Psych Final

A nurse is working with a client who has frequent angry outbursts. Which statement is most helpful when working with this client?

"Anger is a normal feeling, and you can use it to solve problems."

The nurse is assessing a client in crisis. The client states, "I don't feel like I can go on anymore." Which of the following is the nurse's best response?

"Are you having thoughts of hurting yourself?"

The nurse is assessing a client who has been referred for disturbed sleep due to increased anxiety and low mood. In order to determine the role of emotions in the client's stress response, the nurse should ask which question?

"Can you tell me how you have been feeling most of the time for the past month?"

The nurse is conducting a mental health assessment of a client who has been experiencing low mood, anxiety and loss of pleasure for the past month. The client tells the nurse he comes from a "really big family." Despite this, the client tells the nurse he continues to feel alone. Select the nurse's best response.

" You can have lots of people in your social network and still feel isolated."

What question should nurses ask themselves to determine if the care they provide to the grieving client has been both therapeutic and client focused?

"Do I have the strength to be present and to facilitate the client who is grieving?"

During a therapy session, a client with anorexia tells the nurse, "I measured my thighs today. They are a quarter-inch larger than they were yesterday. I feel like a pig; I'm so fat." Which potential response by the nurse is most therapeutic?

"Has something occurred that caused you to measure your thighs?"

A psychiatric nurse is assessing a client with post-traumatic stress disorder (PTSD). During the psychosocial component of the assessment, what assessment question should the nurse include?

"How are your symptoms affecting your day-to-day routines?"

Which nursing statement is most effective in communicating a positive expectation of the client?

"I will sit here quietly with you while you eat"

Which statement, made by a nurse who experienced sexual abuse as as a child, demonstrates being best prepared to work with sexual abuse and trauma survivors?

"I've been supported by health care professionals and now I want to support other survivors."

An elderly client who lives alone is beginning to have difficulty maintaining the household and performing daily tasks. The nurse asks the client to identify someone who can help. The client replies, "I don't need help. I've been managing for years." Which response helps the client shift from denial to consciously coping with the situation?

"If you were to need help with your house, who might you ask for help?"

The nurse has been teaching the client's family about the client's eating disorder, anorexia nervosa. Which statement by the family would indicate to the nurse that teaching was effective?

"We will negotiate resolutions to family conflicts."

A nurse is preparing a presentation for a senior center about elder abuse. When describing individuals associated with abusing older adults, which group would the nurse most likely identify? Select all that apply.

-Family member -Adults - Children -Spouses

The bereaved client has worked through many processes of grief with the nurse. Which are eventual outcomes of the emotional dimension of grieving? Select all that apply.

-The survivor begins to reestablish a sense of personal identity, direction, and purpose for living. -The survivor begins to gain independence and confidence. -The survivor develops new ways of managing life and new relationships.

The nurse is planning care for a client who is a victim of violence. Which of the following should the nurse identify as goals for this client's plan of care? Select all that apply.

-ensure safety -prevent injury -restore health -stop the violence

Which statement regarding posttraumatic stress disorder (PTSD) and children is accurate?

Best practices demonstrate that adolescents who have PTSD are at increased risk of drug abuse.

Successful resolution of a crisis an individual is experiencing is more likely to occur if the individual ...

Has a realistic view of the situation

When the client is in restraints or seclusion, which of the following must occur?

He or she must be monitored continually.

In the stress response, what is consistent with activation of the sympathetic nervous system?

Increased blood sugar

A nurse is developing the plan of care for a client with bulimia. Which intervention would the nurse most likely include?

Increasing client's coping skills for anxiety

A nurse is working with a client who has a history of repeated abusive intimate relationships. The nurse has difficulty understanding why a person would repeatedly enter into relationships with abusive partners. When working with this client, the nurse can best maintain a therapeutic relationship through which approach?

Keeping focused on the client's feelings about the client's life situation

Which characteristic of the abuser should the nurse look for when completing the family assessment of a victim of intimate partner violence?

Need and possessive of a partner

What is accurate regarding a crisis?

Occurs when an individual is at a breaking point

A nurse's response to aggressive behavior on the unit is influenced by the which ability of the nurse?

Own awareness and reaction to aggression

A client has just presented at the emergency department after being raped. The initial nursing action would be to:

Provide emotional support

The community health nurse meets with the family members of an elderly client. The nurse includes which in the plan of care as a preventive measure to guard against elder abuse?

Provide the primary caregiver with additional resources to meet the elder's needs

Which is the primary objective of nursing interventions in the care of a client with anorexia nervosa?

Restoring nutritional status to normal

Physiologic symptoms and problems associated with grief responses are often a source of anxiety and concern for the grieving person as well as for friends or caregivers. Which of the following is the most frequent and persistent bereavement-associated symptom(s)?

Sleep disturbances

The nurse educator is discussing the fight or flight response with a group of nursing students. The nurse recognizes teaching is effective when the students state which brain structures are responsible for interpreting an event as a threat?

The amygdala

The nurse gathers information to formulate a plan of care for the client with aggressive issues. Which is most likely to be the subject of an aggressive attack from a client with mental illness?

The client

What assessment finding would suggest to the nurse that the client with posttraumatic stress disorder (PTSD) is experiencing dissociation?

The client is often "staring into space" and has no idea how much time has passed

A nurse is screening a new client for intimate partner violence (IPV). What aspect of this woman's current circumstances is the most significant risk factor?

The client's family lives on less than $1,000 per month.

Which statement is true regarding children being raised in a home where they have witnessed intimate partner violence?

They are at increased risk for being abused.

Which intervention would be most effective for friends and family members to implement in order to boost the self-esteem of a person who has just experienced trauma or abuse?

To help them to refocus their view of themselves from being victims to being survivors

When admitted to the inpatient unit, a client is 5 feet 10 inches tall and weighs 100 pounds. What is the initial goal in the client's care?

To stop losing weight

A nurse is providing care to a family whose house was destroyed in a tornado. The nurse interprets this as which type of crisis?

Traumatic

Crisis intervention provided by a psychiatric clinician is necessary when an individual's ...

Usual problem-solving methods are ineffective

Which type of elder abuse involves leaving an older adult and no longer providing care for the individual?

abandonment

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on what?

clients safety

46s Assessment of a client reveals a loss of 30 pounds in 3 months. The nurse would be alert for which complication associated with weight loss affecting the client's metabolic function?

hypothyroidism

A client has just been served divorce papers from a spouse. The client has no financial resources and little social support. The client states, "My spouse is not really leaving. My spouse will be back." The most appropriate response by the nurse would be what?

"How is this affecting you right now?"

The nurse is teaching a client with bulimia to use self-monitoring techniques. Which statement by the client would let the nurse know that this has been effective?

"I am learning to recognize events and emotions that trigger my binges and am working on responses other than binging and purging."

Which statement made by a client raises the greatest concern that the client may be experiencing relationship violence?

"I don't know what else I can do to keep him from getting angry at me."

A married client expresses to the nurse that the client's spouse's frequent nagging angers the client. The nurse role plays assertive communication techniques with the client. Which indicates that the client understands how to use assertive techniques effectively?

"I feel unappreciated when you criticize me."

The nurse determines that a client is in the Awareness of the loss phase of bereavement. Which statement by the client would lead the nurse to this conclusion?

"I just can't believe that dad won't every be sitting in that chair anymore."

Which statement made by the nurse managing the care of an anorexic teenager demonstrates an understanding of the client's typical, initial reaction to the nurse?

"I realize this must be very difficult for you but try to remember I'm not your enemy."

The nurse has been teaching a client about bulimia. Which statement by the client indicates that the education has been effective?

"I'll eat small meals and snacks regularly."

A client is admitted with smoke inhalation after a fire has destroyed their home. The client states, "I wish I would have died in the fire." What is the nurse's best response?

"If you wish you would die, do you have a plan for this?"

A nursing instructor teaching about sexual assault identifies a need for further instruction when one of the students makes which statement?

"It is not considered rape if it occurs with same-sex couples."

The nurse is providing counseling to a client who has been experiencing anxiety and sleep disturbance. While providing education to the client, in which way can the nurse best describe allostatic load?

"It is the wear and tear on your body from having stress over a long period of time."

The wife of an affluent and well-known businessman is shocked and distraught at the fact that her husband has been charged with fraud and publicly arrested. Which of the nurse's following statements is most therapeutic?

"It's very understandable that you would feel betrayed and embarrassed right now."

The nurse is discussing expectations of raising a child with a pregnant teenager expecting her first baby. The father will not be a participant in the parenting. Which statement made by the expectant mother would be of greatest concern to the nurse?

"My child will love me, unlike my parents ever did."

A nursing instructor lecturing about death and grief realizes a need for further instruction when a student states what?

"The grieving process is the same for children and adults."

A nurse is providing care to a woman who has just delivered a stillborn baby. Which would be the most appropriate nursing response to address the woman's grief?

"Would you like to hold your child?"

The nurse is working with a client at the battered women's shelter who is in a violent and abusive relationship. The client is considering a separation and asks the nurse, "What do you think about that?" Which is the best response by the nurse?

"You may be in more physical danger after you leave him."

A nurse is providing care to a person involved in a disaster. The nurse interprets which finding as predictive of developing posttraumatic stress disorder at a later time? Select all that apply.

-Fear -Dissociation

Adaptation is a person's capacity to survive and flourish. Adaptation affects which areas? Select all that apply.

-Health -Social functioning -Psychological well-being -Coping

The mental health nurse should discuss an emergency plan for leaving abusive situations will when the woman is able to do which of the following? Select all that apply.

-Identifies safe places to go -Keep emergency money available -Makes a spare car key -Compile a list of important phone numbers

A psychiatric-mental health nurse is working as a part of group to improve the unit culture to reduce the risk of violence. Which factor would the nurse identify as contributing to violence? Select all that apply.

-Strict authority hierarchy -Patronizing staff behavior -Lack of client privacy

The nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) several months ago. During a comprehensive follow-up assessment, what areas should the nurse assess? Select all that apply.

-The client's use of alcohol or other drugs -Characteristics of the client's sleep -The effect of the client's PTSD on the family

The nurse is providing individual support to a female client who attends a group for people who have experienced loss of a family member to suicide. The client's son committed suicide one month ago. The client was not aware that her son experienced depression. Which risk factors for complicated grief are most likely for this client? (Select all that apply.)

-death of a child -sudden, unexpected death -death by suicide

The nurse is assessing a client and suspects that the client is a victim of intimate partner violence. The client is experiencing palpatations. What additional findings should the nurse assess the client for related to intimate partner violence? Select all that apply.

-missing teeth -Inability to fully extend the right leg -wearing clothing inappropriate for the weather -variety of wounds in different stages of healing

The nurse is concerned that a client may be experiencing emotional abuse. The nurse observes an interaction between the client and a family member. Which assessment findings related to the actions of the family member toward the client led the nurse to make this clinical determination? Select all that apply.

-putting the client down -calling the client names -making the client feel guilty

A nurse is offering a support session to a client who is grieving the death of a partner. The nurse is correct in telling the client that the client is more likely to achive positive outcomes if which conditions are present? Select all that apply.

-the client is attending a support group -the client understands why the partner died -the client pays attention to self-care needs

When the school nurse is assessing an adolescent who reports troubling sleeping, which characteristics of the client indicate there may be violence in the home? (Select all that apply.)

-the client's father monitors contact with friends -has a family history of alcohol abuse -must go straight home after school each day

What are characteristics of complicated grief? Select all that apply.

-trouble accepting the death -excessive bitterness -exacerbation of depression

A nurse is providing care to a client with anorexia who is beginning a refeeding protocol. Based on the nurse's understanding of these protocols, the nurse would expect the client to start with how many calories per day?

1500

A client is diagnosed with mild anorexia nervosa based on body mass index (BMI). Which BMI would the nurse identify as reflecting mild anorexia nervosa?

17.3

Approximately what percentage of women rape victims are raped by someone they know?

65%

A nursing student learning about intimate partner violence (IPV) correctly identifies the percentage of deaths attributed to IPV to be what?

70% in women and 30% in men

The nurse is facilitating a wellness group which includes a client who was suspended from work for an angry outburst. The client most likely has the characteristics of which personality type?

A

Which of the following clients being treated for anorexia displays assessment values that warrant hospitalization?

A 25-year-old whose weight is 70% of ideal and who has a serum magnesium level 1.2 mg/dL

Three years after the death of her father in an intensive care unit (ICU), the infection prevention nurse was visiting an ICU in a different hospital to complete a chart review. At one point, the nurse looked at a bed containing a client with the same diagnosis as the nurse's father. The nurse saw the nurse's father's facial features on the client and had a sense of panic. In a few moments, the nurse realized that the client in the bed was not the nurse's father. Which of these manifestations of PTSD was this nurse experiencing?

A flashback

Which individual is most likely to be diagnosed with posttraumatic stress disorder (PTSD)?

A middle-aged woman with a history of anxiety who suffered a random physical assault

Which assessment findings can most accurately be described as complicated grieving?

A person is unable to return to work after a sister's death 18 months ago

Which are common characteristics of violent families regardless of the type of abuse that exists? Select all that apply.

Abuse of power and control Alcohol and other drug abuse Intergenerational transmission Social isolation

According to the stage theories of grief, during which stage of grief and bereavement does social withdrawal occur?

Acute mourning

Which cultural group of women has the highest rate of being victimized by sexual assault?

African American

A nurse is reading a journal article about aggression and violence in health care. Which of the following would the nurse most likely find?

Aggression and violence occur over a wide range of health care settings.

According to Selye (1956, 1974), which stage of reaction to stress stimulates the body to send messages from the hypothalamus to the glands and organs to prepare for potential defense needs?

Alarm reaction

After teaching a class about aggression and violence, the instructor determines that the education was successful when the class states which of the following?

All violence is aggression

Which of the following statements best defines crisis intervention?

An active but temporary entry into the life situation of an individual, a family, or a group during a period of stress

A client is being seen in the health clinic. During the nursing assessment, the client states that she has had amenorrhea for the last 6 months. The client weighs 80 pounds and is 5 feet 2 inches tall. The client states that she usually eats salads to not gain weight. These data supports which diagnosis?

Anorexia nervosa

The family members of a military veteran are distraught that he has withdrawn from them emotionally after returning home from a tour of duty. What is the nurse's most appropriate action?

Assess the client for signs and symptoms associated with post-traumatic stress disorder

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment?

Assessing the clients quality and quantity of sleep

The psychiatric mental health nurse is working with a client who has been diagnosed with posttraumatic stress disorder (PTSD). Assessment reveals that the client is experiencing frequent episodes of intrusion. The nurse should consequently prioritize what assessment?

Assessing the quantity and quality of the client's sleep

A client is being admitted to the in-patient psychiatric unit with a diagnosis of bulimia nervosa. The nurse would expect this client to fall within which age range?

18 to 22 years old

A client with a history of anorexia nervosa comes to the clinic for evaluation. During the visit, the client's body mass index (BMI) is obtained. The nurse determines that treatment has been effective based on which BMI measurement?

19.2 kg/m2

Approximately what percentage of women are victims of intimate partner violence (IPV)?

33%

1m 17s A nurse who provides care at an inpatient eating disorder clinic is performing an admission assessment of a young client who has been diagnosed with anorexia nervosa. Which assessment question reflects therapeutic communication?

About how much do you think you weigh now

Which factor does not influence the grieving person's return to homeostasis?

Adequate self-awareness on the part of the nurse

The advanced practice psychiatric mental health registered nurse is leading a support group for adolescents who have recently experienced disruptions in their life. What participant most warrants further assessment for posttraumatic stress disorder?

An adolescent who has committed uncharacteristic acts of violence since the death of the adolescent's mother

Which describes a strong emotional response to a real or perceived provocation?

Anger

A client is prescribed lorazepam for anxiety experienced with the death of a parent. Which instruction should the nurse provide related to the medication?

Be careful when changing positions from sitting to standing.

A client who has been in recovery from alcohol abuse for over one year tells the nurse he is drinking 5 to 6 beers per night since the client's mother's death. Which is the nurse's most accurate explanation for the client's grief response?

Behavioral

The nurse is helping a client with an eating disorder to accept the client's body image. The client must first learn effective coping skills. Which statement best describes the relationship between body image and coping skills?

Being able to cope in healthy ways improves the ability to accept a realistic body image.

Which may help a person to overcome an eating disorder that causes weight gain?

Believing that gaining weight is an effect of unhealthy lifestyle behaviors and losing weight is an effect of healthy lifestyle behaviors

A client is an overweight 32-year-old who regularly binges on large amounts of food. After the client binges, the client feels guilty and ashamed about eating the food. Despite the bad feelings, the client binges almost daily. Which would the nurse most likely suspect?

Binge eating disorder

A client is suspected of having anorexia nervosa and meets the diagnostic criteria for the disorder. When conducting the physical examination, which would be a probable finding from the assessment?

Bradycardia

When attempting to preserve evidence from a possible rape with no report of oral sex, the female victim should be instructed that which self-care activities are permitted?

Brushing her teeth

Some people try to express their angry feelings by engaging in aggressive but safe activities, such as hitting a punching bag or yelling. Which of the following terms is used to describe an activity used to release anger?

Catharsis

A psychiatric-mental health nurse is reviewing information about biologic theories associated with aggression. The nurse identifies which structure as being primarily involved?

Cerebral Cortex

A client is learning to cope with anxiety and stress. The expected outcome is that the client will ...

Change reactions to stressors

The nurse decides to place an aggressive and violent client in mechanical restraints. The nurse bases this decision on which of the following?

Clients safety

Which intervention has been found to be most effective reducing the initial symptoms of bulimia?

Cognitive behavioral therapy and pharmacological interventions

The nurse is counseling a client who lost a parent one year ago. The client states "I wish I could die too." The nurse is aware that the client is experiencing which type of grief?

Complicated

Which behavior is not associated with purging?

Consuming large amounts of food

Despite being admitted to the hospital yesterday for the treatment of complications of anorexia nervosa, a 19-year-old client continues to refuse fluids and is only taking small bites of food during mealtime. Which nursing diagnosis is paramount in this client's care?

Deficient fluid volume related to refusal to drink

A client visits the clinic and tells the nurse that no matter how difficult the client's child acts, the client simply cannot express any anger. The nurse should plan to assess the client for symptoms of which mental health condition?

Depression

Which is the most common disorder found in clients diagnosed with bulimia nervosa?

Depression

A client with an eating disorder states, "I've gained 2 pounds, so soon I'll be up by 100 pounds." The nurse interprets this as which of the following?

Dichotomous thinking

A nurse is presenting information to a community group about health. Which information should the nurse provide regarding calorie restriction diets at an early age in children?

Dieting at an early age may lead to the development of eating disorders.

Which nursing diagnosis would be most difficult to successfully resolve in a client who had anorexia nervosa?

Disturbed body image

An example of a situational crisis is ...

Divorce

Which is most important to maintain therapeutic boundaries when working with aggressive clients?

Do not personalize a client's anger.

The school health nurse is offering community education to adolescents regarding the impact of stress on the body. When providing information about the body's physiological response to stress, the nurse should include which point?

Dysregulation of the body's autonomic responses is the result of prolonged exposure to cortisol.

The family members of a client with posttraumatic stress disorder (PTSD) state that they are "constantly walking on eggshells" because the client reacts so strongly to stressors that seem inconsequential to them. What is the nurse's best response?

Educate the family about the client's hyperarousal

Which would be most supportive for family and friends of a client with an eating disorder?

Emotional support, love, and attention

The nurse is teaching the family of a client who has bulimia about nutritional needs. Which dietary pattern would be most helpful to assist the client in recovering from bulimia?

Encourage the entire family to engage in a balanced and regular dietary pattern.

Many clients have difficulty expressing anger. Which of the following interventions would assist the client with the appropriate expression of anger?

Encourage verbalization

Which intervention would assist the client with the appropriate expression of anger?

Encourage verbalization

The nurse observes two clients in the day room arguing. One client runs into the corner and huddles while the other follows and continues with verbal abuse. Which is the best action by the nurse?

Engage the attention of the client who is still yelling and ask what is happening.

Which staff behaviors are most likely to trigger clients who are predisposed to aggressive or violent behavior?

Engaging in disputes over medication, supplies, or rules on the unit

In the psychiatric setting, what is the most effective intervention in preventing the hostile client's behavior from escalating to physical aggression?

Engaging the hostile person in dialogue

A group of at-risk teenagers have successfully completed an outdoor training program in which they had to collaborate and conquer a number of challenges. The nurse should identify what likely outcome of this program?

Enhanced resilience for the participants

Which of the following terms describes a lack of clear role boundaries?

Enmeshment

As the nurse is performing an assessment on the client, the client is yelling and is hitting the hand with a rolled up newspaper. Which stage of aggression does the nurse identify that the client is exhibiting?

Escalation

56s The nurse is caring for an adolescent female who reports amenorrhea, weight loss, and depression. Which additional assessment finding would suggest that the woman has an eating disorder?

Excessive exercise

A client being evaluated in the emergency room can not speak logically or follow directions. The client's family states she has been under a great deal of stress for about six months. Which of the following stages of Selye's stress adaptation stages is the client experiencing?

Exhaustion

Which stage of Hans Seyle's general adaptation syndrome (GAS) occurs if homeostasis is not achieved during stress?

Exhaustion

The nurse is caring for a 16-year-old boy with a history of being sexually abused. The nurse might expect this adolescent to ...

Experience flashbacks and nightmares

Which of the following techniques utilized during crisis intervention would be detrimental to the client if utilized by the mental health nurse?

Explaining that the client is exhibiting an abnormal reaction

The nurse is interviewing a client with a history of physical aggression. Which of the following should the nurse avoid?

Explaining the consequences the client will face if control is lost

A nurse is leading an anger management group in the inpatient program. A client says, "I'm feeling really tense, and I'm fidgety today." What is the nurse's most appropriate response to the client's comment?

Explore what is underlying the client's physical and emotional state

A client has been diagnosed with posttraumatic stress disorder (PTSD) after a house fire. Which nursing intervention is most appropriate?

Facilitate the client's introduction to a support group of other people recovering from PTSD

The nurse is providing care for a client whose history of intimate partner violence has resulted in posttraumatic stress disorder (PTSD). The client has few friends and states that the client is estranged from the client's family. How can the nurse best enhance the client's social support?

Facilitate the client's participation in a support group

When lecturing about dissociative disorders to a group of nursing students, a nurse states that an essential feature of these disorders involves what?

Failure to integrate identity, memory, and consciousness

Which is the best explanation for why family violence tends to occur over multiple generations of families?

Family violence may be perpetuated between generations of families by role modeling and social learning.

An 81-year-old woman has been experiencing episodes of increasing forgetfulness in recent months, a problem that prompted her to seek care from her primary care physician. After tests and referrals, she has just received a diagnosis of early-stage Alzheimer's disease. What type of loss is this woman most likely to experience?

Gradual and observable

A nurse on the inpatient unit is talking with a client with a history of violent behavior towards others. It is important for the nurse to minimize her risk during this one-on-one intervention by doing which of the following?

Having the client sit farthest from the door

In the weeks following a natural disaster, which of the following client symptoms does the nurse least expect to see when assessing clients at the community mental health center?

Hearing voices and seeing dead bodies

The prime objective of the crisis intervener is to do which of the following?

Help the client find ways to solve the immediate problem.

A nurse is helping a male client recognize the impact of stressful events on his health. Using the Recent Life Changes Questionnaire, the client learns that the most stressful life change is which type?

His mother was just diagnosed with cancer

24s A client on an in-patient psychiatric unit has been diagnosed with bulimia nervosa. The client states, "I'm going to the bathroom and will be back in a few minutes." Which response by the nurse is most appropriate?

I will accompany you to the bathroom

A young client telephones the emergency department and loudly tells the nurse, "I've been raped! Please help me!" Which is the priority for the nurse to determine?

If the client was in a safe place, the client's condition, and if transportation is available

A nurse manager is working with the nursing staff of a busy community-based walk-in clinic that provides care to a large number of survivors of domestic violence. When helping the staff provide care, which information would be most important for the nurse manager to convey to the staff?

Importance of measuring the clients' progress in small steps

What is the major difference between posttraumatic stress disorder (PTSD) and acute stress disorder?

In PTSD, the symptoms occur 3 months or more after the trauma.

A 35-year-old women comes to the local health center with a large mass in her right breast. She has felt the lump for about a year but was afraid to come to the clinic because she was sure it was cancer. What is the most appropriate nursing diagnosis for this client?

Ineffective coping

A client with post-traumatic stress disorder (PTSD) tells the nurse, "Every morning I wake up with a vicious hangover and swear I'll never drink like that again. Yet, every night I some how end up at the bar." The nurse should consider the possibility of what nursing diagnosis?

Ineffective impulse control

A client with posttraumatic stress disorder (PTSD) has begun to stay out late every night and "party" with their friends. When family members ask about when the client is going to return to work, they become extremely irritated and verbal lashes out, saying some very hurtful things. The priority NANDA for this client would be which of the following?

Ineffective impulse control

The nurse is conducting a history and physical exam on a client who is grieving the unwanted loss of a marriage by divorce. Which physical symptom of grief would the nurse most likely expect to detect in the history?

Insomnia

A psychiatric-mental health nurse is conducting a presentation about grief responses and bereavement processes. The nurse determines that the teaching was successful when the group uses which information to describe grief responses?

Intense reactions to the loss of a loved one

A client comes to the mental health clinic and reports feeling depressed for the last 3 months. The client also admits to having thoughts of suicide. When the nurse inquires about the client's relationships, the client tells the nurse that the client's spouse constantly belittles the client, telling the client often that the client is "stupid and fat." Which problem should the nurse assess for further?

Intimate partner violence

An elderly man tells the nurse that his wife died 1 year ago and that he cannot stop grieving her loss. Social assessment reveals that the loss of his wife has left the client without a key supportive member of his social network. The nurse should encourage the client to consider which action?

Join a lawn bowling league

A nurse must assess for characteristics that are predictive of violent behavior. Research suggests violent behavior is influenced by possession of which attribute?

Low self-esteem

A client with a history of intimate partner violence has been diagnosed with posttraumatic stress disorder. The client is wholly unwilling to discuss any aspects of personal history or current mental status with the nurse. What is the nurse's best initial action?

Make efforts to demonstrate empathy to the client

A combat veteran with posttraumatic stress disorder has been admitted to the psychiatric unit after consuming a large number of antidepressants and drinking half a quart of whiskey 2 days earlier. What aspect of care should the nurse prioritize?

Monitoring the client for suicidal ideation

The nurse is involved in a community education program for new parents and plans to include information on child abuse. The nurse will teach the parents that the most common form of child abuse is what?

Neglect

The school health nurse is asked to see a child who has been coming to school with no lunch for the past week. The child tells the nurse, "I don't get a lunch this week, I have been wetting the bed." The nurse identifies that this child is experiencing which type of abuse?

Neglect

When caring for a client who is experiencing the symptomology of acute stress disorder, the nurse recognizes the importance of minimizing the client's risk for developing which condition?

PTSD

Which of the following would not be essential to assess when working with a person in crisis?

Past history of mental health care

A nurse is conducting a class for a group of colleagues about crisis. Which information would the nurse most likely include as being most influential on the outcome for a person experiencing a crisis?

Perception of the precipitating event

A nurse is reviewing the medical records of several clients at the community mental health center being treated for eating disorders. Which behavior would the nurse identify as differentiating a client who is believed to have bulimia nervosa from one who has anorexia nervosa?

Person engages in episodic binge eating

A client visits the clinic and tells the nurse about being under a great deal of stress on the job for the last month. Using Lazarus' model, the nurse should instruct the client that all stress responses are affected by the ...

Personal meaning of the situation

The nurse is reviewing the medication history of a client who is being treated for posttraumatic stress disorder (PTSD) following an abduction. The nurse should question the use of what medication?

Phenelzine

A couple came to the emergency department with their 5-month-old child. The child was pronounced dead of sudden infant death syndrome (SIDS). In the next day or two, it will be important for this couple to do what?

Plan funeral arrangements for the child

A client has just adopted a child whose traumatic history resulted in a diagnosis of reactive attachment disorder. What nursing action best addresses this child's diagnosis?

Planning activities where the client and the child can bond

At the prompting of friends, a 16-year-old client has agreed to meet with the school nurse who suspects that the client may have an eating disorder. During the nurse's assessment, the nurse has asked the client to describe the client's family. Which family process and characteristic is thought to contribute to eating disorders?

Poor communication and enmeshed family dynamics

A staff development coordinator is planning to teach the use of physical management techniques when clients become physically aggressive. The coordinator should stress the importance of which technique?

Practice and teamwork

A client with posttraumatic stress disorder (PTSD) is experiencing recurring nightmares. The health care provider decides to prescribe a medication to treat the client's nightmares and improve sleep, even though this is considered an off-label use of the medication. Which medication would the nurse expect to administer?

Prazosin, an alpha1 inhibitor

The nurse is seeing a male client who is obese and wants to lose weight. The client discusses why he wants to lose weight, how he recognizes that being obese is unhealthy, and that he plans to remain committed to a healthy lifestyle. The nurse recognizes that the client is engaging in which activity?

Primary arousal

A nurse has been caring for a gunshot victim who has just died. Various family and friends are present. One of the visitors privately discloses to the nurse that the visitor and the client were having an illicit affair. Which is the best action by the nurse after learning of this relationship?

Privately offer support to the visitor who was having the affair with the client

The nurse is seeing a female client who has been experiencing stress due to financial pressure. The client tells the nurse she found a second job so that she earn additional income. The nurse recognizes the client is using which coping style?

Problem focused

The client with a history of explosive outbursts becomes angry and states, "I am really getting angry." The nurse sees this as what?

Progress

The nurse caring for an elderly widow notes her client making statements such as, "Ever since my husband died I can't seem to do anything right." The client was widowed 2 years prior to this current hospitalization, which is her fifth since losing her husband to cancer after a long struggle. The woman says to the nurse, "The doctor says my blood pressure is dangerously high. What is making my blood pressure so high?" What does the nurse know about the probable cause of this client's hypertension?

Prolonged or unrelenting suffering can cause physical illness.

A nurse is developing a care plan for a client who has post-traumatic stress disorder. Which intervention by the nurse is a priority?

Promote discussion of the client's thoughts and feelings about the stressful event.

The nurse on an inpatient psychiatric unit is developing the plan of care for a 17-year-old client admitted with anorexia nervosa. The client's weight is 20% below normal. The client engages in many rituals related to eating, asks to be weighed several times per day, and complains that access to the bathroom is limited. The nurse develops a contract with the client. The purpose of the contract is to do what?

Provide the client with a feeling of responsibility and control over the client's behavior

A client comes to the emergency department after being attacked and sexually assaulted. What is the most accurate nursing diagnosis for this client?

Rape-trauma syndrome

A 38-year-old man has just received word that his latest computed tomography (CT) scan of his head indicates an inoperable brain tumor that is associated with an exceptionally poor prognosis. The man has confided to the nurse, "I think that this is punishment for being unfaithful to my wife, and she doesn't even know that." The nurse would recognize a possible deficit in which of the balancing factors affecting the client's crisis response?

Realistic perception of the event

To integrate feedback about the effects of coping, and to allow for continual processing of new information refers to ...

Reappraisal

A client with posttraumatic stress disorder (PTSD) has been prescribed lorazepam 1 mg SL q6h PRN. What assessment finding indicates that treatment is having the desired effect?

Reduced anxiety

A nurse is describing a client having a Type B personality. The nurse is describing the client as ...

Relaxed

During the nurse's assessment of a new client on a medical unit, the client confides in the nurse that the client's spouse often "slaps me around" after the client has been drinking. What action should the nurse take in response to this statement?

Report the client's statement promptly to the appropriate authorities.

When establishing long-term treatment outcomes for a client experiencing a psychiatric crisis, the nurse references the fundamental goal of crisis interventions, which is to ...

Return the client to his pre-crisis level of function

A client is diagnosed with intermittent explosive disorder. The nurse understands that this disorder is associated with which neurotransmitter?

Serotonin

People diagnosed with bulimia nervosa have lower levels of which neurotransmitter?

Serotonin

A 15-year-old client comes to the clinic in a state of crisis because her boyfriend has ended their relationship. Which type of crisis would the nurse describe this as?

Situational

Eight months ago, a client was in a hotel fire and was the last person to be rescued from the roof. The client watched the client's spouse burn to death from the helicopter. The client continues to have nightmares and is fearful that the client will die in a fire. An appropriate nursing diagnosis for the client is what?

Sleep pattern disturbance related to recurrent nightmares

A client diagnosed with depression following the death of her infant daughter consistently finds excuses to miss most of the unit's group sessions, especially those dealing with loss and grief. The nurse documents that the client is showing evidence of ...

Social withdrawal

A nurse is meeting with a young woman who has recently lost her mother and her job and has moved with her husband to a new city. She is complaining of acute anxiety and depression. What does the nurse knows that would be helpful to this client?

Sometimes too many stressors disrupt homeostasis, and, if adaptation fails, the result is disease.

A client comes to the clinic for a prenatal visit. While the client is in the examining room, her estranged husband appears and insists on seeing the client. The client tells the nurse that they are in the process of getting a divorce and she does not want to be around him. "He's been following me to work and at my home everyday." What should the nurse suspect?

Stalking

Pre-existing genetic, biologic, and psychological vulnerabilities interact with negative or stressful life events to cause illness. This describes the ...

Stress-diathesis model

The nurse is caring for a client who is a victim of intimate violence. The client has pressed charges and the perpetrator is involuntarily remanded to a treatment center for 5 years. The client asks the nurse about the requirements of the treatment center that will help prevent ongoing substance abuse. Which of the following required actions does the nurse include in the correct response?

Submit to random drug testing

Fluoxetine includes a black box warning concerning which of the following?

Suicidality in children and adolescents

During an assessment of a client who is experiencing stress related physiologic symptoms, the nurse recognizes which symptoms the client is having are dermatologic?

Sweating

A client tells the nurse, "I'm taking care of a friend who is ill." The nurse interprets thist statement as reflecting which function of social support?

Tangible

The nurse is counseling a client couple who are trying to reconcile and hold their marriage together. During therapy the wife states, "He makes me so mad when he spends all his weekend time with his friends instead of us. He makes me want to hurt him back." Using concepts from assertiveness training and effective communication techniques, the nurse implements which intervention after hearing the wife's remarks?

Teach the client to make "I" statements.

A college student who was the victim of an attempted sexual assault has sought care due to anxiety that is affecting every aspect of the client's life. Which characteristic of the client's situation and the client's anxiety would suggest a diagnosis of posttraumatic stress disorder (PTSD) rather than acute stress disorder?

The attack took place several months ago, and the client's anxiety has been continuous.

The nurse's assessment of a child from a dysfunctional family background suggests that the child lacks resilience. What outcome should the nurse identify after performing appropriate interventions?

The child demonstrates that the child is empowered to solve life problems

What action by a 6-year-old child would most strongly suggest a diagnosis of disinhibited social engagement disorder?

The child gives adults enthusiastic hugs immediately after meeting them

The nurse is working with two children who have been apprehended from a neglectful and abusive home. Initial assessments reveal that one child is much more traumatized than the other, despite similarities in their circumstances. The nurse should consider what possible explanation for their differing responses?

The children have differing levels of resilience

The nurse has been working with a client following the sudden death of her husband in a work accident. The client initiated counseling because she didn't know how to cope with this crisis and felt totally overwhelmed. The nurse and client set goals for their working relationship to include which of the following?

The client feeling like she is gradually moving toward coping with the loss

A coherent elderly client has been financially and emotionally abused by the client's adult children for the past several years but has failed to report the abuse to anyone. Which is the most likely reason that the client neglects to report the abuse?

The client is emotionally close to the children and does not want to bring them harm.

The nurse is interviewing a client who has been diagnosed with posttraumatic stress disorder (PTSD) after being randomly attacked with a gun. The client describes a recent event where the client panicked and jumped for cover when a car backfired on the street. How should the nurse best interpret this event?

The client is experiencing hyperarousal

A client who has been admitted for an appendectomy states, "I'm really afraid of the surgery because my mother died when she was admitted for an emergency surgery." When preparing to work with the client concerning this anxiety about the surgery, the nurse recognizes what?

The client is expressing fear about the surgery. The client's fear is the body's physiologic and emotional response to a known danger.

A client with a diagnosis of posttraumatic stress disorder (PTSD) tells the nurse, "When things get really bad, it sometimes feels like I'm not even in my body, like I'm floating around and watching myself." How should the nurse best interpret this client's statement?

The client is likely experiencing derealization as a result of PTSD

After a series of admissions to the emergency department over the past several months, an 80-year-old client's malnutrition, vague history, and pattern of physical injuries lead the nurse to suspect elder abuse. Which aspect of the client's situation may contribute to elder abuse? Select all that apply.

The client is physically dependent on the client's son since losing mobility. The client has no income or savings of the client's own. The client's son describes the client as "needy, helpless, and pathetic."

A young female immigrant presents in the rural health clinic with facial bruising and a fractured nose. The client is reluctant to give details of the nature of her injuries. Which should be a consideration in providing care for this client?

The client may fear deportation if she seeks public assistance.

The psychiatric mental health nurse is assessing a client who was diagnosed with posttraumatic stress disorder (PTSD) after the death of the client's child from a medical error. What assessment finding would most warrant interventions aimed at addressing the client's dissociation?

The client reports large gaps in memory of the traumatic event

The nurse is reviewing the health record of a client who developed posttraumatic stress disorder (PTSD) following a spouse's cardiac arrest and death. The health record states that the client experienced derealization during the traumatic event. What assessment finding would substantiate this statement?

The client states that the client cannot remember what happened during and immediately after the event

The nurse is dialoguing with a client who has been referred after witnessing a workplace accident several weeks ago that resulted in a coworker's death. What assessment finding would support a diagnosis of posttraumatic stress disorder (PTSD)?

The client states that the client is often "awake for hours and hours each night."

A client with a history of angry outbursts that have caused interpersonal and work problems has been in counseling for several months. The nurse judges the plan of care to be effective when which outcome is met?

The client uses adaptive coping to manage anger impulses.

After complaining of weakness and confusion while at school, a 16-year-old client was admitted to the hospital where admission assessments revealed hypokalemia. The client has normal body weight. In planning the client's nursing care and treatment, which outcome should be prioritized?

The client will be free of self-induced vomiting

A client who has been diagnosed with post-traumatic stress disorder is scheduled to begin stress inoculation training. The nurse should document what desired outcome related to this therapy?

The client will demonstrate anxiety-reduction strategies

The nurse is caring for a 16-year-old client with a history of sexual abuse. What might the nurse expect to assess with this client?

The client will experience long-term emotional trauma.

The pediatric nurse is caring for a 15-month-old child recently admitted to the hospital for a fractured femur. Which data obtained during the assessment would raise the nurse's suspicion that the child has suffered physical abuse?

The injury occurred several days before the parents sought treatment

A client is scheduled for a mastectomy for breast cancer. She is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on ...

The meaning of the mastectomy to the client

A nurse cared for a terminally ill client over a period of a month. The nurse found that spending time with the client was a pleasure. When the client died, the nurse experienced feelings of sadness, sleeping poorly, lacking energy, and feeling mildly depressed. Eventually the nurse explained the feelings to the nurse supervisor. The nurse supervisor is aware of what?

The nurse is experiencing disenfranchised grief.

A client has developed posttraumatic stress disorder (PTSD) after a violent sexual assault committed by a close family member. When planning this client's care, the nurse should follow what guideline?

The nurse should avoid touching the client during interactions unless necessary

The nurse understands that crises are self-limiting. This implies that upon evaluation of crisis intervention, the nurse should assess for which outcome?

The patient will resume the precrisis level of functioning.

Violent television programs and video games expose children to aggressive models. What part, if any, are these forms of entertainment thought to play in the development of aggressive behavior in children?

They teach that aggressive behavior results in social recognition and defeat of enemies.

A group of nurses is giving a presentation to colleagues on adaptive and maladaptive responses to stress. When talking about assessing coping strategies in clients, the nurses discuss the use of drugs and alcohol to reduce stress. Which aspect would be most most important for the nurses to emphasize about these coping behaviors?

They will increase the risk of illness

The nurse is debriefing a client counseling session with a colleague. The nurse expresses concern about the client's passivity and conflict avoidance. Which of the following personality types does this client most likely possess?

Type D

When assessing a client's anger, which of the following must be assessed first?

Underlying cause of the anger

Which three elements are necessary to legally define rape of a male, female, or mixed gendered person?

Use of force; vaginal, oral, or anal penetration; nonconsent of victim

A nurse is considering using restraint and seclusion for a client who is acting out. Which is the primary guideline for the use of restraint and seclusion?

Use should be limited to emergencies in which the risk of a client physically harming self, staff, or others is imminent.

A nurse is contributing to the interdisciplinary care plan for a client who has been diagnosed with PTSD. Which should be included in the care plan?

Vigilant monitoring for potential indications of self-harm

All of the following would be included as interventions for eating disorders to establish nutritional eating patterns except ...

Weighing the client twice a day

A nurse is working in a mental health clinic and cares for various clients. Which client should the nurse recognize as having the greatest risk for the development of drug dependence?

a 12 year old girl who was raped by a family friend

The nurse is counseling a female client who is the primary caregiver for her older adult mother who requires total care due to stroke. The client reports having difficulty "recovering from the flu." She tells the nurse she has been experiecing flu-like symptoms for over two weeks. The client is most likely experiencing which consequence of chronic stress?

a reduction in lymphocyte function

A client has been diagnosed with posttraumatic stress disorder (PTSD) after witnessing an explosion at the client's industrial worksite. The client will soon begin exposure therapy, so the nurse should prepare the client for:

a visit with the therapist to the place where the explosion occurred.

The nurse in the emergency room is assessing a client who was brought in by the police for evaluation after receiving a call from a neighbor. The client reports to the nurse that the person who has been cooking and helping around the house has not been home for days. Which type of abuse does the nurse suspect based on the client's statement?

abandonment

Considering the spiritual response to grief, which nursing intervention has the potential of providing the most support to a grieving client?

asking, "Do you find comfort in your religion at times like this?"

A client tells the nurse that he or she has a Type A personality. The nurse can anticipate that the client will be ...

competitive

The nurse is caring for a client whose spouse passed away several years ago. Upon assessment, the nurse finds that the client has a history of signs and symptoms of depression since the spouse's death. Which term correctly describes the client's response to the loss?

complicated grief

Which type of grief occurs when a person is stuck in a state of chronic grieving?

complicated grief

A client runs to the urgent care center because the spouse is at home drinking and waving a gun around while yelling at the children. Which action should the nurse take first?

contact the police

When working with the client with bulimia, the nurse should be aware that the nurse's own feelings and needs may affect care. Feelings that may be aroused in the nurse may include what?

control

When working with the family of a client with anorexia nervosa, which of the following issues must be addressed?

control issues

A client with posttraumatic stress disorder (PTSD) tells the nurse that he often feels like he has left his body and is looking at things from a distance. The nurse interprets this as:

disassociation

A client who is in the process of divorce tells the nurse the client will require some time off from work due to the inability to concentrate. According to Bowlby's phases of grieving, which phase best reflects this client's current experience?

disorganization and despair

Which type of elder abuse involves harm of self-worth?

emotional

What behavior is likely a result of an adolescent's attempt to manage the effects of over-productive parenting?

engaging in severe dieting

A client who is a bus driver was involved in an accident in which two of her passengers died. The client blames herself for their death even though she was exonerated in the follow-up investigation. To help the client see the event more realistically, the nurse should:

facilitate a referral for cognitive restructuring therapy.

Structural damage to which of the following lobes of the brain may alter the person's ability to modulate aggression?

frontal

A client with posttraumatic stress disorder (PTSD) asks the nurse about this eye movement, desensitization, and reprocessing (EMDR) treatment. The nurse explains that this treatment:

guides the client through images of the trauma, allowing for progressive desensitization.

The nurse is performing the history and physical examination on a client who is being admitted for anorexia nervosa. The client, a 23-year-old, is 5 feet 2 inches, and weighs 88 pounds. The nurse assesses the client's history of weight gain and loss, typical daily food intake, electrolyte and other blood studies, and elimination patterns. The nurse observes typical physical findings such as dry skin, lanugo, and brittle hair and nails. Which factor is a priority for the nurse to assess next?

heart rate and rhythm

A nurse is working with a patient who is experiencing large amounts of stress due to relational, financial, and physiologic factors. The nurse can best enhance this patient's resilience by:

helping the patient to think about herself in a positive way.

A nurse is caring for a client who has chronic stress related to a long history of mentally abusive parents. Which assessment findings should the nurse anticipate the client reporting during the initial assessment? Select all that apply.

history of frequent illnesses diagnosis of bipolar disorder

In many cases, family members tolerate abusive and violent behavior from relatives that they would never accept from strangers. In violent families, which normal safe haven may be the most dangerous place for victims?

home

A female client with post-traumatic stress disorder (PTSD) has just completed a session of eye movement, desensitization, and reprocessing (EMDR) therapy and exposure therapy. The client states that she is exhausted because she has been:

imagining the details of the traumatic event with the therapist.

What are clients with a history of damage to the cerebral cortex more likely to exhibit? Select all that apply.

increased impulsivity decreased inhibition decreased judgment

While assessing the family dynamics of a client with an eating disorder, which does the nurse most likely discover?

over controlling parents

A nurse is reading a journal article about anorexia nervosa and comorbidities. The article describes a strong association between anorexia and obsessive-compulsive disorder. The nurse demonstrates understanding of this information by identifiying which aspect as common to both of these disorders?

perfectionism

Which of the following terms is used to describe behavior in which a person attacks or injures another person, or behavior that involves destruction of property?

physical aggression

A client has not been to work in three days. When she returns to work, she is wearing dark glasses. Facial and body bruises are visible. Her supervisor takes her to the occupational nurse. Which assessment is the priority for the nurse?

physical injuries

A nurse is reading a journal article about disasters. The article describes natural and human-made disasters as conceptualized into phases. The nurse demonstrates understanding of these phases by identifying which activity as as the primary focus during the recuperative phase?

preventing complications of health problems

Which phase of disaster focuses on implementing strategies for healing sick and injured people?

recuperative effort

Which behavior is considered inconsistent with the clinical picture of a client who is becoming increasingly aggressive?

sobbing inconsolably

Which is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency?

stalking

According to Johnson's systematic review of the literature about violence on inpatient psychiatric units, what is a predictor of violence?

suspiciousness

When working with a client with post traumatic stress disorder (PTSD), who has frequent flashbacks, the nurse should include which intervention?

teaching various relaxation techniques

The nurse is working with a client who has the tendency to "tend and befriend." The nurse identifies this is characteristic of:

the female response to stress

A client is scheduled for a mastectomy for breast cancer. The client is quiet, shows little emotion, and states that she has no questions. The nurse's assessment would need to focus on:

the meaning of the mastectomy to the client.

A nurse in charge on a unit with a client who is receiving postoperative care for a below the knee amputation is deciding which nurse to assign to this client. Which nurse would be most beneficial for the client?

the nurse who has worked with the client before and after the amputation

When working with a client with bulimia, the nurse should encourage the client to keep a self-monitoring journal for what reason?

to raise self awareness and sense of control

The psychiatric-mental health nurse is conducting an assessment of a client who has been under a large amount of interpersonal stress. In order to best assess the client's psychological domain, the nurse should:

use a broad introduction, such as "Let's talk about what you're feeling today."

The primary goal of de-escalation is to resolve which that can happen on an inpatient unit?

angry conflicts

A client who experienced serious and repeated traumas has been diagnosed with dissociative identity disorder after being rescued from an abuser. Before caring for this client, the nurse should be prepared for:

wide variations in the personality that the client exhibits.

Which of the following would not be expected to occur during the sympathetic response (or the fight-or-flight reaction) to a stressor?

blood clotting ability decreases

A possible outcome of surveying a disaster is that the surveyor often experiences ...

An exaggerated fear for his or her safety

Which of the following clients exhibits the most realistic perception of his or her present crisis?

A woman newly diagnosed with lung cancer laments the fact that she has never made a sincere effort to quit smoking.

The advanced practice psychiatric mental health nurse is preparing to begin stress inoculation training with a client who has post-traumatic stress disorder. What should the nurse teach the client about this therapy?

"We're going to work to help you develop a new perspective on your traumatic memories."

After an angry outburst, a client quickly appears more calm and rational. The nurse approaches the client. Which is the most helpful response to the client at this time?

"What happened that got you so upset?"

A nurse is beginning the process of providing therapy to a client with anger management problems. When implementing this therapy, which should occur first to promote optimal effectiveness?

Development of a therapeutic relationship

The nurse is seeing a client who is the primary caregiver for a parent with dementia. The client reports having a low mood and anxiety. The client tells the nurse, "I think I am completely burnt out." Select the nurse's best response.

"What has helped you in the past when you have felt like this?"

A new nurse asks the nurse manager about the best intervention to use when trying to de-escalate a potentially violent client. Which response would be most appropriate?

"What works best is what fits the client and the situation."

Which statement, made by the nurse, focuses on the purposeful assessment of a client coping with a terminal diagnosis?

"Who do you want to share information about your prognosis with?"

A nurse is assessing a client in a community clinic who reports feeling anxious lately because she is considering leaving her marriage. The client describes a long history of partner abuse associated with this relationship. How should the nurse respond to this client?

"You have the right to be safe and respected."

After the death of a client's wife, a man tells the nurse "I can never live without my wife. My wife was my whole life." Which is the most therapeutic response from the nurse?

"Your wife death is a terrible loss for you"

The nurse has just completed an admission assessment of the client with anorexia. When documenting the mental status exam findings in the chart, the nurse notes poor judgment and insight. Which client statement would support this impression?

"others are just trying to keep me from looking good"

The nurse is collecting assessment data on a client who is suspected to be a victim of violence. Which assessment data would support the suspicion that the client is a victim of abuse? Select all that apply.

-The client has few friends. -There is a large amount of alcohol use in the home. -The client reports that the client's father was abusive during childhood.

The nurse is seeing a male client who is experiencing anxiety and having difficulty managing anger. The client tells the nurse he received an email last week in which a co-worker was insulting and dismissive. The client states he had difficulty sleeping after receiving the email. Select the nurse's best response.

"Is there any other way in which can you interpret what the co-worker said in the email?"

The nurse is sitting with the client at mealtime. The nurse uses cognitive-behavioral approaches to assist the client with bulimia toward recovery. Which statement by the nurse would be consistent with this approach?

"Is there any way you can look at that sandwich as fuel for your body?"

A nurse is part of a team developing strategies to help reduce the risk of violence on the mental health unit. Which of the following would the team identify as contributing to the risk for violence?

Rigid unit rules

A nurse is working with a client who is a survivor of rape. The client asks the nurse, "It's been 6 months since it happened. Why can't I get back into doing the things I did before?" What is the nurse's best response?

"It can take at least a year or more to get back to where you were before."

What is a characteristic of unit culture that predicts client violence?

Rigid unit rules

The cycle of violence or abuse is a reason often cited for why women have difficulty leaving abusive relationships. Which of the following is an inaccurate picture of the cycle of abuse that occurs over time?

Violent episodes are less frequent

The nurse is concerned that a victim of intimate violence is experiencing revictimization. Which client statement leads the nurse to this assessment? Select all that apply.

"My parents used marijuana and cocaine." "My uncle sexually abused me when I was 8 years old." "I smoke marijuana and have several cocktails in the evening."

The nurse is working with a client who is suspected of having posttraumatic stress disorder after witnessing a violent crime. What statement by the client's spouse would suggest that the client is experiencing hyperarousal?

"My spouse always seems so irritated now, which isn't like my spouse."

A nurse is teaching a class on type D personalites. Which statement by a student indicates an understanding of this instruction?

"Pessimism is a key quality with this personality."

Which statement by the nurse would be most appropriate to a colleague who very quietly and numbly tells the nurse that the colleague had arrived at the scene of an automobile-pedestrian accident and unsuccessfully performed CPR on a victim 3 days ago? The nurse and her colleague are sitting in the break room and no one else is present.

"Tell me what you saw"

Which of the following conditions triggers the general adaptation syndrome?

Distress

A group of psychiatric nurses working in a community mental health center are participating in a training program for preventing and managing aggressive behavior offered regularly by the center. Which statement by the nurses indicates that the program was successful in achieving its outcome?

"We have the most up-to-date information on the best ways to handle this problem."

A nurse is assessing a person who has suffered a loss and is grieving. When applying the dual process model, the nurse would most likely interpret which client statement as reflecting loss-oriented coping?

"I just can't believe that my spouse is gone."

A nurse's colleague expresses sympathy for a client who is traumatized following a terrorist attack 1 week earlier. The colleague states, "I'm certain that the client has posttraumatic stress disorder (PTSD)." What is the nurse's best response?

"Acute stress disorder is a possibility, which might develop into PTSD."

A nurse is working in the emergency department. Which situation would lead the nurse to suspect possible abuse of a client? Select all that apply.

-A 6-year-old is being seen for the 5th time for a urinary tract infection -A baby with contrecoup injuries to the brain -A 3-month-old with a fractured femur

Which individual is exhibiting signs or symptoms that are characteristic of posttraumatic stress disorder (PTSD)? Select all that apply.

-A client who has frequent nightmares about the time a fellow soldier died from an improvised explosive device -A client who is unable to relax without first barricading the client's home after a violent home invasion and assault -A client who has quit the client's job so that the client no longer has to go to the client's old office where the client was attacked and robbed -A police officer who experiences panic attacks when thinking about the time the police officer was forced to shoot a violent suspect

A nurse is conducting a class for a local community group about how to deal with anger in constructive ways. When discussing the benefits of managing anger constructively, which of the following points should the nurse include? Select all that apply.

-An improvement in mood -Improved overall health -Improved blood pressure control

A client is receiving cognitive-behavioral therapy as part of the treatment plan for anger. Which of the following would most likely be included? Select all that apply.

-Avoiding stimuli identified to provoke the anger -Monitoring one's self for cues related to anger arousal -Identifying ways to disrupt the anger response -Engaging in relaxation training

During an interview, a client reveals to the nurse, "I was sexually abused as a child." Based on this information, which finding would the nurse most likely anticipate being revealed during the assessment? Select all that apply.

-Client has difficulty establishing interpersonal relationships -Client has a history of substance abuse -Client has difficulty establishing a mutually satisfying sexual relationship -Client engages in self-harming behaviors

A nurse is caring for a client in the hospital who was admitted for injuries sustained from an abusive spouse. The client says she's scared to leave her husband for fear he will hurt her. Which actions should the nurse plan to include in the plan of care for this client? Select all that apply.

-Consult social services. -Plan an interdisciplinary team meeting regarding this situation. -educate the client on resources available to her

What are some types of behavior that the nurse would recognize as qualifying as psychological abuse? Select all that apply.

-Criticizing -Ridiculing -Threatening a victim's dog

A client is diagnosed with anorexia nervosa, restricting type. The nurse interprets this as indicating the use of which of the following? Select all that apply.

-Dieting -Exercising

A pregnant woman comes to the clinic for a routine visit. Upon examination the nurse notices bruises on the client's upper arms and neck. The client reports that her husband has been abusive to her. The nurse is concerned because abuse during pregnancy can lead to which condition? Select all that apply.

-Low birth weight -Low maternal weight gain -Infections -Anemia -Miscarriage

When applying the general aggression model, which area would the nurse most likely identify as an affect component? Select all that apply.

-Mood -Emotion -Expressive motor response

Which risk factors in a client's history would alert the nurse to screen for intimate partner violence? Select all that apply.

-Multiracial -Low income -Live in a rural area

A nurse is interviewing several clients who survived a school shooting ten years ago when they were in high school. Which clients should the nurse identify as having achieved adaptation following this event? Select all that apply.

-Nurse manager for the local hospital. -Married, mother of three, who is a stay at home mother. -Father of two who works in a tire store and has a second job as a mechanic.

Which issue would be most important for nurses to be aware of when working with angry, aggressive or violent clients? Select all that apply.

-Nurses must be aware of their own feelings about anger and their use of assertive communication and conflict resolution. -Nurses must discuss situations or the care of potentially aggressive clients with experienced nurses. -Nurses must be calm, nonjudgmental, and nonpunitive when using techniques to control a client's aggressive behavior.

Which interventions are effective in managing the environment to reduce or eliminate aggressive behavior? Select all that apply.

-Planning group activities such as playing games -Scheduling one-to-one interactions with the client -Providing structure and consistency in the unit

A client is seeking counseling due to difficulty coping with being a victim of a violent attack 16 months ago. The initial medical diagnosis is to rule out posttraumatic stress disorder (PTSD). Which would the nurse assess for when determining the major elements of PTSD? Select all that apply.

-Reexperiencing the trauma through dreams or recurrent and intrusive thoughts -Showing emotional numbing such as feeling detached from others -Being on guard, irritable, or experiencing hyperarousal

A nurse is caring for client who has been aggressive and violent in the past. What would be appropriate for the nurse to do? Select all that apply.

-Respect the client's personal space and boundaries. -Ensure that team members know where the nurse is. -Ensure immediate access to an exit in case leaving is necessary.

While interacting with a client experiencing aggression, which of the following client assessments would lead the nurse to suspect that an episode of aggression is about to occur? Select all that apply.

-Staring in an intimidating fashion -Using sarcastic comments -Mumbling -Pacing

The nurse is interviewing a client who witnessed a fatal accident at the workplace and was unable to save a colleague. What assessment findings would support a diagnosis of posttraumatic stress disorder (PTSD)? Select all that apply.

-The client has nightmares about the accident -The client says the client is "unable to face that place again" -The client says the client's family describes the client now as "edgy" and "irritable"

The nurse is aware that fewer than half of rapes and sexual assaults are reported. Which are some of the reasons people do not report being sexually assaulted? Select all that apply.

-The client is embarrassed of the assault. -They have a fear of being blamed for the incident. -The perpetrator may use coercion or threats to control the victim.

When working with the survivors of a major natural disaster, the psychiatric health care team integrates knowledge of which concepts? Select all that apply.

-The period of recovery may last for years -There will likely be a major increase of psychiatric emergencies -Crimes such as looting will be viewed by many as being acceptable

A nurse has determined that a client requires restraint. Based on guidelines, the nurse contacts the physician who must examine the client within which time frame?

1 hour

A nurse is aware of the high incidence of intimate partner violence (IPV) and actively seeks opportunities to screen women for IPV. Which female client represents the best opportunity for assessing for IPV?

A client who is in the third trimester of pregnancy and who is having biweekly prenatal appointments at a clinic

Treatment of eating disorders often combines psychotherapy and psychopharmacology. Which classes of medications can be used to treat eating disorders?

Antidepressants

The nurse is caring for a client diagnosed with bulimia. Which would be important for the nurse to do first?

Ask the client about hard to self or others

The nurse is assessing an elderly client in the emergency department. There are many bruises present on the client's body in varying stages of healing. After documenting the bruising in the assessment, what should the nurse do next?

Ask the client when and how the bruises occurred

The nurse's interview with a client who has post-traumatic stress disorder reveals that the client is living in a state of hyperarousal. Which action would the nurse identify as a priority?

Assess the impact of the client's hyperarousal on the family

While a nurse talks to the mother of a 15-year-old client, the mother expresses concern over the client's eating and exercise habits. The mother says that as soon as the client comes home from school, the client exercises for 2 to 3 hours every day. She says the client eats very little at dinner, but in the morning she notices that large amounts of food are missing from the kitchen. The client was complaining of tooth pain, and when the mother took the client to the dentist, the client had over 10 cavities. Which disorder is the client most likely suffering from?

Bulimia nervosa

An angry client has just thrown a chair across the room and is racing to pick up another chair to throw. The most appropriate action by the nurse would be what?

Call for an emergency response from trained personnel.

Which term is used to describe an activity used to release anger?

Catharsis

The nurse is caring for a client who has just been diagnosed with cancer. The client states that the client will "never be able to cope with this situation." What is the nurse aware that coping is?

Coping is the physiologic and psychological processes that people use to adapt to change.

A nurse is reviewing the events that occur in the body as it responds to stress. The nurse demonstrates understanding of the information by identifying which hormone as primarily secreted by the adrenal cortex during stress?

Cortisol

The nurse in the psychiatric unit is aware the atmosphere can change at any time. At which point in the stages of aggressive incidents is intervention least likely to be effective in preventing physically aggressive behavior?

Crisis

Which factor is likely to have the greatest impact on how a client responds to grief?

Cultural influences

A 42-year-old client was recently diagnosed with hypertension. Which of the following occurrences would be a positive reaction to the acute stress of this new diagnosis?

Decreased dietary sodium and fat intake

A client meets some (but not all) of the diagnostic criteria for anorexia nervosa. Despite having lost considerable weight, the client's weight is within the normal range. The nurse understands that based on DSM-5 criteria, this client would most likely be diagnosed with which of following?

Eating disorder not otherwise specified

The nurse is working with a client who lost the client's youngest child 2 months ago. When the nurse approaches, the client yells, "I don't want to talk to you. You have no idea what it's like to lose a child!" The nurse bases a response to the client on the understanding of what?

Hostility is a common behavioral response to grief.

Which is a true statement regarding anger?

Humans can choose to slow their reactions and to think and behave differently in response to various events.

A 19-year-old college student sought care at the campus medical clinic with complaints of unusual vaginal discharge and was subsequently diagnosed with gonorrhea. The student's friends and family all live in her home state, and she has not yet formed close relationships with her classmates and roommates. What risk does the student's lack of situational support most clearly pose?

Interpretation of the crisis as overwhelming or irresolvable

The client is talking to the nurse about the client's intimate relationships. Which statement regarding intimate partner violence is true?

Intimate partner violence can exist with former partners.

Which is one of the most common nursing diagnoses for clients experiencing intense anger and aggression?

Risk for Self-Directed Violence

The client with bulimia reports feeling helpless and says, "What's the use?" As the nurse plans the client's care, the priority diagnosis is which?

Risk for self-directed violence

The nursing student learning about intimate partner violence correctly identifies its prevalence in same-sex couples as what?

Same frequency as in heterosexual couples

A client is diagnosed with intermittent explosive disorder. A nurse would expect to administer what as part of the treatment plan?

Selective serotonin reuptake inhibitors

The nurse is caring for a client hospitalized in an inpatient psychiatric setting for a history of violent behaviors and delusions. The nurse should instruct the client's family that aggression has been linked to low levels of which bodily chemical?

Seretonin

Low levels of which neurotransmitter may lead to aggressive behavior?

Serotonin

You are caring for a 4-day-old set of conjoined twins and their parents. The infants are doing well at this point, but the parents are each in a heightened anxiety state after being told that when the babies are separated one of them may become permanently disabled. By the statements the parents are making, the nurse knows they are cognitively appraising the situation their family is in. While talking with the parents, you note that the father of the babies has an aggressive stance, is speaking in a loud voice, and makes several hostile statements such as, "I'd like to strangle that doctor who told us our babies would be okay." You know that this father's cognitive appraisal has led to what?

The development of negative emotions

The parents of a teenage girl who has just been diagnosed with anorexia nervosa are distraught at this development, stating, "We have no idea where this all came from." The anorexia nervosa client is typically what?

The high achiever

A school nurse is educating a group of adolescent girls about rape and sexual assault. The nurse evaluates the students' understanding when they report which as a high-risk factor regarding the incidence of rape?

The highest incidence of rape occurs in adolescents and young adult women.

Which would not increase the likelihood that an older adult will incur physical abuse?

The older adult is independent with activities of daily living.

A situational crisis refers to ...

The result of an external source of severe stress the individual is not prepared to cope with effectively

A female college student comes to the counseling center and tells the nurse she is afraid of her boyfriend. She states, "He is so jealous and overprotective; he wants to know where I am and who I'm with every minute." The nurse recognizes this as which of the following?

The tension-building phase of the violence cycle

Which client on the mental health unit should be assessed as being at highest risk for directing violent behavior toward others?

a client who has paranoid delusions and believes is being followed by members of the mafia

The psychiatric-mental health nurse is assisting with a support group for individuals diagnosed with post-traumatic stress disorder. Which information would the nurse incorporate into the plan for this group?

Women are much more likely to develop PTSD than men

Which referral would a nurse make for a client who was badly beaten by a spouse, has no place to go, and no financial means?

a women shelter

Crisis intervention differs from the typical therapeutic relationship in that ...

crisis intervention seeks to alleviate the immediate external threat.