Psych Midterm

The client with mania attempts to hit the nurse. Which is the best response by the nurse?

"Do not swing at me again. If you cannot control yourself, we will help you." Stating, "Do not swing at me again. If you cannot control yourself, we will help you," firmly states behavioral expectations and lets the client know his behavior will be safely controlled if he is unable to do so. Arguing that the nurse does not deserve the attack provokes confrontation rather than communicating clear expectations. Stating "If you do that one more time, you will be put in seclusion immediately" is likely to be perceived as a threat rather than an assertive statement. Similarly, stating "Why do you continue that kind of behavior? You know I won't let you do it" may be perceived as a challenge or threat.

A client who is hospitalized with depression tells a nurse, "I don't want to take the medication because I'm afraid I'll become suicidal." Which response by the nurse would be mostappropriate?

"Have you ever thought about hurting yourself?" The nurse's best response is, "Have you ever thought about hurting yourself?" This response seeks to clarify the client's statement about hurting oneself and opens the door to allow a therapeutic discussion, since clients with depression may have suicidal thoughts. Telling the client to take the medication, agreeing with the client, or giving advice will block therapeutic communication.

The family of a 22-year-old client with bipolar disorder is having difficulty coping with the client's rapid mood swings, irritability, grandiose delusions, and overly intrusive behaviors. Following a visit to the unit, the parents discuss their frustration and anger with the nurse and ask what they should do to help the client. Which reply by the nurse is most appropriate?

"Help the client monitor medication adherence and watch for changes in mood and sleep." A normal routine and careful monitoring of mood assists the client to take action when the routine or mood becomes disrupted. Medication adherence is the best way to ensure prevention of relapse. Changes in mood and sleep can be early signs of relapse; therefore, observing closely for these can ensure early intervention. Maximum independence within a supportive community is the priority. Advising the family to follow the client's medications and monitor the client's spending or restrict spending and driving will create a controlling relationship and promote tension. This will increase caregiver burden and create disagreements over illness management and financial responsibilities. Waiting to call the police is also incorrect and indicates that the situation has spiraled out of control. The parents may resort to this to protect themselves and their property, but a more proactive solution is to teach the client to keep doctor's appointments and follow the treatment regimen.

The nurse is working with a client who is experiencing a crisis due to a divorce. Which statement would alert the nurse to the client's need for referral for further mental health counseling?

"I am trying to work through this but have had to cut myself a few times." The client who is using self-mutilation such as cutting is in need of further mental health counseling and potentially admission to a psychiatric unit. This is evidence of having difficulty coping and the client needs a more in-depth assessment of potential support measures. Having a hard time going to work or sleeping are normal grief reactions. The client who is angry is also working through a stage of grief but there is no evidence with any of these other situations that the client is not coping with this crisis.

If a client states, "I carry this lucky rabbit's foot for luck, my dad did too, and it really works," which statement by the nurse reflects respect for the client's belief?

"I can accept that you feel it is lucky, so let's get to our activities for the day." At times, a nurse's values and beliefs will conflict with those of the client or with the client's behavior. The nurse must learn to accept these differences among people and view each client as a worthwhile person regardless of that client's opinions and lifestyle. The nurse does not need to share the client's views and behavior; the nurse merely needs to accept them as different from the nurse's own and not let them interfere with care.

A client approaches the nurse and loudly states, "I'm not putting up with this anymore!" The most appropriate response by the nurse would be what?

"I can see you are angry. Tell me what's going on." In the triggering phase, the nurse should approach the client in a nonthreatening, calm manner in order to de-escalate the client's emotion and behavior. Conveying empathy for the client's anger or frustration is important. Acknowledging the client's anger and giving the client permission to explain is an appropriate response because it can deescalate the situation. Referring to rules ("You are not allowed ...") may make the situation worse. Stating that the client can leave is not therapeutic and will likely perceived as an ultimatum. It is appropriate to ask, "Why do you say that?" but this should be preceded by an acknowledgment of the client's feelings.

The client states, "I can't go to group today. I have a very upset stomach this morning." Which would be the nurse's most appropriate response?

"I know you don't feel well, but it's important for you to participate in therapy." The challenge for the nurse is to validate the client's feelings while encouraging her or him to participate in activities. The nurse should not strip clients of their somatizing defenses until adequate assessment data are collected and other coping mechanisms are learned. The nurse should not attempt to confront clients about somatic symptoms or attempt to tell them that these symptoms are not "real." They are very real to clients who actually experience the symptoms and associated distress. Deferring to "doctor's orders" provides no genuine explanation to the client.

During a night shift, a hospitalized client with depression tells a nurse that the client is going to kill himself or herself. The client is placed on constant observation. When the client asks to use the toilet, the nurse follows the client into the bathroom. The client says, "You don't need to follow me into the bathroom. Give me some space." Which response by the nurse is mostappropriate?

"I must stay with you until we are sure you will not hurt yourself." The client is depressed and has expressed suicidal thoughts. The client has been placed on constant supervision as required by unit policy. Staying with the client, even when the client is in the bathroom, demonstrates an understanding of constant observation. Staying with the client also demonstrates professional judgment regarding the policy and situation. The other options do not ensure the client's safety during this time of crisis.

When talking with the spouse of a client who attempted suicide, the psychiatric nurse demonstrates understanding of the priority areas of assessment by asking which questions? Select all that apply.

-"Does your spouse harm himself or herself physically when stressed?" -"Has your spouse attempted to kill himself or herself by injuring him/herself." Case finding requires careful and concerned questioning and listening that make the client feel valued and cared about. Similar questions can be used when talking with the spouse of a client who attempted suicide, the psychiatric nurse shows an understanding of the priority areas of assessment by the following: "Does your spouse harm himself or herself physically when stressed?"; "Has your spouse attempted to kill himself or herself by injuring him- or herself?" Asking about who will be responsible for getting the client to therapy sessions, if the client has ever been psychiatrically unstable, or if the client gave any clues do not provide information needed to determine suicide risk. People who are contemplating suicide often do not share their ideation. This lack of disclosure often means that family, friends, and health professionals are unable to intervene until the suicidal ideation and planning have progressed.

A nurse is caring for clients who are psychologically abused. Which clients should the nurse screen for psychological abuse? Select all that apply.

-A partner of a client who has destroyed the front door of their home. -A client whose partner is monitoring the amount of money spent on food and clothing. -A partner of client who does not want the client to spend any time with family or friends. -A parent of a client who is threatening to injure the family's pet. Psychological abuse includes behaviors such as criticizing, insulting, humiliating, or ridiculing someone in private or in public. It can also involve action such a destroying another's property, threatening or harming pets, controlling or monitoring spending and activities, or isolating a person from family and friends. Making a joke about someone's clothing is unlikely to qualify as psychological abuse.

A client who has been prescribed fluoxetine for depression and has just had the dosage increased comes the emergency department. The nurse suspects serotonin syndrome based on which assessment?

-Change in mental status -Ataxia -Diaphoresis -Fever The symptoms of serotonin syndrome include altered mental status, autonomic dysfunction, and neuromuscular abnormalities. At least three of the following must be present for a diagnosis: mental status changes, agitation, myoclonus, hyperreflexia, fever, shivering, diaphoresis, ataxia, and diarrhea.

A nurse suspects that a client has overdosed on the prescribed tricyclic antidepressant. Which assessment findings would support this suspicion? Select all that apply.

-Confusion -Hallucinations -Agitation In acute overdose, almost all symptoms develop within 12 hours. Confusion, hallucinations, and agitation are signs of overdose. CNS suppression (ranging from drowsiness to coma) or an agitated delirium may occur. Orthostatic hypotension and headache are side effects of MAOIs.

A client is being discharged on lithium. The nurse encourages the client to follow which health maintenance recommendations? Select all that apply.

-Drink a 2 L bottle of decaffeinated fluid daily. -Do not alter dietary salt intake. -See the doctor if the client gets the flu. Clients should drink adequate water (approximately 2 L/day) and continue with the usual amount of dietary table salt. Having too much salt in the diet because of unusually salty foods or the ingestion of salt-containing antacids can reduce receptor availability for lithium and increase lithium excretion, so the lithium level will be too low. If there is too much water, lithium is diluted, and the lithium level will be too low to be therapeutic. Drinking too little water or losing fluid through excessive sweating, such as with strenuous exercise, vomiting, or diarrhea increases the lithium level, which may result in toxicity. Monitoring daily weights and the balance between intake and output and checking for dependent edema can be helpful in monitoring fluid balance. The physician should be contacted if the client has diarrhea, fever, flu, or any condition that leads to dehydration.

The nurse who is developing a suicide prevention strategy would need to ensure which step is included?

-Figuring out who is at risk for suicide -Determining imminent risk of suicide -Using assertive interventions if there is a threat of suicide -Following up with interventions to prevent suicide in the future The beginning evidence points to four steps in preventing suicide and promoting long-term mental health: identification of those thinking about suicide (case finding), assessment to determine an imminent suicidal threat, intervening to change suicidal behavior associated with a specific suicidal threat, and institution of effective interventions to prevent future episodes of suicidal behavior.Consulting with family members about the risk for suicide is not one of the four steps that have been identified in the research as evidence to support actions of health care providers in intervening and preventing suicide.

A client on a medical unit has a comorbid diagnosis of depression and has been taking mirtazapine for several months prior to the current admission. When providing care to the client, which action would be most appropriate for the nurse to do? Select all that apply.

-Monitor the client's mood and affect over the course of the admission. -Ensure that the client is not cheeking or stockpiling the medication. With any antidepressant, the nurse should monitor the client's mood and ensure that he or she is not stockpiling medication for a suicide attempt. Antidepressants do not have a short-term affect on mood, so assessment 30 minutes after administration is unnecessary. Mirtazapine is not associated with hypertensive crises and dietary modifications are unnecessary.

A client presents to the emergency department with a flat affect. The nurse suspects the client may be experiencing a major depressive episode. Which variable would the nurse need to keep in mind as representing the highest risk for this condition? Select all that apply.

-Mood disorder in first-degree relatives -Substance abuse -Divorced Major depression is twice as common in women and has a 1.5 to 3 times greater incidence in first-degree relatives than in the general population. Incidence of depression decreases with age in women and increases with age in men so being an older adult is not necessarily a risk factor for depression. Single and divorced people have the highest incidence. There is a higher incidence of depression among people who abuse alcohol or drugs.

A nurse is preparing to administer pharmacotherapy as part of the treatment plan for a client with bipolar disorder. The nurse understands that this therapy is designed to achieve which goal? Select all that apply.

-Rapid control of symptoms -Decreased frequency of manic episodes -Prevention of future episodes -Decreased severity of manic episodes Pharmacotherapy is essential to the successful management of bipolar disorder to achieve the goals of rapid control of symptoms and prevention of future episodes, or, at least, reduction in their severity and frequency.

A client is experiencing a panic attack while in the recreation room. Which intervention would be a priority to promote the client's safety? Select all that apply.

-Remaining with the client to assess needs -Turning off any televisions or radios in the immediate area During a panic attack, the nurse's first concern is to provide a safe environment. Staying with the client to assess needs is vital. If the environment is overstimulating, the client should move to a less stimulating place. Decreasing external stimuli will help lower the client's anxiety level. An antianxiety agent may be helpful, but it is not the priority; obtaining a prescription would require that the nurse leave the client, which would be inappropriate. Trying to engage the client in recreational activities is likely to exacerbate his or her anxiety.

The nurse has used wrist and ankle restraints for a client who was extremely aggressive. What assessments should the nurse perform on a regular basis after restraining the client? Select all that apply.

-Side effects of medication -Skin condition -Peripheral circulation -Emotional well-being The nurse should perform routine assessments for the client who has been physically restrained. The assessments should include the skin condition of the client and the circulation of the client. The use of restraints could impede the peripheral blood supply and cause skin breakdown. The client should be monitored for side effects of medication. The client's emotional well-being (stability) should also be assessed to determine if the restraints can be removed. The client is physically restrained; thus, it would be inappropriate to assess the memory.

An aggressive client gets hold of a glass piece and prevents anyone from entering the room. What interventions should the nurse perform to ensure safety of the client, staff, and other clients? Select all that apply.

-Summon help from others -Leave the area immediately -Shift other clients to a safe place The aggressive client with a potentially harmful weapon in hand can be dangerous to self, staff, and other clients. The nurse should summon help to help control the client. The nurse should leave the area immediately if unable to calm the client and the situation is an emergent one. The other clients should be shifted to another area to ensure safety. Attempting to remove the weapon from the client may increase the risk of injury to the nurse. The client may not be able to understand the instructions; therefore, taking down the client may not be helpful.

A nurse is seeing a client prior to discharge after being admitted to hospital for suicidal ideation. As the nurse begins the discharge process, the client closes the eyes and begins rapid, shallow breathing. The client also begins to shake and perspire profusely. Which actions should the nurse take? Select all that apply.

-Talk to the client in a comforting manner. -Take the client to a quiet space. -Reassure the client of being safe. Given the sudden change in the client's behavior when discussing a stressful transition such as hospital discharge, this client is experiencing panic level of anxiety. In this case, the nurse should keep talking to the client in a comforting manner even though at the time, the client may not be able to process what is being said. Taking the client to a quiet space can decrease environmental stimuli to help reduce anxiety. Providing reassurance to the client that the feeling will pass and that the client is safe is therapeutic and can also decrease anxiety. The nurse should remain with the client until the panic recedes. There is no evidence that the client is experiencing suicidal ideation.

A client with major depressive disorder is prescribed new drug therapy. To best the client's adherence to this therapy, which information would the nurse include in the teaching plan for the client? Select all that apply.

-The length of time treatment is anticipated -The possibility that two or more drugs will be prescribed -A detailed description of possible side effects -The importance of staying in touch with mental health care provider To best minimize the risk of a client's noncompliance with new drug therapy for a mood disorder, the nurse discusses anticipated length of treatment time, the possibility of two more drugs being prescribed, possible side effects of the drug(s), and the importance of staying in touch with a mental health care provider.

A client taking lithium for bipolar disorder comes to the clinic and reports symptoms which the nurse interprets as consistent with moderate lithium toxicity. Which action should the nurse perform? Select all that apply.

-Withhold additional doses of lithium. -Obtain a blood sample for lithium level. -Push fluids. -Contact the physician. If symptoms of moderate to severe toxicity to lithium are noted, the nurse should withhold the medication, obtain a blood sample to analyze the lithium level, push fluids, and contact the physician for further instructions.

The nurse suspects that a client is a victim of intimate partner violence. What should the nurse consider when caring for this client? Select all that apply.

-availability of support -support can be accessed safely The challenge for health care providers is twofold—ensuring that support is both available and safely accessible. Many victims of intimate partner violence are afraid or reluctant to identify their abusers, fearing retaliation against themselves and/or their children. They may continue to hold strong feelings for their partners despite the abuse. When medical care is required, women may attribute their injuries to other causes; health care providers may be reluctant to inquire about abuse. Provision of assistance to clients who are involved in violent intimate relationships can pose unique problems in that seeking support can be dangerous to the women if their activities are discovered by the abusive partner. Cost of care, legal counsel, and family counseling are not areas for consideration for a client suspected of being a victim of intimate violence.

A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time?

Accompany the client to his or her room to get dressed. Redirecting the client to appropriate behavior without confrontation is most effective. Seclusion is not an appropriate intervention for this situation. Ignoring the behavior is not indicated. The client is in the manic phase; telling him or her to stop the behavior may make the behaviors escalate.

A client with pain who has been diagnosed with somatic symptom disorder and depression is prescribed medication therapy to treat both the pain and the symptoms of depression. When educating the client about the medication, which would the nurse emphasize?

Alcohol should be avoided The client will likely be prescribed a nonsteroidal analgesic and selective serotonin reuptake inhibitor medication. In both cases, the client should be reminded to avoid consuming alcohol as this can increase the sedative effects of the antidepressants and increase dehydration leading to dysfunctional metabolism of the medications. Photosensitivity is not associated with the use of monoamine oxidase inhibitors. Water intake needs to be monitored when lithium is used. Clients should also be encouraged to give the medications enough time to be effective because many medications require up to 6 weeks before the client has a response or a relief of symptoms.

A client with bipolar disorder is admitted to the psychiatric unit. The client is talking loudly, walking back and forth rapidly, and exhibiting a short attention span. Which nursing intervention should occur first?

Decrease the client's environmental stimuli. When the client is agitated, decreasing stimuli is the priority because it is likely to reduce the client's agitation. Giving an agitated client feedback about his or her behavior may provoke confrontation. Similarly, making reference to rules and policies may make the client reactive or defensive, exacerbating the situation. Introducing the client to other staff does nothing to address the client's agitation.

During an interview, the nurse has asked a client with depression about any hopes or plans for the future. In response, the client silently made a gesture of drawing the index finger from one side of the client's throat to the other. The nurse has informed the client that this must be communicated to the care team. What is the main rationale for the nurse's action?

Ensuring the client's safety Plans of suicide must be communicated in order to protect clients' safety. Even though this action is consistent with collaborative practice and continuity of care, safety is the priority rationale. This is a justifiable violation of the client's autonomy and privacy.

Initially, the nurse should focus on successfully achieving which goal in order to effectively provide care for a client diagnosed with a mental illness?

Establishing trust and rapport with the client Establishing trust and rapport are the most important components when caring for a client with mental illness. Without this foundation, therapeutic nursing care is not possible. The nurse does not offer advice but rather works with the client to arrive at effective solutions to existing problems. Reasonable limits regarding the actual work that is accomplished is important but limits can't be set or enforced until there is a therapeutic relationship established. The nurse-client relationship is therapeutic in its nature; it does not involve a social friendship.

The nurse is caring for a client with conversion disorder. The client reports having paralysis of the right side of the body. Which action by the nurse would constitute a secondary gain?

Feeding the client during mealtime Secondary gains refer to the personal benefits that the client experiences from being considered sick. In this case, being fed is considered the secondary gain. Discussion about family and friends with the client is a treatment strategy that may help the client develop insight into the cause of the condition. Teaching the client techniques of meditation and relaxation is a treatment strategy that may help the client relieve stress. Discussing the coping strategies that the client used in the past may help the client identify and integrate those coping strategies in the future.

A client is being transferred from a group home to an evolving consumer household. The goal of this transition is for the client to eventually do what?

Fulfill daily responsibilities without supervision. The evolving consumer household is a group-living situation in which the residents make the transition from a traditional group home to a residence where they fulfill their own responsibilities and function without onsite supervision from paid staff. In this model, activities of daily living are prioritized over therapy and crisis resolution, even though these may be necessary for some clients.

A 21-year-old client has been recently diagnosed with agoraphobia. Which situation is mostlikely to cause the client anxiety?

Going to a crowded, outdoor market independently Agoraphobia is the fear of being alone in public places from which the person thinks escape would be difficult or help would be unavailable if he or she were incapacitated.

Before eating a meal, a client with obsessive-compulsive disorder must wash the hands for 14 minutes, comb the hair for 114 strokes, and switch the light off and on 44 times. When evaluating the progress of the client, what is the most important objective for this client?

Gradually decrease the amount of time spent for performing rituals. Ritualistic behaviors must oftenay be decreased gradually over time. The nurse must respect the client's choices, but allowing ample time for their completion may cause them to go unaddressed. Acceptance of medications is a means to reducing rituals, not an end in and of itself. Dictating a reduction every four days is overly prescriptive; every client's needs and progress will differ.

Which meal would the nurse provide to best meet the nutritional needs of a client who is manic?

Ham sandwich, cheese slices, milk Finger foods, or things clients can eat while moving around, are the best options to improve nutrition. Such foods should be as high in calories and protein as possible. Sandwiches and cheese are finger foods and are calorie-dense. Chips and cola are not nutritious, even though they are high in calories. Fried chicken, potatoes and spaghetti cannot be eaten while the client is moving.

A client is admitted to the mental health unit because the client was found trying to inject diluted feces into the client's hospitalized child's intravenous line. The client has a history of similar attempts of harming the child. The nurse would most likely suspect what?

Munchausen's syndrome by proxy The client who attempts to injure someone else, usually a child, to gain the attention of the health care provider most likely has factitious disorder by proxy, or Munchausen's syndrome by proxy. Typically, this disorder affects mothers. The client's history does not reflect manifestations of schizoid personality traits or borderline personality disorder. Functional neurologic symptoms involve severe emotional distress or unconscious conflict expressed through physical symptoms.

The client is a 32-year-old diagnosed with bipolar disorder. The client attends group therapy for 6 hours a day and then returns home to the client's residence. In which setting would the client receive this type of care?

Partial hospitalization program Partial (day) hospitalization programs are an alternative for those who continue to need some supervision, but are not appropriate clients for long-term admission. Partial (day) hospitalization programs provide activities and therapy sessions (group and individual) for 6 to 8 hours per day. Clients then return to their primary residence or workplace.

The client feels that the client's rights have been violated. Placing a client in restraints before using other methods of intervention violates which of the client's rights?

Receive treatment in the least restrictive environment The least restrictive environment means that the client must be free of restraint or seclusion unless it is necessary. Less restrictive treatments must be tried and found to be ineffective before more restrictive measures, such as restraints, can be used. It is not necessary for the client to provide informed consent for restraints to be used when appropriate. Premature use of restraints does not violate principles of informed consent. Confidentiality involves the protection of private information, not restriction of mobility. Restraints would violate the client's autonomy, not the timeliness of treatment.

When intervening with a suicidal client, the initial goal is to keep the client safe. Measures to optimize safety would include what?

Remove access to the means to attempt suicide It is important to remove methods of suicide, if possible, from the person. If a person has a concern that someone is thinking of suicide, ask directly. Nurses need to take any threat of suicide seriously. Mood disorders are common in people who die by suicide; treatment needs to be encouraged.

A client has been diagnosed with somatic symptom disorder. The client's assessment reveals high levels of anxiety. Which would the nurse expect to be prescribed?

Selective serotonin reuptake inhibitors (SSRIs) Clients with anxiety are treated pharmacologically, similar to those with depression. The first line of treatment for all anxiety disorders is with an SSRI. Doses for somatic symptom disorder are usually higher than those prescribed for depression to relieve and manage the symptoms of the anxiety disorders.

A client with mental illness expresses interest in having a date with the nurse. Which would be the nurse's best response in this situation?

Set boundaries of a professional relationship. The nurse should remind the client of the boundaries of the professional relationship. Requesting to be assigned to another client may not be a viable solution. Scolding the client may cause the client to stop communicating. The nurse should not yield to the client's desire against the nurse's wishes.

A client who is manic threatens others on the unit. Which would be the initial nursing action in response to this behavior?

Setting limits on aggressive and intimidating behavior Because of the safety risks that clients in the manic phase take, safety plays a primary role in care, followed by issues related to self-esteem and socialization. It is necessary to set limits when clients cannot set limits on themselves. Giving the client the opportunity to exercise self-control is most therapeutic. If the client cannot control his or her behavior, then more restrictive measures can be taken, such as room restriction or sedation. Clearing the area is not necessary during limit setting and may cause excessive panic on the part of other clients. When setting limits, it is important to clearly identify the unacceptable behavior and the expected, appropriate behavior. All staff must consistently set and enforce limits for those limits to be effective.

A client has lost a job of 20 years. This is an example of which type of crisis?

Situational Situational crises are unanticipated or sudden events that threaten the individual's integrity. Maturational crises are predictable events in the normal course of life. Developmental crises are also called maturational crises. Adventitious crises include natural disasters like floods, earthquakes, or hurricanes.

The nurse is caring for a client who is being treated in the emergency department for a panic attack. Which nursing intervention would be most appropriate?

Stay with the client, emphasizing that the client is safe and that the nurse will remain with the client. It is important to stay with the client and remain calm to help relax the client. Trying to mimic the client's symptoms would further add to the client's anxiety level. It is also important to stress that you will stay with the client and that the client is safe. The nurse should use clear, concise directions and short sentences. Medical jargon, such as telling the client this is an acute exacerbation with a positive prognosis, should be avoided.

A nurse is assessing a client and suspects obsessive-compulsive disorder .The nurse understands that to rule a behavior as obsessive-compulsive disorder (OCD), the obsession or compulsion must meet which criteria?

Take up more than 1 hour/day and cause stress to the client. OCD is diagnosed when recurrent obsessions or compulsions (or both) take up more than 1 hour a day or cause considerable stress to the individual. These obsessions or compulsions are not caused by substance or medication use or other disorders. Some individuals recognize that these obsessions or compulsions are excessive and unrealistic; others have limited insight and are unsure whether the obsessive thoughts are true but continue to have the thoughts and feel compelled to perform the actions. Another group of individuals are convinced that their obsessive thoughts are true. These thoughts and compulsive behaviors are stressful and interfere with normal daily routines.

A client with obsessive-compulsive disorder describes all doorknobs as being contaminated with a variety of viruses. The client cleans each knob three times with paper towels before use. Such behavior allows the client to do what?

Temporarily reduce anxiety Compulsions, such as cleaning the doorknob three times prior to use, are an unconscious mechanism by which the individual can reduce his or her anxiety level. These behaviors often become problematic, as they often eventually interfere with the individual's activities of daily living.

The nurse is assessing a client who has been receiving treatment for obsessive-compulsive disorder (OCD). What finding helps the nurse to evaluate the effectiveness of the treatment?

The client is able effectively carry out functional and occupational tasks. The treatment is effective when the client is able to carry out all responsibilities without any interfering rituals. The treatment is progressing correctly when the client has reduced the number of repetitions and the time spent in the ritual. Medication is an important part of treatment for OCD and must not be discontinued until treatment is complete. An improvement in the client's condition helps to reduce the family's anxiety.

A client with obsessive-compulsive disorder (OCD) spends several hours each day cleansing the home and washing the hands. The client tells the nurse, "I don't think you quite realize how many bacteria, viruses, and fungi live around us." What is the nurse's most accurate interpretation of this client's statement?

The client may lack insight into the OCD The client's statement is an attempt to present a rational justification for the client's actions. This suggests a lack of insight. There is no particular association between this client's statement and physiologic factors. A lack of insight is a challenge for treatment, but it does not necessarily mean that the client will be unresponsive to treatment. Rituals often have no direct relationship with a specific event in the past.

A client is hospitalized on a psychiatric unit secondary to a suicide attempt. The client has been diagnosed with depression and is consistently depressed. When assessing the client, which finding would alert the nurse that the client's suicidal risk has increased?

The client says the client feels better, with more energy to interact with others During the depths of depression, clients may not have the energy to complete a suicide. As clients begin to feel better and have increased energy, they may be at a greater risk for suicide. If a previously depressed client appears to become energized overnight, he or she may have made a decision to commit suicide and thus may be relieved that the decision is finally made. The nurse may misinterpret the mood improvement as a positive move toward recovery; however, this client may be very intent on suicide. These individuals should be carefully monitored to maintain their safety.

A client developed conversion blindness after witnessing the death of the client's twin in a car accident. When teaching the client's parent about the client's illness, the nurse explains what?

The client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis. Conversion blindness is an unconscious process; it will not disappear with ophthalmologic care. Conversion symptoms are unconsciously designed to reduce anxiety, so "the client's blindness is a reaction to the trauma of losing the twin and has no physiologic basis" is appropriate.

Which nursing action would be a protective factor in the prevention of suicide for a client who has been identified at risk?

The nurse facilitates a referral to a drug and alcohol recovery program. Protective factors buffer individuals from suicidal thoughts and behavior. Protective factors have not been studied as extensively as risk factors, but identifying and understanding them are very important. Protective factors include effective clinical care for mental, physical, and substance abuse disorders. The nurse facilitating a referral for a client to a drug and alcohol recovery program can serve to mitigate or prevent the risk for suicide in a client who also has risk factors. Although medical interventions for depression are important, effective depression treatment is multitudinal and should incorporate psycho-social and spiritual care as well. Clients should not be told to avoid conflict rather the nurse should assist the client in building personal capacity to manage conflict in adaptive ways. Clients who are at risk for suicide would find social support to be a protective factor in mitigating or preventing self harm. Client's should be encouraged to be connected to family and community support whenever possible.

It is brought to the nurse administrator's attention that a nurse has developed an intimate relationship with a client. Which behavior indicates the nurse has engaged in an intimate relationship with a client?

The nurse is having dinner with a client outside the hospital premises. The nurse having dinner with a client outside the hospital premises indicate that the nurse may have an intimate relationship with the client. The nurse talking to the spouse of the client regarding the client's condition or examining the genital area of a client with venereal disease is indicative of a therapeutic behavior of the nurse. Involving the client in conversation about sports indicates that the nurse is trying to build a social relationship with the client.

Nurses who work with children should be on alert for which physical signs of child abuse?

Unexplained cuts, bruises, burns, and scars Cuts, bruises, burns, and scars are common indicators of physical abuse in children. The other choices include symptoms that are common in children (e.g., crying, temper tantrums, poor appetite) and may occur with specific physical illnesses (e.g., stomach aches, skin rashes) but are not necessarily indicators that abuse has occurred.

A client is being screened for clinical symptoms related to depression over the past 2 weeks. Which self-assessment screening instruments would be most appropriate?

Zung Self-Assessment Scale The Zung Self-Assessment Scale incorporates 20 items that are self-rated by clients to assess feelings, with a focus on clinical symptoms of depression within the past 2 weeks. The Beck Depression Inventory is a 5-minute, 21-item scale that assesses the intensity of depression in people 13 to 80 years of age. The Hamilton Rating Scale for Depression is one of the most widely used instruments for the clinical assessment of depressive states. The Geriatric Depression Scale is used to evaluate depression in older adults.

What activity should be included in the first step of self-awareness?

identifying one's own values, attitudes, strengths and weakness One tool that is useful in learning more about oneself is the Johari window. In creating a Johari window, the first step is for the nurse to appraise his or her own qualities by creating a list of them: values, attitudes, feelings, strengths, behaviors, accomplishments, needs, desires, and thoughts. The second step is to find out others' perceptions by interviewing them and asking them to identify qualities, both positive and negative, they see in the nurse. To learn from this exercise, the opinions given must be honest; there must be no sanctions taken against those who list negative qualities. The third step is to compare lists and assign qualities to the appropriate quadrant.

The nurse learns that a client has been receiving unwanted gifts and visits from someone in the neighborhood. For which unwelcomed behavior should the nurse plan interventions for this client?

stalking Stalking is a pattern of repeated unwanted contact, attention, and harassment that often increases in frequency. Stalking is a crime of intimidation. Stalkers harass and terrorize their victims through behavior that causes fear or substantial emotional distress. Stalking may include such behaviors as following someone, showing up at the person's home or workplace, vandalizing property, or sending unwanted gifts. Hazing is an activity that causes humiliation. Bullying is the targeting of someone to be shunned, ignored, or harassed. Ostracizing is ignoring or excluding someone as another form of bullying.

The client stated, "I was so upset about my sister ignoring me when I was talking about being ashamed." Which nontherapeutic communication technique would the nurse be using if the nurse stated, "How are your stress reduction classes going?"

Changing the subject The nurse did not respond to the client's statement and instead introduced an unrelated topic. Advising would be telling the client what to do. Challenging would be demanding proof from the client. Disapproving would be denouncing the client's behavior or ideas.

The client tells the nurse, "I'm frightened about my surgery tomorrow." What response by the nurse is best?

"Can you tell me what frightens you?" The nurse uses many therapeutic communication techniques to interact with clients. The choice of technique depends on the intent of the interaction and the client's ability to communicate verbally. The nurse selects techniques that facilitate the interaction and enhance communication between the client and nurse."What's to be frightened about?," "The OR crew will take care of you," "Didn't the surgeon answer all your questions?" and "Hundreds of people have this surgery daily" are not examples of therapeutic communication techniques.

The client asks the nurse, "What does having psychosomatic symptoms mean?" What is the nurse's best reply?

"It means that stress and/or emotions are causing your symptoms." Clients who do not cope well with stress or emotions develop physical symptoms that are real as a means of coping. Characterizing them as products of the imagination downplays the effect of the disorder. Stating that a client needs to get his or her life in order is not therapeutic and mischaracterizes the etiology of these illnesses. Stating that the client is not physically sick does not adequately or empathically address the role of the mind and emotions.

A nurse is interacting with a client who is expressing feelings about the client's child's insensitive behavior. Which statement made by the nurse indicates the nurse is empathizing with the client? Choose the best answer.

"It sounds like this is very difficult for you, I can see why it causes you stress." Empathizing is placing oneself in the experience of another. Developing empathy with the client can lead to better therapeutic communication and better nursing interventions. Telling the client not to worry would indicate that the nurse is trying to be supportive of the client but not empathetic. The nurse telling the client that it must be hard for the client to cope conveys sympathy and feeling sorry for the client. Telling the client that the behavior is unbelievable indicates that the nurse feels shocked at the client's statement.

A nurse is meeting with a client prior to discharge from the hospital. The client tells the nurse he is "really worried about returning home." Which response indicates the nurse is employing therapeutic communication?

"Please share with me what is worrying you right now." Asking the client what worries him the most helps identify the most important client concern at the moment. This helps to set a client-cantered goal. The incorrect responses all reflect non-therapeutic communication given the client's individual situation. Stating, "Home is a much better place for you," communicates reassuring indicating there is no reason for anxiety or other feelings of discomfort. Stating, "It is best to complete your recovery surrounded by loved ones" is advising otherwise telling the client what to do. Stating, "Most clients have anxiety before they return home," belittles the expressed emotions of the client. The nurse misjudging the degree of the clients discomfort.

A client who is manic states, "What time is it? I have to see the doctor. Is breakfast here yet? I've got to see the doctor first. Can I get my cereal out of the kitchen?" Which response by the nurse would be most appropriate ?

"Please slow down. I'm not sure what you need first." The speech of manic clients may be pressured, rapid, circumstantial, rhyming, noisy, or intrusive with flights of ideas. The nurse must keep channels of communication open with clients, regardless of speech patterns. The nurse can say, "Please speak more slowly. I'm having trouble following you." This puts the responsibility for the communication difficulty on the nurse rather than on the client. Stating that the client will have to be quiet is non-therapeutic because it is unnecessarily prescriptive. Asking if the client is hungry does not address the client's pressured speech. Stating that the client's thought seem to be racing ignores the fact that the client clearly has needs that he or she is trying to express.

After an angry outburst, the client is tearful and remorseful. Which statement by the nurse would be most supportive?

"What could you have done when you first started to feel angry?" In the post-crisis phase, the nurse should not lecture or chastise the client for the aggressive behavior but should discuss the behavior in a calm, rational manner. The client can be given feedback for regaining control, with the expectation that he or she will be able to handle feelings or events in a nonaggressive manner in the future.

A nurse is caring for a client who is hospitalized for a mental disorder. The nurse is legally obligated to breach the client's confidentiality if the client states:"

"When I get out of here, I'm going to kill my neighbor." When there is a judgment that a client has harmed someone or is about to injure someone, a nurse is mandated to breach confidentiality and report this to the authorities. The statement about killing the neighbor is an example. Thinking that the federal government is spying on the person reflects paranoid thinking. The statement about being "turned on" reflects manipulative behavior. The statement about feeling angry about the doctor provides information about the client's feelings. The nurse would be mandated to report this statement only if the client went on to say that he or she was planning to "hurt" the doctor.

When conducting a focused assessment on a newly admitted client who attempted suicide, which question should the nurse include to ensure the client's safety? Select all that apply.

-"Do you still have a plan to harm yourself?" -"Have you ever tried to hurt yourself before?" -"Are you willing to tell us if you plan to harm yourself again?" In the event of a suicide attempt, the nurse would assess the client's mood, affect, and behavior. Data regarding the attempted suicide and any previous attempts of self-destructive behavior would also be collected. Questions related to the client's actual intent and family history would not be part of a focused assessment.

Which clients would be most likely to attempt situational suicidal thoughts?

A client who has been given a diagnosis of cancer with a poor prognosis Situational suicidal clues describe events or situations that present themselves either around or within the person, such as the diagnosis of a malignant tumor. Verbal suicidal clues include talking about death such as asking questions about lethal dosages of drugs. Behavioral suicidal clues include giving away personal, beloved items and directing angry messages at a significant other who has rejected the person.

A client has just been diagnosed as having major depression. At which time would the nurse expect the client to be at highest risk for self-harm?

Approximately 2 weeks after starting antidepressant medication Observe the client closely for suicide potential, especially after antidepressant medication begins to raise the client's mood. Risk for suicide increases as the client's energy level is increased by medication. The other choices are not significantly associated with increased risk for suicide.

A nurse is working in a psychiatric-mental health facility. The nurse observes a client pacing and punching the wall. Which measure can the nurse take for personal safety?

Avoid being alone with the client. If a nurse gets into a "situation": take a position just outside the client's personal space (slightly out of arm's reach); if possible, stand on the client's nondominant side (usually the side on which he or she wears a wristwatch); keep an open posture with hands in sight; keep the client in visual range; and make sure the door of a room is readily accessible. Avoid letting the client get between the nurse and the door, be friendly and concerned, and avoid being demanding unless the danger is imminent. If the latter occurs, it is perfectly acceptable to say "please stop that now" authoritatively. Retreat from the situation and summon help if the client's aggression escalates to imminent violence, and avoid being alone with an escalating client.

A client states, "I'm worthless, and I don't deserve to live." This theme in the client's expressed thought may signal a maladaptive response to which disorder?

Depression This theme in the client's expressed thoughts may signal unhealthy responses to depression. The other options are not indicative of a depressed state.

Before a client became depressed, the client was an active, involved parent with three children, often attending school functions and serving as a volunteer. The client is hospitalized for a major depressive episode and now reveals feeling like an unnecessary burden on the family. Which nursing diagnosis is most appropriate?

Disturbance of self-concept related to feelings of worthlessness The client does not express anxiety, anger, or apathy. Instead, the client has experienced a change from being an involved, interested parent to feeling as though the client is a burden, which would be reflective of a disturbance of self-concept. The self-concept changes the client is experiencing are related to feelings of worthlessness brought on by the depressive episode.

Which is the most important skill the nurse must bring to the therapeutic nurse-client relationship?

Empathy The nurse must be able to express caring and concern for the client. Empathy is the ability of the nurse to perceive the meanings and feelings of the client and to communicate that understanding to the client. The ability to use confrontation, humor and reframing are also important skills in particular circumstances but not as important and universally applicable as the skill of empathy.

A nurse is assessing a client with bipolar disorder who is experiencing mania. The client states, "I'm just so beautiful. Everyone just stops and stares at how gorgeous I am. People constantly want to have sex with me." The nurse interprets these statements as indicative of which type of mood?

Expansive The client's statements reflect an expansive mood, which is characterized by lack of restraint in expressing feelings, an overvalued sense of self-importance, and a constant and indiscriminate enthusiasm for interpersonal, sexual, or occupational interactions. An irritable mood is characterized by easy annoyance and provocation to anger, particularly when wishes are challenged or thwarted. An elevated mood can be expressed as euphoria (exaggerated feelings of well-being) or elation (feeling high), "ecstatic," "on top of the world," "up in the clouds").

During a session with a client, the client asks the nurse what the client should do about the client's "cheating" spouse. The nurse replies, "You should divorce. You deserve better than that." The nurse used which nontherapeutic communication technique?

Giving advice The nurse should not give advice, or tell the patient what to do. Advising implies that only the nurse knows what is best for the client. Giving information is therapeutic when the patient needs facts, but the nurse's statement is suggesting course of action, not objective information. Verbalizing the implied is a therapeutic communication technique which involves putting clearly into words what the patient has suggested, but this client has not suggested divo. Verbalizing tends to make the discussion less obscure. Agreeing, or giving approval, indicates the patient is right or wrong. Nurses should remain neutral when using therapeutic communication skills.

Clients with a somatization disorder typically do what?

Have a history of going to many different providers without satisfaction Clients living with a somatization disorder usually present exaggerated, inconsistent, yet complicated medical histories. They often seek treatment from multiple health care providers when their physical complaints are not addressed to their satisfaction.

While conducting a class on anxiety and stress reduction, a nurse describes the symptoms of anxiety (including panic), informing the class that the physical symptoms of a panic attack can mimic what?

Heart attack The physical symptoms of anxiety can mimic those of a heart attack. These symptoms are physically taxing and psychologically frightening to clients. Recognition of the seriousness of panic attacks should be communicated to the client.

To care for an acutely suicidal client, which is the most effective initial mode of treatment?

Inpatient care If a person is acutely suicidal, inpatient care is often the initial mode of treatment. Frequently, inpatient treatment is short term, focused on crisis intervention, and followed up with outpatient approaches when the immediate danger has subsided.

A client is admitted to a mental health unit with a diagnosis of factitious disorder. When reviewing the client's history, which would a nurse most likely find?

Intentional self-injurious behavior Clients with factitious disorder intentionally cause an illness or injury to receive the attention of health care professionals. Pain for a self-serving goal, malingering, or restrictive parents are not associated with factitious disorder.

The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says the client still has terrible neck pain, but the client will be better once he gets "a big insurance settlement." What condition might the nurse suspect?

Malingering Malingering is suspected when the client is exaggerating physical complaints for some type of material gain. Hypochondriasis is a preoccupation with the fear that one has a serious disease. La belle indifference is a seeming lack of concern or distress about a functional loss. A conversion reaction involves unexplained, usually sudden, deficits in sensory or motor function related to an emotional conflict the client experiences but does not handle directly.

The nurse observes a client sitting alone at a table, looking sad and preoccupied. The nurse sits down and says, "I saw you sitting alone and thought I might keep you company." The client turns away from the nurse. Which would be the most therapeutic nursing intervention?

Move to a chair a little further away and say, "We can just sit together quietly." Moving away gives the client more personal space; staying with the client indicates acceptance and genuine interest. It is not necessary for the nurse to talk to the client the entire time; rather, silence can convey that clients are worthwhile even if they are not interacting. Pressuring or pushing the client to speak has the potential to cause the client to withdraw even more. The nurse may eventually need to leave the client alone, but should first attempt to establish therapeutic rapport through silent presence.

Which type of service is provided to medically stable clients who do not require inpatient, residential, or home care environments?

Outpatient care Outpatient care is a level that occurs outside of the hospital or institution. Outpatient services usually are less intensive and provided to patients who do not require inpatient, residential, or home care environments.

Which are cognitive-behavioral therapy techniques that may be used effectively with anxious clients? Select all that apply.

Positive reframing Decatastrophizing Assertiveness training Positive reframing means turning negative messages into positive messages. Decatastrophizing involves the therapist's use of questions to more realistically appraise the situation. Assertiveness training helps the person take more control over life situations. Positive reframing, decatastrophizing, and assertiveness training are cognitive-behavioral therapy techniques. Humor is not a cognitive-behavioral therapy technique. Unlearning is the theory underlying behavioral therapy but it is not a therapy technique in and of itself.

In clients who do not completely recover from being victimized by rape, which mental illness is most likely to develop?

Post-traumatic distress syndrome Post-traumatic distress syndrome can result at least 1 month after an identifiable traumatic event. Symptoms include generalized anxiety, intrusive thoughts or images of the trauma, flashbacks, nightmares, and other sleep disturbances.

A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to the client's feelings of sadness and hopelessness, the nurse would likely assess which physiologic symptoms of depression?

Psychomotor retardation and poor appetite Psychomotor retardation or agitation, often accompanies depression. The incorrect answers are not physiologic or somatic but psychological or functional symptoms of depression. Usually in depressive illness, grooming and hygiene are not tended to.

Which is the priority for admission to inpatient care?

Safety of self or others Safety is a priority; the inpatient setting provides for the safety of the client and/or others. Confusion or disorientation, need for medication changes, and withdrawal from alcohol or other drugs may also require inpatient care, but the priority is safety.

Which medication classification has been shown to be effective in some cases of somatoform disorders?

Serotonin reuptake inhibitors (SSRIs) SSRIs have been shown to be effective in some cases of somatoform disorders.

The ultimate goal of the treatment plan in inpatient care settings is what?

Stabilize the client The ultimate goal of the treatment plan is to stabilize clients and prepare them for discharge teaching.

Which would be most important to assess and document in a client with depression?

Suicide risk In determining the severity of depressive symptoms, the nursing assessment should explore physical changes in appetite and sleep patterns and decreased energy. Considering the possibility of suicide should always be a priority with clients who are depressed. Assessment and documentation of suicide risk should always be included in client care.

A concerned family member tells the nurse, "I am concerned about my sibling. My sibling has been acting very different lately." Knowing the family has a history of bipolar disorder, the nurse inquires further about this. Which behavior during the past week might indicate that the sibling has bipolar disorder?

Taking unnecessary risks The diagnosis of a manic episode or mania requires at least 1 week of unusual and incessantly heightened, grandiose, or agitated mood in addition to three or more of the following symptoms: exaggerated self-esteem; sleeplessness; pressured speech; flight of ideas; reduced ability to filter extraneous stimuli; distractibility; increased activities with increased energy; and multiple, grandiose, high-risk activities involving poor judgment and severe consequences, such as spending sprees, sex with strangers, and impulsive investments.

What would be the most appropriate action by the student nurse when the client asked the student nurse to keep it a secret that the client plans to kill a family member?

The student nurse must tell the client that the student nurse cannot keep that secret and then report it to the instructor and/or staff members. If a client tells a professional that the he or she has homicidal thoughts, the professional is required to notify intended victims and police of such a threat. The nurse must report the homicidal threat to the nursing supervisor and attending physician so that both the police and the intended victim can be notified. It would be dishonest to tell the client that the secret will be kept and then violate that statement.

Which is one of the most common reasons clients are often concerned about confidentiality of treatment for mental health problems?

They are worried about the opinions of people who know them outside the hospital, due to shame produced by societal views of mental illness. Mental health concerns frequently carry social stigmas. Confidentiality protects patient information so that persons not involved with treatment are not privileged to patient information. This prevents further stigmatization.

A nurse is preparing to assess a middle-aged client who was brought to the emergency department by the client's spouse. The spouse reports that the client has been "extremely depressed lately." When assessing this client, which would be a priority assessment?

Thoughts of self-harm Although appetite and weight changes, sleep disturbances, decreased energy, and fatigue are important indicators for the severity of depression, identifying the possibility of self-harm (suicide) is always a priority in clients who are depressed.

Which phase of the aggression cycle is defined as occurring when an event or circumstance in the environment initiates the client's response?

Triggering During the triggering phase of the aggression cycle, an event or circumstance in the environment initiates the client's response, which is often anger or hostility. None of the other phases of the cycle are focused on the initiation of the anger.

A nurse tells a client that the nurse will come back in 10 minutes to reassess the client's pain. When the nurse returns in 10 minutes, which aspect of the therapeutic relationship is the nurse developing?

Trust When a nurse repeatedly upholds commitments made to a client, it fosters foundational trust within the therapeutic relationship. The other options may be part of the therapeutic relationship, but in this case the nurse's behavior will instill trust.

When assessing a client's potential for aggression and violence, which would the nurse identify as the most important predictor?

client's history The client's history is the most important predictor of potential for aggression and violence. The age, gender, and race of clients are not good predictors.

With a client who is aggressive with a potential for violence, which item would the nurse want to limit or remove from the breakfast tray?

coffee A client who is aggressive would need to limit intake of stimulants such as caffeine with coffee. Eggs, milk, and wheat products such as toast would contain tryptophan which is an amino acid that helps with making serotonin, a neurotransmitter that helps regulate mood. Additionally, coffee that is hot could be potentially used for injury of another person.

A 22-year-old client has been manipulative of staff and disruptive in the milieu. Although the client is not dangerous to the client or others, the client has created problems on the unit and clearly is not making progress. The nurses offer prescribed medication, but the client consistently refuses "any drugs." The staff realizes that legally this client can ...

continue to refuse treatment. The client maintains the right to refuse treatment, even if it is needed, when the client is not dangerous to the self or others. If a client is able to give consent, she cannot be coerced into treatment, have the client's family sign permission for the client, or be committed by the family to receive treatment unless the client is a danger to the self or others.

A client with a specific phobia of spiders is seeing a therapist for the first session of treatment. The therapist hands the client a clear container with a large house spider inside. This activity is repeated continuously until the client's fear subsides. Which strategy is being used to treat the client's specific phobia?

flooding Flooding is a form of rapid desensitization in which a behavioral therapist confronts the client with the phobic object until it no longer produces anxiety. The goal is to rid the client of the phobia within two sessions.

A nurse is seeing a client in the emergency department who repeatedly presents with gastrointestinal discomfort. Despite exhaustive medical investigations, there are no significant medical findings to explain the discomfort. The nurse should suspect:

somatic symptoms. Somatic symptoms occur when a person experiences anxiety and expresses the emotion through physical complaints. A common somatic manifestation of anxiety is gastrointestinal pain or discomfort. Medical causes must always be ruled out prior to considering a psychological source for the problem. Anxiety disorders due to another medical condition can be attributed to endocrine dysfunction, chronic obstructive pulmonary disease, and heart disease.

A client is being assessed after experiencing house damage from a tornado. Which client need would be a priority for the nurse to determine?

where the client will stay temporarily Safety is an important needs for the client who is in a crisis. The client with home damage has most immediate needs with food, shelter, and clothing as basic needs. Once this safety is established as well as determining who will be the client's support system, the client can then focus on other needs such as work, finances and insurance.

The nurse is planning care for a client who has been newly diagnosed with a mental illness. Which should be the nurse's first step in managing this client's nursing care?

Assessment The first step in caring for a client with mental illness is the initial data collection process (i.e., assessment) so as to arrive at a diagnosis. The second step is establishing a plan of care, followed by implementation of the identified plan. Lastly, the client has to be evaluated for progress.

When teaching a client with generalized anxiety disorder, which is the priority for the nurse to teach the client to avoid?

Caffeine The effects of caffeine are similar to some anxiety symptoms, and, therefore, caffeine ingestion will worsen anxiety. The other types of foods are also potentially harmful to physical as well as psychological health, but the worst offender is caffeine.