleptic malignant syndrome is a potentially fatal condition characterized by rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics because they have fewer side effects and present a lower risk.

A 16-year-old client diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing response? 1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions." 2. "Your child's hallucinations are caused by medication interactions." 3. "Your child has too little serotonin in the brain, causing delusions and hallucinations." 4. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: 1 Rationale: The nurse should explain that a chemical imbalance of the brain leads to altered perceptions. Hallucinations, or false sensory perceptions, may occur in all five senses. The client hearing voices is experiencing an auditory hallucination.

A client diagnosed with schizophrenia spectrum disorder is prescribed clozapine (Clozaril). Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? 1. Sore throat, fever, and malaise 2. Akathisia and hypersalivation 3. Akinesia and insomnia 4. Dry mouth and urinary retention

ANS: 1 Rationale: The nurse should intervene immediately if the client experiences signs of an infectious process, such as a sore throat, fever, and malaise, when taking the atypical antipsychotic drug clozapine. Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur, leading to infection

A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." 3. "Doxepin (Sinequan) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

ANS: 1 Rationale: The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and the related symptoms.

The diagnosis of catatonic disorder associated with another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which of the following? (Select all that apply.) 1. Hyperthyroidism2. Hypothyroidism 3. Hyperadrenalism 4. Hypoadrenalism 5. Hyperaphia

ANS: 1, 2, 3, 4 Rationale: The diagnosis of catatonic disorder associated with another medical condition is made when the symptomatology is evidenced from medical history, physical examination, or laboratory findings to be directly attributable to the physiological consequences of a general medical condition. Types of medical conditions that have been associated with catatonic disorder include metabolic disorders (e.g., hepatic encephalopathy, hypo- and hyperthyroidism, hypo- and hyperadrenalism, and vitamin B12 deficiency) and neurological conditions (e.g., epilepsy, tumors, cerebrovascular disease, head trauma, and encephalitis). Hyperaphia is an excessive sensitivity to touch

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

ANS: 1, 2, 4, 5 Rationale: The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part of rehabilitative programs for clients diagnosed with schizophrenia spectrum disorder. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort

An attractive female client presents with high anxiety levels because of her belief that her facial features are large and grotesque. Body dysmorphic disorder (BDD) is suspected. Which of the following additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. History of an eating disorder 4. History of delusional thinking 5. Skin picking

ANS: 1, 2, 5 Rationale: The DSM-5 lists preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others as a diagnostic criteria for the diagnosis of BDD. Also listed is that at some point during the course of the disorder, the person has performed repetitive behaviors, such as mirror checking, excessive grooming, skin picking, or reassurance seeking.

A nurse has been caring for a client diagnosed with generalized anxiety disorder (GAD). Which of the following nursing interventions would address this client's symptoms? (Select all that apply.) 1. Encourage the client to recognize the signs of escalating anxiety. 2. Encourage the client to avoid any situation that causes stress. 3. Encourage the client to employ newly learned relaxation techniques. 4. Encourage the client to cognitively reframe thoughts about situations that generate anxiety. 5. Encourage the client to avoid caffeinated products.

ANS: 1, 3, 4, 5 Rationale: Nursing interventions that address GAD symptoms should include encouraging the client to recognize signs of escalating anxiety, to employ relaxation techniques, to cognitively reframe thoughts about anxiety-provoking situations, and to avoid caffeinated products. Avoiding situations that cause stress is not an appropriate intervention, because avoidance does not help the client overcome anxiety and because not all situations are easily avoidable

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia spectrum disorder. Which of the following client symptoms would most likely decrease because of the therapeutic effect of this medication? (Select all that apply.) 1. Somatic delusions 2. Social isolation 3. Gustatory hallucinations 4. Flat affect 5. Clang associations

ANS: 1, 3, 5 Rationale: The nurse should expect that risperidone would be effective treatment for the positive symptoms of somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms

A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit? (Select all that apply.) 1. Fatigue 2. Anorexia 3. Hyperventilation 4. Insomnia 5. Irritability

ANS: 1, 4, 5 Rationale: The nurse should expect that a client diagnosed with GAD would experience fatigue, insomnia, and irritability. GAD is characterized by chronic, unrealistic, and excessive anxiety and worry.

A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

ANS: 2 Rationale: An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast. The nurse should also provide a structured schedule of activities and begin to gradually limit the time allowed for rituals

A nurse prepares to assess a client using the Abnormal Involuntary Movement Scale (AIMS). Which side effect of antipsychotic medications led to the use of this assessment tool? 1. Dystonia 2. Tardive dyskinesia 3. Akinesia 4. Akathisia

ANS: 2 Rationale: The AIMS is a rating scale that was developed in the 1970s by the National Institute of Mental Health to measure involuntary movements associated with tardive dyskinesia

A nursing student questions an instructor regarding the order for fluvoxamine (Luvox) 300 mg daily for a client diagnosed with obsessive-compulsive disorder (OCD). Which instructor response is most accurate? 1. High doses of tricyclic medications will be required for effective treatment of OCD. 2. Selective serotonin reuptake inhibitor (SSRI) doses, in excess of what is effective for treating depression, may be required for OCD. 3. The dose of Luvox is low because of the side effect of daytime drowsiness. 4. The dose of this selective serotonin reuptake inhibitor (SSRI) is outside the therapeutic range and needs to be questioned.

ANS: 2 Rationale: The most accurate instructor response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the Food and Drug Administration for the treatment of OCD. Common side effects include headache, sleep disturbances, and restlessness

A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Anxiety is a complex phenomenon and is effectively treated only with psychotropic medications."

ANS: 2 Rationale: The most appropriate response by the nurse is to explain to the family member that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establishing personal contact with family members 2. Being reliable, honest, and consistent during interactions 3. Sharing limited personal information 4. Sitting close to the client to establish rapport

ANS: 2 Rationale: The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? 1. Assess for medication nonadherance. 2. Note escalating behaviors and intervene immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors

ANS: 2 Rationale: The nurse should note escalating behaviors and intervene immediately, to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. 4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia

ANS: 2 Rationale: The nurse should recognize that positive symptoms of schizophrenia include, but are not limited to, paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include, but are not limited to, flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a diminution or loss of normal functions

Which nursing intervention would be most appropriate when caring for an acutely agitated paranoid client diagnosed with schizophrenia spectrum disorder? 1. Provide neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

ANS: 4 Rationale: The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident (CVA)." 4. "These clients experience the symptoms of tachycardia, dysphagia, and diaphoresis."

ANS: 2 Rationale: The nursing instructor should evaluate that learning has occurred when the student knows that clients with phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response. Even though the disorder is relatively common among the general population, people seldom seek treatment unless the phobia interferes with ability to function.

A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that learning has occurred? 1. Onset of symptoms most commonly occurs in early adolescence and persists until midlife. 2. Onset of symptoms most commonly occurs in the 20s and 30s and persists for many years. 3. Onset of symptoms most commonly occurs in the 40s and 50s and persists until death. 4. Onset of symptoms most commonly occurs after the age of 60 and persists for at least 6 years.

ANS: 2 Rationale: The onset of the symptoms of agoraphobia most commonly occurs in the 20s and 30s and persists for many years

A client has been assigned an admission diagnosis of brief psychotic disorder. Which assessment information would alert the nurse to question this diagnosis? 1. The client has experienced impaired reality testing for a 24-hour period. 2. The client has experienced auditory hallucinations for the past 3 hours. 3. The client has experienced bizarre behavior for 1 day. 4. The client has experienced confusion for 3 weeks.

ANS: 2 Rationale: This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month.

A nurse is discussing treatment options with a client whose life has been negatively impacted by claustrophobia. Which of the following commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Assertiveness training 5. Aversion therapy

ANS: 2, 3 Rationale: The nurse should explain to the client that systematic desensitization and imploding are the most common behavioral therapies used for treating phobias. Systematic desensitization involves the gradual exposure of the client to anxiety-provoking stimuli. Imploding is the intervention used in which the client is exposed to extremely frightening stimuli for prolonged periods of time

Which nursing statement to a client about social anxiety disorder versus schizoid personality disorder (SPD) is most accurate? 1. "Clients diagnosed with social anxiety disorder can manage anxiety without medications, whereas clients diagnosed with SPD can only manage anxiety with medications." 2. "Clients diagnosed with SPD are distressed by the symptoms experienced in social settings, whereas clients diagnosed with social anxiety disorder are not." 3. "Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life." 4. "Clients diagnosed with SPD avoid interactions only in social settings, whereas clients diagnosed with social anxiety disorder tend to avoid interactions in all areas of life."

ANS: 3 Rationale: Clients diagnosed with social anxiety disorder avoid interactions only in social settings, whereas clients diagnosed with SPD avoid interactions in all areas of life. Social anxiety disorder is an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others.

A nurse is assessing a client diagnosed with substance induced psychotic disorder (SIPD). What would differentiate this client's symptoms from the symptoms of a client diagnosed with brief psychotic disorder (BPD)? 1. Clients diagnosed with SIPD experience delusions, whereas clients diagnosed with BPD do not. 2. Clients diagnosed with BPD experience hallucinations, whereas clients diagnosed with SIPD do not. 3. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features. 4. Catatonic features may be associated with BPD, whereas SIPD has no catatonic features.

ANS: 3 Rationale: The diagnosis of SIPD is made when symptoms are directly attributable to substance intoxication or withdrawal. The symptoms are more excessive and more severe than those usually associated with the intoxication or withdrawal syndrome. Hallucinations and delusions are associated with both SIPD and BPD. Catatonic features may be associated with SIPD, whereas BPD has no catatonic features.

A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "The voices must sound scary, but the devil is not talking to you. This is part of your illness." 4. "The devil only talks to people who are receptive to his influence."

ANS: 3 Rationale: The most appropriate nursing response is to reassure the client while not reinforcing the hallucination. Reminding the client that "the voices" are a part of the illness is a way to help the client accept that the hallucinations are not real. It is also important for the nurse to connect with the client's fears and inner feelings.

Parents ask a nurse how they should reply when their child, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which is the appropriate nursing response? 1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."

ANS: 3 Rationale: The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception.

28. An elderly person presents with symptoms of delirium. The family reports, "Everything was fine until yesterday." What is the most important assessment information for the nurse to gather? a. A list of all medications the person currently takes b. Whether the person has experienced any recent losses c. Whether the person has ingested aged or fermented foods d. The person's recent personality characteristics and changes

ANS: A Delirium is often the result of medication interactions or toxicity. The distracters relate to MAOI therapy and depression.

An aging client diagnosed with schizophrenia spectrum disorder takes an antipsychotic and a beta-adrenergic blocking agent for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

ANS: 3 Rationale: The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension

A client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a Trendelenburg position. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

ANS: 3 Rationale: The nurse can meet this client's physiological need by having the client breathe into a paper bag. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the client to breathe into a small paper bag held over the mouth and nose. Six to twelve natural breaths should be taken, alternating with short periods of diaphragmatic breathing.

A paranoid client diagnosed with schizophrenia spectrum disorder states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? 1. Magical thinking; administer an antipsychotic medication. 2. Persecutory delusions; orient the client to reality. 3. Command hallucinations; warn the psychiatrist. 4. Altered thought processes; call an emergency treatment team meeting

ANS: 3 Rationale: The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. Clients demonstrating a risk for violence could potentially be physically, emotionally, and/or sexually harmful to others or to self.

A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. A psychiatric nurse practitioner decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: 3 Rationale: The nurse should explain to the client that when participating in systematic desensitization he or she will go through a series of increasingly anxiety-provoking steps that will gradually increase tolerance. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with citalopram (Celexa) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

ANS: 3 Rationale: The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be included in the nurse's teaching? 1. The side effects of medications 2. Deep breathing techniques to decrease stress 3. How to make eye contact when communicating 4. How to be a leader

ANS: 3 Rationale: The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients to communicate needs and to establish relationships.

A client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill the president. Which is the priority nursing diagnosis for this client? 1. Disturbed sensory perception 2. Altered thought processes 3. Risk for violence: directed toward others 4. Risk for injury

ANS: 3 Rationale: The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

A client is diagnosed with schizophrenia spectrum disorder. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Restlessness and muscle rigidity 4. Reports of hearing disturbing voices

ANS: 3 Rationale: The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

A client diagnosed with schizophrenia spectrum disorder takes an antipsychotic agent daily. Which assessment finding should a nurse prioritize? 1. Respirations of 22 beats/minute 2. Weight gain of 8 pounds in 2 months 3. Temperature of 104F (40C) 4. Excessive salivation

ANS: 3 Rationale: When assessing a client diagnosed with schizophrenia spectrum disorder who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high may indicate neuroleptic malignant syndrome, a life-threatening side effect of antipsychotic medications.

A nurse is assessing a client diagnosed with schizophrenia spectrum disorder. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Thought insertion 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

ANS: 4 Rationale: The nurse is assessing for the potential symptom of delusions of reference. A client that believes he or she receives messages through the radio is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward him- or herself.

A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

ANS: 4 Rationale: The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors. Attempting to distract the client, seeking medication increase, and locking the client's room are not appropriate interventions, because they do not help the client gain insight.

A 60-year-old client diagnosed with schizophrenia spectrum disorder presents in an ED with uncontrollable tongue movements, stiff neck, and difficulty swallowing. Which medical diagnosis and treatment should a nurse anticipate when planning care for this client? 1. Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications 2. Agranulocytosis treated by administration of clozapine (Clozaril) 3. Extrapyramidal symptoms treated by administration of benztropine (Cogentin) 4. Tardive dyskinesia treated by discontinuing antipsychotic medications

ANS: 4 Rationale: The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medication. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be a side effect of typical antipsychotic medications.

A client diagnosed with an obsessive-compulsive disorder spends hours bathing and grooming. During a one-on-one interaction, the client discusses the rituals in detail but avoids any feelings that the rituals generate. Which defense mechanism should the nurse identify? 1. Sublimation 2. Dissociation 3. Rationalization 4. Intellectualization

ANS: 4 Rationale: The nurse should identify that the client is using the defense mechanism of intellectualization when discussing the rituals of obsessive-compulsive disorder in detail while avoiding discussion of feelings. Intellectualization is an attempt to avoid expressing emotions associated with a stressful situation by using the intellectual process of logic, reasoning, and analysis.

During an admission assessment, a nurse assesses that a client diagnosed with schizophrenia spectrum disorder has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? 1. Haloperidol (Haldol), because it is used only in older patients 2. Clozapine (Clozaril), because it is incompatible with desipramine 3. Risperidone (Risperdal), because it exacerbates symptoms of depression 4. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

ANS: 4 Rationale: The nurse should know that thioridazine would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine and thioridazine are both classified as phenothiazines

What symptoms should a nurse recognize that differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Hyperventilation is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is commonly seen in panic disorder and absent in GAD.

ANS: 4 Rationale: The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety

ANS: 4 Rationale: The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror

6. A patient diagnosed with delirium is experiencing perceptual alterations. Which environmental adjustment should the nurse make for this patient? a. Provide a well-lit room without glare or shadows. Limit noise and stimulation. b. Maintain soft lighting day and night. Keep a radio on low volume continuously. c. Light the room brightly day and night. Awaken the patient hourly to assess mental status. d. Keep the patient by the nurse's desk while awake. Provide rest periods in a room with a television on.

ANS: A A quiet, shadow-free room offers an environment that produces the fewest sensory perceptual distortions for a patient with cognitive impairment associated with delirium. The other options have the potential to produce increased perceptual alterations.

1. An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of: a. delirium. b. dementia c. amnestic syndrome. d. Alzheimer's disease.

ANS: A Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. The onset of dementia or Alzheimer's disease, a type of dementia, is more insidious. Amnestic syndrome involves memory impairment without other cognitive problems.

25. An older adult is prescribed digoxin (Lanoxin) and hydrochlorothiazide daily as well as lorazepam (Ativan) as needed for anxiety. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. What is the most likely reason for the patient's change in mental status? a. Drug actions and interactions b. Benzodiazepine withdrawal c. Hypotensive episodes d. Renal failure

ANS: A Drug actions and interactions are common among elderly persons and predispose this population to delirium. Delirium is characterized by an abrupt onset of fluctuating levels of awareness, clouded consciousness, perceptual disturbances, and disturbed memory and orientation. The patient takes lorazepam on a PRN basis, so withdrawal is unlikely. Hypotensive episodes or problems with renal function may occur associated with the patient's drug regime, but interactions are more likely the problem.

16. An older adult patient in the intensive care unit has visual and auditory illusions. Which intervention will be most helpful? a. Using the patient's glasses and hearing aids b. Placing personally meaningful objects in view c. Placing large clocks and calendars on the wall d. Assuring that the room is brightly lit but very quiet at all times

ANS: A Illusions are sensory misperceptions. Glasses and hearing aids help clarify sensory perceptions. Without glasses, clocks, calendars, and personal objects are meaningless. Round-the-clock lighting promotes sensory overload and sensory perceptual alterations.

14. A patient has progressive memory deficits associated with dementia. Which nursing intervention would best help the individual function in the environment? a. Assist the patient to perform simple tasks by giving step-by-step directions. b. Reduce frustration by performing activities of daily living for the patient. c. Stimulate intellectual function by discussing new topics with the patient. d. Read one story from the newspaper to the patient every day.

ANS: A Patients with cognitive impairment should perform all tasks of which they are capable. When simple directions are given in a systematic fashion, the patient is better able to process information and perform simple tasks. Stimulating intellectual functioning by discussing new topics is likely to prove frustrating for the patient. Patients with cognitive deficits may enjoy the attention of someone reading to them, but this activity does not promote their function in the environment.

26. A hospitalized patient diagnosed with delirium misinterprets reality, while a patient diagnosed with dementia wanders about the home. Which outcome is the priority in both scenarios? The patients will: a. remain safe in the environment. b. participate actively in self-care. c. communicate verbally. d. acknowledge reality.

ANS: A Risk for injury is the nurse's priority concern. Safety maintenance is the desired outcome. The other outcomes are lower priorities and may not be realistic.

20. Goals of care for an older adult patient diagnosed with delirium caused by fever and dehydration will focus on: a. returning to premorbid levels of function. b. identifying stressors negatively affecting self. c. demonstrating motor responses to noxious stimuli. d. exerting control over responses to perceptual distortions.

ANS: A The desired overall goal is that the delirious patient will return to the level of functioning held before the development of delirium. Demonstrating motor response to noxious stimuli is an indicator appropriate for a patient whose arousal is compromised. Identifying stressors that negatively affect the self is too nonspecific to be useful for a patient with delirium. Exerting control over responses to perceptual distortions is an unrealistic indicator for a patient with sensorium problems related to delirium.

21. An older adult with moderately severe dementia forgets where the bathroom is and has episodes of incontinence. Which intervention should the nurse suggest to the patient's family? a. Label the bathroom door. b. Take the older adult to the bathroom hourly. c. Place the older adult in disposable adult briefs. d. Limit the intake of oral fluids to 1000 ml per day.

ANS: A The patient with moderately severe dementia has memory loss that begins to interfere with activities. This patient may be able to use environmental cues such as labels on doors to compensate for memory loss. Regular toileting may be helpful, but a 2-hour schedule is often more reasonable. Placing the patient in disposable briefs is more appropriate at a later stage. Severely limiting oral fluid intake would predispose the patient to a urinary tract infection

4. What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations? a. Risk for injury related to altered cerebral function, fluctuating levels of consciousness, disturbed orientation, and misperception of the environment b. Bathing/hygiene self-care deficit related to cerebral dysfunction, as evidenced by confusion and inability to perform personal hygiene tasks c. Disturbed thought processes related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations d. Fear related to sensory perceptual alterations as evidenced by visual and tactile hallucinations

ANS: A The physical safety of the patient is of highest priority among the diagnoses given. Many opportunities for injury exist when a patient misperceives the environment as distorted, threatening, or harmful or when the patient exercises poor judgment or when the patient's sensorium is clouded. The other diagnoses may be concerns, but are lower priorities.

For the client whose nursing diagnosis is powerlessness related to an inability to control compulsive cleaning, the nurse must understand that the client uses the cleaning to a. temporarily reduce anxiety. b. gain a feeling of superiority. c. receive praise from friends and family. d. ensure the health of household members.

ANS: A The primary gain achieved from the client's use of these rituals is anxiety relief. Unfortunately, the anxiety relief is short lived and the client must frequently repeat the ritual. The other options are not related to the dynamics of compulsive behavior.

A nurse has been counseling a client with generalized anxiety disorder to increase the client's anxiety self-control. The client has identified several stressful situations that cause physical and psychological manifestations of anxiety. The indicator the nurse should monitor relative to the Nursing Outcomes Classification outcome of anxiety self-control is a. plans coping strategies for stressful situations. b. identifies situations that precipitate hostility. c. refrains from destroying property. d. identifies alternatives to aggression.

ANS: A This indicator is directly related to having identified situations that precipitate anxiety. The other options are indicators of aggression self-control.

A client who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse "I know it's probably crazy, but I just can't bring myself to leave my apartment alone." An appropriate nursing intervention for the nurse to include in the nursing care plan is to a. teach the client to use positive self-talk. b. assist the client to apply for disability benefits. c. reinforce the irrationality of the client's fears. d. advise the client to accept the situation and use a companion.

ANS: A This intervention, a form of cognitive restructuring, replaces negative thoughts such as "I can't leave my apartment" with positive thoughts such as "I can control my anxiety." This technique helps the client gain mastery over his symptoms. The other options reinforce the sick role.

12. Consider these diagnostic findings: apolipoprotein E (apoE) malfunction, neurofibrillary tangles, neuronal degeneration in the hippocampus, and brain atrophy. Which health problem corresponds to these diagnostic findings? a. Huntington's disease b. Alzheimer's Disease c. Parkinson's disease d. Vascular dementia

ANS: B All of the options relate to dementias; however, the pathophysiological phenomena described apply to Alzheimer's disease. Parkinson's disease is associated with dopamine dysregulation. Huntington's disease is genetic. Vascular dementia is the consequence of circulatory changes.

5. What is the priority intervention for a patient diagnosed with delirium who has fluctuating levels of consciousness, disturbed orientation, and perceptual alterations? a. Distraction using sensory stimulation b. Careful observation and supervision c. Avoidance of physical contact d. Activation of the bed alarm

ANS: B Careful observation and supervision are of ultimate importance because an appropriate outcome would be that the patient will remain safe and free from injury. Physical contact during care cannot be avoided. Activating a bed alarm is only one aspect of providing for the patient's safety.

18. During morning care, a nurse asks a patient diagnosed with dementia, "How was your night?" The patient replies, "It was lovely. I went out to dinner and a movie with my friend." Which term applies to the patient's response? a. Sundown syndrome b. Confabulation c. Perseveration d. Delirium

ANS: B Confabulation refers to making up of stories or answers to questions by a person who does not remember. It is a defensive tactic to protect self-esteem and prevent others from noticing memory loss. The patient's response was not sundown syndrome. Perseveration refers to repeating a word or phrase over and over. Delirium is not present in this scenario.

13. A patient with stage 3 Alzheimer's disease tires easily and prefers to stay home rather than attend social activities. The spouse does the grocery shopping because the patient cannot remember what to buy. Which nursing diagnosis applies at this time? a. Self-care deficit b. Impaired memory c. Caregiver role strain d. Adult failure to thrive

ANS: B Memory impairment begins at stage 2 and progresses in stage 3. This patient is able to perform most self-care activities. Caregiver role strain and adult failure to thrive occur later.

19. A nurse counsels the family of a patient diagnosed with Alzheimer's disease who lives at home and wanders at night. Which action is most important for the nurse to recommend to enhance safety? a. Apply a medical alert bracelet to the patient. b. Place locks at the tops of doors. c. Discourage daytime napping. d. Obtain a bed with side rails.

ANS: B Placing door locks at the top of the door makes it more difficult for the patient with dementia to unlock the door because the ability to look up and reach upward is diminished. The patient will try to climb over side rails, increasing the risk for injury and falls. Avoiding daytime naps may improve the patient's sleep pattern but does not assure safety. A medical alert bracelet will be helpful if the patient leaves the home, but it does not prevent wandering or assure the patient's safety.

23. A patient with severe dementia no longer recognizes family members and becomes anxious and agitated when they attempt reorientation. Which alternative could the nurse suggest to the family members? a. Wear large name tags. b. Focus interaction on familiar topics. c. Frequently repeat the reorientation strategies. d. Place large clocks and calendars strategically.

ANS: B Reorientation may seem like arguing to a patient with cognitive deficit and increases the patient's anxiety. Validating, talking with the patient about familiar, meaningful things, and reminiscing give meaning to existence both for the patient and family members. The option that suggests using validating techniques when communicating is the only option that addresses an interactional strategy. Wearing large name tags and placing large clocks and calendars strategically are reorientation strategies. Frequently repeating the reorientation strategies is inadvisable because patients with dementia sometimes become more agitated with reorientation.

The nurse has a client who checks and rechecks her home in response to an obsessive thought that her house will burn down. The nurse and client explore the likelihood that the house will actually burn. The client states this event is not likely. This counseling demonstrates principles of a. desensitization. b. cognitive restructuring. c. relaxation technique. d. flooding.

ANS: B Cognitive restructuring involves the client in testing automatic thoughts and drawing new conclusions. Option A: Desensitization involves graduated exposure to a feared object. Option C: Relaxation training teaches the client to produce the opposite of the stress response. Option D: Flooding exposes the client to a large amount of an undesirable stimulus in an effort to extinguish the anxiety response.

Two forms of therapy that call for the nurse to plan for an initial rise in client anxiety level are a. relaxation training and meditation. b. flooding and response prevention. c. anxiolytic therapy and ß-blocker use. d. modeling and cognitive restructuring.

ANS: B Flooding introduces a phobic client to the feared stimulus in continual large doses, and response prevention requires a client with obsessive-compulsive disorder to avoid performing the ritual that relieves anxiety. Both cause an initial rise in anxiety before the anxiety level is reduced. The goal of options A and C is anxiety reduction without initial anxiety increase. Option D: Modeling will not cause an initial rise in anxiety, and cognitive restructuring is performed in a nonthreatening way.

A client with generalized anxiety disorder and depression comes to the anxiety disorders clinic displaying severe anxiety. Of the medications listed in the client's medical record, which one, with an appropriate order, can be given as a prn anxiolytic? a. Buspirone (BuSpar) b. Lorazepam (Ativan) c. Phenytoin (Dilantin) d. Fluoxetine (Paxil)

ANS: B Lorazepam is a benzodiazepine used to treat anxiety. It may be given as a prn medication. Option A: Buspirone has a long action and is not useful as a prn drug. Option C: Phenytoin is an anticonvulsant. Option D: Fluoxetine is a selective serotonin reuptake inhibitor used to treat the client's depression.

A nurse is counseling a client with an anxiety disorder by using cognitive therapy strategies. She gives the client a homework assignment to keep a diary in which he records the symptoms of anxiety he experiences and the events that transpired just before the onset of symptoms. The rationale for this strategy is a. to keep the client intellectually occupied to prevent dwelling on physiologic phenomena. b. to link symptoms with precipitating events, which provides a basis for discussion and reframing. c. that anxiety gives rise to automatic, negative cognitions that must be analyzed. d. that antecedent events have less to do with the anxiety onset than internal events.

ANS: B Reframing is necessary for change. It permits the client to see situations in a new way and move away from the use of automatic, negative thinking. The other options are not reasonable explanations of the use of a diary to support cognitive reframing.

For the client with compulsive hand washing, which outcome indicator can be used to evaluate that social interaction is occurring? The client a. asks for anxiolytic medication when anxiety increases. b. spends time talking to staff and clients in the lounge area. c. decreases the amount of time spent hand washing. d. sleeps 7 to 8 hours nightly.

ANS: B The behavior that indicates improved social interaction is spending more time interacting with others. The other indicators are desirable but not related to improved social interaction.

A client believes doorknobs are "filthy" with bacteria, and he must clean each knob three times before he can touch it or must use a paper towel to avoid putting his fingers in contact with the knob. The nurse must make the assessment that this behavior serves the purpose of reducing a. sexual ideation. b. anxiety. c. guilt. d. hallucinations.

ANS: B The client's behavior is termed a compulsion. Compulsions serve the purpose of temporarily relieving anxiety. Option A: Obsessions may involve sexual ideation, but the purpose of compulsions is to relieve anxiety. Option C: Guilt may be obsessive in nature, but compulsive behavior serves the purpose of relieving anxiety. Option D: Compulsive does not reduce hallucinations.

2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, "Bugs are crawling on my legs. Get them off!" Which problem is the patient experiencing? a. Aphasia b. dystonia c. Tactile hallucinations d. Mnemonic disturbance

ANS: C The patient feels bugs crawling on both legs, even though no sensory stimulus is actually present. This description meets the definition of a hallucination, a false sensory perception. Tactile hallucinations may be part of the symptom constellation of delirium. Aphasia refers to a speech disorder. Dystonia refers to excessive muscle tonus. Mnemonic disturbance is associated with dementia rather than delirium.

A client tells the nurse that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nurse's reply should be based on the knowledge that buspirone a. can be administered prn. b. does not predispose the client to blood dyscrasias. c. is not habituating. d. is faster acting.

ANS: C Buspirone is considered effective in the long-term management of anxiety because it is not habituating. Options A and D: Because it is long acting, it is not valuable as a prn medication or a fast-acting medication. Option B: This fact is of lesser relevance in the decision to prescribe buspirone.

When the nurse diagnoses that a client is experiencing panic-level anxiety, an intervention that should be immediately implemented is to a. teach relaxation techniques. b. administer anxiolytic medication. c. provide calm, brief, directive communication. d. gather a show of force in preparation for physical control.

ANS: C Calm, brief, directive verbal interaction can help the client gain control of overwhelming feelings and impulses related to anxiety. Option A: Clients experiencing panic-level anxiety are unable to focus on reality; thus learning is virtually impossible. Option B should be considered if option C is ineffective. Option D: Although the client is disorganized, violence may not be imminent, ruling out this option until other less-restrictive measures are proven ineffective

The care plan for an engineer with agoraphobia includes increasing self-esteem with cognitive restructuring. When the client tells the nurse "I'm not smart enough to get that job," the nurse should say a. "It must be difficult to be in that position." b. "You should not demean your abilities." c. "Let's think about what you just said." d. "You seem intelligent to me."

ANS: C Cognitive restructuring calls for the client to examine automatic negative thoughts about himself and replace them with more realistic evaluations of his own abilities. The other options would not promote examination of the negative thinking exhibited by the client.

For planning purposes, the nurse caring for a client with a social phobia should know that an effective treatment for this disorder is a. analysis. b. thought stopping. c. cognitive therapy. d. response prevention.

ANS: C Cognitive therapy assists the client to identify automatic, negative beliefs that cause anxiety, reevaluate the situation, and replace negative self-talk with supportive ideas. Option A: Analysis is expensive, requires years of commitment, and may not be effective. Options B and D: Thought stopping and response prevention are more useful to treat obsessive-compulsive disorder.

When the psychiatrist prescribes alprazolam (Xanax) for the acute anxiety experienced by a client with agoraphobia, health teaching should include instructions to a. eat a tyramine-free diet. b. report drowsiness. c. avoid alcoholic beverages. d. adjust dose and frequency of ingestion based on anxiety level.

ANS: C Drinking alcohol or taking other anxiolytics along with the prescribed benzodiazepine should be avoided because depressant effects of both drugs will be potentiated. Option A: Tyramine-free diets are necessary only with monoamine oxidase inhibitors. Option B: Drowsiness is an expected effect and needs to be reported only if it is excessive. Option D: Clients should be taught not to deviate from the prescribed dose and schedule for administration

The psychiatric home care nurse visits a client who tells the nurse that he experiences palpitations, difficulty breathing, and a sense of overwhelming dread whenever he leaves his home. This problem began after he was robbed on his way to work. He has been unable to go to his office for more than a month. The nurse recognizes this problem as a. mysophobia. b. claustrophobia. c. acrophobia. d. agoraphobia.

ANS: D Agoraphobia refers to the client's fear of open spaces. Option A: Mysophobia refers to fear of dirt or germs. Option B: Claustrophobia refers to fear of closed spaces. Option C: Acrophobia refers to fear of heights.

An assessment question that would be highly appropriate to ask a client with possible generalized anxiety disorder would be a. "Have you been a victim of a crime or seen someone badly injured or killed?" b. "Do you feel especially uncomfortable in social situations involving people?" c. "Do you repeatedly do certain things over and over again?" d. "Do you find it difficult to control your worrying?"

ANS: D Clients with generalized anxiety disorder frequently engage in excessive worrying. They are less likely to engage in ritualistic behavior, fear social situations, or have been involved in a highly traumatic event.

A veteran of the Gulf War has intrusive thoughts of missiles screaming toward her and exploding. She re-experiences feelings of terror first experienced in combat. These recurrent events are part of a. obsessive-compulsive disorder. b. generalized anxiety disorder. c. panic disorder with agoraphobia. d. posttraumatic stress disorder.

ANS: D DSM-IV-TR criteria mention re-experiencing the traumatic event as consistent with posttraumatic stress disorder. These symptoms are not part of the clinical manifestations of obsessive-compulsive disorder, generalized anxiety disorder, or agoraphobia.

A client with moderate to severe anxiety associated with generalized anxiety disorder can be assessed as successfully lowering her anxiety level to mild when she a. asks "What's the matter with me?" b. stays in her room and paces. c. states she is uninterested in eating. d. can concentrate on what the nurse is saying.

ANS: D The ability to concentrate and attend to reality is increased slightly in mild anxiety and decreased in moderate, severe, and panic-level anxiety. Option A: Clients with high levels of anxiety often ask this question. Option B: This behavior suggests moderate anxiety. Option C is not necessarily a criterion for evaluation of anxiety

Which statement made by a client who has agoraphobia and does not leave her home identifies the thinking typical of a client with this disorder? a. "I know I'll get over not wanting to leave home soon; it just takes time." b. "When I have a good incentive to go out, I'll be able to do it." c. "My husband and kids tell me they like it now that I stay home." d. "Being afraid to go out seems ridiculous, but I can't go out the door."

ANS: D The individual who is agoraphobic generally acknowledges that the behavior is not constructive and that he or she does not really like it. The symptom is ego dystonic. However, the client will state he or she is unable to change the behavior. Options A and B: Agoraphobics are not optimistic about change. Option C: Most families are dissatisfied with the behavior.

. ___________________________ disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania).

ANS: Schizoaffective Rationale: Schizoaffective disorder is manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania). The decisive factor in the diagnosis of schizoaffective disorder is the presence of hallucinations and/or delusions that occur for at least 2 weeks in the absence of a major mood episode.

26. Order the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe. ________ Delusional disorder ________ Schizotypal personality disorder ________ Schizophrenia ________ Brief psychotic disorder ________ Psychotic disorder associated with another medical condition ________ Catatonic disorder associated with another medical condition ________ Schizoaffective disorder ________ Schizophreniform disorder ________ Substance-induced psychotic disorder

ANS: The correct order is 2, 1, 9, 3, 5, 6, 8, 7, 4 Rationale: A spectrum of schizophrenic and other psychotic disorders has been identified in the DSM-5. These include (on a gradient of psychopathology from least to most severe): schizotypal personality disorder, delusional disorder, brief psychotic disorder, substance-induced psychotic disorder, psychotic disorder associated with another medical condition, catatonic disorder associated with another medical condition, schizophreniform disorder, schizoaffective disorder, and schizophrenia. 1. Schizotypal personality disorder 2. Delusional disorder 3. Brief psychotic disorder 4. Substance-induced psychotic disorder 5. Psychotic disorder associated with another medical condition 6. Catatonic disorder associated with another medical condition 7. Schizophreniform disorder 8. Schizoaffective disorder 9. Schizophrenia

The most common hallucination is;

Auditory

Client Needs: Psychosocial Integrity 21. A patient diagnosed with depression repeatedly tells staff, "I have cancer. It's my punishment for being a bad person." Diagnostic tests reveal no cancer. Select the priority nursing diagnosis. a. Powerlessness c. Stress overload b. Risk for suicide d. Spiritual distress

B A patient diagnosed with depression who feels so worthless as to believe cancer is deserved is at risk for suicide. Safety concerns take priority over the other diagnoses listed. PTS: 1 DIF: Cognitive Level: Analyze (Analysis) REF: Page 255 | Page 256 (Case Study and Nursing Care Plan 14-1) | Page 260 TOP: Nursing Process: Diagnosis/Analysis

Client Needs: Psychosocial Integrity 7. A patient says to the nurse, "My life doesn't have any happiness in it anymore. I once enjoyed holidays, but now they're just another day." The nurse documents this report as an example of: a. dysthymia. c. euphoria. b. anhedonia. d. anergia.

B Anhedonia is a common finding in many types of depression. It refers to feelings of a loss of pleasure in formerly pleasurable activities. Dysthymia is a diagnosis. Euphoria refers to an elated mood. Anergia means "without energy." PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 250 | Page 264 TOP: Nursing Process: Assessment

Client Needs: Psychosocial Integrity 5. Priority interventions for a patient diagnosed with major depression and feelings of worthlessness should include: a. distracting the patient from self-absorption. b. careful unobtrusive observation around the clock. c. allowing the patient to spend long periods alone in meditation. d. opportunities to assume a leadership role in the therapeutic milieu.

B Approximately two-thirds of people with depression contemplate suicide. Patients with depression who exhibit feelings of worthlessness are at higher risk. Regular planned observations of the patient diagnosed with depression may prevent a suicide attempt on the unit. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 263 (Table 14-3) | Page 256 (Case Study and Nursing Care Plan 14-1) TOP: Nursing Process: Planning

Client Needs: Physiological Integrity 10. A patient diagnosed with major depression tells the nurse, "Bad things that happen are always my fault." Which response by the nurse will best assist the patient to reframe this overgeneralization? a. "I really doubt that one person can be blamed for all the bad things that happen." b. "Let's look at one bad thing that happened to see if another explanation exists." c. "You are being extremely hard on yourself. Try to have a positive focus." d. "Are you saying that you don't have any good things happen?"

B By questioning a faulty assumption, the nurse can help the patient look at the premise more objectively and reframe it as a more accurate representation of fact. The incorrect responses cast doubt but do not require the patient to evaluate the statement. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 263 (Table 14-4) TOP: Nursing Process: Implementation

Client Needs: Physiological Integrity 14. What is the focus of priority nursing interventions for the period immediately after electroconvulsive therapy treatment? a. Nutrition and hydration b. Supporting physiological stability c. Reducing disorientation and confusion d. Assisting the patient to identify and test negative thoughts

B During the immediate post-treatment period, the patient is recovering from general anesthesia; hence, the priority need is to establish and support physiological stability. Reducing disorientation and confusion is an acceptable intervention but not the priority. Assisting the patient in identifying and testing negative thoughts is inappropriate in the immediate post-treatment period because the patient may be confused. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 271-272 TOP: Nursing Process: Planning

Client Needs: Physiological Integrity 23. During a psychiatric assessment, the nurse observes a patient's facial expression is without emotion. The patient says, "Life feels so hopeless to me. I've been feeling sad for several months." How will the nurse document the patient's affect and mood? a. Affect depressed; mood flat c. Affect labile; mood euphoric b. Affect flat; mood depressed d. Affect and mood are incongruent.

B Mood refers to a person's self-reported emotional feeling state. Affect is the emotional feeling state that is outwardly observable by others. When there is no evidence of emotion in a person's expression, the affect is flat. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 257-258 TOP: Nursing Process: Assessment

Client Needs: Health Promotion and Maintenance 28. A nurse instructs a patient taking a medication that inhibits the action of monoamine oxidase (MAO) to avoid certain foods and drugs because of the risk of: a. hypotensive shock. c. cardiac dysrhythmia. b. hypertensive crisis. d. cardiogenic shock.

B Patients taking MAO-inhibiting drugs must be on a tyramine-free diet to prevent hypertensive crisis. In the presence of MAOIs, tyramine is not destroyed by the liver and in high levels produces intense vasoconstriction, resulting in elevated blood pressure. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 266 (Table 14-6) | Page 268-269 | Page 270 (Table 14-8) TOP: Nursing Process: Planning

Client Needs: Physiological Integrity 13. A nurse taught a patient about a tyramine-restricted diet. Which menu selection would the nurse approve? a. Macaroni and cheese, hot dogs, banana bread, caffeinated coffee b. Mashed potatoes, ground beef patty, corn, green beans, apple pie c. Avocado salad, ham, creamed potatoes, asparagus, chocolate cake d. Noodles with cheddar cheese sauce, smoked sausage, lettuce salad, yeast rolls

B The correct answer describes a meal that contains little tyramine. Vegetables and fruits contain little or no tyramine. Fresh ground beef and apple pie are safe. The other meals contain various amounts of tyramine-rich foods or foods that contain vasopressors: avocados, ripe bananas (banana bread), sausages/hot dogs, smoked meat (ham), cheddar cheese, yeast, caffeine drinks, and chocolate. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 266-267 (Table 14?6) | Page 268-269 (Table 14-7) TOP: Nursing Process: Evaluation

Client Needs: Physiological Integrity 29. Transcranial Magnetic Stimulation (TCM) is scheduled for a patient diagnosed with major depression. Which comment by the patient indicates teaching about the procedure was effective? a. "They will put me to sleep during the procedure so I won't know what is happening." b. "I might be a little dizzy or have a mild headache after each procedure." c. "I will be unable to care for my children for about 2 months." d. "I will avoid eating foods that contain tyramine."

B Transcranial Magnetic Stimulation (TCM) treatments take about 30 minutes. Treatments are usually 5 days a week. Patients are awake and alert during the procedure. After the procedure, patients may experience a headache and lightheadedness. No neurological deficits or memory problems have been noted. The patient will be able to care for children. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 271-272 TOP: Nursing Process: Evaluation

What is an appropriate outcome for clients experiencing somatization disorders? A) Will admit to feigning physical symptoms to gain benefits such as attention or absence from role responsibilities B) Will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms C) Will comply with medical treatments for physical symptoms D) Will seek assistance from multiple care providers or specialists to decrease the burden on any given person

B) Will effectively use adaptive coping strategies during stressful situations without resorting to physical symptoms

The mental health nurse recognizes the new nurse requires more teaching when she makes this statement about panic disorder: A. " The panic attacks are manifested by intense apprehension, fear or terror, often associated with feelings of impending doom and accompanied by intense physical discomfort." B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation." C. "Some common symptoms of panic disorder are: palpitations, pounding heart, sweating and sensations of shortness of breath." D. "The average onset of panic disorder is in the late 20s."

B. "Episodes of panic attacks associated with panic disorder are predictable and often occur on exposure to an anxiety producing situation."

The nurse looks for which of the following characteristics in a client diagnosed with a personality disorder? A. Flexibility and adaptability to stress B. A tendency to evoke some form of interpersonal conflict C. A concomitant physical disorder D. A desire for interpersonal relationships

B. A tendency to evoke some form of interpersonal conflict

Client Needs: Psychosocial Integrity 27. A patient diagnosed with major depression received six electroconvulsive therapy sessions and aggressive doses of antidepressant medication. The patient owns a small business and was counseled not to make major decisions for a month. Select the correct rationale for this counseling. a. Antidepressant medications alter catecholamine levels, which impairs decision-making abilities. b. Antidepressant medications may cause confusion related to limitation of tyramine in the diet. c. Temporary memory impairments and confusion may occur with electroconvulsive therapy. d. The patient needs time to readjust to a pressured work schedule.

C Recent memory impairment and/or confusion is often present during and for a short time after electroconvulsive therapy. An inappropriate business decision might be made because of forgotten important details. The rationales are untrue statements in the incorrect responses. The patient needing time to reorient to a pressured work schedule is less relevant than the correct rationale. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 271-272 TOP: Nursing Process: Implementation

Client Needs: Psychosocial Integrity 12. A patient diagnosed with depression begins selective serotonin reuptake inhibitor (SSRI) antidepressant therapy. The nurse should provide information to the patient and family about: a. restricting sodium intake to 1 gram daily. b. minimizing exposure to bright sunlight. c. reporting increased suicidal thoughts. d. maintaining a tyramine-free diet.

C Some evidence indicates that suicidal ideation may worsen at the beginning of antidepressant therapy; thus, close monitoring is necessary. Avoiding exposure to bright sunlight and restricting sodium intake are unnecessary. Tyramine restriction is associated with monoamine oxidase inhibitor (MAOI) therapy. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 268 (Box 14-3) TOP: Nursing Process: Implementation

Client Needs: Psychosocial Integrity 18. A patient being treated for depression has taken 300 mg amitriptyline (Elavil) daily for a year. The patient calls the case manager at the clinic and says, "I stopped taking my antidepressant 2 days ago. Now I am having cold sweats, nausea, a rapid heartbeat, and nightmares." The nurse will advise the patient to: a. "Go to the nearest emergency department immediately." b. "Do not to be alarmed. Take two aspirin and drink plenty of fluids." c. "Take a dose of your antidepressant now and come to the clinic to see the health care provider." d. "Resume taking your antidepressants for 2 more weeks and then discontinue them again."

C The patient has symptoms associated with abrupt withdrawal of the tricyclic antidepressant. Taking a dose of the drug will ameliorate the symptoms. Seeing the health care provider will allow the patient to discuss the advisability of going off the medication and to be given a gradual withdrawal schedule if discontinuation is the decision. This situation is not a medical emergency, although it calls for medical advice. Resuming taking the antidepressant for 2 more weeks and then discontinuing again would produce the same symptoms the patient is experiencing. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 263 (Table 14-4) TOP: Nursing Process: Implementation

Client Needs: Physiological Integrity 16. Major depression resulted after a patient's employment was terminated. The patient now says to the nurse, "I'm not worth the time you spend with me. I am the most useless person in the world." Which nursing diagnosis applies? a. Powerlessness c. Situational low self-esteem b. Defensive coping d. Disturbed personal identity

C The patient's statements express feelings of worthlessness and most clearly relate to the nursing diagnosis of situational low self-esteem. Insufficient information exists to lead to other diagnoses. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 250-251 | Page 256 (Case Study and Nursing Care Plan 14-1) | Page 259 TOP: Nursing Process: Diagnosis/Analysis

A nurse is performing a thorough health history on a client suspected of having hypochondriasis. Which information, elicited by the nurse, should enable a physician to distinguish between hypochondriasis and somatization disorder? A) Pain B) Gender distribution C) Persistent fear D) Impaired functioning

C) Persistent fear

Which psychodynamic theory describes the underlying symptoms of conversion disorder? A) Relief from despair B) Repression of anger C) Unconscious resolution of internal conflicts D) Cognitive deficit

C) Unconscious resolution of internal conflicts

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

C. The client will perceive an ideal body weight and shape as normal.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

C. The home environment is overprotective and demands perfection.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

C. The nurse who refuses to engage in power struggles related to food consumption

Client Needs: Psychosocial Integrity 11. A nurse worked with a patient diagnosed with major depression, severe withdrawal, and psychomotor retardation. After 3 weeks, the patient did not improve. The nurse is most at risk for feelings of: a. guilt and despair. c. interest and pleasure. b. over-involvement. d. ineffectiveness and frustration.

D Nurses may have expectations for self and patients that are not wholly realistic, especially regarding the patient's progress toward health. Unmet expectations result in feelings of ineffectiveness, anger, or frustration. Nurses rarely become over-involved with patients with depression because of the patient's resistance. Guilt and despair might be seen when the nurse experiences the patient's feelings because of empathy. Interest is possible, but not the most likely result. PTS: 1 DIF: Cognitive Level: Understand (Comprehension) REF: Page 260-261 TOP: Nursing Process: Evaluation

Client Needs: Physiological Integrity 15. A nurse provided medication education for a patient diagnosed with major depression who began a new prescription for phenelzine (Nardil). Which behavior indicates effective learning? The patient: a. monitors sodium intake and weight daily. b. wears support stockings and elevates the legs when sitting. c. can identify foods with high selenium content that should be avoided. d. confers with a pharmacist when selecting over-the-counter medications.

D Over-the-counter medicines may contain vasopressor agents or tyramine, a substance that must be avoided when the patient takes MAOI antidepressants. Medications for colds, allergies, or congestion or any preparation that contains ephedrine or phenylpropanolamine may precipitate a hypertensive crisis. MAOI antidepressant therapy is unrelated to the need for sodium limitation, support stockings, or leg elevation. MAOIs interact with tyramine-containing foods, not selenium, to produce dangerously high blood pressure. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 266-267 (Table 14-6) | Page 268-269 (Table 14-7) TOP: Nursing Process: Evaluation

Chapter 14: Depressive Disorders MULTIPLE CHOICE 1. A patient became severely depressed when the last of the family's six children moved out of the home 4 months ago. The patient repeatedly says, "No one cares about me. I'm not worth anything." Which response by the nurse would be the most helpful? a. "Things will look brighter soon. Everyone feels down once in a while." b. "Our staff members care about you and want to try to help you get better." c. "It is difficult for others to care about you when you repeatedly say the same negative things." d. "I'll sit with you for 10 minutes now and 10 minutes after lunch to help you feel that I care about you."

D Spending time with the patient at intervals throughout the day shows acceptance by the nurse and will help the patient establish a relationship with the nurse. The therapeutic technique is "offering self." Setting definite times for the therapeutic contacts and keeping the appointments show predictability on the part of the nurse, an element that fosters trust building. The incorrect responses would be difficult for a person with profound depression to believe, provide false reassurance, and are counterproductive. The patient is unable to say positive things at this point. PTS: 1 DIF: Cognitive Level: Apply (Application) REF: Page 263 (Table 14-4) | Page 256 (Case Study and Nursing Care Plan 14-1) TOP: Nursing Process: Implementation

When working with a client with a somatization disorder, which is the most appropriate nursing intervention? A) Avoiding discussion of physical symptoms B) Allowing the client to freely explore the meaning of the physical symptoms C) Confronting the client on the validity of the physical symptoms D) Gradually limiting the focus on physical symptoms

D) Gradually limiting the focus on physical symptoms

A psychiatric nurse often cares for clients with somatoform disorders. Which characteristic is common to all somatoform disorders? A) Delusions B) Pain C) Paranoia D) Physical symptoms

D) Physical symptoms

Which client statement would demonstrate a common characteristic of Cluster "B" personality disorder? A. "I wish someone would make that decision for me." B. "I built this building by using materials from outer space." C. "I'm afraid to go to group because it is crowded with people." D. "I didn't have the money for the ring, so I just took it.

D. "I didn't have the money for the ring, so I just took it.

What statement by a client would indicate that goals for treatment of her somatization disorder are being achieved? A. "I feel less anxiety that before." B. "My memory is better than it was a month ago." C. "I take my medications just as the physician prescribed." D. "I don't find myself thinking about my symptoms all the time as I used to."

D. "I don't find myself thinking about my symptoms all the time as I used to."

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

D. "I don't know why people are worried. I need to lose this weight."

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

Elaine is a 62-year-old patient who is recovering from a urinary tract infection during which she was hospitalized with delirium. She is following up with her primary care provider 4 weeks after being discharged. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess at this time? Sleeping habits Sexual functioning Symptoms of posttraumatic stress Depression and level of cognition

Depression and level of cognition Although delirium is usually a short-term condition, it may have long-term consequences. In patients with preexisting cognitive impairment, there is an acceleration of cognitive decline. Although there are reports of long-term cognitive impairment (in the absence of preexisting cognitive impairment) and functional decline following delirium, results of studies have been inconsistent. An association also exists with depression after delirium. Although a holistic examination would assess sleep, this is not the area that research has found to be problematic. A holistic examination would include sexual functioning, but it is not the priority at this time. Posttraumatic stress symptoms have been seen in younger patients who experienced delirium while hospitalized.

What statement about the comorbidity of depression is accurate? Depression most often exists in an individual as a single entity. Depression is commonly seen in individuals with medical disorders. Substance abuse and depression are seldom seen as comorbid disorders. Depression may coexist with other disorders but is rarely seen with schizophrenia.

Depression is commonly seen in individuals with medical disorders. Depression commonly accompanies medical disorders. The other options are false statements.

Interventions for Acute Mania

Depressive Episodes: hospitalization is required for suicidal ideation, psychosis, or catatonia Lithium if first line treatment (takes 7-14 days to get right level) Antidepressants are not recommended since CNS may become overactive and result in hypomania or mania Second generation antipsychotic may be added to medication if psychotic features are present Manic Episodes: Hospitalization provides safety Use calm voice use short statements remain neutral be consistent in expectations frequent staff meetings redirect energy maintain low level stimuli structured solitary activities high calorie fluids frequent rest periods redirect violent behavior use phenothiazines and seclusion to minimize physical harm observe for lithium toxicity don't let them give away money or possessions monitor intake and output and vitals finger foods remind them to eat provide warm baths, soothing music, and medication to sleep No caffeine supervise clothing choice give simple step by step reminders for hygiene and dress Monitor bowl habits

Neuroendocrine

Hypothalmic-pituitary-thyroid-adrenal axis; hypothyroidism is known to be associated with depressed mood and is seen inpatients experiencing rapid cycling treatment-resistant bipolar disorder is treated with high-dose thyroxine

The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray? Plastic plate Cloth napkin Styrofoam cup Metal utensils

Metal utensils In most health care agencies, suicidal clients receive plastic dinnerware on their meal trays.

hypo-mania

change in mood must be evident for at least 4 days lasting for 2 years in adults and 1 year in children

What is a compulsion and what is a obsession?

Obsessive-compulsive disorder: A psychiatric disorder characterized by obsessive thoughts and compulsive actions, such as cleaning, checking, counting, or hoarding. Obsessive-compulsive disorder (OCD), one of the anxiety disorders, is a potentially disabling condition that can persist throughout a person's life. The individual who suffers from OCD becomes trapped in a pattern of repetitive thoughts and behaviors that are senseless and distressing but extremely difficult to overcome. OCD occurs in a spectrum from mild to severe, but if severe and left untreated, can destroy a person's capacity to function at work, at school, or even in the home. The obsessions are unwanted ideas or impulses that repeatedly well up in the mind of the person with OCD. Persistent fears that harm may come to self or a loved one, an unreasonable concern with becoming contaminated, or an excessive need to do things correctly or perfectly, are common. Again and again, the individual experiences a disturbing thought, such as, "My hands may be contaminated--I must wash them"; "I may have left the gas on"; or "I am going to injure my child." These thoughts are intrusive, unpleasant, and produce a high degree of anxiety. Sometimes the obsessions are of a violent or a sexual nature, or concern illness. In response to their obsessions, most people with OCD resort to repetitive behaviors called compulsions. The most common of these are washing and checking. Other compulsive behaviors include counting (often while performing another compulsive action such as hand washing), repeating, hoarding, and endlessly rearranging objects in an effort to keep them in precise alignment with each other. Mental problems, such as mentally repeating phrases, listmaking, or checking are also common. These behaviors generally are intended to ward off harm to the person with OCD or others. Some people with OCD have regimented rituals while others have rituals that are complex and changing. Performing rituals may give the person with OCD some relief from anxiety, but it is only temporary.

The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? Select all that apply. 1. Patient identifies three signs and symptoms of relapse. 2. Patient states, "My wife doesn't mind if I still drink a little." 3. Patient describes the purpose of each medication he has been prescribed. 4. Patient states, "I no longer have a disease." 5. Patient identifies two ways to problem-solve a specific situation.

Patient identifies three signs and symptoms of relapse. Patient describes the purpose of each medication he has been prescribed. Patient identifies two ways to problem-solve a specific situation.

Which of the following is true regarding schizophrenia treatment and outcomes? If treated quickly following diagnosis, schizophrenia can be cured. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, "I hear voices of aliens trying to contact me." The nurse should recognize this presentation as which type of major depressive disorder (MDD)? 1. Catatonic 2. Atypical 3. Melancholic 4. Psychotic

Psychotic

What intervention can the nurse suggest when a client reports that lithium gives him an upset stomach? A. Take it with meals B. Take it with an antacid C. Take it 30 minutes before meals D. Take it 2 hours after meals

Take it with meals

dysthymia

chronic low level depression

What is it called when one's thoughts have been removed from her body/mind;

Thought withdrawal

cyclothymia

chronic mood disorder of a at least 2 year hypomania. milder form of bipolar disorder

What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L? A. Withhold medication and notify the physician B. Continue to administer medication as ordered C. Advise the client to limit fluids for 12 hours D. Advise the client to curtail salt intake for 24 hours

Withhold medication and notify the physician

what is Milieu Therapy

a scientific structuring of the environment in order to effect behavioral changes and to improve the psychological health and functioning of the individual.

transcranial magnetic stimulation (TMS)

a technique that permits scientists to temporarily enhance or depress activity in a specific area of the brain

which responses of a child to a father's untimely death represent an early stage of normal grieving? select all that apply a. The child lies in bed, banging his head against the mattress, shouting, "No, no, no!" b. The child refuses to go to school 2 weeks after his father's funeral, claiming "aches and pains all over my body." c. the child begins to obsessively attend to his game card collection and spends hours sorting and ordering cards for the first month after his father's death. d. the child repeatedly comes home from school and reports "seeing Dad" around a corner, but then "just disappears."

a, b, c, d all the answers are correct

A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? a. "I check where my car keys are eight times." b. "My legs often feel weak and spastic." c. "I'm embarrassed to go out in public." d. "I keep reliving a car accident."

a. "I check where my car keys are eight times."

6. When administering a mental status examination to a patient, the nurse suspects depression when the patient responds with a. "I don't know." b. "Is that the right answer?" c. "Wait, let me think about that." d. "Who are those people over there?

a. "I don't know." Answers such as "I don't know" are more typical of depression. The response "Who are those people over there?" is more typical of the distraction seen in a patient with delirium. The remaining two answers are more typical of a patient with dementia.

A nurse assesses a patient diagnosed with functional neurological (conversion) disorder. Which comment is most likely from this patient? a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion." b. "I have daily problems with nausea, vomiting, and diarrhea. My skin is very dry and I think I'm getting seriously dehydrated." c. "Sexual intercourse is painful. I pretend as if I'm asleep so I can avoid it. I think it's starting to cause problems with my marriage." d. "I get choked very easily and have trouble swallowing when I eat. I think I might have cancer of the esophagus."

a. "Since my father died, I've been short of breath and had sharp pains that go down my left arm, but I think it's just indigestion."

11. An 89-year-old diagnosed with dementia was until recently responding well to cognitive cueing techniques. The nurse shows an understanding of dementia when sharing with staff that: a. "We will implement new interventions that address the disease's progression." b. "It's important that we frequently re-cue the client to improve his quality of life." c. "The client's family needs to be made aware of this decline." d. "This poor response to cueing is likely a result of advanced aging."

a. "We will implement new interventions that address the disease's progression." Positive responses to selected interventions may continue for a time but may decline as the disease progresses, which results in the need to reevaluate strategies.

1. While a 78-year-old client was admitted dehydration and anorexia, the nurse assesses and documents observations that support dementia in this age cohort that includes which of the following? Select all that apply. a. Forgetting what she ate for lunch today b. Crying frequently when alone c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door e. Repeatedly asking to call her son

a. Forgetting what she ate for lunch today c. Inability to find her way back to her room from the dayroom d. Being impatient with the nursing staff for not closing her door Symptoms common to both depression and dementia include irritability, inability to concentrate or feel pleasure, loss of interest in life, and lack of energy and initiative. Individuals with dementia are more likely to show signs of disorientation and loss of short-term memory and are less likely to feel sadness or guilt or to complain about pain, insomnia, and poor appetite.

11. A patient with mild dementia has a new prescription for donepezil (Aricept). Which nursing action will be most effective in ensuring compliance with the medication? a. Having the patient's spouse administer the medication b. Setting the medications up weekly in a medication box c. Calling the patient daily with a reminder to take the medication d. Posting reminders to take the medications in the patient's house

a. Having the patient's spouse administer the medication Because the patient with mild dementia will have difficulty with learning new skills and forgetfulness, the most appropriate nursing action is to have someone else administer the drug. The other nursing actions will not be as effective in ensuring that the patient takes the medications.

A client diagnosed with Alzheimer's disease looks confused when the phone rings and cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this loss of function as apraxia. agnosia. aphasia. anhedonia.

agnosia. Agnosia is loss of the ability to recognize familiar objects.

Rosa, a 78-year-old patient with Alzheimer's disease, picks up her glasses from the bedside table but does not recognize what they are or their purpose. She is experiencing: apraxia. agnosia. aphasia. agraphia.

agnosia. Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write.

The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should allow him to use the razor under staff supervision. tell him he must use a safety razor provided by the unit. suggest that this would be a good time to grow a beard. give him the razor and ask him to return it when he is finished.

allow him to use the razor under staff supervision. Because the razor is cordless, independent use is relatively safe.

Sasha's roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, "Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?" Your response is based on the knowledge that: amitriptyline (Elavil) is very expensive, so the patient may have to buy fewer at a time. Dr. Travis is going to see how Kate responds to the first week of medication to evaluate its effectiveness. Dr. Travis wants to see whether any minor side effects occur within the first week of administration. amitriptyline (Elavil) is lethal in overdose.

amitriptyline (Elavil) is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the patient had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the patient would not be evaluated after only one week. Side effects are always a consideration but not the most important consideration with TCAs.

Clonazepam (klonopin) and lorazepam (Ativan)

antianxiety drugs useful in treatment of acute mania in some patients who resist other treatments; also help to manage psychomotor agitation seen in mania.

What are side effects of tricyclics?

anticholinergic effects

The family of a client diagnosed with Alzheimer's disease mentions to the nurse that seeing his loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be ineffective denial. anticipatory grieving. disabled family coping. ineffective family therapeutic regimen management.

anticipatory grieving. Anticipatory grieving involves working through potential loss.

A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should suggest that the client take something for her fever and get extra rest. advise the physician that the client should be admitted to the hospital. arrange for the client to have blood drawn for a white blood cell count. consider recommending a change of antipsychotic medication.

arrange for the client to have blood drawn for a white blood cell count. Antipsychotic medications may cause agranulocytosis, the first manifestation of which may be a sore throat and flulike symptoms.

A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will ask for validation of reality. describe content of hallucinations. demonstrate a cool, aloof demeanor. identify prodromal symptoms of disorder.

ask for validation of reality. Beginning to question his or her own altered perceptions by seeking input from staff is highly desirable.

When working with a client who may have made a covert reference to suicide, the nurse should be careful not to mention the idea of suicide. listen carefully to see whether the client mentions it a second time. ask about the possibility of suicidal thoughts in a covert way. ask the client directly if he or she is thinking of attempting suicide.

ask the client directly if he or she is thinking of attempting suicide. Covert references should be made overt. The nurse should directly address any suicidal hints given by the client. Self-destructive ideas are a personal decision. Talking openly about suicide leads to a decrease in isolation and can increase problem-solving alternatives for living. People who attempt suicide, even those who regret the failure of their attempt, are often extremely receptive to talking about their suicide crisis.

Which assessment questions would be most appropriate for the nurse to ask a patient with possible obsessive-compulsive disorder? Select all that apply. a. "Are there certain social situations that cause you to feel especially uncomfortable?" b. "Are there others in your family who must do things in a certain way to feel comfortable?" c. "Have you been a victim of a crime or seen someone badly injured or killed?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

b. "Are there others in your family who must do things in a certain way to feel comfortable?" d. "Is it difficult to keep certain thoughts out of your awareness?" e. "Do you do certain things over and over again?"

The nurse assesses a patient who complains of loneliness and episodes of anxiety. Which statement by the patient is mostly likely if this patient also has agoraphobia? a. "I'm sure I will get over not wanting to leave home soon. It takes time." b. "Being afraid to go out seems ridiculous, but I can't go out the door." c. "My family says they like it now that I stay home most of the time." d. "When I have a good incentive to go out, I can do it."

b. "Being afraid to go out seems ridiculous, but I can't go out the door."

A person comes to the clinic reporting, "I wear a scarf across my lower face when I go out but because of my ugly appearance." Assessment reveals an average appearance with no actual disfigurement. Which problem is most likely? a. Dissociative identity disorder b. Body dysmorphic disorder c. Pseudocyesis d. Malingering

b. Body dysmorphic disorder

A patient with a somatic symptom disorder has the nursing diagnosis: Interrupted family processes, related to patient's disabling symptoms as evidenced by spouse and children assuming roles and tasks that previously belonged to patient. An appropriate outcome is that the patient will: a. Assume roles and functions of the other family members. b. Demonstrate a resumption of former roles and tasks. c. Focus energy on problems occurring in the family. d. Rely on family members to meet his or her personal needs.

b. Demonstrate a resumption of former roles and tasks.

A patient performs ritualistic hand washing. Which action should the nurse implement to help the patient develop more effective coping? a. Allow the patient to set a hand-washing schedule. b. Encourage the patient to participate in social activities. c. Encourage the patient to discuss hand-washing routines. d. Focus on the patient's symptoms rather than on the patient.

b. Encourage the patient to participate in social activities.

A nurse wants to teach alternative coping strategies to a patient experiencing severe anxiety. Which action should the nurse perform first? a. Verify the patient's learning style. b. Lower the patient's current anxiety. c. Create outcomes and a teaching plan. d. Assess how the patient uses defense mechanisms.

b. Lower the patient's current anxiety.

12. Which intervention will the nurse include in the plan of care for a patient who has late-stage Alzheimer's disease (AD)? a. Encourage the patient to discuss events from the past. b. Maintain a consistent daily routine for the patient's care. c. Reorient the patient to the date and time every 2 to 3 hours. d. Provide the patient with current newspapers and magazines.

b. Maintain a consistent daily routine for the patient's care. Providing a consistent routine will decrease anxiety and confusion for the patient. In late-stage AD, the patient will not remember events from the past. Reorientation to time and place will not be helpful to the patient with late-stage AD, and the patient will not be able to read.

A patient with an abdominal mass is scheduled for a biopsy. The patient has difficulty understanding the nurse's comments and asks, "What do you mean? What are they going to do?" Assessment findings include tremulous voice, respirations 28, and pulse 110. What is the patient's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

b. Moderate

1. The spouse of a male patient with early stage Alzheimer's disease (AD) tells the nurse, "I am just exhausted from the constant worry. I don't know what to do." Which action is best for the nurse to take next (select all that apply)? a. Suggest that a long-term care facility be considered. b. Offer ideas for ways to distract or redirect the patient. c. Suggest that the spouse consult with the physician for antianxiety drugs. d. Educate the spouse about the availability of adult day care as a respite. e. Ask the spouse what she knows and has considered about dementia care options.

b. Offer ideas for ways to distract or redirect the patient. d. Educate the spouse about the availability of adult day care as a respite. e. Ask the spouse what she knows and has considered about dementia care options. The stress of being a caregiver can be managed with a multicomponent approach. This includes respite care, learning ways to manage challenging behaviors, and further assessment of what the spouse may already have considered. The patient is in the early stages and does not need long-term placement. Antianxiety medications may be appropriate but other measures should be tried first.

5. Which action will the nurse in the outpatient clinic include in the plan of care for a patient with mild cognitive impairment (MCI)? a. Suggest a move into an assisted living facility. b. Schedule the patient for more frequent appointments. c. Ask family members to supervise the patient's daily activities. d. Discuss the preventive use of acetylcholinesterase medications.

b. Schedule the patient for more frequent appointments. Ongoing monitoring is recommended for patients with MCI. MCI does not interfere with activities of daily living, acetylcholinesterase drugs are not used for MCI, and an assisted living facility is not indicated for MCI.

14. During the morning change-of-shift report at the long-term care facility, the nurse learns that the patient with dementia has had sundowning. Which nursing action should the nurse take while caring for the patient? a. Provide hourly orientation to time of day. b. Move the patient to a quieter room at night. c. Keep blinds open during the daytime hours. d. Have the patient take a brief mid-morning nap.

c. Keep blinds open during the daytime hours. The most likely cause of sundowning is a disruption in circadian rhythms and keeping the patient active and in daylight will help to reestablish a more normal circadian pattern. Moving the patient to a different room might increase confusion. Taking a nap will interfere with nighttime sleep. Hourly orientation will not be helpful in a patient with memory difficulties.

A patient with predominant pain disorder says, "My pain is from an undiagnosed injury. I can't take care of myself. I need pain medicine six or seven times a day. I feel like a baby because my family has to help me so much." It is important for the nurse to assess: a. Mood b. Cognitive style c. Secondary gains d. Identity and memory

c. Secondary gains

A person has minor physical injuries after an auto accident. The person is unable to focus and says, "I feel like something awful is going to happen." This person has nausea, dizziness, tachycardia, and hyperventilation. What is the person's level of anxiety? a. Mild b. Moderate c. Severe d. Panic

c. Severe

10. When teaching the children of a patient who is being evaluated for Alzheimer's disease (AD) about the disorder, the nurse explains that a. the most important risk factor for AD is a family history of the disorder. b. new drugs have been shown to reverse AD dramatically in some patients. c. a diagnosis of AD can be made only when other causes of dementia have been ruled out. d. the presence of brain atrophy detected by MRI confirms the diagnosis of AD in patients with dementia.

c. a diagnosis of AD can be made only when other causes of dementia have been ruled out. The diagnosis of AD is one of exclusion. Age is the most important risk factor for development of AD. Drugs can slow the deterioration but do not dramatically reverse the effects of AD. Brain atrophy is a common finding in AD, but it can occur in other diseases as well and does not confirm an AD diagnosis.

15. A long-term care patient with moderate dementia develops increased restlessness and agitation. The nurse's initial action should be to a. reorient the patient to time, place, and person. b. administer the PRN dose of lorazepam (Ativan). c. assess for factors that might be causing discomfort. d. have a nursing assistant stay with the patient to ensure safety.

c. assess for factors that might be causing discomfort. Increased motor activity in a patient with dementia is frequently the patient's only way of responding to factors like pain, so the nurse's initial action should be to assess the patient for any precipitating factors. Administration of sedative drugs may be indicated, but this should not be done until assessment for precipitating factors has been completed and any of these factors have been addressed. Reorientation is unlikely to be helpful for the patient with moderate dementia. Assigning a nursing assistant to stay with the patient also may be necessary, but any physical changes that may be causing the agitation should be addressed first.

3. The nurse is conducting an admission assessment on a mildly confused older client. The nurse best assures an accurate history by first: a. scoring the client's cognitive responses using the Dementia Rating Scale (DRS). b. focusing on the client to respond. c. directing the questions to both client and family. d. asking permission to arrange for a Mini-Mental State Examination (MMSE) .

c. directing the questions to both client and family. An interview with the friend or family member is an appropriate method to first implement when a client is exhibiting confused behavior.

Contraindications of Lithium

cardiovascular disease brain damage renal disease thyroid disease myasthenia gravis pregnant women breastfeeding

1. An older adult who is experiencing age-related postural hypotension shares with the nurse that he fears "something is really wrong" because he is the only one in his social group experiencing the problems. The nurse responds: a. "Don't be concerned; just be very careful about your risk for falling." b. "Your doctor has been very thorough testing you for the common causes of such dizziness so don't worry about it being serious." c. "It's just a matter of time before they too have to watch not to get up too quickly." d. "While your dizziness appears to be age-related, the compensating mechanisms of your friends may be the reason they don't have the problem."

d. "While your dizziness appears to be age-related, the compensating mechanisms of your friends may be the reason they don't have the problem." The age-related symptoms of postural hypotension are dizziness or lightheadedness when changing positions rapidly. However, compensatory processes in the cortex and subcortical areas of the brain help aging individuals maintain relatively normal motor performance.

A nurse assessing a patient with a somatic system disorder is most likely to note that the patient: a. Readily sees a relationship between symptoms and interpersonal conflicts. b. Rarely derives personal benefit from the symptoms. c. Has little difficulty communicating emotional needs. d. Has altered comfort and activity needs.

d. Has altered comfort and activity needs.

A person who has been unable to leave home for more than a week because of severe anxiety says, "I know it does not make sense, but I just can't bring myself to leave my apartment alone." Which nursing intervention is appropriate? a. Help the person use online video calls to provide interaction with others. b. Advise the person to accept the situation and use a companion. c. Ask the person to explain why the fear is so disabling. d. Teach the person to use positive self-talk techniques.

d. Teach the person to use positive self-talk techniques.

8. To determine whether a new patient's confusion is caused by dementia or delirium, which action should the nurse take? a. Assess the patient using the Mini-Mental Status Exam. b. Obtain a list of the medications that the patient usually takes. c. Determine whether there is positive family history of dementia. d. Use the Confusion Assessment Method tool to assess the patient.

d. Use the Confusion Assessment Method tool to assess the patient. The Confusion Assessment Method tool has been extensively tested in assessing delirium. The other actions will be helpful in determining cognitive function or risk factors for dementia or delirium, but they will not be useful in differentiating between dementia and delirium.

4. To protect a patient from injury during an episode of delirium, the most appropriate action by the nurse is to a. secure the patient in bed using a soft chest restraint. b. ask the health care provider about ordering an antipsychotic drug. c. instruct family members to remain with the patient and prevent injury. d. assign a nursing assistant to stay with the patient and offer frequent reorientation.

d. assign a nursing assistant to stay with the patient and offer frequent reorientation. The priority goal is to protect the patient from harm, and a staff member will be most experienced in providing safe care. Visits by family members are helpful in reorienting the patient, but families should not be responsible for protecting patients from injury. Antipsychotic medications may be ordered, but only if other measures are not effective because these medications have multiple side effects. Restraints are sometimes used but tend to increase agitation and disorientation.

3. When administering a mental status examination to a patient with delirium, the nurse should a. medicate the patient first to reduce any anxiety. b. give the examination when the patient is well-rested. c. reorient the patient as needed during the examination. d. choose a place without distracting environmental stimuli.

d. choose a place without distracting environmental stimuli. Because overstimulation by environmental factors can distract the patient from the task of answering the nurse's questions, these stimuli should be avoided. The nurse will not wait to give the examination because action to correct the delirium should occur as soon as possible. Reorienting the patient is not appropriate during the examination. Antianxiety medications may increase the patient's delirium.

A patient checks and rechecks electrical cords related to an obsessive thought that the house may burn down. The nurse and patient explore the likelihood of an actual fire. The patient states this event is not likely. This counseling demonstrates principles of: a. flooding. b. desensitization. c. relaxation technique. d. cognitive restructuring.

d. cognitive restructuring.

10. The son of a 78-year-old suspected of experiencing Alzheimer's disease (AD) asks the nurse if there is a diagnostic test that can confirm the diagnosis. The nurse responds that: a. an electroencephalogram is often very useful in diagnosing AD. b. a positron emission tomography (PET) scan is a cheap but dependable tool. c. magnetic resonance imaging (MRI) is often ordered for that purpose. d. postmortem autopsy is the only definitive diagnostic tool.

d. postmortem autopsy is the only definitive diagnostic tool. Autopsy remains the gold standard for the diagnosis of AD.

7. When planning care for the older adult with advanced dementia, the nurse recognizes that the best way to implement reality orientation is to: a. place printed labels on important items, such as the telephone. b. place a clock and calendar in the client's immediate environment. c. use hand gestures instead of verbal communications to demonstrate meaning. d. show him a picture of a toothbrush when it time for oral hygiene.

d. show him a picture of a toothbrush when it time for oral hygiene. Reality orientation supports failing memory in early stages of dementia and preserves independent functioning for a longer duration. Although written messages and signs may become meaningless to individuals with advancing dementia, pictures often evoke a response.

After having a mastectomy, a patient shows no emotion, asks no questions and smiles almost continually. The nursing priority is to focus on: a. identification of the patient's support system b. a knowledge deficit pertaining to her illness c. referral for the patient to see a psychiatrist d. the meaning of the mastectomy to the patient

d. the meaning of the mastectomy

a patient tells the nurse that his wife of 50 years died unexpectedly 6 weeks ago. The best response from the nurse would be a. It must be comforting to know you had a wonderful marriage b. It often takes 6 weeks to get over a loss such as yours. c. certain medications might be very helpful for you at this time d. this must be a difficult time for you now.

d. this must be difficult time

A Client diagnosed with Borderline Personality Disorder is admitted to a psychiatric unit. What behavior pattern would the nurse expect to observe? a.) Social isolation b.) Suspicion of others c.) Bizarre speech patterns d.) Generating conflict among the staff

d.) Generating conflict among the staff

The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be day care. acute care hospitalization. long-term institutionalization. group home residency.

day care. Day care is a good option for clients with early-stage Alzheimer's disease. It provides supervision, a protected environment, and supportive interactions.

A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning she is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with delirium. dementia. amnesic disorder. selective inattention.

delirium. Delirium is characterized by a disturbance of consciousness, a change in cognition (such as impaired attention span), and a fluctuating level of consciousness that develop over a short period of time.

When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of anger. denial. confusion. sympathy.

denial. Denial and the minimization of suicidal ideation or gestures is a defense against experiencing the feelings aroused by a suicidal person. Denial can be seen in such statements as "I cannot understand why anyone would want to take his own life."

Dementia in an older adult is often a misdiagnosis for depression. cerebral emboli. normal effects of aging. poor nutritional status.

depression. Depression in an older adult is frequently confused with dementia.

Schizophrenia is best characterized as split personality. multiple personalities. ambivalent personality. deteriorating personality.

deteriorating personality. The course of schizophrenia is marked by recurrent acute exacerbations. With each relapse of psychosis, an increase in residual dysfunction and deterioration occurs.

nursing interventions for serotonin syndroms

discontinue meds and notify the prescribing authority

what are some major adverse effects of Lorazepam/Ativan?

dizziness, drowsiness, lethargy, hangover, headache, ataxia, slurred speech, forgetfulness, confusion, mental depression, apnea, and cardiac arrest.

When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is hallucinating. experiencing an illusion. hypervigilant. demonstrating agnosia.

experiencing an illusion Illusions are errors in the perception of a sensory stimulus.

A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is hopelessness. deficient knowledge. chronic low self-esteem. compromised family coping.

hopelessness. The defining characteristics are present for the nursing diagnosis of hopelessness.

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions she will take the medication along with the St. John's wort she uses daily. The nurse should A. agree that taking the drugs at the same time will help her remember them daily. B. caution the client to drink several glasses of water daily. C. suggest that the client also use a sun lamp daily. D. explain the high possibility of an adverse reaction.

explain the high possibility of an adverse reaction.

A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions that she will take the medication along with the St. John's wort she uses daily. The nurse should agree that taking the drugs at the same time will help her remember them daily. caution the client to drink several glasses of water daily. suggest that the client also use a sun lamp daily. explain the high possibility of an adverse reaction.

explain the high possibility of an adverse reaction. Serotonin malignant syndrome is a possibility if St. John's wort is taken with other antidepressants.

A client with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to anger. fear. an unmet physical need. the need for social interaction.

fear. Clients with delirium often misinterpret reality, perceiving threat where none actually exists. Delirious clients who are fearful may strike out at others, seemingly without provocation.

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat avocado salad plate. fruit and cottage cheese plate. kielbasa and sauerkraut. liver and onion sandwich.

fruit and cottage cheese plate. Fruit and cottage cheese do not contain tyramine. Avocados, fermented food such as sauerkraut, processed meat, and organ meat contain tyramine. Monoamine oxidase inhibitors inhibit the breakdown of tyramine, which can lead to high blood pressure, a hypertensive crisis, and eventually a cerebrovascular accident.

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nurse interacting with a neutral attitude. using concrete language. giving multistep directions. providing nutritional supplements.

giving multistep directions. The thought processes of the client with disorganized schizophrenia are severely disordered, and severe perceptual problems are present, making it extremely difficult for the client to understand what others are saying. All communication should be simple and concrete and may need to be repeated several times.

hypomania

have an increased appetite for social engagement, spending, and activity, even indiscriminate sex; constant activity prevents restful sleep. some may stay up for days.

Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by having a staff member sit at the door and check packages as visitors enter. having a staff member make frequent rounds during visiting hours to inspect gifts. asking all visitors to report to the nurse's station before visiting a client. asking clients to give staff any unsafe item that might have been left by a visitor.

having a staff member sit at the door and check packages as visitors enter. A number of ways to inspect items are possible.Taking all potentially harmful gifts from visitors before allowing them to see clients, going through client's belongings (with client present) and removing all potentially harmful objects, ensuring that visitors do not leave potentially harmful objects in the client's room, and searching clients for harmful objects on return from pass are all effective methods to ensure a high rate of client safety.

Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine's method of using a gun to attempt suicide is considered: high risk, or a hard method. low risk, or a soft method. not an actual suicide attempt because he was intoxicated. a nonlethal means.

high risk, or a hard method. Higher-risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

Cyclothymic Disorder

hypomania alternates with mild to moderate depression for at least 2 years in adults and 1 year in children; aren't severe enough for bipolar diagnosis, but enough to disturb social and occupational functioning; difficult to distinguish from Bipolar II; have irritable hypomanic episodes

cyclothymia

hypomanic episodes alternate w/ minor depressive disorder (at least 2 yrs in duration). Episodes tend to be irritable.

What is Cyclothymia?

hypomanic episodes alternating with minor depressive disorder. has at least a 2 yr duration.

major long term effects of lithium

hypothyroidism and kidney impairment

Trudy is a 72-year-old patient hospitalized with pneumonia and experiencing delirium. She points to her IV pole and screams, "Get him out of here! He's going to hurt me!" You recognize that what Trudy is experiencing is a(n): hallucination. delusion. illusion. confabulation.

illusion. Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem.

Mood Assessment

inappropriately euphoric mood; may change quickly to irritation or anger when thwarted; spend lots of money; have irrational plans to get rich; busy all day and night; very self-confident; then they become hostile, irritable, and paranoid

A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of self-blame. catatonia. learned helplessness. discounting positive attributes.

learned helplessness. Learned helplessness results in depression when the client feels no control over the outcome of a situation.

acute phase

injury prevention: reflect both physiological and psychiatric issues. ex. hydration, cardiac status, skin integrity, sleep, self-control, and no self harm.

cognitive-behavioral therapy (CBT)

involves identifying maladaptive cognition and behaviors that may be barriers to a person's recovery and ongoing mood stability. Focuses on medication adherence, early detection and intervention for manic or depressive episodes.

When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination is a projection of the client's own feelings. derives from neuronal impulse misfiring. is a retained memory fragment. may signal seizure onset.

is a projection of the client's own feelings. One theory about derogatory hallucinations is that the content is a projection of the individual's feelings about himself or herself. The derogatory hallucinations are an extension of the strong feelings of rejection and lack of self-respect experienced by the individual during the prodromal period.

Central serotonin syndrome

is a rare but life threatening event associated with SSRIs. Signs/Symptoms: abdominal pain, diarrhea, sweating, muscle spasms, fever, tachycardia, elevated B/P, delirium, increased motor activity, irritability, hostility and mood change. Severe-high fever, cardiovascular shock or death.

An outcome for a manic client during the acute phase that would indicate that his treatment plan was successful would be that the client A. reports racing thoughts. B. is free of injury. C. is highly distractible. D. ignores food and fluid.

is free of injury.

hypothyroidism

is known to be associated w/ depressed moods, and is seen in some patients experiencing rapid cycling.

Grief

is the emotional reaction that follows the loss of a love object.

Bereavement

is the expected reactions of grief and sadness upon learning of the loss of a loved one.

lithium carbonate

is used to treat some forms of depression and manic episodes of manic-depressive disorder

A depressed client tells the nurse "There is no sense in trying. I am never able do anything right!" The nurse can identify this cognitive distortion as an example of A. self-blame. B. catatonia. C. learned helplessness. D. discounting positive attributes.

learned helplessness.

Behavioral Assessment

like social engagement, spending, and activity; even indiscriminate sex; reduced need for sleep prevent proper rest; nonstop physical activity and lack of sleep and food can lead to exhaustion and death and is an emergency; constantly go from one place to another; many projects get started, but never get finished; religious preoccupation is common; they are manipulative, profane, fault finding, and good at exploiting other's vulnerabilities; push the limits; dress is outlandish, colorful, and inappropriate; highly distractible; concentration is poor; judgement is poor

Mood Stabilizer for Bipolar Disorders

lithium -first line agent for bipolar disorder

The first-line drug used to treat mania is A. lithium. B. carbamazepine. C. lamotrigine D. clonazepam.

lithium.

anhedonia

loss of interest and pleasure in activities

Bipolar II Disorder

low level mania (hypomania) alternates with profound depression; mania tends to be euphoric and increases functioning; high energy lasts for at least 4 days and involves at least 3 symptoms of mania; psychosis is never present with hypomania but may be present with the depressive stage; does not cause much impairment and hospitalization is rare; depressive symptoms put people at risk for suicide

Conventional Antipsychotics

maintenance mania

what is the number one reason relapse usually occurs?

medication non-adherence

what is lithium carbonate?

medication that is effective in acute treatment of mania and depressive episodes. Also used for prevention.

First breaks for women are what age

mid twenties to late twenties

Dysphoric Mania

mixed state or agitated depression, with depressive symptoms along with mania; irritable, angry, suicidal, or hypersexual; may experience panic attacks, pressured speech, agitation, insomnia, grandiosity, persecutory delusions and confusion.

What are the 4 characteristics of mania?

mood, behavior, thought process and speech patterns, and cognitive function.

Environmental Factors

more prevalent in upper socioeconomic classes because people with bipolar disorder appear to achieve higher levels of education and higher occupational status that people with unipolar depression

flight of ideas

nearly a continuous flow of accelerated speech w/ abrupt change from topic to topic that are usually based on understandable associations or play on words.

what is flight of ideas?

nearly continuous flow of accelerated speech with abrupt changes among topics that are usually based on understandable associations or a play on words. speech is rapid, verbose, and circumstantial. when condition is severe speech may be disorganized and incoherent.

Beck suggests that the etiology of depression is related to A. sleep abnormalities. B. serotonin circuit dysfunction. C. negative processing of information. D. a belief that one has no control over outcomes.

negative processing of information.

Beck's cognitive theory suggests that the etiology of depression is related to sleep abnormalities. serotonin circuit dysfunction. negative processing of information. a belief that one has no control over outcomes.

negative processing of information. Beck is a cognitive theorist who developed the theory of the cognitive triad of three automatic thoughts responsible for people becoming depressed: (1) a negative, self-deprecating view of oneself; (2) a pessimistic view of the world; and (3) the belief that negative reinforcement will continue.

A client diagnosed with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by chronic uncooperativeness. personality conflict. neural dysfunction. dependency needs.

neural dysfunction. Schizophrenia is considered a neurobiological disorder. The course of schizophrenia involves recurrences. With each relapse further deterioration is noted. Residual schizophrenia refers to the disorder when active phase symptoms are no longer present and the individual is left with two or more of the following symptoms: lack of initiative, social withdrawal, impaired role function, marked speech deficits, and odd beliefs.

What are the 2 major neurotransmitters associated with depression and mania?

norepinephrine and serotonin

Neurobiological

norepinephrine, dopamine, and serotonin; too few= depression; too many= mania; could also be receptor site insensitivity; brain pathways include: subregions of the prefrontal cortex and median temporal lobe; structural and functional brain changes: prefrontal cortex changes are evident in early stages and lateral ventricle abnormalities develop with repeated episodes; differences in anterior limbic regions which control emotion, memory, motivation, and fear (These are most deeply effected)

An identical twin recently committed suicide. The parent tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. justified because twin studies suggest no genetic factor is involved in suicide. unjustified because the parent has failed to consider the importance of the "copycat" factor. likely evidence of her denying the possibility of a parental role in the causation of the suicide.

not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide. Twin studies, in fact, show that a genetic component of suicide may be present.

The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises never to attempt suicide. to alert someone if he or she has made an attempt. not to consider suicide for 72 hours. not to attempt suicide in the next 24 hours.

not to attempt suicide in the next 24 hours. A no-suicide contract is quite straightforward in seeking a client's promise not to attempt to harm oneself within a specified period. When that time expires, a new contract is negotiated.

Why are TCAs not usually given to suicidal patients?

overdose can cause severe cardiotoxicity and neurotoxicity, and is a significant cause of fatal drug poisoning

What is fear of object or situation?

phobia

DD Signs and Symptoms

poor appetite or overeating, insomnia or hypersomnia, fatigue, low self esteem, poor concentration, feelings of hopelessness. And often begins in childhood.

Interventions for Continuation Phase

prevention of relapse, community resources, referrals, **medication adherence** Day hospitals, psychiatric home care

The term "perceptual disturbance" refers to difficulty processing information about one's internal and external environment. changing one's way of thinking to accommodate new information. performing purposeful motor movements. formulating words appropriately.

processing information about one's internal and external environment. Perceptual distortion refers to impaired ability to process intellectual, sensory, and emotional data in a logical, meaningful way.

Seclusion Protocol

proper reporting through the chain of command physicians order must be reviewed and rewritten every 24 hours include type and restraint with order In an emergency, must get order within 30 minutes after behavior must be observed and documented every 15 minutes offered food and fluids every 30 to 60 minutes use the bathroom every 1 to 2 hours vitals measured every 1 to 2 hours

mood disorders

psychological disorders characterized by emotional extremes

SSRI (select serotonin re-uptake inhibitors)

reason for use: depression blocks uptake of serotonin to increase serotonin at synapse

A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be risk for injury. acute confusion. imbalanced nutrition. impaired environmental interpretation syndrome.

risk for injury. Memory loss, agnosia, poor judgment, and the other symptoms of Alzheimer's disease contribute to placing the client at risk for injuries such as burns and falling down stairs.

What teaching should you do with patients taking benzo's?

safety-explain addiction-explain

A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should say "I understand" and allow the client to close the door. keep the door open, but step to the side out of the client's view. leave the client's room and wait outside in the hall. say "For your safety I can be no more than an arm's length away."

say "For your safety I can be no more than an arm's length away." This level of suicide watch does not make adjustments based on client preference. The explanation quoting the protocol and the reason (your safety) is appropriate.

A suicidal individual calls a suicide hot line. This represents the level of intervention classified as primary. secondary. tertiary. quaternary.

secondary. Secondary prevention is essentially treatment.

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by suggesting, "Let's look at what you just said, that you can 'never do anything right.'" querying, "Tell me what things you think you are not able to do correctly." asking, "Is this part of the reason you think no one likes you?" saying, "That is the most unrealistic thing I have ever heard."

suggesting, "Let's look at what you just said, that you can 'never do anything right.'" Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate.

The nursing diagnosis Risk for self-directed violence has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will reclaim any prized possessions that were given away. name three personal strengths. seek help when feeling self-destructive. participate in a self-help group.

seek help when feeling self-destructive. Having the client cope with self-destructive impulses in a healthy way is the only appropriate short-term goal here.

selective serotonin reuptake inhibitors (SSRIs)

selectively inhibits serotonin reuptake and results in potentiation of serotonergic neurotransmissions (Luvox, Paxilo, Prozac, Zoloft)

Assessment of thought processes of a client with depression is most likely to reveal A. good memory and concentration. B. delusions of persecution. C. self-deprecatory ideation. D. sexual preoccupation.

self-deprecatory ideation.

Assessment of the thought processes of a client diagnosed with depression is most likely to reveal good memory and concentration. delusions of persecution. self-deprecatory ideation. sexual preoccupation.

self-deprecatory ideation. Depressed clients never feel good about themselves. They have a negative, self-deprecating view of the world.

flight of ideas

shifting from one idea to another quickly

A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be safety and crisis intervention. acute symptom stabilization. stress and vulnerability assessment. social, vocational, and self-care skills.

social, vocational, and self-care skills. During the stable plateau phase of schizophrenia, planning is geared toward client and family education and skills training that will help maintain the optimal functioning of schizophrenic individuals in the community.

It is likely that a client with seasonal affective disorder will begin to feel better in the A. fall. B. winter. C. spring. D. summer.

spring.

It is likely that a client diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the fall. winter. spring. summer.

spring. Seasonal affective disorder occurs during the months when sunlight diminishes. Clients may begin to feel effects in the late fall and will be affected throughout the winter. They improve during the spring and feel well during the summer.

A client diagnosed with Alzheimer's disease has become more forgetful and has difficulty performing familiar tasks like bathing and dressing. The nurse would assess the client as being in the stage of Alzheimer's disease labeled stage 1, mild. stage 2, moderate. stage 3, moderate-severe. stage 4, end.

stage 3, moderate-severe. Moderate-severe Alzheimer's disease requires a high level of supervision because of the severe memory loss the client is experiencing. Wandering and inability to meet self-care needs become problematic.

In your assessment of a patient who is severely depressed and just started on antidepressants, what would be behavior that would concern you and require further assessment?

sudden change in mood or behavior

A depressed client tells the nurse "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by A. suggesting "Let's look at what you just said, that you can 'never do anything right.'" B. querying "Tell me what things you think you are not able to do correctly." C. asking "Is this part of the reason you think no one likes you?" D. saying "That is the most unrealistic thing I have ever heard."

suggesting "Let's look at what you just said, that you can 'never do anything right.'"

The major reason for hospitalization for depressed patients is: inability to go to work. suicidal ideation. loss of appetite. psychomotor agitation.

suicidal ideation. Suicidal thoughts are a major reason for hospitalization for patients with major depression. It is imperative to intervene with such patients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

anterior limbic regions of the brain

the areas most deeply affected by bipolar disorder are the areas associated w/ emotion, motivation, memory and fear. What region of the brain is this associated w/

To plan care for a manic client the nurse must consider that lithium cannot be started until A. the physical examination and laboratory tests are analyzed. B. the initial doses of antipsychotic medication have brought behavior under control. C. seclusion has proven ineffective as a means of controlling assaultive behavior. D. electroconvulsive therapy can be scheduled to coincide with lithium administration.

the physical examination and laboratory tests are analyzed.

When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that A. no research exists to suggest genetic transmission. B. much depends on the socioeconomic class of the individuals. C. highly creative people tend toward development of the disorder. D. the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

the rate of bipolar disorder is higher in relatives of people with bipolar disorder.

what is clang associations?

the stringing together of words because of their rhyming sounds, without regard to their meaning

learned helplessness theory

the view that clinical depression and related mental illnesses may result from a perceived absence of control over the outcome of a situation.

anticonvulsant drugs

this class of medications have demonstrated efficacy and been approved for the tx of mood disorders; (Depakote, Tegretol, Lamictal.)

interpersonal and social rhythm therapy

treatment for patients during the maintenance phase of bipolar illness. this therapy addresses the variables that relate to recurrence of s/s, esp non-adherence w/ medication, stress management, and maintenance of social supports.

vagus nerve stimulation (VNS)

treatment in which the vagus nerve-the part of the autonomic nervous system that carries information from the head, neck, thorax, and abdomen to several areas of the brain, including the hypothalamus and amygdala-is stimulated by a small electronic device much like a cardiac pacemaker, which is surgically implanted under a patient's skin in the left chest wall

Antianxiety Drugs

treatment of acute mania managing psychomotor agitation do not give to patients with substance abuse

tricyclic antidepressants (TCAs)

used to treat depression/anxiety, moderate anticholinergic side effects; can be lethal in overdose

Epidemiology

usually begins with depressive episode; women with postpartum psychosis within 2 weeks of giving birth have 4 times the chance of conversion to bipolar disorder; women are likely to abuse alcohol, commit suicide, and develop thyroid disease; men are likely to have legal problems and commit acts of violence; may get confused with ADHD; Bipolar II is under diagnosed and confused with major depression or personality disorders; Cyclothymic disorder usually begins in adolescence or early adulthood and 15% to 50% risk that they will develop bipolar disorder

When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention should be A. questioning client motive. B. verbal limit setting. C. physical confrontation. D. seclusion.

verbal limit setting.

When the nurse remarks to a depressed client "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to A. wait quietly for the client to reply. B. prompt the client if the reply is slow. C. repeat the question if the client does not answer promptly. D. seek information from the client's significant others.

wait quietly for the client to reply.

When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to wait quietly for the client to reply. prompt the client if the reply is slow. repeat the question if the client does not answer promptly. review the client's medical record to support the client's response.

wait quietly for the client to reply. Depressed clients think slowly and take long periods to formulate answers and respond. The nurse must be prepared to wait for a reply.

Some of the most important characteristics of staff members who work with suicidal clients are the ability to be consistently organized. the ability to teach problem-solving skills. warmth and consistency when interacting. interview and counseling skills.

warmth and consistency when interacting. Crucial characteristics of staff members who work with suicidal clients include warmth, sensitivity, interest, and consistency.

The nursing diagnosis Imbalanced nutrition: less than body requirements has been identified for a client with severe depression. The most reliable evaluation of outcomes will be based on A. energy level. B. weekly weights. C. observed eating patterns. D. client statement of appetite.

weekly weights.