Unit 1 exam EAQ practice questions
Which action would the nurse take first for a client with a generalized anxiety disorder? 1. Encourage the client to exercise on a daily basis. 2. Have the client list the behaviors used to reduce anxiety. 3. Remove as many stimuli from the client's environment as possible. 4. Administer as-needed medications prescribed by the primary health care provider.
3. Remove as many stimuli from the client's environment as possible The first action the nurse would take is to remove as many stimuli from the client's environment as possible. Removing as many stimuli from the client's environment helps reduce the client's anxiety by limiting the factors that must be confronted; decreasing stimuli usually decreases anxiety. Although exercising can help decrease anxiety, it is not the first action the nurse would take; this would follow later in the treatment. The anxiety level must be decreased before the client is asked to discuss coping strategies. Administering as-needed medications prescribed by the primary health care provider may or may not be necessary; it is not the first intervention.
Which intervention would the nurse include in the plan of care for a client with posttraumatic stress disorder who verbalizes a desire to have control over personal feelings related to being the only survivor 1. Work on self-forgiveness. 2. Explore specific feelings related to survivor guilt. 3. Discuss life situations that the client is able to manage. 4. Focus on the client's inability to limit escalating anxiety.
Discuss life situations that the client is able to manage. The nurse would add to the plan of care and discuss life situations that the client is able to manage. Focusing on situations that are manageable will enable the client to experience a sense of personal power. Working on self-forgiveness relates to feelings of self-blame and depression. Talking about survivor guilt will not allow the development of a sense of control over the trauma; instead, the client may focus on being a survivor through luck or chance. Focusing on negative responses (inability to limit escalating anxiety) will not help the client gain a sense of personal control over the feelings related to the trauma.
Which therapy would have the highest success rate for people with phobias? 1. Desensitization involving relaxation techniques 2. Insight therapy to determine the origin of the fear 3. Psychotherapy aimed at rearranging the maladaptive thought processes 4. Psychoanalytic exploration of repressed conflicts of an earlier developmental phase
1. Desensitization involving relaxation techniques The highest success rate for phobia therapy is desensitization involving relaxation techniques. The most successful therapy for people with phobias consists of behavior modification techniques involving desensitization. Insight into the origin of the phobia will not necessarily help the client overcome the problem. Psychotherapy may increase understanding of the phobia but may not help the client cope with the fear; there is no maladaptive thought process associated with phobias. Psychoanalysis may increase understanding of the phobia but may not help the client cope successfully with the unreasonable fear.
Which action would be priority for a client with major depression who is experiencing psychotic features and says, "All of my relatives have been killed because I've been sinful and need to be punished"? 1. Protecting the client against any suicidal impulses 2. Supporting the client's interest in the outside world 3. Helping the client manage the concern for family members 4. Reassuring the client that past behaviors are not being punished
1. Protecting the client against any suicidal impulses The priority is protecting the client against any suicidal impulses. Suicidal impulses take priority, and the client must be stopped from acting on them while treatment is in progress; the client's safety is the focus of nursing interventions. Even though the client has psychotic features, supporting the client's interest in the outside world is not the priority. The client is focusing on the current personal situation, not the outside world. Helping the client manage the concern for family members is important, but it is a secondary priority. Reassurance is not the priority at this time; safety of the client is the priority.
Which action would the nurse take for a client with panic disorder who jumps when spoken to, reports feeling uneasy, and says, "It's as though something bad is going to happen"? 1. Stay with the client to be a calming presence 2. Encourage the client to communicate with the staff. 3. Allow the client to set the parameters for the interaction. 4. Help the client understand the cause of the feelings described.
1. Stay with the client to be a calming presence. The nurse would stay with the client to be a calming presence. Fear can be overwhelming; the nurse's presence provides protection from possible escalating anxiety. The client's anxiety level is interfering with the ability to communicate; anxiety must be reduced first before the nurse would encourage the client to communicate with the staff. The client's anxiety level is so high that sufficient emotional energy to set parameters is not available. Helping the client understand the cause of the feelings he or she describes may increase the client's anxiety at this time.
Which action would the nurse implement for a client with somatic symptoms? Select all that apply. One, some, or all responses may be correct. 1. Scheduling office visits once a year 2. Having the client direct all requests to the case manager 3. Reminding the client who is in charge of their care 4. Conducting a physical examination only when necessary 5. Explaining to the client that the symptoms are not real 6. Taking vital signs each time client complains of symptoms
2. Having the client direct all requests to the case manager Clients with somatic symptoms would be instructed to direct all requests to the case manager to reduce manipulation. Frequent, brief, and regular office visits are recommended for clients with somatic symptoms. It would be counterproductive to remind the client who is in charge of their care, as power struggles are not helpful. A physical examination would always be conducted. The nurse would never imply that a client's symptoms are not real; rather, the nurse would acknowledge that the psychogenic symptoms are real to the client. After physical complaints have been investigated, the nurse would avoid taking vital signs for each complaint because this further reinforces the somatization.
Which action would the nurse take for a client with an obsessive-compulsive disorder who continually walks up and down the hall, touching every other chair and becomes upset if interrupted? 1.Distract the client, which will help the client forget about touching the chairs. 2. Encourage the client to continue touching the chairs as long as the client wants until fatigue sets in. 3. Remove chairs from the hall, thereby relieving the client of the necessity of touching every other one. 4. Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed.
4. Allow the behavior to continue for a specified time, letting the client help set the time limits to be imposed. The nurse would allow the behavior to continue for a specified time, letting the client help set the time limits. It is important to set limits on the behavior, but it is also important to involve the client in the decision-making. Distracting the client, which will help the client forget about touching the chairs, is nontherapeutic; rarely can a client be distracted from a ritual when anxiety is high. Encouraging the client to continue touching the chairs for as long the client desires until fatigue sets in is a nontherapeutic approach; some limits must be set by the client and nurse together. Removing chairs from the hall, thereby relieving the client of the necessity of touching every other one, will increase the client's anxiety because the client uses the ritual as a defense against anxiety.
Which characteristics of affect are expected for a client with the diagnosis of somatoform disorder, conversion type? Select all that apply. One, some, or all responses may be correct. Calm Cheerful Depressed Frightened Matter-of-fact
Calm and matter-of-fact Emotional conflicts are transferred to physical symptoms; thus the symptoms reduce anxiety and remove the conflict. The individual demonstrates a lack of concern about the symptoms (la belle indifférence). The individual will not be happy and cheerful, sad and depressed, or frightened.
Four clients are admitted to a hospital with different symptoms associated with depression. The nurse identifies which client as benefiting most from mirtazapine? Client 1 fatigue Client 2 insomnia Client 3 chronic pain Client 4 sexual dysfunction
Client 2 insomnia Mirtazapine causes substantial sedation. Client 2 would benefit from mirtazapine. Client 1 requires a central nervous system stimulant such as fluoxetine. Client 3 would benefit from duloxetine, a medication that relieves chronic pain. Client 4 would benefit from bupropion, which enhances a person's libido.
A client's antidepressant medication therapy has recently been modified to substitute a tricyclic antidepressant for the monoamine oxidase inhibitor (MAOI) prescribed 2 years ago. In light of the assessment data collected during the follow-up appointment, which action will the nurse take first? 1. Retake the individual's blood pressure 2. Determine exactly when the client began taking the amitriptyline. 3. Ask how the client is managing the stress related to the new job and pregnancy. 4. Identify what measures the client has implemented to help manage the recurrent headaches.
Determine exactly when the client began taking the amitriptyline. Improper weaning from an MAOI can result in the development of hypertensive crisis. The client's increased blood pressure and chronic headache are possible early warning signs of this serious side effect. Determining exactly when the client began taking the newly prescribed tricyclic medication will help the nurse determine whether the MAOI had sufficient time to be excreted from the body. Reassessing the client's blood pressure, though not inappropriate, does not have the same priority as does gathering new information that could help identify the root of the hypertension and headaches. Stress can be a factor in increased blood pressure and headaches, but in this situation a more serious potential complication must be explored. Identifying the self-treatment the client has implemented for the reported headaches, though appropriate, does not take priority over determining the possible cause of the increased blood pressure and headaches.
Which intervention would the nurse include in the plan of care for a client with posttraumatic stress disorder who verbalizes a desire to have control over personal feelings related to being the only survivor? 1. Work on self-forgiveness. 2. Explore specific feelings related to survivor guilt 3. Discuss life situations that the client is able to manage. 4. Focus on the client's inability to limit escalating anxiety.
Discuss life situations that the client is able to manage. The nurse would add to the plan of care and discuss life situations that the client is able to manage. Focusing on situations that are manageable will enable the client to experience a sense of personal power. Working on self-forgiveness relates to feelings of self-blame and depression. Talking about survivor guilt will not allow the development of a sense of control over the trauma; instead, the client may focus on being a survivor through luck or chance. Focusing on negative responses (inability to limit escalating anxiety) will not help the client gain a sense of personal control over the feelings related to the trauma.
A client with a history of schizophrenia has recently begun reporting symptoms of depression and is now prescribed a selective serotonin reuptake inhibitor (SSRI). In light of the information in the client's chart, which action is the nurse's priority? 1. Educating both the client and family on how to identify the early signs of extrapyramidal symptoms 2. Requesting a gastrointestinal consult to identify the cause of the client's need for frequent antacids 3. Stressing the importance of managing the client's diet while taking the prescribed antidepressant 4. Discussing the stressors that have developed since the client moved in with the sister and brother-in-law
Educating both the client and family on how to identify the early signs of extrapyramidal symptoms Extrapyramidal symptoms can result from antipsychotic medication therapy, and the risk is increased when the treatment plan includes an SSRI antidepressant. The cause of the frequent use of antacids should be explored but does not take priority in this situation. A well-balanced diet is always important, but the importance of diet management would still exist if the antidepressant were a monoamine oxidase inhibitor (MAOI) and not an SSRI. Identifying and addressing stressors is important, but it does not take priority in this situation.
Which action would the nurse take to help a client participate in an activity whose depression is beginning to lift but remains aloof from the other clients on the mental health unit? 1. Find solitary pursuits that the client can enjoy. 2. Speak to the client about the importance of entering into activities. 3. Ask the primary health care provider to speak to the client about participating 4. Invite another client to take part in a joint activity with the nurse and the client.
Invite another client to take part in a joint activity with the nurse and the client. The nurse would invite another client to take part in a joint activity with the nurse and the client. Bringing another client into a set situation is the most therapeutic, least threatening approach. At this point in time, it is not therapeutic to allow the client to follow solitary pursuits; it will promote isolation. Explanations about the importance of entering into activities will not necessarily change behavior. Asking the primary health care provider to speak to the client about participating transfers the nurse's responsibility to the primary health care provider.
Which medication would the nurse instruct a client to avoid while taking alprazolam? Select all that apply. Opioids Alcohol Barbiturates Antidepressants First-generation antipsychotics
Opioids Alcohol Barbiturates Respiratory depression can occur if a client combines benzodiazepines with opioids, alcohol, or barbiturates. Antidepressants and first-generation antipsychotics are safe to take with benzodiazepines.
Which client education information would the nurse give to a client who has suicidal ideations and is recently prescribed a tricyclic antidepressant medication to ease depression? 1 Aged cheese may cause a hypertensive crisis that could result in a stroke. 2. There may not be a noticeable improvement for 2 to 3 weeks or longer 3.Medication must be taken with milk to avoid gastrointestinal irritation. 4.Blood specimens are required weekly for 3 months to monitor medication levels.
There may not be a noticeable improvement for 2 to 3 weeks or longer Tricyclic antidepressants do not produce an immediate effect, and lack of improvement can affect compliance. Also nursing measures must continue to decrease the risk of suicide. Avoiding aged cheese is a precaution taken with monoamine oxidase (MAO) inhibitors. Giving the medicine with milk is unnecessary. Blood specimens are not necessary; toxicity is more of a concern with medications such as lithium.