bstrandable NCLEX Mental Health 1 of 2

THERAPEUTIC COMMUNICATION - BLOCKS Focusing on the Nurse

"I feel that way, too."

THERAPEUTIC COMMUNICATION - TOOLS Validating

"I hear you saying that..."

THERAPEUTIC COMMUNICATION - BLOCKS Agreeing and Disagreeing

"I think you did the right thing."

THERAPEUTIC COMMUNICATION - TOOLS Offering Self

"I will stay with you."

A client, age 40, is admitted for a surgical biopsy of a suspicious lump in her left breast. When the nurse comes to take her to surgery, she is tearfully finishing a letter to her two children. She tells the nurse, "I want to leave this for my children in case anything goes wrong today." Which response by the nurse would be most therapeutic?

"In case anything goes wrong? What are your thoughts and feelings right now?"

During the client-teaching session, which instruction should the nurse give to a client receiving alprazolam (Xanax)?

"Inform the physician if you become pregnant or intend to do so."

An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "We'll go to the day room when you are ready for group." B. "I'll walk with you to the day room. Group is about to start." C. "It must be difficult for you to attend group when you feel so bad." D. "Let me tell you about the benefits of attending this group."

ANS: B A client diagnosed with major depressive disorder exhibits little to no motivation and must be firmly directed by staff to participate in therapy. It is difficult for a severely depressed client to make decisions, and this function must be temporarily assumed by the staff.

Before eating a meal, a client with obsessive-compulsive disorder (OCD) must wash his hands for 18 minutes, comb his hair 444 strokes, and switch the bathroom light on and off 44 times. What is the most appropriate goal of care for this client?

"Systematically decrease the number of repetitions of rituals and the amount of time spent performing them.

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

ANS: B A nurse should remain with clients diagnosed with either anorexia nervosa or bulimia nervosa for at least 1 hour after meals. This allows the nurse to monitor for food discarding (anorexia nervosa) and/or self-induced vomiting (bulimia nervosa).

THERAPEUTIC COMMUNICATION - TOOLS Broad Openings

"Tell me what you would like to talk about."

THERAPEUTIC COMMUNICATION - BLOCKS Judging

"That was good."

A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

ANS: B A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive disorder. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming.

THERAPEUTIC COMMUNICATION - TOOLS Summarizing

"Today we have discussed..."

THERAPEUTIC COMMUNICATION - TOOLS Clarifying

"What does that mean to you?"

A client in an acute care center lacerates her wrists. She has a history of conflicts and acting out. The client tells the nurse, "I did a good job didn't I?" Which of the following responses would be appropriate?

"What were you feeling before you hurt yourself?"

A nurse is assessing a psychiatric client's ability to make sound judgments. Which assessment request best helps evaluate the client's judgment?

"What would you do if you smelled gas in your house?"

A mother who has a history of chronic heroin use has lost custody of her children due to abuse and neglect. She has been admitted to an inpatient substance-abuse program. Which client statement should a nurse associate with a positive prognosis for this client? A. "I'm not going to use heroin ever again. I know I've got the willpower to do it this time." B. "I cannot control my use of heroin. It's stronger than I am." C. "I'm going to get all my children back. They need their mother." D. "Once I deal with my childhood physical abuse, recovery should be easy."

ANS: B A positive prognosis is more likely when a client admits that he or she is addicted to a substance and has a loss of control. One of the first steps in accepting treatment is for the client to admit powerlessness over the substance.

In a group therapy setting, one member is very demanding, repeatedly interrupting others, and taking most of the group time. The appropriate response by the nurse would be:

"Will you briefly summarize your point because others need time also?"

Which is an example of an intentional tort? A. A nurse fails to assess a client's obvious symptoms of neuroleptic malignant syndrome. B. A nurse physically places an irritating client in four-point restraints. C. A nurse makes a medication error and does not report the incident. D. A nurse gives patient information to an unauthorized person.

ANS: B A tort is a violation of civil law in which an individual has been wronged and can be intentional or unintentional. A nurse who physically places an irritating client in restraints has touched the client without consent and has committed an intentional tort.

THERAPEUTIC COMMUNICATION - TOOLS Restating Main Idea

"You are sad?"

An agitated client demands to see her chart so she can read what has been written about her. Which statement is the nurse's best response to the client?

"You have the right to see your chart. Please discuss this with your primary care provider."

THERAPEUTIC COMMUNICATION - TOOLS Making Observations

"You seem angry..."

THERAPEUTIC COMMUNICATION - BLOCKS Advising

"You should..."

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

ANS: B Based on Maslow's hierarchy, the priority nursing diagnosis for this client must address physical needs prior to emotional considerations. This client must be immediately physically stabilized due to the life-threatening nature of his or her nutritional status.

A client who has been referred for stress management asks the nurse, "Which one of these relaxation techniques requires reimbursement from my health insurance?" Which is the appropriate nursing reply? A. "Meditation requires reimbursement from health insurance." B. "Biofeedback requires reimbursement from health insurance." C. "Physical exercise requires reimbursement from health insurance." D. "Deep breathing requires reimbursement from health insurance."

ANS: B Biofeedback is costly and would require reimbursement from health insurance. It requires the use of a machine that gives immediate information about the client's physical state and a biofeedback technician to interpret the results.

A client is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

"repetitive thoughts and recurring, irresistible impulses.

(SELECT ALL THAT APPLY) In the emergency department, a client reveals to the nurse a lethal plan for committing suicide and agrees to a voluntary admission to the psychiatric unit. Which information will the nurse discuss with the client to answer the question, ""How long do I have to stay here?""

(1) "You may leave the hospital at any time unless you are suicidal.", (2) "Let's talk more after the health team has assessed you.", (4) "Because you could hurt yourself, you must be safe before being discharged."

(SELECT ALL THAT APPLY) A client is prescribed bupropion (Wellbutrin) to treat depression. The nurse should monitor the client for which adverse reactions associated with bupropion therapy?

(1) Seizures, (2), Anxiety, (3) Insomnia

(SELECT ALL THAT APPLY) The nurse is teaching a client about the antidepressant amitriptyline (Elavil). Which points should she include in her teaching plan?

(1) Smoking may lower the drug level., (2) Avoid prolonged exposure to the sun., (5) Increase fluid and fiber intake to prevent constipation.

(SELECT ALL THAT APPLY) The nurse has developed a relationship with a client who has an addiction problem. Which information would indicate that the therapeutic interaction is in the working stage?

(1) The client addresses how the addiction has contributed to family distress., (4) The client discusses the financial problems related to the addiction., (6) The client acknowledges the addiction's effects on the children.

SELECT ALL THAT APPLY client suffering posttraumatic stress disorder is prescribed sertraline (Zoloft), 50 mg by mouth once daily. Which actions should the nurse take when administering this drug?

(2) Mix the oral concentrate with 4 oz (120 ml) of water, ginger ale, or lemon-lime soda., (3) Administer the oral solution immediately after dilution., (4) Instruct the client to check with the prescriber or pharmacist before taking over-the-counter preparations., (5) Advise the client to use caution when performing hazardous tasks that require alertness.

(SELECT ALL THAT APPLY) The nurse is explaining the Bill of Rights for psychiatric patients to a client who has voluntarily sought admission to an inpatient psychiatric facility. Which of the following rights should the nurse include in the discussion?

(2) Right to refuse treatment, (4) Right to confidentiality, (5) Right to personal mail

PHOBIC DISORDERS Types

(Manifestations depend on the type of phobia.) - Agoraphobia: fear of being places outside the home. - Arachnophobia: fear of spiders. - Social Phobia: **MOST COMMON** (also referred to as Social Anxiety Disorder) irrational fear of embarrassment or ridicule in any social setting or event.

THERAPEUTIC COMMUNICATION - BLOCKS Changing the Subject/Ignoring Patient

(self-explainatory)

SCHIZOPHRENIA Symptoms

- Delusions: fixed, false beliefs of grandeur. - Hallucinations: visual or auditory. - Perceptions: without environmental stimuli. - Illusions: misinterpretation of actual stimuli. - Ideas of Reference: only personalizing environmental stimuli to self. - Neologisms: self-coined words. - Circumstantiality: can't come to a point. - Blocking: sudden interruption of speech due to distraction of thoughts. - Echolalia: the repetition of words or phrases heard from another person. - Echopraxia: imitation of movement or gestures of another person. - Pressured Speech: speaking rapidly.

SCHIZOPHRENIA Types

- Disorganized: incoherent, severe thought disturbance with inappropriate behaviors. - Catatonic (psychomotor): stupor, excitement, waxy flexibility or bizarre posturing, negativism, and mutism. - Paranoid: hallucinations, delusions, anger, suspiciousness, mistrust. - Undifferentiated: mixed characteristics; meets criteria of more than one type.

OCD Interventions

- Don't interrupt the client's compulsive act. - Schedule time for client to compete his ritual (client may perform ritual slowly). - Decrease the time and frequency of the client's rituals. - Distract and substitute self-esteem-building activities. - Provide safety, structure, and activities. - Demonstrate acceptance of the client's feelings.

NURSE/CLIENT RELATIONSHIP Orientation Phase

- Establish confidentiality, trust, honesty and empathy with the client. - Clarify client's and nurse's roles. - Assess the client's physical and emotional status. - Prioritize client problems and client goals. - Formulate contracts when appropriate. - Begin discussions related to termination of the relationship.

NURSE/CLIENT RELATIONSHIP Working Phase

- Explore thoughts and feelings related to client's health status. - Take action to meet goals set with the client. - Use therapeutic communication to facilitate interactions.

PHOBIC DISORDERS Symptoms

- Feeling of uncontrollable anxiety when exposed to the source of fear. - Attempts made to avoid source and, when exposed, an inability to function normally. - Awareness that fear is unreasonable or exaggerated but client is powerless to control it. - Physical symptoms such as diaphoresis, rapid heart rate, difficulty breathing, and feeling of intense panic and anxiety.

PTSD Symptoms

- Flashback episodes, where the event seems to be happening again and again. - Repeated upsetting memories of the event; repeated nightmares of the event. - Emotional "numbing"; feeling detached; inability to remember important aspects of the trauma. - Having a lack of interest in normal activities. - Avoiding places, people, or thoughts that remind you of the event. - Difficulty concentrating. - Agitation or excitability; insomnia.

Gamma Aminobutyric Acid (GABA) Function/Mental Implications

- GABA interrupts the progression of the electrical impulse at the synaptic junction, producing a significant slowdown of body activity. -decreased levels of GABA have been implicated in the etiology of anxiety disorders, movement disorders such as Huntington's Disease, and various forms of epilepsy.

SCHIZOPHRENIA Client Education

- Importance of group work and psychotherapy. - Importance of self-care activities. - Med compliance. - Avoid drugs and alcohol. - Case management to provide follow-up for the client and family.

OCD Define

- Obsession is a persistent recurring fixed idea or thought that can't be voluntarily removed from consciousness. - Compulsion is an irresistible impulse to perform an action, regardless of it's logic. - (May occur together or separately!) Physiological and biological factors play a role in causing the disorder.

SCHIZOPHRENIA Interventions - Hallucinations

- Promote therapeutic communication and establish a trusting relationship with the client. - Provide for client safety. - Don't confront; Don't deny. - Point out that others don't share the same perception, but acknowledge that the hallucinations are real to the client. - Encourage to verbalize auditory hallucinations. - Engage client in activities and encourage participation in group work. - Provide least restrictive environment and avoid restraining. - Provide consistency, positive reinforcement, and acceptance.

SCHIZOPHRENIA Interventions

- Provide physical care and promote safety. - Increase client trust while developing 1-on-1 RN/pt relationship. - Orient to reality. - Provide structure; keep interactions simple, concrete; often nonverbal and short. - Help client cope with regressive or bizarre behavior, anxiety, and irritation. - Intervene with hallucinations!

CONVERSION DISORDERS (HYSTERIA) Interventions

- Redirect client away from manifestations. - Encourage client to express feelings. - Teach relaxation and stress-reduction techniques. - Schedule daily activities for the client to decrease the time focused on symptoms.

OCD Symptoms

- Repeated, persistent, and unwanted ideas, thoughts, images, or impulses. - Impulses are involuntary and seem to make no sense. - Obsessions typically intrude when client is attempting to think of or do other things. - Feelings of inferiority, low self-esteem. - Irrational coping to handle guilt.

NURSE/CLIENT RELATIONSHIP Pre-Interaction Phase

- Review available data including medical and nursing history. - Anticipate health concerns or issues. - Identify location to promote privacy and comfort; plan adequate time for initial interaction.

CONVERSION DISORDERS (HYSTERIA) Symptoms

- Sensory: blindness, deafness, and/or loss of sensation in extremities. - Motor: mutism, ataxia, paralysis. - Visceral: Migraines, dyspnea. - "La Belle Indifference": condition in which the person is unconcerned with symptoms caused by a conversion disorder. A naive, inappropriate lack of emotion or concern for the perceptions by others of one's disability, usually seen in persons with conversion disorder.

OCD Client Education

- Teach relaxation techniques. - Teach importance of maintaining medication regimen at home. - Identify triggers that enhance symptoms and develop a plan when symptoms return. - Avoid drug and ETOH use.

PTSD Interventions

- Teach stress reduction techniques. - Identify community support systems. - Encourage client to attend a support group.

NURSE/CLIENT RELATIONSHIP Termination Phase

- This phase is initially address on admission or first contact with the client. - Evaluate goal achievement with the client. - Transfer care to other support systems. - Separate from the client by relinquishing responsibility. - Facilitate a smooth transition for the client to other caregivers as needed.

PHOBIC DISORDERS Interventions

- Use gradual desensitization experiences. - Employ behavior modification techniques. - Teach relaxation techniques and biofeedback. - Avoid decision making or competitions. - Discuss use of positive coping strategies.

Trazodone and Nefazodone -action on neurotransmitter/receptor -physiological effect -side effect

-5-HT reuptake block, 5-HT2 receptor antagonism, adrenergic receptor blockade -reduces depression and anxiety -nausea, sedation, orthostasis, priapism

Antianxiety: Buspirone -action on neurotransmitter/receptor -physiological effect -side effect

-5-HT1A agonist, D2 agonist, D2 antagonist -relief of anxiety -nausea, headache, dizziness, restlessness

Treatment for Alcohol Withdrawal

-Anxiolytics -DTs are frightening, they should be prevented -Detox protocol usually includes thiamine injections, multivitamins, and perhaps magnesium

OCD Signs and Symptoms

-Can't stop obsessions and compulsions -Behavior relieves anxiety and it comes from the anxiety -Need structured schedule -Anxiety goes up if they can't perform their rituals

Generalized Anxiety Disorder Signs and Symptoms

-Chronic -person lives with it daily -fatigue due to constant anxiety and muscle tension -uncomfortable -seek help

Other Alcohol Rehab notes

-Client must have a relapse prevention plan in place -12 step program very effective -Must have support once detox is over -Family issues emerge once the alcoholic is sober (dynamics change and this is stressful)

Which of the following is not a negative symptom of schizophrenia? -Inappropriate affect -Emotional Ambivalence -Delusions -Waxy Flexibility

-Delusions. Other negative symptoms include: bland or flat affect, apathy, autism, deteriorated appearance, anergia, posturing, pacing and rocking, anhendonia, regression.

Post Traumatic Stress Disorder Signs and Symptoms

-Exposure to life-threatening event; severe trauma, natural disasters, war -Relive the experience (nightmares, flashbacks) -emotionally numb -difficulty with relationships -isolate themselves

Nursing Considerations for OCD

-Give them time for rituals -Never take away the ritual without replacing it with another coping mechanism, such as anxiety reduction techniques -Do not verbalize disapproval

Treatment for Personality Disorders like Borderline

-Improve self esteem -treat co-diagnoses (depression, eating disorders) -relaxation techniques -enforce rules and limits -don't reinforce any negative behaviors -treat self-mutilation and suicide gestures in matter-of-fact way

Suicide Signs and symptoms

-Is there a plan? what? how lethal? access? -Watch for isolating self, writing a will, collecting harmful objects, giving away belongings

Personality disorders S/S

-Most commonly encountered is borderline personality disorder -intensely emotional -manipulative -suicidal gestures -self-mutilation -may be depressed or bulimic -may abuse substances -fear of abandonment, many negative relationships -to this person, any relationship is better than no relationship -may be sexually promiscuous -scared of being along (abandonment)

Phases of Schizophrenia

-Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior -Phase II Prodromal Phase- certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness. -Phase III Schizophrenia- active phase of the disorder. Two or more of the following present for a significant amount of time during one month: delusions, hallucinations, social/occupational dysfunction, duration, schizoaffective and mood disorder exclusion, substance/general medical condition exclusion, relationship to a pervasive developmental disorder Phase IV Residual Phase- characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness.

The nurse is providing tips on using herbal remedies. Which teaching point should the nurse provide? o Select a reputable brand o Herbal remedies are subject to FDA approval o No need to monitor for adverse reactions o They are natural and completely safe

-Select a reputable brand

Other Nursing Implications for Depression

-Sometimes just sitting with the patient is best -interacting with others actually makes them feel better; don't isolate -these people have hard time making simple decisions -as depression lifts, suicide risk goes up -depressed people can have delusions and hallucinations -talk and thoughts are slowed -In mild depression...hypersomnia; in moderate or more, sometimes insomnia

Panic Disorder Notes

-Stay 6 feet away -Simple messages -Have to learn how to stop the anxiety -teach that symptoms should peak within 10 minutes -Teach journaling to manage anxiety -Helps the patient gain insight into the peaks and valleys of anxiety and triggers -Relaxation techniques

A 60 year old client with chronic schizophrenia presents in to ER with uncontrollable tongue movements, stiff neck, and difficulty swallowing. What is happening and how is it resolved? -Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications -Angranulocytosis treated by administration of clozapine -extrapyramidal dyskinesia treated by discontinuing antipsychotic medications -tardive dyskinesia treated by discontinuing antipsychotic medications

-Tardive dyskinesia treated by discontinuing antipsychotic medications

Progressive relaxation exercise therapy focuses on: -use of instrumentation to become aware of processes in the body -use of own imagination as frame of reference - hair-thin, sterile, disposable, stainless steel needles -tensing and relaxing groups of muscles

-Tensing and relaxing groups of muscles

Treatment of OCD

-Time delay techniques, relaxation techniques -Medications such as SSRIs or TCAs

Phobia notes

-Usually the object the person is scared of does not present danger -Must have a trusting relationship -Desensitization (gradual exposure to fear) -Don't talk about the phobia a lot -follow-up is the key to successful treatment

Hallucination notes

-Warn before you touch them -don't say "they" -let the patient know that you don't share the perception -connected with times of anxiety -involve in an activity (get them out of the hallucination and into the real world) -elevate head of bed -turn off radio -offer reassurance if the patient is frightened

What is a self help group?

-allow clients to talk about their fears and relieve feelings of isolation, while receiving comfort and advice from others undergoing similar experiences

Paranoia Signs and Symptoms

-always suspicious without reason to be -guarded in relationships...huge trust issues -pathologic jealousy -hypersensitive -can't relax -no humor -unemotional -craves attention, life's not fair -reacts with rage

Glyceine Function/Mental Implications

-appears to be involved in recurrent inhibition of motor neurons within the spinal cord and is possibly involved in the regulation of spinal and brainstem reflexes. -decreased levels of glycine have been implicated in the pathogenesis of certain types of spastic disorders. Toxic accumulation of the neurotransmitter in the brain and cerebrospinal fluid can result in "glycine encephalopathy"

Define Altruism

-assimilated by group members through mutual sharing and concern for each other. Providing assistance and support to others creates a positive self image and promotes self growth.

Treatment of Paranoia

-be reliable -Do what you say -brief visits -be careful with touch -respect personal space -avoid whispering -don't mix meds -can't handle over-friendly nurse -Always ID meds -eating sealed foods -no competitive activities -be honest

Antianxiety: Benzodiazepines -action on neurotransmitter/receptor -physiological effect -side effect

-binds to BZ receptor sites on the GABA-A receptor complex, increases receptor affinity for GABA -relief of anxiety, sedation -dependence, confusion, memory impairment, motor incoordination

Pre-procedure ECT (electro-convulsive therapy)

-can induce a grand mal seizure -for severe depression and manic episodes -NPO, void, Atropine to dry secretions -Signed permit is necessary -series of treatments, depend on client response -very effective treatment, and very humane with current medications -Succinylcholine Chloride (Anectine)

Restraint Rules

-check q15m, remember hydration, nutrition, and elimination -Stay away from them as long as possible -Observation at 15 and 30 minutes intervals or 1-1 if the client can't contract for safety

Treatment for Dissociative Disorders

-client must process the trauma over time -medications may be used to treat co-existing depression and anxiety

Mania Notes

-continuous high with labile emotions -Delusions of grandeur or persecution -inappropriate dress -spending sprees -no inhibitions -hypersexual -Manipulates a lot...makes them feel powerful and secure -Hallucinations

Therapeutic Relationships, The Orientation (Introductory) Phase

-create environment for the establishment of trust and rapport -contract for intervention that details expectations/responsibilities - gathering assessment data to build strong client database. -identify strengths/weakness of client -formulating nursing dx -set goals that are mutually agreeable -develop a plan of action that is realistic for meeting the established goals -explore feelings of both the client and nurse

Crying with depression

-crying spells with mild to moderate depression -no more tears with severe depression

Nursing Considerations with Schizophrenia

-decrease stimuli -Observe frequently without looking suspicious -Orient frequently -Keep conversations reality based -make sure personal needs are met

Nursing Considerations for Mania

-decrease stimuli -limit group activities -stay with client as anxiety increases -structured schedule -writing activities -Brief, frequent contact with staff. Too much intense conversation stimulates the client -finger food -weight daily -walk with client during meals -change environment if they are wild or manic

S/S Anorexia

-distorted body image -sees and overweight person in the mirror -won't eat, but preoccupied with food -periods stop -decreased sex development -exercise -lose weight -uses intellectualization as defense mechanism -high achiever, perfectionist

How the nurse should interact with manic person with delusions and hallucinations

-do not argue about the belief -do not talk a lot about the delusion -Let the patient know that you accept that he needs the belief, but you do not believe it. -Look for the underlying need for the delusion

Histamine Function/Mental Implications

-exact processes mediated by histamine within CNS are unclear -some data suggest that histamine may play a role in depressive illnesses

Crises occur when an individual: -is exposed to a precipitating stressor -perceives a stressor to be threatening -has no support systems -experiences a stressor and perceives coping strategies to be ineffective

-experiences a stressor and perceives coping strategies to be ineffective

Schizophrenia signs and symptoms

-focus is inward, create their own world -inappropriate or flat affect -disorganized, rapid, jumpy thoughts -Echolalia -Neologism -word salad (jumble of words) -Hallucinations (auditory most common, then visual) -child-like mannerisms -religiousity

What is a task group?

-function is to accomplish a specific outcome or task. The focus is on solving problems and making decisions to achieve this outcome. Often, a deadline is placed.

Glutamate Function/Mental Implications

-functions in the relay of sensory information an in the regulation of carious motor and spinal reflexes. -increased receptor activity has been implicated in the etiology of certain neurodegenerative disorders such as Parkinson's disease. Decreased receptor activity can induce psychotic behavior.

Acetylcholine Functions/Mental Implications

-implicated in sleep, arousal, pain perception, the modulation and coordination of movement, and memory acquisition and retention -cholinergic mechanisms may have some role in certain disorders of motor behavior and memory, such as Parkinson's, Huntington's, and Alzheimer's disease. Increased levels of acetylcholine have been associated with depression

MAO Inhibitors -action on neurotransmitter/receptor -physiological effect -side effect

-increase NE and 5-HT by inhibiting the enzyme that degrades them -reduces depression and anxiety -sedation, dizziness, sexual dysfunction, hypertensive crisis

Treatment for Anorexia

-increase weight gradually -monitor exercise routine -teach healthy eating and exercising -allow client input in choosing healthy foods for meals -Limit activity and decisions if weight is low enough to be life threatening

SSRI -action on neurotransmitter/receptor -physiological effect -side effect

-inhibit reuptake of serotonin -reduces depression, controls anxiety, controls obsessions -nausea, agitation, headache, sexual dysfunction

Tricyclic Antidepressants -action on neurotransmitter/receptor -physiological effect -side effect

-inhibit reuptake of serotonin, norepinephrine, block NE receptor, ACh receptor, histamine receptor -reduces depression, relief of severe pain, prevent panic attacks -sexual dysfunction, sedation, weight gain, dry mouth, constipation, blurred vision, urinary retention, postural hypotension, and tachycardia

Bupropion -action on neurotransmitter/receptor -physiological effect -side effect

-inhibits reuptake of NE and dopamine -reduces depression, aid in smoking cessation, decrease in symptoms of ADHD -insomnia, dry mouth, tremor, seizures

Dopamine Function/Mental Implications

-involved in regulation of movements and coordination, emotions, voluntary decision-making ability, and because of its influence on the pituitary gland, it inhibits the release of prolactin -decreased levels of dopamine have been implicated in the etiology of Parkinson's disease and depression. Increased levels of dopamine are associated with mania and schizophrenia.

Therapeutic Relationships, The Preinteraction Phase

-involves preparation for the 1st encounter -obtain available info about the client. Initial assessment -Examine one's own feelings, fears, and anxieties about working with particular client

Therapeutic Relationships, The Working Phase

-maintain trust/rapport -promote client's insight and perception of reality -problem solving using the model -overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues -continuously evaluating progress toward the goal

A nurse assesses a patient with suspected of having major depression disorder. Which symptom would eliminate the diagnosis? -Maxed out charge cards and exhibits perniscuous behaviors -refuses to interact with others -unable to feel any pleasure 0disheveled and malodorous

-maxed out charge cards and exhibits perniscuous behavior. Depressed mood, loss of interest or pleasure in usual activities and significant weight loss are signs of major depressive disorder.

Norepinephrine Function/Mental Implications

-may have role in the regulation of mood, cognition, perception, and in cardiovascular functioning, and in sleep and arousal. -implicated in certain mood disorders such as depression and mania, anxiety states, and in schizophrenia. Levels of the neurotransmitter are thought to be decreased in depression and increased in mania, anxiety disorders, and in schizophrenia

Endorphins and Enkephalins Functions/Mental Implications

-natural morphine like properties, they are thought to have a role in pain modulation -modulation of dopamine activity by opioid peptides may indicate some link to the symptoms of schizophrenia

Define Transference:

-occurs when the client unconsciously attributes to the nurse feelings and behavioral predispositions formed toward a person from his or her past.

Signs and Symptoms of Alcohol Dependency and problems

-peripheral neuritis (nerve problems from vitamin deficiency) -liver and pancreas problems -impotence -gastritis (alcohol kills GI tract) -Mg and K loss (diuresis) -Denial and rationalization defense mechanisms

Serotonin Function/Mental Implications

-play a role in sleep and arousal, libido, appetite, mood, aggression, and pain perception -increased levels of serotonin have been implicated in schizophrenia and anxiety states. Decreased levels of the neurotransmitter have been associated with depression

Post Procedure ECT

-position on side (so as not to aspirate) -stay with client -temporary memory loss -reorient -involve in days activities as soon as possible

SSNRIs: venlafaxine, desvenlafaxine, and duloxetine -action on neurotransmitter/receptor -physiological effect -side effect

-potent inhibitor of serotonin and norepinephrine reuptake. Weak inhibitor of dopamine reuptake. -Reduces depression, relieves pain of neuropathy, relieves anxiety -nausea, increase sweating, insomnia, tremors, sexual dysfunction

What is a supportive/therapeutic group?

-prevent future upsets by teaching participants effective ways to deal with emotional stress rising from situational of developmental crises. -focus on group relations, interactions among group members, and the consideration of a selected issue

Therapeutic Relationships, The Termination Phase

-progress has been made toward attainment of mutually set goals -a plan for continuing care or assistance during stressful life situations -feelings about termination of the relationship are recognized and explored.

Antipsychotics: Novel: clozapine, olanzepine, aripiprazole, quetiapine, risperdone, ziprasidone, paliperidone, iloperidone, and asenapine -action on neurotransmitter/receptor -physiological effect -side effect

-receptor antagonism of 5-HT1 and 5-HT2, D1-D5, H1, alpha-adrenergic, muscarinic -relief of psychosis, relief of anxiety, and acute mania -potential with some of the drugs for mild EPS, sedation, weight gain, orthrostasis and dizziness, blurred vision, dry mouth, sweating, constipation, urinary retention, tachycardia

Define Countertransference:

-refers to the nurse's behavioral and emotional response to the client. These responses may be related to unresolved feelings toward significant others form the nurse's past, or they may be generated in response to transference feelings on the part of the client.

Nursing Considerations for Suicidal patient

-safe-proof room -contract to postpone -re-channel anger (exercise) -stay calm

Treatment of generalized anxiety

-short term use of anxiolytics -relaxation techniques -journaling to gain insight into triggers

Antipsychotics: phenthiazines and haloperidol -action on neurotransmitter/receptor -physiological effect -side effect

-strong D2 receptor blockade, weaker blockade of ACh, H1, alpha-adrenergic and 5-HT2 receptors -relief of psychosis, relief of anxiety, some provide relief from nausea and vomiting and intractable hiccoughs

Treatment for PTSD

-support groups -talk about the experience, but don't push -medications may be helpful

What is a teaching group?

-teaching/educational groups to convey knowledge and information to a number of individuals. nurses can be involved in teaching groups of many varieties, such as medication education, childbirth, breast exams, and parenting. usually have a set number of meetings

Anxiety Signs and Symptoms

-universal emotion (we all have felt) -It becomes a disorder when it interferes with everyday life -nurses should stay with highly anxious client -this patient needs step by step instructions

Dissociative Disorders (signs and symptoms)

-uses dissociation as a coping mechanism to protect self from severe physical and or psychological trauma -may see history of physical or sexual abuse -not common disorder -client or others may be aware of the problem, except that the client may have periods of time or events that he can't remember

Aaron, age 27, was brought to the E.D by police. he smelled strongly of alcohol and was combative. His B.A.C was measured 293 mg/dL. His girlfriend reports that he drinks excessively every day and is verbally and physically abusive. The nurses give John the nursing dx of Risk for other-directed violence. What would be appropriate outcome objectives for this diagnosis? Select all that apply. -client will not verbalize anger or hit anyone -will verbalize anger rather than hit others -client will not harm self or others -client will be restrained if becomes verbally/physically abusive

-will verbalize anger rather than hit others -client will not harm self or others

A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. "I cannot drink any alcohol with this medication." B. "It is going to take 2 to 3 weeks in order for me to begin to feel better." C. "This drug causes physical dependence and I need to strictly follow doctor's orders." D. "I can't take this medication with food. It needs to be taken on an empty stomach."

ANS: B Buspar takes at least 2 to 3 weeks to be effective in controlling symptoms of depression. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.

A newly admitted client diagnosed with major depressive disorder states, "I have never considered suicide." Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply? A. "I'm glad you shared this. There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all your options prior to taking this action."

ANS: B By admitting to the staff a suicide plan, this client has taken responsibility for possible personal actions and expresses trust in the nurse. Therefore, the client may be receptive to continuing a safety plan. Recognition of this achievement reinforces this adaptive behavior.

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

ANS: B By asking the client to recall a time in life when food could be consumed without purging, the nurse is assessing previously successful coping strategies. This information can be used by the client to modify maladaptive behaviors in the present and future.

A client with panic disorder is taking alprazolam (Xanax) 1 mg P.O. three times daily. The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which of the following neurotransmitters? 1. Gamma-aminobutyrate. 2. Serotonin. 3. Dopamine. 4. Norepinephrine.

1. Alprazolam, a benzodiazepine used on a short-term or temporary basis to treat symptoms of anxiety, increases gamma-aminobutyrate, a major inhibitory neurotransmitter. Because gamma-aminobutyric acid is increased and the reticular activating system is depressed, incoming stimuli are muted and the effects of anxiety are blocked. Alprazolam does not directly target serotonin, dopamine, or norepinephrine.

The director of nursing (DON) sets up a meeting with the newly appointed nurse manager who, to this point, has done an excellent job. The nurse manager anticipates job termination. What is the best description of the cognitive error being employed by the nurse manager? A. Thinking from an "all-or-nothing" perspective B. Always thinking the worst will occur without considering positive outcomes C. Viewing only selected negative evidence while editing out positive aspects D. Undervaluing the positive significance of an event

ANS: B Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The nurse manager has quickly jumped to the conclusion that the meeting will result in job termination.

The nurse is caring for a Vietnam War veteran with a history of explosive anger, unemployment, and depression since being discharged from the service. The client reports feeling ashamed of being "weak" and of letting past experiences control thoughts and actions in the present. What is the nurse's best response?

1. "Many people who have been in your situation experience similar emotions and behaviors."

A client with a history of drug and alcohol abuse is concerned that the hospital will divulge her history to her employer without her knowledge. What response by the nurse would be appropriate?

1. "Your personal health information can't be disclosed to your employer without your permission."

Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply. 1. Excessive worry about items difficult to control. 2. Muscle tension. 3. Hypersomnia. 4. Excessive amounts of energy. 5. Feeling "keyed up" or "on edge."

1. A client diagnosed with generalized anxiety disorder (GAD) would experience excessive worry about items difficult to control. 2. A client diagnosed with GAD would experience muscle tension. 5. A client diagnosed with GAD would experience an increased startle reflex and tension, causing feelings of being "keyed up" or being "on edge." TEST-TAKING HINT: To answer this question correctly, the test taker would need to recognize the signs and symptoms of GAD.

Which of the following would the nurse expect to assess in a client diagnosed with posttraumatic stress disorder? Select all that apply. 1. Dissociative events. 2. Intense fear and helplessness. 3. Excessive attachment and dependence toward others. 4. Full range of affect. 5. Avoidance of activities that are associated with the trauma.

1. A client diagnosed with posttraumatic stress disorder (PTSD) may have dissociative events in which the client feels detached from the situation or feelings. 2. A client diagnosed with PTSD may have intense fear and feelings of helplessness. 5. A client diagnosed with PTSD avoids activities associated with the traumatic event. TEST-TAKING HINT: To answer this question correctly, the test taker must be aware of the different symptoms associated with the diagnosis of PTSD.

A client diagnosed with cluster "C" traits sits alone and ignores other's attempts to converse. When ask to join a group the client states, "No thanks." In this situation, which should the nurse assign as an initial nursing diagnosis? A. Fear R/T hospitalization B. Social isolation R/T poor self-esteem C. Risk for suicide R/T to hopelessness D. Powerlessness R/T dependence issues

ANS: B Clients diagnosed with cluster "C" traits are described as anxious and fearful. The DSM-IV-TR divides cluster "C" personality disorders into three categories: avoidant, dependent, and obsessive-compulsive. Anxiety and fear contribute to social isolation.

While improving, a client demands to have a phone installed in the intensive care unit (ICU) room. When a nurse states, "This is not allowed. It is a unit rule." The client angrily demands to see the doctor. Which approach should the nurse use in this situation? A. Provide an explanation for the necessity of the unit rule. B. Assist the client to discuss anger and frustrations. C. Call the physician and relay the request. D. Arrange for a phone to be installed in the client's unit room.

ANS: B Clients who demand special privileges may be diagnosed with narcissistic personality disorder. The best approach in this situation is for the nurse to identify the function that anger, frustration, and rage serve for the client. The verbalization of feelings may help the client to gain insight into his or her behavior.

A client leaving home for the first time in a year arrives on the psychiatric in-patient unit wearing a surgical mask and white gloves and crying, "The germs in here are going to kill me." Which nursing diagnosis addresses this client's problem? 1. Social isolation R /T fear of germs AEB continually refusing to leave the home. 2. Fear of germs R /T obsessive-compulsive disorder, resulting in dysfunctional isolation. 3. Ineffective coping AEB dysfunctional isolation R /T unrealistic fear of germs. 4. Anxiety R /T the inability to leave home, resulting in dysfunctional fear of germs.

1. According to the North American Nursing Diagnosis Association (NANDA), the nursing diagnosis format must contain three essential components: (1) identification of the health problem, (2) presentation of the etiology (or cause) of the problem, and (3) description of a cluster of signs and symptoms known as "defining characteristics." The correct answer, "1," contains all three components in the correct order: health problem/NANDA stem (social isolation); etiology/cause, or R /T (fear of germs); and signs and symptoms, or AEB (refusing to leave home for the past year). Because this client has been unable to leave home for a year as a result of fear of germs, the client's behaviors meet the defining characteristics of social isolation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to know the components of a correctly stated nursing diagnosis and the order in which these components are written.

A nursing instructor is teaching about the didactic aspects of cognitive therapy. Which student statement indicates a deficit in meeting the learning objectives of this content? A. "The therapist provides information about the process of cognitive therapy." B. "The therapist uses guided imagery in an effort to elicit automatic thoughts." C. "The therapist provides information about how cognitive therapy works." D. "The therapist uses reading assignments to reinforce learning."

ANS: B Cognitive therapy prepares the client to become his or her own cognitive therapist. The didactic portion of the therapy provides educational material to reinforce learning about the therapy and how it affects psychiatric disorders.

A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which correctly stated nursing diagnosis takes priority? 1. Anxiety R /T obsessive thoughts AEB ritualistic behaviors. 2. Powerlessness R /T ritualistic behaviors AEB statements of lack of control. 3. Fear R /T a traumatic event AEB stimulus avoidance. 4. Social isolation R /T increased levels of anxiety AEB not attending groups.

1. Anxiety is the underlying cause of the diagnosis of obsessive compulsive disorder (OCD), therefore, anxiety R/T obsessive thoughts is the priority nursing diagnosis for the client newly admitted for the treatment of this disorder. TEST-TAKING HINT: When the question is asking for a priority, the test taker should consider which client problem would need to be addressed before any other problem can be explored. When anxiety is decreased, social isolation should improve, and feelings about powerlessness can be expressed.

During a panic attack, a client runs to the nurse and reports breathing difficulty, chest pain, and palpitations. The client is pale with his mouth wide open and eyebrows raised. What should the nurse do first?

1. Assist the client to breathe deeply into a paper bag

During alprazolam (Xanax) therapy, the nurse should be alert for which dose-related adverse reaction?

1. Ataxia

Because antianxiety agents such as lorazepam (Ativan) can potentiate the effects of other drugs, the nurse should incorporate which instruction in her teaching plan?

1. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants

(SELECT AL THAT APPLY) A 54-year-old client diagnosed with generalized anxiety disorder is admitted to the facility. Which therapeutic modalities are typically used to treat this disorder?

1. Biofeedback 2. Buspirone 3. Relaxtion technique

The nurse refers a client with severe anxiety to a psychiatrist for medication evaluation. The physician is most likely to prescribe which psychotropic drug regimen for this client?

1. Buspirone (BuSpar), 5 mg orally three times per day "

Tricyclics

1. CNS depression 2. Anticholinergic It takes tri weeks for tricyclics to be effective.

Anxiety is a symptom that can result from which of the following physiological conditions? Select all that apply. 1. Chronic obstructive pulmonary disease. 2. Hyperthyroidism. 3. Hypertension. 4. Diverticulosis. 5. Hypoglycemia.

1. Chronic obstructive pulmonary disease causes shortness of breath. Air deprivation causes anxiety, sometimes to the point of panic. 2. Hyperthyroidism (Graves's disease) involves excess stimulation of the sympathetic nervous system and excessive levels of thyroxine. Anxiety is one of several symptoms brought on by these increases. 5. Marked irritability and anxiety are some of the many symptoms associated with hypoglycemia. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that anxiety is manifested by physiological responses.

Which of the following medications can be used to treat clients with anxiety disorders? Select all that apply. 1. Clonidine hydrochloride (Catapres). 2. Fluvoxamine maleate (Luvox). 3. Buspirone (BuSpar). 4. Alprazolam (Xanax). 5. Haloperidol (Haldol).

1. Clonidine hydrochloride (Catapres) is used in the treatment of panic disorders and generalized anxiety disorder. 2. Fluvoxamine maleate (Luvox) is used in the treatment of obsessive-compulsive disorder. 3. Buspirone (BuSpar) is used in the treatment of panic disorders and generalized anxiety disorders. 4. Alprazolam (Xanax), a benzodiazepine, is used for the short-term treatment of anxiety disorders. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand that many medications are used off-label to treat anxiety disorders.

Which mental disorder ranks first among the top ten causes of disability worldwide?

1. Depression ranks first among the top ten causes of disability worldwide

A client on an in-patient psychiatric unit is experiencing a flashback. Which intervention takes priority? 1. Maintain and reassure the client of his or her safety and security. 2. Encourage the client to express feelings. 3. Decrease extraneous external stimuli. 4. Use a nonjudgmental and matter-of-fact approach.

1. During a flashback, the client is experiencing severe-to-panic levels of anxiety; the priority nursing intervention is to maintain and reassure the client of his or her safety and security. The client's anxiety needs to decrease before other interventions are attempted. TEST-TAKING HINT: It is important to understand time-wise interventions when dealing with individuals experiencing anxiety. When the client experiences severe-to-panic levels of anxiety during flashbacks, the nurse needs to maintain safety and security until the client's level of anxiety has decreased.

A newly admitted client diagnosed with social phobia has a nursing diagnosis of social isolation R/T fear of ridicule. Which outcome is appropriate for this client? 1. The client will participate in two group activities by day 4. 2. The client will use relaxation techniques to decrease anxiety. 3. The client will verbalize one positive attribute about self by discharge. 4. The client will request buspirone (BuSpar) PRN to attend group by day 2.

1. Expecting the client to participate in a set number of group activities by day 4 directly relates to the stated nursing diagnosis of social isolation and is a measurable outcome that includes a timeframe. TEST-TAKING HINT: To express an appropriate outcome, the statement must be related to the stated problem, be measurable and attainable, and have a timeframe. The test taker can eliminate "2" immediately because there is no timeframe, and then "3" because it does not relate to the stated problem.

After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?

1. Exploring the meaning of the traumatic event with the client

A 10-year-old client diagnosed with nightmare disorder is admitted to an in-patient psychiatric unit. Which of the following interventions would be appropriate for this client's problem? Select all that apply. 1. Involving the family in therapy to decrease stress within the family. 2. Using phototherapy to assist the client to adapt to changes in sleep. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both. 4. Giving central nervous system stimulants, such as amphetamines. 5. Using relaxation therapy, such as meditation and deep breathing techniques, to assist the client in falling asleep.

1. Family stress can occur as the result of repeated client nightmares. This stress within the family may exacerbate the client's problem and hamper any effective treatment. Involving the family in therapy to relieve obvious stress would be an appropriate intervention to assist in the treatment of clients diagnosed with a nightmare disorder. 3. Administering medications such as tricyclic antidepressants or low-dose benzodiazepines or both is an appropriate intervention for clients diagnosed with a parasomnia disorder, such as a nightmare disorder. 5. Relaxation therapy, such as meditation and deep breathing techniques, would be appropriate for clients diagnosed with a nightmare disorder to assist in falling back to sleep after the nightmare occurs. TEST-TAKING HINT: To answer this question correctly, the test taker must be able first to understand the manifestation of a nightmare disorder and then to choose the interventions that would address these manifestations effectively.

The nurse notices that a client with obsessive-compulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be therapeutic?

1. I saw you change clothes several times today. That must be very tiring.

Which nursing diagnosis reflects the intrapersonal theory of the etiology of obsessivecompulsive disorder? 1. Ineffective coping R /T punitive superego. 2. Ineffective coping R /T active avoidance. 3. Ineffective coping R /T alteration in serotonin. 4. Ineffective coping R /T classic conditioning.

1. Ineffective coping R /T punitive superego reflects an intrapersonal theory of the etiology of obsessive-compulsive disorder (OCD). The punitive superego is a concept contained in Freud's psychosocial theory of personality development. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the different theories of the etiology of OCD. The keyword "intrapersonal" should make the test taker look for a concept inherent in this theory, such as "punitive superego."

During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? A. The husband is expressing an emotional cutoff. B. The husband is expressing double-bind communication. C. The husband is expressing indirect messages. D. The husband is expressing avoidance behaviors.

ANS: B Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong.

A hospitalized client diagnosed with posttraumatic stress disorder has a nursing diagnosis of ineffective coping R /T history of rape AEB abusing alcohol. Which is the expected short-term outcome for this client problem? 1. The client will recognize triggers that precipitate alcohol abuse by day 2. 2. The client will attend follow-up weekly therapy sessions after discharge. 3. The client will refrain from self-blame regarding the rape by day 2. 4. The client will be free from injury to self throughout the shift.

1. It is a realistic expectation for a client who copes with previous trauma by abusing alcohol to recognize the triggers that precipitate this behavior. This outcome should be developed mutually early in treatment. TEST-TAKING HINT: It is important to relate outcomes to the stated nursing diagnosis. In this question, the test taker should choose an answer that relates to the nursing diagnosis of ineffective coping. Answer "4" can be eliminated immediately because it does not assist the client in coping more effectively. Also, the test taker must note important words, such as "short-term." Answer "2" can be eliminated immediately because it is a long-term outcome.

Which symptom should a nurse identify as typical of the "fight-or-flight" response? A. Pupil constriction B. Increased heart rate C. Increased salivation D. Increased peristalsis

ANS: B During the "fight-or-flight" response, the heart rate increases in response to the release of epinephrine. Pupils dilate to enhance vision. Salivation and peristalsis decrease as the body slows unessential functions.

Which of the following are characterisitcs of a holistic approach to psychiatric-mental health nursing care? (Select all that apply) 1. The biological aspect of illness is considred 2. Physical symptoms are interrelated with mental factors 3. Mental illness does not impact physiologi homeostasis 4. The client's socioeconomic status is considered in planning care 5. The client's spiritual needs are not considered when planning nursing care

1. Rationale: A holistic approach to psychiatric-mental health nursing care examines how physiologic changes that occur with an illness affect emotional well-being. 2. Rationale: Physical symptoms can directly impact a client's emotional well-being and mental health. 4. Rationale: A client's socioeconomic status can directly affect a client's ability to access health care.

Your client blames his family for the exacerbation of ulcerative colitis. You establish the foundation for a trusting relationship. the client reports "having rapport" with you. If your goal is to explore family relationships, which nursing strategy should you implement next? 1. Gather date about family circumstances 2. Matter-of-factly point out the need to accept responsibility for physical illness 3. Explore strressors and methods of coping that have been effective in the past. 4. Connect the client's family with a chronic illness support group

1. Rationale: An accurate assessment of family circumstances and the client's perception is the basis on which interventions are built.

The nurse is assessing the client for a possible mental disorder using contemporary beliefs about mental illness as a theoretical base for practice. Given this approach, the nurse would definitely as about: 1. Current medications and recent stressors 2. Early childhood experiences and dreams 3. Religious practices 4. Recent blood transfusions

1. Rationale: Asking about current medications will elicit information about any current psychotropic drugs that treat mental illness from a biochemical perspective. Asking about recent stressors will elicit information from the social dimension. These areas reflect contemporary thinking related to mental illness.

An outcome of evidence-based practice includes: 1. Practice guidelines 2. Standardized care 3.Reduced hospital length of stay 4. Reduced workload for nurses

1. Rationale: Based on clinical research and clinical practice, nurses can develop clinical quidelines for nursing care.

Which step in the nursing process is necessary to initiate a change to evidence-based practice? 1. Assessment 2. Planning 3. Implementation 4. Evaluation

1. Rationale: In order to make a change, an assessment of the need to change is needed

One of the obstacles in describing mental disorders is that the phrase "deviant behavior": 1. Has a pejorative connotation 2. Derives its meaning from the culture 3. Is used colloquially 4. Is value-free

1. Rationale: It is challenging to describe behavior that deviates from the norm with nonjudgemental , value-neutral language

According to Healthy People 2010 report, major mental health problems do not include clients with which of the following? (Select all that apply)

1. Rationale: Only bullet 8 includes people who abuse substances (as individuals with co-occuring substance abuse and mental disorders) 2. Rationale: As veterans return from abroad, incidence and prevalence of PTSD will increase 5. Rationale: As veterans return from abroad, incidence and prevalence of co-occuring mental disorders and traumatic brain injury will increase.

A peer on the Medical-Surgical floor consults with you regarding a client admitted with an infection-induced delirium. Her family reports she has never discussed religion, but in her delirium, she appears fearful and screams, "I repent here before the fires of Hell!" Your peer says, "Her family wants to know where that came from." The information you reccommend for the family is based on your knowledge of which of the following defense mechanisms? 1. Repression 2. Introjection 3. Fantasy 4. Suppression

1. Rationale: Repression is the basis for all defense mechanisms and refers to the unconscious exclusion of distressing thoughts and feelings from awareness. Clients experiencing delirium may verbalize feelings such as guilt that were previously repressed.

The role of the nurse in a humanistic interactional therapeutic model includes: 1. Participating in political systems to promote a holistic approach to mental health care 2. Advanced knowledge of cient dynamics and personality development 3. Implementing a token economy to reward desirable client behavior 4. Outreach and case management to a large group of clients with chronic mental illness

1. Rationale: The humanistic interactional model promotes a holisitc approach to mental health care.

Your client, a survivor of Hurricane Katrina, now owns her own house and business. She describes herself as "successful and blessed." She reports difficulty falling asleep "nearly every night" and has had sleep deprivation for over 2 years. "I didn't have insomnia before the storm. I should be happy. I have more than I ever did before." Based on this information, your tentative nursing diagnosis is: 1. Insomnia related to anticipation of threat to basic needs and security 2. Insomnia related to survivor guilt 3. Alteration in self-concept related to survivoe guilt 4. Anxiety related to inevitability of future loss

1. Rationale: The sleep pattern disturbance of insomnia is the client's presenting problem. The etiology relates to potential threat. Either actual interference with basic needs or anticipation of interference with basic needs may cause anxiety.

"Deviant behavior" itself does not define mental disorders, unless the deviance or conflict is symptomatic of the individual's dysfunction. "Deviant" behavior is defined by which of the following? Select all that apply. 1. historical and social norms 2. Situational context 3. Peer relationships 4. Understanding of human behavior 5. Political norms

1. Rationale: Today, the "ship of fools" would be described as mass murder 2. Rationale: The man on the street corner who calls himself Napoleon is deviant, yet the man at the masquerade who calls himself Napoleon is ordinary. 4. Rationale: Homosexuality was voted out of the DSM-III in 1973 5. Rationale: Soviet dissidents were diagnosed and institutionalized for deviant behavior labeled as mental illness ("Delusions of Societal Reform")

A nurse's first scientific responsibility in conducting research is to: 1. Identify what research questions to pursue 2. Apply to the Institutional Review Board (IRB) for permission to conduct research 3. Identify the participants in the study after the study has been approved 4. Select members of the oversight committee.

1. Rationale: the first step in any research project is to establish the research the research questions that the study will try to answer

When a client experiences a panic attack, which outcome takes priority? 1. The client will remain safe throughout the duration of the panic attack. 2. The client will verbalize an anxiety level less than 2/10. 3. The client will use learned coping mechanisms to decrease anxiety. 4. The client will verbalize the positive effects of exercise by day 2.

1. Remaining safe throughout the duration of the panic attack is the priority outcome for the client. TEST-TAKING HINT: All outcomes must be appropriate for the situation described in the question. In the question, the client is experiencing a panic attack; having the client verbalize the positive effects of exercise would be inappropriate. All outcomes must be client-centered, specific, realistic, positive, and measurable, and contain a timeframe.

A client with obsessive-compulsive disorder may use reaction formation as a defense mechanism to cope with anxiety and stress. What typically occurs in reaction formation?

1. The client assumes an attitude that is the opposite of an impulse that the client harbors.

While in the facility, a client with obsessive-compulsive disorder saves all used medicine cups and paper cups and arranges them in elaborate sculptures in the room. At home, the client saves mail and magazines and makes elaborate paper sculptures from them. Which outcome would indicate successful treatment for this client?

1. The client throws away all disposable cups

A client diagnosed with generalized anxiety disorder has a nursing diagnosis of panic anxiety R/T altered perceptions. Which of the following short-term outcomes is most appropriate for this client? 1. The client will be able to intervene before reaching panic levels of anxiety by discharge. 2. The client will verbalize decreased levels of anxiety by day 2. 3. The client will take control of life situations by using problem-solving methods effectively. 4. The client will voluntarily participate in group therapy activities by discharge.

1. The client's being able to intervene before reaching panic levels of anxiety by discharge is measurable, relates to the stated nursing diagnosis, has a timeframe, and is an appropriate short-term outcome for this client. TEST-TAKING HINT: When evaluating outcomes, the test taker must make sure that the outcome is specific to the client's need, is realistic, is measurable, and contains a reasonable timeframe. If any of these components is missing, the outcome is incorrectly written and can be eliminated.

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

1. The nurse should recognize the statement, "I can't do this anymore," as evidence of hopelessness and assess further the potential for suicidal ideations. TEST-TAKING HINT: To answer this question correctly, the test taker should apply the nursing process. Assessment is the first step of this process. The nurse initially must assess a situation before determining appropriate nursing interventions.

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

1. This statement is an indication that the cognitive intervention was successful. By remembering that panic attacks are self-limiting, the client is applying the information gained from the nurse's cognitive intervention. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand which interventions support which theories of causation. When looking for a "cognitive" intervention, the test taker must remember that the theory involves thought processes.

Lorazepam (Ativan) is often given along with a neuroleptic agent, such as haloperidol (Haldol). What is the purpose of administering the drugs together?

1. To reduce anxiety and potentiate the sedative action of the neuroleptic

A client newly admitted to an in-patient psychiatric unit is diagnosed with obsessivecompulsive disorder. Which behavioral symptom would the nurse expect to assess? 1. The client uses excessive hand washing to relieve anxiety. 2. The client rates anxiety at 8/10. 3. The client uses breathing techniques to decrease anxiety. 4. The client exhibits diaphoresis and tachycardia.

1. Using excessive hand washing to relieve anxiety is a behavioral symptom exhibited by clients diagnosed with obsessivecompulsive disorder (OCD). TEST-TAKING HINT: To answer this question correctly, the test taker must be able to differentiate various classes of symptoms exhibited by clients diagnosed with OCD. The keyword "behavioral" determines the correct answer to this question.

In the situation presented, which nursing intervention constitutes false imprisonment? A. The client is combative and will not redirect stating, "No one can stop me from leaving." The nurse seeks the physician's order after the client is restrained. B. The client has been consistently seeking the attention of the nurse much of the day. The nurse institutes seclusion. C. A psychotic client, admitted in an involuntary status, runs off the psychiatric unit. The nurse runs after the client and the client agrees to return. D. A client hospitalized as an involuntary admission attempts to leave the unit. The nurse calls the security team and they prevent the client from leaving.

ANS: B False imprisonment is the deliberate and unauthorized commitment of a person within fixed limits by the use of verbal or physical means. Seclusion should only be used in an emergency situation to prevent harm after least restrictive means have been unsuccessfully attempted.

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

1. When a client is newly admitted, it is important for the nurse to assess past coping mechanisms and their effects on anxiety. Assessment is the first step in the nursing process, and this information needs to be gathered to intervene effectively. 2. Allowing time for the client to complete compulsions is important for a client who is newly admitted. If compulsions are limited, anxiety levels increase. If the client had been hospitalized for a while, then, with the client's input, limits would be set on the compulsive behaviors. 5. It is important for the nurse to allow the client to express his or her feelings about the obsessions and compulsions. This assessment of feelings should begin at admission. TEST-TAKING HINT: It is important for the test taker to note the words "newly admitted" in the question. The nursing interventions implemented vary and are based on length of stay on the unit, along with client's insight into his or her disorder. For clients with obsessive-compulsive disorder, it is important to understand that the compulsions are used to decrease anxiety. If the compulsions are limited, anxiety increases. Also, the test taker must remember that during treatment it is imperative that the treatment team includes the client in decisions related to any limitation of compulsive behaviors.

A client diagnosed with posttraumatic stress disorder is close to discharge. Which client statement would indicate that teaching about the psychosocial cause of posttraumatic stress disorder was effective? 1. "I understand that the event I experienced, how I deal with it, and my support system all affect my disease process." 2. "I have learned to avoid stressful situations as a way to decrease emotional pain." 3. "So, natural opioid release during the trauma caused my body to become 'addicted.'" 4. "Because of the trauma, I have a negative perception of the world and feel hopeless."

1. When the client verbalizes understanding of how the experienced event, individual traits, and available support systems affect his or her diagnosis, the client demonstrates a good understanding of the psychosocial cause of posttraumatic stress disorder (PTSD). To answer this question correctly, the test taker should review the different theories as they relate to the causes of different anxiety disorders, including PTSD. Only "1" describes a psychosocial etiology of PTSD.

A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, the nurse should focus on:

1. helping the client identify and verbalize feelings about the incident.

A client diagnosed with generalized anxiety disorder is prescribed paroxetine (Paxil) 30 mg QHS. Paroxetine is supplied as a 20-mg tablet. The nurse would administer ______tablets.

1.5 tablets

An elderly client is prescribed fluoxetine (Prozac), 40 mg by mouth twice per day, for treatment of depression. The client has difficulty swallowing, so the pharmacy dispenses the oral solution containing 20 mg/5 ml. How many milliliters of solution should the nurse administer to achieve the prescribed dose?

10

A nurse is reviewing that stat labs of a client in the ER. At what minimum blood alcohol level should a nurse expect intoxication to occur? o 50 mg/dL o 100 mg/dL o 250 mg/dL o 300 mg/dL

100 mg/dL

A client with borderline personality disorder tells the nurse, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond?

2. ""I'll have to discuss your request with the team. Can we talk about how you're feeling right now?""

Which of the following assessment data would support the disorder of acrophobia? 1. A client is fearful of basements because of encountering spiders. 2. A client refuses to go to Europe because of fear of flying. 3. A client is unable to commit to marriage after a 10-year engagement. 4. A client refuses to leave home during stormy weather.

2. Acrophobia is the fear of heights. An individual experiencing acrophobia may be unable to fly because of this fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the definitions of specific commonly diagnosed phobias.

A client diagnosed with panic attacks is being admitted for the fifth time in 1 year because of hopelessness and helplessness. Which precaution would the nurse plan to implement? 1. Elopement precautions. 2. Suicide precautions. 3. Homicide precautions. 4. Fall precautions.

2. Any client who is exhibiting hopelessness or helplessness needs to be monitored closely for suicide intentions. TEST-TAKING HINT: To answer this question correctly, the test taker should note the words "hopelessness" and "helplessness," which would be indications of suicidal ideations that warrant suicide precautions.

When treating individuals with posttraumatic stress disorder, which variables are included in the recovery environment? 1. Degree of ego strength. 2. Availability of social supports. 3. Severity and duration of the stressor. 4. Amount of control over reoccurrence.

2. Availability of social supports is part of environmental variables. Others include cohesiveness and protectiveness of family and friends, attitudes of society regarding the experience, and cultural and subcultural influences. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the following three significant elements in the development of posttraumatic stress disorder: traumatic experience, individual variables, and environmental variables.

In which situation would benzodiazepines be prescribed appropriately? 1. Long-term treatment of posttraumatic stress disorder, convulsive disorder, and alcohol withdrawal. 2. Short-term treatment of generalized anxiety disorder, alcohol withdrawal, and preoperative sedation. 3. Short-term treatment of obsessive-compulsive disorder, skeletal muscle spasms, and essential hypertension. 4. Long-term treatment of panic disorder, alcohol dependence, and bipolar affective disorder: manic episode.

2. Benzodiazepines are prescribed for shortterm treatment of generalized anxiety disorder and alcohol withdrawal, and can be prescribed during preoperative sedation. TEST-TAKING HINT: The test taker needs to note the words "long-term" and "short-term" in the answers. Benzodiazepines are prescribed in the short-term because of their addictive properties. The test taker must understand that when taking a test, if one part of the answer is incorrect, the whole answer is incorrect, as in answer choice "3."

A physician's order states to administer lorazepam (Ativan), 20 mg by mouth twice per day, to treat anxiety. How should the nurse proceed?

2. Clarify the order with the prescribing physician because the amount prescribed exceeds the recommended dose.

A client in a psychiatric facility is prescribed escitalopram (Lexapro) for anxiety. She tells the nurse that she has been having "weird dreams" and feelings of wanting to "end it all." What action should the nurse take?

2. Consult a pharmacist to see if these symptoms are adverse effects of the drug.

"After months of coaxing by her husband, a client comes to the mental health clinic. She reports that she suffers from an overwhelming fear of leaving her house. This overwhelming fear has caused the client to lose her job and is beginning to take a toll on her marriage. The physician diagnoses the client with agoraphobia. Which treatment options are effective in treating this disorder?

2. Desensitization 3. Alprazolam (Xanax) therapy 4. Paroxetine (Paxil) therapy

In assessing a client diagnosed with polysubstance abuse, the nurse should recognize that withdrawal from which substance may require a life-saving emergency intervention? A. Dextroamphetamine (Dexedrine) B. Diazepam (Valium) C. Morphine (Astramorph) D. Phencyclidine (PCP)

ANS: B If large doses of central nervous system (CNS) depressants (like Valium) are repeatedly administered over a prolonged duration, a period of CNS hyperexcitability occurs on withdrawal of the drug. The response can be quite severe, even leading to convulsions and death.

The nurse is using an intrapersonal approach to assist a client in dealing with survivor's guilt. Which intervention would be appropriate? 1. Encourage the client to attend a survivor's group. 2. Encourage expression of feelings during one-to-one interactions with the nurse. 3. Ask the client to challenge the irrational beliefs associated with the event. 4. Administer regularly scheduled paroxetine (Paxil) to deal with depressive symptoms.

2. Encouraging expressions of feelings during one-to-one interactions with the nurse is an intrapersonal approach to interventions that treat survivor's guilt associated with PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker needs to differentiate various theoretical approaches and which interventions reflect these theories.

A client diagnosed with obsessive-compulsive disorder is newly admitted to an inpatient psychiatric unit. Which cognitive symptom would the nurse expect to assess? 1. Compulsive behaviors that occupy more than 4 hours per day. 2. Excessive worrying about germs and illness. 3. Comorbid abuse of alcohol to decrease anxiety. 4. Excessive sweating and an increase in blood pressure and pulse.

2. Excessive worrying about germs and illness is a cognitive symptom experienced by clients diagnosed with OCD. TEST-TAKING HINT: To answer this question correctly, the test taker must note the keyword "cognitive." Only "2" is a cognitive symptom.

A client is diagnosed with obsessive-compulsive disorder. Which intervention should the nurse include when assisting with development of the plan of care?

2. Giving the client adequate time to perform rituals

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

2. It is important for the client to learn techniques to reduce overall levels of anxiety to decrease the need for compulsive behaviors. The teaching of these techniques should begin by day 4. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that nursing interventions should be based on timeframes appropriate to the expressed symptoms and severity of the client's disorder. The length of hospitalization also must be considered in planning these interventions. The average stay on an in-patient psychiatric unit is 5 to 7 days.

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

2. It is important for the nurse to ask the client about a potential plan for suicide to intervene in a timely manner. Clients who have developed suicide plans are at higher risk than clients who may have vague suicidal thoughts. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the importance of assessing the plan for suicide. Interventions would differ depending on the client's plan. The intervention for a plan to use a gun at home would differ from an intervention for a plan to hang oneself during hospitalization.

A client recently diagnosed with generalized anxiety disorder is prescribed clonazepam (Klonopin), buspirone (BuSpar), and citalopram (Celexa). Which assessment related to the concurrent use of these medications is most important? 1. Monitor for signs and symptoms of worsening depression and suicidal ideation. 2. Monitor for changes in mental status, diaphoresis, tachycardia, and tremor. 3. Monitor for hyperpyresis, dystonia, and muscle rigidity. 4. Monitor for spasms of face, legs, and neck and for bizarre facial movements.

2. It is important for the nurse to monitor for serotonin syndrome, which occurs when a client takes multiple medications that affect serotonin levels. Symptoms include change in mental status, restlessness, myoclonus, hyperreflexia, tachycardia, labile blood pressure, diaphoresis, shivering, and tremor. TEST-TAKING HINT: To answer this question correctly, the test taker must be familiar with the signs and symptoms of serotonin syndrome and which psychotropic medications affect serotonin, potentially leading to this syndrome.

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

2. It is important to teach the client that the onset of action for buspirone (BuSpar) is 2 to 3 weeks. Often the nurse may see a benzodiazepine, such as clonazepam, prescribed because of its quick onset of effect, until the buspirone begins working. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that buspirone (BuSpar) has a delayed onset of action, which can affect medication compliance. If the effects of the medication are delayed, the client is likely to stop taking the medication. Teaching about delayed onset is an important nursing intervention.

A client tells the nurse that she has an overwhelming fear of having a heart attack. This client is most likely suffering from which disorder?

2. Panic disorder

The Healthy People 2010 report suggests that the mental health problems listed are associated with which of the following? (Select all that apply)

2. Rationale: Bullets 5, 7, 8, 1o and 11 pertain to treatment of individuals with identified mental disorders 3. Rationale: the theme of "individuals with identified mental disorders who do not receive treatment," coupled with bullet 10 (cultural competence), suggests that stigma may interfere with treatment 4. Rationale: Bullets 1, 4, 10, 11, and 12 involve screening and identification of at-risk individuals

The basis for evidence-based practice is: 1.The nursing process 2 Clinical reasearch and practice. 3. Critical thinking 4. Clinical algorithms

2. Rationale: Clinical research is the basis for evidence-based practice

A benefit of critical pathways is that they: 1. Clearly define skills required to care for clients. 2. Reflect client outcomes based on nursing interventions. 3. Are professional mandates to clinical practice. 4. Are based on trial-and-error nursing.

2. Rationale: Critical pathways integrate nursing interventions to achieve client outcomes

In determining a nurse's readiness to engage in evidence-based practice, the nurse will: 1. Ask other staff members what their beliefs are related to evidence-based practice 2. Identify resources needed to access evidence-based information 3. Recognize the value of maintaining the status quo 4. Let other staff initiate the change process

2. Rationale: Determining availability of resources to assist in the change to evidence-based practice will support the change process

Which of the following statements is FALSE? 1. Fantasy is a common defense mechanism of young children. 2. Dissociation is functional for adults 3. Projection and reaction formation are associated with paranoid thinking 4. Rationalization is associated with rejection of personal responsibility

2. Rationale: Dissociation is often disruptive for adults when they act without conscious awareness and have periods of time for which they can not account. Dissociation serves an important purpose for a child in a traumatic situation, keeping the trauma from conscious awareness.

The best evidence on which to base your clinical practice is based on: 1. Standards of nursing care 2. Outcomes of a research project 3. Practice guidelines 4. Critical pathways

2. Rationale: Outcomes of research will reveal evidence to support clinical practice

The nurse explains to a group of clients that they will receive an additional 30 minutes of recreation time if they actively participate in group therapy. What is this an example of? 1. Conditioned response 2. Reinforcement 3. Operant conditioning 4. Positive punishment

2. Rationale: Reinforcement rewards desired behaviors

(SELECT ALL THAT APPLY) After receiving a referral from the occupational health nurse, a client comes to the mental health clinic with a suspected diagnosis of obsessive-compulsive disorder. The client explains that his compulsion to wash his hands is interfering with his job. Which interventions are appropriate when caring for a client with this disorder?

2. Support the use of appropriate defense mechanisms. 4. Explore the patterns leading to the compulsive behavior. 6. Encourage activities, such as listening to music."

A client experiencing a panic attack would display which physical symptom? 1. Fear of dying. 2. Sweating and palpitations. 3. Depersonalization. 4. Restlessness and pacing.

2. Sweating and palpitations are physical symptoms of a panic attack. TEST-TAKING HINT: The test taker must note important words in the question, such as "physical symptoms." Although all the answers are actual symptoms a client experiences during a panic attack, only "2" is a physical symptom.

A client diagnosed as having panic disorder with agoraphobia is admitted to the inpatient psychiatric unit. Until her admission, she had been a virtual prisoner in her home for 5 weeks, afraid to go outside even to buy food. When planning care for this client, what is the nurse's overall goal?

2. To help the client function effectively in her environment

A nurse has been providing care to the same group of clients for 4 consecutive days. On day 5, she sees that her assignment has changed, and she is concerned about the continuity of care for these clients. What should the nurse do?

2. Voice her concerns about continuity of care with the charge nurse.

During a shift report, the nurse learns that she will be providing care for a client who's vulnerable to panic attacks. Treatment for panic attacks includes behavioral therapy, supportive psychotherapy, and medication such as

2. antianxiety drugs.

The nurse is collecting data on a client suffering from stress and anxiety. A common physiological response to stress and anxiety is:

2. diarrhea

Initial interventions for the client with acute anxiety include:

2. encouraging the client to verbalize feelings and concerns.

A client with a conversion disorder reports blindness, and ophthalmologic examinations reveal that no physiologic disorder is causing progressive vision loss. The most likely source of this client's reported blindness is:

2. having been forced to watch a loved one's torture.

While shopping at a mall, a woman experiences an episode of extreme terror accompanied by anxiety, tachycardia, trembling, and fear of going crazy. A friend drives her to the emergency department, where a physician rules out physiological causes and refers her to the psychiatric resident on call. To control the client's anxiety, the nurse caring for this client may expect the resident to prescribe:

2. lorazepam (Ativan).

A client with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobias include:

2. severe anxiety and fear.

what percentage of women can expect to be victim of an ongoing unwanted pursuit from stalking? -25% -50% -10% -40%

25%

PTSD occurs w/i what frame of the experience?

3 months -in PTSD, the symptoms occur 3 months or more after the trauma, which distinguished PTSD from acute stress disorder which happens right after and last four weeks

While interviewing a 3-year-old girl who has been sexually abused about the event, which approach would be most effective? 1. Describe what happened during the abusive act. 2. Draw a picture and explain what it means. 3. "Play out" the event using anatomically correct dolls. 4. Name the perpetrator.

3. A 3-year-old child has limited verbal skills and should not be asked to describe an event, explain a picture, or respond verbally or nonverbally to questions. More appropriately, the child can act out an event using dolls. The child is likely to be too fearful to name the perpetrator or will not be able to do so.

One of the myths about sexual abuse of young children is that it usually involves physically violent acts. Which of the following behaviors is more likely to be used by the abusers? 1. Tying the child down. 2. Bribery with money. 3. Coercion as a result of the trusting relationship. 4. Asking for the child's consent for sex.

3. Coercion is the most common strategy used because the child commonly trusts the abuser. Tying the child down usually is not necessary. Typically the abusive person can control the child by his or her size and weight alone. Bribery usually is not necessary because the child wants love and affection from the abusive person, not money. Young children are not capable of giving consent for sex before they develop an adult concept of what sex is.

A client with suspected abuse describes her husband as a good man who works hard and provides well for his family. She does not work outside the home and states that she is proud to be a wife and mother just like her own mother. The nurse interprets the family pattern described by the client as best illustrating which of the following as characteristic of abusive families? 1. Tight, impermeable boundaries. 2. Unbalanced power ratio. 3. Role stereotyping. 4. Dysfunctional feeling tone.

3. The traditional and rigid gender roles described by the client are examples of role stereotyping. Impermeable boundaries, unbalanced power ratio, and dysfunctional feeling tone are also common in abusive families.

A woman, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the psychiatric unit where she is diagnosed with conversion disorder. The client asks the nurse, "Why has this happened to me?" What is the most appropriate response?

3. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened."

A client is undergoing treatment for an anxiety disorder. Such a disorder is considered chronic and generalized when excessive anxiety and worry about two or more life circumstances exist for at least:

3. 6 months

Which client would the charge nurse assign to an agency nurse who is new to a psychiatric setting? 1. A client diagnosed with posttraumatic stress disorder currently experiencing flashbacks. 2. A newly admitted client diagnosed with generalized anxiety disorder beginning benzodiazepines for the first time. 3. A client admitted 4 days ago with the diagnosis of algophobia. 4. A newly admitted client with obsessive-compulsive disorder.

3. A client admitted 4 days ago with a diagnosis of algophobia, fear of pain, would be an appropriate assignment for the agency nurse. Of the clients presented, this client would pose the least challenge to a nurse unfamiliar with psychiatric clients. TEST-TAKING HINT: To answer this question correctly, the test taker needs to recognize the complexity of psychiatric diagnoses and understand the ramifications of potentially inappropriate nursing interventions by inexperienced staff members.

The nurse has received evening report. Which client would the nurse need to assess first? 1. A newly admitted client with a history of panic attacks. 2. A client who slept 2 to 3 hours last night because of flashbacks. 3. A client pacing the halls and stating that his anxiety is an 8/10. 4. A client diagnosed with generalized anxiety disorder awaiting discharge.

3. A client pacing the halls and experiencing an increase in anxiety commands immediate assessment. If the nurse does not take action on this assessment, there is a potential for client injury to self or others. TEST-TAKING HINT: When the nurse is prioritizing client assessments, it is important to note which client might be a safety risk. When asked to prioritize, the test taker must review all the situations presented before deciding which one to address first.

A client diagnosed with generalized anxiety disorder is placed on clonazepam (Klonopin) and buspirone (BuSpar). Which client statement indicates teaching has been effective? 1. The client verbalizes that the clonazepam (Klonopin) is to be used for long-term therapy in conjunction with buspirone (BuSpar). 2. The client verbalizes that buspirone (BuSpar) can cause sedation and should be taken at night. 3. The client verbalizes that clonazepam (Klonopin) is to be used short-term until the buspirone (BuSpar) takes full effect. 4. The client verbalizes that tolerance can result with long-term use of buspirone (BuSpar).

3. Clonazepam would be used for shortterm treatment while waiting for the buspirone to take full effect, which can take 4 to 6 weeks. TEST-TAKING HINT: To answer this question correctly, the test taker must note appropriate teaching needs for clients prescribed different classifications of antianxiety medications.

A newly admitted client is diagnosed with posttraumatic stress disorder. Which behavioral symptom would the nurse expect to assess? 1. Recurrent, distressing flashbacks. 2. Intense fear, helplessness, and horror. 3. Diminished participation in significant activities. 4. Detachment or estrangement from others.

3. Diminished participation in significant activities is a behavioral symptom of PTSD. TEST-TAKING HINT: To answer this question correctly, the test taker should take note of the keyword "behavioral," which determines the correct answer. All symptoms may be exhibited in PTSD, but only answer choice "3" is a behavioral symptom.

A client enters the crisis unit complaining of increased stress from her studies as a medical student. She states that she has been increasingly anxious for the past month. Her physician prescribes alprazolam (Xanax), 25 mg by mouth three times per day, along with professional counseling. Before administering alprazolam, the nurse reviews the client's medication history. Which drug can produce additive effects when given concomitantly with alprazolam?

3. Diphenhydramine (Benadryl)

A client diagnosed with social phobia has an outcome that states, "Client will voluntarily participate in group activities with peers by day 3." Which would be an appropriate intrapersonal intervention by the nurse to assist the client to achieve this outcome? 1. Offer PRN lorazepam (Ativan) 1 hour before group begins. 2. Attend group with client to assist in decreasing anxiety. 3. Encourage discussion about fears related to socialization. 4. Role-play scenarios that may occur in group to decrease anxiety.

3. Encouraging discussion about fears is an intrapersonal intervention. TEST-TAKING HINT: It is important to understand that interventions are based on theories of causation. In this question, the test taker needs to know that intrapersonal theory relates to feelings or developmental issues. Only "3" deals with client feelings.

A nurse observes a medical student walk into a client's room and begin questioning her about her current health status. The client appears reluctant to respond. How should the nurse intervene?

3. Explain to the client that she has the right to refuse to answer questions asked by the medical student.

Which assessment data would support a physician's diagnosis of an anxiety disorder in a client? 1. A client experiences severe levels of anxiety in one area of functioning. 2. A client experiences an increased level of anxiety in one area of functioning for a 6-month period. 3. A client experiences increased levels of anxiety that affect functioning in more than one area of life over a 6-month period. 4. A client experiences increased levels of anxiety that affect functioning in at least three areas of life.

3. For a client to be diagnosed with an anxiety disorder, the client must experience symptoms that interfere in a minimum of two areas, such as social, occupational, or other important functioning. These symptoms must be experienced for durations of 6 months or longer. TEST-TAKING HINT: To answer this question correctly, the test taker must understand that specific symptoms must be exhibited and specific timeframes achieved for clients to be diagnosed with anxiety disorders.

A client admitted to the unit is visibly anxious. When collecting data on the client, the nurse would expect to see which cardiovascular effect produced by the sympathetic nervous system?

3. Increased heart rate

A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct? 1. The client is exhibiting signs and symptoms of an exacerbation of generalized anxiety disorder. 2. The client's signs and symptoms are due to an underlying medical condition. 3. A physical examination is needed to determine the etiology of the client's problem. 4. The client's anxiolytic dosage needs to be increased.

3. Physical problems should be ruled out before determining a psychological cause for this client's symptoms. TEST-TAKING HINT: The test taker needs to remember that although a client may have a history of a psychiatric illness, a complete, thorough evaluation must be done before assuming exhibited symptoms are related to the psychiatric diagnosis. Many medical conditions generate anxiety as a symptom.

The nurse asks the client to describe what the client was feeling prior to an outburst of aggressive behavior during group therapy. The nurse is utilizing what theoretical framework? 1. Medical-psychobiologic 2. Psychoanalytic 3. Cognitive behavioral 4. Social-interpersonal

3. Rationale: Cognitive behavioral interventions focus on what the client thinks and feels and identifies the meaning of behavior

A philosophy of service to benefit humanity through science, reason, and democracy is: 1. Symbolic interactionism 2. Psychobiology 3. Humanism 4. Psychic determinism

3. Rationale: Humanism focuses on humanity, science, and democracy.

In the early 19th century, individuals with mental disorders were believed to be: 1. Controlled by evil spirits 2. Influenced by the moon 3. Incurable and dangerous 4. Divinely inspired

3. Rationale: In the early 19th century the emphasis was on classification of symptoms of mental disorders. The mentally ill were seen as dangerous and incurable

Which of the following critical thinking competencies is NOT applicable to evidence-based practice? 1. Identifying meaningful research evidence 2. Critically and objectively critiquing research evidence 3. Integrating personal experiences and beliefs into the process 4. Developing a plan of care based on research findings.

3. Rationale: Including personal experiences and beliefs will inhibit one's ability to remain objective

The psychiatric mental-health nurse is utilizing interactionism as a theraeutic modality for clients. In using this model, the nurse understansa that: 1. The underlying cause of mental illness is organic and located in the CNS 2. Each psychic event is determined by the ones that preceed it 3. All behavior has meaning 4. The focus of treatment is on the present rather than the past.

3. Rationale: The belief that behavior has different meanings for different people reflects interactionism

The nurse and physician are discussing a thepeutic approach for a client experiencing depression. The nurse states that clients ahve control over their own lives. What therapeutic approach does this opinion represent? 1. Humanism 2. Psychoanalysis 3. Interactionism 4. Conditioning

3. Rationale: The belief that individuals control their own lives and events is the basis of interactionism.

Which of the following is most congruent with the nursing process? 1. Social readjustment rating 2. General adaptation syndrome 3. Process of cognitive appraisal 4. Categorization of individuals as either "disease prone" or "self-healing"

3. Rationale: The steps of primary appraisal, secondary appraisal, coping, and reappraisal may be equated with assessment, planning, implementation, and evaluation.

According to psychoanalytic theory, the superego is concerned with: 1. The desire to seek pleasure while avoiding pain 2. the ability to delay an immediate release of tension or achievement of pleasure 3. Moral behavior 4. Mutually satisfying relationships with others

3. Rationale: The superego focuses on moral behavior.

Which of the following is a defining characteristic of a mental disorder? 1. A psychological group of symptoms associated with disability 2. A psychological group of symptoms associated with distress 3. A response that is other than that expected and culturally accepted to an event 4. A psychological group of symptoms associated with suffering, pain, loss of freedom, or death

3. Rationale: This characteristic distinguishes mental disorders from other disorders that nurses may encounter

Your client has been hospitalized for the 17th time with chronic schizophrenia, paranoid type. For years, he has steadfastly denied having mental illness. During this hospitalization, you overhear him telling another client that he thinks he may have "this horrible disease". Which nursing intervention is most essential? 1. Modify his priority nursing care plan problem from "Ineffective Denial" to "Spiritual Distress" 2. Give him positive reinforcement for his insight 3. Gather more data regarding his mental status. 4. Reassure him that many clients with schizophrenia may lead productive lives

3. Rationale: You need more data regarding the nature of "this horrible disease." (He may not be referring to schizophrenia). If the disease to which he refers is schizophrenia, denial has been protecting him form anxiety. He may experience increased disorganization and may harm himself.

Parents of a 3-year-old have noticed an improvement in behavior because of using a "time out" behavioral approach. What aspect of "time out" therapy may be responsible for this child's improved behavior? A. "Negative reinforcement discourages maladaptive behavior." B. "Positive reinforcement is removed." C. "Covert sensitization is being applied. D. "Reciprocal inhibition is eliminated."

ANS: B In a "time out," the positive reinforcement of attention is removed from the child during inappropriate behavior.

A client seen in an out-patient clinic for ongoing management of panic attacks states, "I have to make myself come to these appointments. It is hard because I don't know when an attack will occur." Which nursing diagnosis takes priority? 1. Ineffective breathing patterns R /T hyperventilation. 2. Impaired spontaneous ventilation R /T panic levels of anxiety. 3. Social isolation R /T fear of spontaneous panic attacks. 4. Knowledge deficit R /T triggers for panic attacks.

3. Social isolation is seen frequently with individuals diagnosed with panic attacks. The client in the question expresses anticipatory fear of unexpected attacks, which affects the client's ability to interact with others. TEST-TAKING HINT: To answer this question correctly, the test taker must link the behaviors presented in the question with the nursing diagnosis that is reflective of these behaviors. The test taker must remember the importance of time-wise interventions. Nursing interventions differ according to the degree of anxiety the client is experiencing. If the client were currently experiencing a panic attack, other interventions would be appropriate.

A client diagnosed with posttraumatic stress disorder has a nursing diagnosis of disturbed sleep patterns R /T nightmares. Which evaluation would indicate that the stated nursing diagnosis was resolved? 1. The client expresses feelings about the nightmares during group. 2. The client asks for PRN trazodone (Desyrel) before bed to fall asleep. 3. The client states that the client feels rested when awakening and denies nightmares. 4. The client avoids napping during the day to help enhance sleep.

3. The client's feeling rested on awakening and denying nightmares are the evaluation data needed to support the fact that the nursing diagnosis of disturbed sleep patterns R/T nightmares has been resolved. TEST-TAKING HINT: To answer this question correctly, the test taker needs to discern evaluation data that indicate problem resolution. Answers "1," "2," and "4" all are interventions to assist in resolving the stated nursing diagnosis, not evaluation data that indicate problem resolution.

Using psychodynamic theory, which intervention would be appropriate for a client diagnosed with panic disorder? 1. Encourage the client to evaluate the power of distorted thinking. 2. Ask the client to include his or her family in scheduled therapy sessions. 3. Discuss the overuse of ego defense mechanisms and their impact on anxiety. 4. Teach the client about the effect of blood lactate level as it relates to the client's panic attacks.

3. The nurse discussing the overuse of ego defense mechanisms illustrates a psychodynamic approach to address the client's behaviors related to panic disorder. TEST-TAKING HINT: When answering this question, the test taker must be able to differentiate among various theoretical perspectives and their related interventions.

Clients diagnosed with obsessive-compulsive disorder commonly use which mechanism? 1. Suppression. 2. Repression. 3. Undoing. 4. Denial.

3. Undoing is a defense mechanism commonly used by individuals diagnosed with OCD. Undoing is used symbolically to negate or cancel out an intolerable previous action or experience. An individual diagnosed with OCD experiencing intolerable anxiety would use the defense mechanism of undoing to undo this anxiety by substituting obsessions or compulsions or both. Other commonly used defense mechanisms are isolation, displacement, and reaction formation. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand the underlying reasons for the ritualistic behaviors used by individuals diagnosed with OCD.

Which mental disorders rank among the top ten causes of disability worldwide? (Select all that apply) 1. PTSD 2. Antisocial personality disorder 3. Bipolar affective disorder 4. anxiety disorders 5. Schizophrenia

3. and 5.

A client with obsessive-compulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. The nurse notices that the client's hair is thinning and the skin on the forehead is irritated — possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to:

3. setting consistent limits on the ritualistic behavior if it harms the client or others.

The nurse is caring for a client experiencing an anxiety attack. Appropriate nursing interventions include:

3. staying with the client and speaking in short sentences.

during 2001, what percentage of children died form neglect? -15% -48% -50% -33%

33% -1,300 children died from maltreatment, with 33% dying from neglect in 2001

An adult client diagnosed with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do? 1. Instruct the woman to avoid touching these foods. 2. Ask the woman why she becomes anxious in these situations. 3. Assist the woman to make a plan for her family to do the food shopping and preparation. 4. Teach the woman to use cognitive behavioral approaches to manage her anxiety.

4. Cognitive behavioral therapy is effective in treating anxiety disorders. The nurse can assist the client in identifying the onset of the fears that cause the anxiety and develop strategies to modify the behavior associated with the fears. Avoiding touching foods, asking about reasons for the anxiety, and providing ways to work around touching the foods do not deal with the anxiety and are not interventions that will help this client.

An adolescent client was recently admitted to the psychiatric unit because of impulsivity and acting-out behavior at school. The nurse should initially implement which nursing action? A. Redirect the client to activities to decrease stress. B. Explain the unit rules and consequences of breaking the rules. C. Place the client on close observation to insure a trusting relationship. D. Administer an anti-anxiety medication.

ANS: B It is important for the nurse to initially explain the unit rules and consequences of breaking the rules. It is imperative that consequences of rule infractions are explained early in treatment to avoid misunderstanding and manipulation.

During the admission data collection, a client with a panic disorder begins to hyperventilate and says, "I'm going to die if I don't get out of here right now!" What is the nurse's best response?

4. ""You're having a panic attack. I'll stay here with you

The nurse teaches an anxious client diagnosed with posttraumatic stress disorder a breathing technique. Which action by the client would indicate that the teaching was successful? 1. The client eliminates anxiety by using the breathing technique. 2. The client performs activities of daily living independently by discharge. 3. The client recognizes signs and symptoms of escalating anxiety. 4. The client maintains a 3/10 anxiety level without medications.

4. A client's ability to maintain an anxiety level of 3/10 without medications indicates that the client is using breathing techniques successfully to reduce anxiety. TEST-TAKING HINT: To answer this question correctly, the test taker should understand that anxiety cannot be eliminated from life. This understanding would eliminate "1" immediately.

In which situation would the nurse suspect a medical diagnosis of social phobia? 1. A client abuses marijuana daily and avoids social situations because of fear of humiliation. 2. An 8-year-old child isolates from adults because of fear of embarrassment, but has good peer relationships in school. 3. A client diagnosed with Parkinson's disease avoids social situations because of embarrassment regarding tremors and drooling. 4. A college student avoids taking classes that include an oral presentation because of fear of being scrutinized by others.

4. A student who avoids classes because of the fear of being scrutinized by others meets the criteria for a diagnosis of social phobia. TEST-TAKING HINT: The test taker must understand the DSM-IV-TR diagnostic criteria for social phobia to answer this question correctly.

During a panic attack, a client hyperventilates, becomes unable to speak, and reports symptoms that mimic those of a heart attack. Which nursing intervention would be best?

4. Accompany the client to his room; remain there and provide instructions in short, simple statements.

During an assessment, a client diagnosed with generalized anxiety disorder rates anxiety as 9/10 and states, "I have thought about suicide because nothing ever seems to work out for me." Based on this information, which nursing diagnosis takes priority? 1. Hopelessness R /T anxiety AEB client's stating, "Nothing ever seems to work out." 2. Ineffective coping R /T rating anxiety as 9/10 AEB thoughts of suicide. 3. Anxiety R /T thoughts about work AEB rates anxiety 9/10. 4. Risk for suicide R /T expressing thoughts of suicide.

4. Because the client is expressing suicidal ideations, the nursing diagnosis of risk for suicide takes priority at this time. Client safety is prioritized over all other client problems. TEST-TAKING HINT: When looking for a priority nursing diagnosis, the test taker always must prioritize client safety. Even if other problems exist, client safety must be ensured.

A client was admitted to an in-patient psychiatric unit 4 days ago for the treatment of obsessive-compulsive disorder. Which outcome takes priority for this client at this time? 1. The client will use a thought-stopping technique to eliminate obsessive/compulsive behaviors. 2. The client will stop obsessive and/or compulsive behaviors. 3. The client will seek assistance from the staff to decrease obsessive or compulsive behaviors. 4. The client will use one relaxation technique to decrease obsessive or compulsive behaviors.

4. By day 4, it would be realistic to expect the client to use one relaxation technique to decrease obsessive or compulsive behaviors. This would be the current priority outcome. TEST-TAKING HINT: The test taker must recognize the importance of time-wise interventions when establishing outcomes. In the case of clients diagnosed with obsessive-compulsive disorder, expectations on admission vary greatly from outcomes developed closer to discharge.

From a cognitive theory perspective, which is a possible cause of panic disorder? 1. Inability of the ego to intervene when conflict occurs. 2. Abnormal elevations of blood lactate and increased lactate sensitivity. 3. Increased involvement of the neurochemical norepinephrine. 4. Distorted thinking patterns that precede maladaptive behaviors.

4. Distorted thinking patterns that precede maladaptive behaviors relate to the cognitive theory perspective of panic disorder development. TEST-TAKING HINT: The test taker should note important words in the question, such as "cognitive." Although all of the answers are potential causes of panic disorder development, the only answer that is from a cognitive perspective is "4."

Victims of sexual assault can experience posttraumatic stress reactions after the attack. Which of the following statements best describes symptoms associated with posttraumatic stress disorder (PTSD)?

4. Flashbacks, recurring dreams, and numbness

(SELECT ALL THAT APPLY) A registered nurse caring for a client with generalized anxiety disorder identifies a nursing diagnosis of Anxiety. The short-term goal identified is: The client will identify his physical, emotional, and behavioral responses to anxiety. Which nursing interventions will help the client achieve this goal?

4. Observe the client for overt signs of anxiety. 5. Help the client connect anxiety with uncomfortable physical, emotional, or behavioral responses. 6. Introduce the client to new strategies for coping with anxiety, such as relaxation techniques and exercise.

While driving home from work, a nurse realizes that she failed to communicate to the oncoming nurse that a client asked for more information about advance directives. Which action would be appropriate for the nurse to take?

4. Phone the nurse caring for the client and inform her of the client's request.

Whenever you inquire about the circumstances of your client's admission to your inpatient psychiatric unit, your client responds, "I would rather not talk about that." As the client's discharge date approaches, which nursing intervention is most essential? 1. Reiterate the need to deal with recent stressors, since discharge is imminent. 2. Confront the client's denial 3.Review the police report and list some coping strategies for the client to utilize after discharge. 4. Create a safe interpersonal environment so that the client can explore precipitating events.

4. Rationale: A safe interpersonal environment reduces anxiety. If the client perceives decreased anxiety, the client will experience decreased threat and increased ability to work with the nurse.

To objectively evaluate the findings of a research study, the nurse will: 1. Compare the findings to a similar study 2. Rely on clinical experience and knowledge 3. Replicate the study to determine if similar results are obtained 4. Establish criteria to be used in the evaluation process

4. Rationale: Decide what criteria you will use to evaluate this study's value to clients in your clinical area

Which of the following scenarios depicts an individual using symbolic substitutes as a coping strategy? 1. Despite knowledge of the health consequences, a health care provider smokes a pack a day, and two packs every Monday. The individual reports smoking as "soothing" 2. Your client has been in recovery form alcohol and chemical dependence for 25 years. The client states, "When I don't know what else to do I go to bed. i always feel better when I get out of bed." 3. Your co-worker, a psychiatric-mental health nurse, does not believe psychotherapy whould be effective for herself. "I'm into self-analysis. I usually get what I need as i meditate the problem" 4. Your friend informs you that when she is stressed, she copes with massages, mancures, and osmetic makeovers. "When my body looks better and feels better, it makes me feel emotionally grounded, like the outside mirrors the inside."

4. Rationale: For this individual, physical appearance and comfort are a symbolic substitute for management of emotional tension

In the general systems theory framework, nursing care is based on the belief that: 1. Mental illness is caused by an organic disease process 2. Clients need to understan the meaning of their behavior before they can overcome it. 3. Individuals have the capacity to avoid anxiety and establish security 4. A holistic approach to care includes the client system.

4. Rationale: General systems theory looks at the whole being, including the family structure, and is a holistic approach.

Everyday methods people use to cope and Antonovsky's generalized resistance resources (GRRs) are congruent with which of the following? 1. Resistance phase of the General Adaption Syndrome 2. the client's score on the Social Readjustment Scale 3. Defense mechanisms 4. Lazarus's Secondary appraisal results

4. Rationale: Generalized resistance resources (factors in the person, group, or organization that help in managing tension) equate to secondary appraisal results (coping resources and options)

The belief that emotional and behavioral disturbances are teh result of a disease process reflects which theory? 1. Psychic determinism 2. Shaping 3. Symbolic interactionism 4. Psychobiology

4. Rationale: Psychobiology focuses on the disease process and how it impacts mental health

The nurse knows that to maintain an evidence-based practice model of care, the nurse will: 1. Follow traditions and customs that have been practiced for years 2. Rely in trial and error to determine the safest method of care 3. Follow the agency's policies and prcedures of care 4. Review current nursing research

4. Rationale: Reviewing current current nursing research will assist the nurse in maintaining an evidence-based model of care

Mental disorders were conceptualized as disordered neurology under the purview of medicine by: 1. Freud 2. Pinel 3. Hippocrates 4. Rush

4. Rationale: Rush, the father of American psychiatry, viwed mental illness as a neurophysiological disorder.

Clients whose medical conditions are intensely influenced by psychological or behavioral factors: 1. Have few dependence and aggression conflicts 2. Are excellent candidates for long-term psychotherapy 3. Display insight and interest in self-awareness and personal growth 4. Demonstrate involvement of the neurological, endocrine, and immunological systems.

4. Rationale: The emotional centers of the brain-the cerebral cortex and limbic system- are intimately tied to the endocrine organs, through the axis of the hypothalamus and the anterior pituitary.

A newly admitted client diagnosed with posttraumatic stress disorder is exhibiting recurrent flashbacks, nightmares, sleep deprivation, and isolation from others. Which nursing diagnosis takes priority? 1. Posttrauma syndrome R /T a distressing event AEB flashbacks and nightmares. 2. Social isolation R /T anxiety AEB isolating because of fear of flashbacks. 3. Ineffective coping R /T flashbacks AEB alcohol abuse and dependence. 4. Risk for injury R /T exhaustion because of sustained levels of anxiety.

4. Risk for injury is the priority nursing diagnosis for this client. In the question, the client is exhibiting recurrent flashbacks, nightmares, and sleep deprivation that can cause exhaustion and lead to injury. It is important for the nurse to prioritize the nursing diagnosis that addresses safety. TEST-TAKING HINT: When the question asks for a priority, it is important for the test taker to understand that all answer choices may be appropriate statements. Client safety always should be prioritized.

Counselors have been sent to a location that has experienced a natural disaster to assist the population to deal with the devastation. This is an example of __________________ prevention.

4. Sending counselors to a natural disaster site to assist individuals to deal with the devastation is an example of primary prevention. Primary prevention reduces the incidence of mental disorders, such as posttraumatic stress disorder, within the population by helping individuals to cope more effectively with stress early in the grieving process. Primary prevention is extremely important for individuals who experience any traumatic event, such as a rape, war, hurricane, tornado, or school shooting. TEST-TAKING HINT: To answer this question correctly, it is necessary to understand the differences between primary, secondary, and tertiary prevention.

Which of the following statements explains the etiology of obsessive-compulsive disorder (OCD) from a biological theory perspective? 1. Individuals diagnosed with OCD have weak and underdeveloped egos. 2. Obsessive and compulsive behaviors are a conditioned response to a traumatic event. 3. Regression to the pre-Oedipal anal sadistic phase produces the clinical symptoms of OCD. 4. Abnormalities in various regions of the brain have been implicated in the cause of OCD.

4. The belief that abnormalities in various regions of the brain cause OCD is an explanation of OCD etiology from a biological theory perspective. TEST-TAKING HINT: To answer this question correctly, the test taker must understand the different theories of OCD etiology. This question calls for a biological theory perspective, making "4" the only correct choice.

A client diagnosed with posttraumatic stress disorder states to the nurse, "All those wonderful people died, and yet I was allowed to live." Which is the client experiencing? 1. Denial. 2. Social isolation. 3. Anger. 4. Survivor's guilt.

4. The client in the question is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others died and the individual survived. TEST-TAKING HINT: To answer this question correctly, the test taker needs to understand common phenomena experienced by individuals diagnosed with posttraumatic stress disorder and relate this understanding to the client statement presented in the question.

The nurse discovers that a client with obsessive-compulsive disorder (OCD) is attempting to resist the compulsion. Based on this finding, the nurse should look for signs of:

4. increased anxiety.

what percentage of staking victims is female?

80%

SCHIZOPHRENIA Define

A chronic mental disorder characterized by regression, thought disturbances, and bizarre dress that may be accompanied by delusions, hallucinations and/or abnormal motor behaviors; requires lifelong treatment. Cause is unknown, but researchers believe that a combination of genetics and environment contributes to the development of the disease. Having a family history of schizophrenia, fetal exposure to viruses, toxins or malnutrition, stressful life circumstances, older paternal age, and taking psychoactive drugs during adolescence and young adulthood are thought to be risk factors.

A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Expressions of poor self-esteem

ANS: B Lack of attention to grooming and hygiene is the only behavioral symptom presented. Depressed clients do not care enough about themselves to participate in grooming and hygiene.

Which of the following is a correct assumption regarding the concept of crisis? -Crises occur only in individuals with psychopathology -The stressful event that precipitates crisis is seldom identifiable -A crisis situation contains the potential for psychological growth or deterioration -Crises are chronic situations that recur many times during an individual's life

A crisis situation contains the potential for psychological growth or deterioration

SOMATOFORM DISORDERS

A group of disorders characterized by reports of physical symptoms, with no organic pathology (e.g., a soldier paralyzed during a war, but who has no physical injury). ** SEE CONVERSION DISORDERS **

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

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

The nurse should recognize which factors that distinguish personality disorders from psychosis? A. Functioning is more limited in personality disorders than in psychosis. B. Major disturbances of thought are absent in personality disorders. C. Personality disordered clients require hospitalization more frequently. D. Personality disorders do not affect family relationships as much as psychosis.

ANS: B Major disturbances of thought are absent in personality disorders and are a classic symptom of psychosis.

A 29-year-old client living with parents has few interpersonal relationships. The client states, "I have trouble trusting people." Based on Erikson's developmental theory, which should the nurse recognize as a true statement about this client? A. The client has not progressed beyond the trust versus mistrust developmental stage. B. Developmental deficits in earlier life stages have impaired the client's adult functioning. C. The client cannot move to the next developmental stage until mastering all earlier stages. D. The client's developmental problems began in the intimacy versus isolation stage.

ANS: B Many individuals with mental health problems are still struggling to achieve tasks from a number of developmental stages. Nurses can plan care to assist these individuals to complete these tasks and move on to a higher developmental level.

Define Empathy

A process wherein an individual is able to see beyond outward behavior and sense accurately another's inner experience at a given point in time.

PTSD Define

A severe anxiety disorder that occurs following exposure to a major traumatic event, which results in repeated flashbacks, nightmares, or emotionally crippling fear responses. PTSD changes the body's response to stress. It affects the stress hormones and chemicals that carry neurotransmitters. - Cause of PTSD is unknown. - Psychological, genetic, physical, and social factors are involved. - History or recent trauma may increase risk: assault, domestic abuse, prison stay, rape, terrorism, and war.

DEFENSE MECHANISMS - Unconscious Isolation

A splitting-off response in which the psyche blocks unpleasant feelings (an individual is inappropriately calm when told of the death of a loved one).

ANXIETY

A stress-based sense of apprehension in response to a perceived physiological or psychological threat, resulting in feelings of fear and helplessness. MANIFESTATIONS: (Psychological) Sense of fear and helplessness. Poor self-confidence and insecurity. Anger or guilt. (Physiological) ↑BP, ↑pulse, ↑RR. Palpitations, diaphoresis. Dry mouth, sweaty palms. Hyperventilation. Diarrhea. Fidgeting, giggling, talkative. Maladaptive physiological manifestations. (Panic Attacks) Sudden onset of intense apprehension, dear, terror that is out of proportion to occuring external events [may last from minutes to hours]. Dyspnea and faintness. CP with palpitations. Hyperventilation and choking. Fear of dying or going crazy. **POINT TO REMEMBER!** The initial nursing PRIORITY is to reduce the client's anxiety to levels that are tolerable. Progress can't be made until the anxiety is manageable!

DEFENSE MECHANISMS - Unconscious Splitting

A viewpoint of absolutes in which individuals are all good or all bad.

Physical tolerance and withdrawal symptoms can occur with stimulants. Stimulant withdrawal is characterized by which symptoms?

A violation of confidentiality because she informed the officer that the client wasn't there

An adolescent comes from a dysfunctional family where physical and verbal abuse prevail. At school this adolescent bullies and fights with classmates. Based on principles of behavior therapy, what is the probable source of this behavior? A. Shaping B. Modeling C. Premack principle D. Reciprocal inhibition

ANS: B Modeling is the learning of new behaviors by imitating the behaviors of others. This adolescent, witnessing physical and verbal abuse in the home, models this behavior in school.

A nursing instructor is teaching about the behavior technique of modeling. When asked to give an example of this behavioral intervention, which student statement meets the learning objective? A. "A child is first rewarded for using a spoon to eat and then rewarded for using a fork, and finally rewarded for cutting food with a knife." B. "An adolescent imitates Dad by using and caring for tools appropriately." C. "A client and therapist agree to conditions of therapy stating explicitly in writing the behavior change that is desired." D. "A mother tells her child that television can be watched only after homework is completed."

ANS: B Modeling refers to the learning of new behaviors by imitating the behavior of others.

A pessimistic client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which underlying cause of this client's personality disorder should a nurse recognize? A. "Nurturance was provided from many sources, and independent behaviors were encouraged." B. "Nurturance was provided exclusively from one source, and independent behaviors were discouraged." C. "Nurturance was provided exclusively from one source, and independent behaviors were encouraged." D. "Nurturance was provided from many sources, and independent behaviors were discouraged."

ANS: B Nurturance provided from one source and discouragement of independent behaviors can attribute to the etiology of dependent personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I have been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."

ANS: B Often suicidal clients resist personal monitoring which impedes the implementation of a suicide plan. A nurse should continually observe a client when risk for suicide is suspected.

A nursing assistant has failed a prerequisite course toward admission to nursing school and states, "I will always be only a nursing assistant and never an RN." Her nursing advisor understands this is an example of which automatic thought? A. Arbitrary inference B. Overgeneralization C. Dichotomous thinking D. Personalization

ANS: B Overgeneralization occurs when sweeping conclusions are made based on one incident. Because the student failed a prerequisite nursing course, the student over generalizes that the goal of being an RN will never be attained.

A client who experiences stress on a regular basis asks a nurse what causes these feelings. Which is the most appropriate nursing response? A. "Genetics have nothing to do with your temperament." B. "How you reacted to past experiences influences how you feel now." C. "If you're in good health physically, your stress level will be low." D. "Stress can always be avoided if appropriate coping mechanisms are employed."

ANS: B Past experiences are occurrences that result in learned patterns that can influence an individual's current adaptation response. They include previous exposure to the stressor or other stressors in general, learned coping responses, and degree of adaptation to previous stressors.

A school nurse is assessing a distraught female high school student who is overly concerned because her parents can't afford horseback riding lessons. How should the nurse interpret the student's reaction to her perceived problem? A. The problem is endangering her well-being. B. The problem is personally relevant to her. C. The problem is based on immaturity. D. The problem is exceeding her capacity to cope.

ANS: B Psychological stressors to self-esteem and self-image are related to how the individual perceives the situation or event. Self-image is particularly important to adolescents who feel entitled to have all the advantages that other adolescents experience.

A nurse is teaching a client deep breathing exercises. The client asks, "Why do I need to make that funny shape with my lips when I breathe out?" What is the most appropriate nursing reply? A. "You can actually exhale anyway you like; the lip shape is not important." B. "Pursed lip breathing helps you control the exhalation and helps to keep your airways open." C. "Don't worry about the lip shape; concentrate instead on the pace of your breathing." D. "The shape of the lip decreases the cough and choking reflex."

ANS: B Pursed lip breathing is controlled, allowing for longer exhalation because it is more effective in keeping the airways open.

A client is diagnosed with an anxiety disorder. The nurse counselor recommends intervention with the behavioral technique of reciprocal inhibition. The client asks, "What's that?" Which is the most appropriate nursing reply? A. "At the beginning of this intervention, a contract will be drawn up explicitly stating the behavior change agreed upon." B. "By introducing an adaptive behavior that is mutually exclusive to your maladaptive behavior, we will expect subsequent behavior to improve." C. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." D. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

ANS: B Reciprocal inhibition decreases or eliminates an undesired behavior by introducing a more adaptive behavior that is incompatible with the undesired behavior.

The experience of being physically restrained can be traumatic. Which nursing intervention would best help the client deal with this experience? A. Administering a tranquilizing medication before applying the restraints B. Talking to the client at brief but regular intervals while the client is restrained C. Decreasing stimuli by leaving the client alone most of the time D. Checking on the client infrequently, in order to meet documentation requirements

ANS: B Restraints are never to be used as punishment or for the convenience of the staff. Connecting with the client by maintaining communication during the period of restraint will help the client recognize this intervention as a therapeutic treatment versus a punishment.

A psychiatric nurse uses Sullivan's theories in group and individual therapy. According to Sullivan and other theorists like him, how are client symptoms viewed? A. Client symptoms are viewed as learned behaviors that are maintained because they are reinforced. B. Client symptoms are viewed as responses to anxiety arising from interpersonal relationships. C. Client symptoms are viewed as internal conflicts arising from early childhood trauma. D. Client symptoms are viewed as the misinterpretations of experiences.

ANS: B Sullivan believed that anxiety is the chief disruptive force in interpersonal relations and the main factor in the development of serious difficulty in living.

Which statement is most likely to be made by a nurse practitioner who shares the philosophy of an interpersonal theorist? A. "Let's discuss your use of defense mechanisms." B. "We need to examine how your relationships affect your ability to cope." C. "It is important that you take the medications that I have prescribed for you." D. "Your genetic background is a factor in your predisposition to mental illness."

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships.

From an interpersonal theory perspective, which intervention would a nurse use to assist a client diagnosed with major depressive disorder? A. Encourage discussion of feelings B. Offer family therapy sessions C. Discuss childhood events D. Teach alternate coping skills

ANS: B Sullivan, an interpersonal theorist, believed that individual behavior and personality development are the direct result of interpersonal relationships. Family therapy would assist the client to deal with relationships within the family system.

Which is the priority nursing intervention for a client admitted for acute alcohol intoxication? A. Darken the room to reduce stimuli in order to prevent seizures. B. Assess aggressive behaviors in order to intervene to prevent injury to self or others. C. Administer lorazepam (Ativan) to reduce the rebound effects on the central nervous system. D. Teach the negative effects of alcohol on the body.

ANS: B Symptoms associated with the syndrome of alcohol intoxication include but are not limited to aggressiveness, impaired judgment, impaired attention, and irritability. Safety is a nursing priority in this situation.

According to behavioral theory, the treatment of phobic symptoms should involve which action? A. The manipulation of the environment B. The use of desensitization C. The use of family therapy D. The uncovering of past events

ANS: B Systematic desensitization is a technique for assisting individuals to overcome their fear of a phobic stimulus. It is "systematic" in that there is a hierarchy of anxiety-producing events through which the individual progresses during therapy.

During a hiring interview, which response by a nursing applicant should indicate that the applicant operates from an ethical egoism framework? A. "I would want to be treated in a caring manner if I were mentally ill." B. "This job will pay the bills, and the workload is light enough for me." C. "I will be happy caring for the mentally ill. Working in Med/Surg kills my back." D. "It is my duty in life to be a psychiatric nurse. It is the right thing to do."

ANS: B The applicant's comment reflects an ethical egoism framework. This framework promotes the idea that decisions are made based on what is good for the individual and may not take the needs of others into account.

During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the most appropriate nursing statement to address this behavior? A. "You are very disrespectful. You need to learn to control yourself." B. "I understand that you are angry, but this behavior will not be tolerated." C. "What behaviors could you modify to improve this situation?" D. "What anti-personality-disorder medications have helped you in the past?"

ANS: B The appropriate nursing statement is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism. Antidepressants and anxiolytics are used for symptom relief; however, there are no specific medications targeted for the diagnosis of a personality disorder.

In response to a student's question regarding choosing a psychiatric specialty, a charge nurse states, "Mentally ill clients need special care. If I were in that position, I'd want a caring nurse also." From which ethical framework is the charge nurse operating? A. Kantianism B. Christian ethics C. Ethical egoism D. Utilitarianism

ANS: B The charge nurse is operating from a Christian ethics framework. The imperative demand of Christian ethics is to treat others as moral equals by permitting them to act as we do when they occupy a position similar to ours. Kantianism states that decisions should be made based on moral law and that actions are bound by a sense of moral duty. Utilitarianism holds that decisions should be made focusing on the end result being happiness. Ethical egoism promotes the idea that what is right is good for the individual.

A nursing instructor is teaching students about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which student statement indicates that learning has occurred? A. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." B. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." C. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." D. "They pay particular attention to details which can frustrate the development of relationships."

ANS: B The instructor should evaluate that learning has occurred when the student describes clients diagnosed with histrionic personality disorder as having shallow, fleeting interpersonal relationships that serve their dependency needs. Histrionic personality disorder is characterized by colorful, dramatic, and extroverted behavior. These individuals also have difficulty maintaining long-lasting relationships.

A client is brought to an emergency department after being violently raped. Which nursing action is appropriate? A. Discourage the client from discussing the event as this may lead to further emotional trauma. B. Remain nonjudgmental and actively listen to the client's description of the event. C. Meet the client's self-care needs by assisting with showering and perineal care. D. Provide cues, based on police information, to encourage further description of the event.

ANS: B The most appropriate nursing action is to remain nonjudgmental and actively listen to the client's description of the event. It is important to also communicate to the victim that he or she is safe and that it is not his or her fault. Nonjudgmental listening provides an avenue for client catharsis needed in order to begin the process of healing.

From a behavioral perspective, which nursing intervention is most appropriate when caring for a client diagnosed with borderline personality disorder? A. Seclude the client when inappropriate behaviors are exhibited. B. Contract with the client to reinforce positive behaviors with unit privileges. C. Teach the purpose of antianxiety medications to improve medication compliance. D. Encourage the client to journal feelings to improve awareness of abandonment issues.

ANS: B The most appropriate nursing intervention from a behavioral perspective is to contract with the client to reinforce positive behaviors with unit privileges. Behavioral strategies offer reinforcement for positive change.

A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effective of suicide on family dynamics. B. Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self esteem.

ANS: B The most effective way to interrupt a suicide attempt is to carefully, unobtrusively observe based on assessed data at varied intervals around the clock. If a nurse observes behavior that indicates self-harm, the nurse can intervene to stop the behavior and keep the client safe.

Which nursing behavior will enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia? A. Establishing personal contact with family members. B. Being reliable, honest, and consistent during interactions. C. Sharing limited personal information. D. Sitting close to the client to establish rapport.

ANS: B The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude when dealing with agitated behavior.

Which situation exemplifies both assault and battery? A. The nurse becomes angry, calls the client offensive names, and withholds treatment. B. The nurse threatens to "tie down" the client and then does so against the client's wishes. C. The nurse hides the client's clothes and medicates the client to prevent elopement. D. The nurse restrains the client without just cause and communicates this to family.

ANS: B The nurse in this situation has committed both assault and battery. Assault refers to an action that results in fear and apprehension that the person will be touched without consent. Battery is the touching of another person without consent.

During an admission assessment, a nurse asks a client diagnosed with schizophrenia, "Have you ever felt that certain objects or persons have control over your behavior?" The nurse is assessing for which type of thought disruption? A. Delusions of persecution B. Delusions of influence C. Delusions of reference D. Delusions of grandeur

ANS: B The nurse is assessing the client for delusions of influence when asking if the client has ever felt that objects or persons have control of the client's behavior. Delusions of control or influence are manifested when the client believes that his or her behavior is being influenced. An example would be if a client believes that a hearing aid receives transmissions that control personal thoughts and behaviors.

A client reports taking St. John's wort for depression. The client states, "I'm taking the recommended dose, but it seems like if two capsules are good, four would be better!" Which is an appropriate nursing reply? A. "Herbal medicines are more likely to cause adverse reactions than prescription medications." B. "Increasing the amount of herbal preparations can lead to overdose and toxicity." C. "The FDA does not regulate herbal remedies, therefore ingredients are often unknown." D. "Certain companies are better than others. Always buy a reputable brand."

ANS: B The nurse should advise the client that increasing the amount of herbal preparations can lead to overdose and toxicity. The use of herbal medicines such as St. John's wort should be approached with caution and responsibility. This herb is generally recognized as safe when taken at recommended dosages (900 mg/day).

A nurse evaluates a client's patient-controlled analgesia (PCA) pump and notices 100 attempts within a 30-minute period. Which is the best rationale for assessing this client for substance dependence? A. Narcotic pain medication is contraindicated for all clients with active substance-abuse problems. B. Clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. C. There is no need to assess the client for substance dependence. There is an obvious PCA malfunction. D. The client is experiencing symptoms of withdrawal and needs to be accurately assessed for lorazepam (Ativan) dosage.

ANS: B The nurse should assess the client for substance dependence because clients who are dependent on alcohol or benzodiazepines may have developed cross-tolerance to analgesics, and require increased doses to achieve effective pain control. Cross-tolerance occurs when one drug lessened the client's response to another drug.

A nurse is caring for a hospitalized client who is quarrelsome, opinionated, and has little regard for others. According to Sullivan's interpersonal theory, the nurse should associate the client's behaviors with a previous deficit in which stage of development? A. Infancy B. Childhood C. Early adolescence D. Late adolescence

ANS: B The nurse should associate the client's behavior with a deficit in the childhood stage of Sullivan's interpersonal theory. The childhood stage in Sullivan's interpersonal theory typically occurs from the ages of 18 months to 6 years of age, during which the child learns to experience a delay in personal gratification without undue anxiety.

According to Freud, which statement should a nurse associate with predominance of the superego? A. "No one is looking, so I will take three cigarettes from Mom's pack." B. "I don't ever cheat on tests. It is wrong." C. "If I skip school I will get in trouble and fail my test." D. "Dad won't miss this little bit of vodka."

ANS: B The nurse should associate the statement "I don't ever cheat on tests. It is wrong." as indicative of the predominance of the superego. Freud described the superego as the part of the personality that internalizes the values and morals set forth by primary caregivers. The superego can be referred to as the "perfection principle."

A client diagnosed with schizophrenia tells a nurse, "The 'Shopatouliens' took my shoes out of my room last night." Which is an appropriate charting entry to describe this client's statement? A. "The client is experiencing command hallucinations." B. "The client is expressing a neologism." C. "The client is experiencing a paranoid delusion." D. "The client is verbalizing a word salad."

ANS: B The nurse should describe the client's statement as experiencing a neologism. A neologism is when a client invents a new word that is meaningless to others but may have symbolic meaning to the client. Word salad refers to a group of words that are put together randomly.

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression can generate somatic symptoms that can mask actual physical disorders. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.

ANS: B The nurse should determine that a client with a diagnosis of major depressive disorder needs a full physical health assessment because depression can generate somatic symptoms that can mask actual physical disorders. Somatization is the process by which psychological needs are expressed in the form of physical symptoms.

A nurse observes a 3-year-old client willingly sharing candy with a sibling. According to Peplau, which psychological stage of development should the nurse determine that this child has completed? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: B The nurse should determine that this client has completed the "Learning to delay satisfaction" stage of development according to Peplau's interpersonal theory. This stage typically occurs in toddlerhood when one learns the satisfaction of pleasing others.

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

ANS: B The nurse should educate the family on the correlation between certain familial patterns and anorexia nervosa. Families engaging in conflict avoidance and struggling with issues of power and control may contribute to the development of this disorder.

A nurse is reviewing STAT laboratory data of a client presenting in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? A. 50 mg/dL B. 100 mg/dL C. 250 mg/dL D. 300 mg/dL

ANS: B The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL. Death has been reported at levels ranging from 400 to 700 mg/dL.

A 1-month-old infant is left alone for extended periods, has little physical stimulation, and is malnourished. Based on this infant's history, in which phase of development according to Mahler's theory, should a nurse expect to see a potential deficit? A. The symbiotic phase B. The autistic phase C. The consolidation phase D. The rapprochement phase

ANS: B The nurse should expect that a 1-month-old infant who is left alone, has little physical stimulation, and is malnourished would not meet the autistic phase of development. The autistic phase of development usually occurs from birth to 1 month, at which time the infant's focus is on basic needs and comfort.

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? A. The use of highly lethal methods to commit suicide B. The use of suicidal gestures to evoke a rescue response from others C. The use of isolation and starvation as suicidal methods D. The use of self-mutilation to decrease endorphins in the body

ANS: B The nurse should expect that a client diagnosed with borderline personality disorder might use suicidal gestures to evoke a rescue response from others. Repetitive, self-mutilative behaviors are common in clients diagnosed with borderline personality disorders. These behaviors are generated by feelings of abandonment following separation from significant others.

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

ANS: B The nurse should expect that a client diagnosed with borderline personality disorder would be most likely to be admitted to an inpatient facility for self-destructive behaviors. Clients diagnosed with this disorder often exhibit repetitive, self-mutilative behaviors. Most gestures are designed to evoke a rescue response.

A client inquires about the practice of therapeutic touch. Which nursing reply best explains the goal of this therapy? A. "The goal is to improve circulation to the body by deep, circular massage." B. "The goal is to re-pattern the body's energy field by the use of rhythmic hand motions." C. "The goal is to improve breathing by increasing oxygen to the brain and body tissues." D. "The goal is to decrease blood pressure by body toxin release."

ANS: B The nurse should explain that the goal of the practice of therapeutic touch is to re-pattern the body's energy field by the use of rhythmic hand motions. Therapeutic touch is based on the philosophy that the human body projects fields of energy that become blocked when pain or illness occurs. Therapeutic touch practitioners use this method to correct the blockages and relieve discomfort and improve health.

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results with the combination of these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."

ANS: B The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

A client has been recently admitted to an inpatient psychiatric unit. Which intervention should the nurse plan to use to reduce the client's focus on delusional thinking? A. Present evidence that supports the reality of the situation B. Focus on feelings suggested by the delusion C. Address the delusion with logical explanations D. Explore reasons why the client has the delusion

ANS: B The nurse should focus on the client's feelings rather than attempt to change the client's delusional thinking by the use of evidence or logical explanations. Delusional thinking is usually fixed, and clients will continue to have the belief in spite of obvious proof that the belief is false or irrational.

Which client should a nurse identify as a potential candidate for involuntary commitment? A. A client living under a bridge in a cardboard box B. A client threatening to commit suicide C. A client who never bathes and wears a wool hat in the summer D. A client who eats waste out of a garbage can

ANS: B The nurse should identify the client threatening to commit suicide as eligible for involuntary commitment. The suicidal client who refuses treatment is a danger to self and requires emergency treatment.

A paranoid client presents with bizarre behaviors, neologisms, and thought insertion. Which nursing action should be prioritized to maintain this client's safety? A. Assess for medication noncompliance B. Note escalating behaviors and intervene immediately C. Interpret attempts at communication D. Assess triggers for bizarre, inappropriate behaviors

ANS: B The nurse should note escalating behaviors and intervene immediately to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A client with a history of heavy alcohol use is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 24 hours. Which client symptom should the nurse immediate report to the ED physician? A. Tactile hallucinations B. Blood pressure of 180/100 mm Hg C. Mood rating of 2/10 on numeric scale D. Dehydration

ANS: B The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal and should promptly report this finding to the physician. Complications associated with alcohol withdrawal may progress to alcohol withdrawal delirium and possible seizure activity on about the second or third day following cessation of prolonged alcohol consumption.

A nurse is caring for a client who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? A. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. B. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. C. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. D. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

ANS: B The nurse should recognize that positive symptoms of schizophrenia include paranoid delusions, neologisms, and echolalia. The negative symptoms of schizophrenia include flat affect, anhedonia, and anergia. Positive symptoms reflect an excess or distortion of normal functions. Negative symptoms reflect a decrease or loss of normal functions.

An anorexic client states to a nurse, "My father has recently moved back to town." Since that time the client has experienced insomnia, nightmares, and panic attacks that occur nightly. She has never married or dated and lives alone. What should the nurse suspect? A. Possible major depressive disorder B. Possible history of childhood incest C. Possible histrionic personality disorder D. Possible history of childhood physical abuse

ANS: B The nurse should suspect that this client might have a history of childhood incest. Adult survivors of incest are at risk for developing posttraumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders.

A nursing instructor is teaching about complementary therapies. Which student statement indicates that learning has occurred? A. "Complementary therapies view all humans as being biologically similar." B. "Complementary therapies view a person as a combination of multiple, integrated elements." C. "Complementary therapies focus on primarily the structure and functions of the body." D. "Complementary therapies view disease as a deviation from a normal biological state."

ANS: B The nurse should understand that complementary therapies view a person as a combination of multiple, integrated elements. A complementary therapy is an intervention that is used in conjunction with, but is different from, traditional medicine.

A college student has quit attending classes, isolates self due to hearing voices, and yells accusations at fellow students. Based on this information, which nursing diagnosis should the nurse prioritize? A. Altered thought processes R/T hearing voices AEB increased anxiety B. Risk for other-directed violence R/T yelling accusations C. Social isolation R/T paranoia AEB absence from classes D. Risk for self-directed violence R/T depressed mood

ANS: B The nursing diagnosis that must be prioritized in this situation should be risk for other-directed violence R/T yelling accusations. Hearing voices and yelling accusations indicates a potential for violence, and this potential safety issue should be prioritized.

A client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? A. Allow the clients to apply the democratic process when developing unit rules. B. Maintain consistency of care by open communication to avoid staff manipulation. C. Allow the client spokesman to verbalize concerns during a unit staff meeting. D. Maintain unit order by the application of autocratic leadership.

ANS: B The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients diagnosed with borderline personality disorder can exhibit negative patterns of interaction such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

A bright student confides in the school nurse about conflicts related to attending college, or working to add needed financial support to the family. Which coping strategy is most appropriate for the nurse to recommend to the student at this time? A. Meditation B. Problem-solving training C. Relaxation D. Journaling

ANS: B The student must assess his situation and determine the best course of action. Problem-solving training, by providing structure and objectivity, can assist in his decision making.

Group therapy is strongly encouraged, but not mandatory, on an inpatient psychiatric unit. The unit manager's policy is that clients can make a choice about whether or not to attend group therapy. Which ethical principle does the unit manager's policy preserve? A. Justice B. Autonomy C. Veracity D. Beneficence

ANS: B The unit manager's policy regarding voluntary client participation in group therapy preserves the ethical principle of autonomy. The principle of autonomy presumes that individuals are capable of making independent decisions for themselves and that health-care workers must respect these decisions.

A client is admitted with a diagnosis of depression NOS (not otherwise specified). Which client statement would describe a somatic symptom that can occur with this diagnosis? A. "I am extremely sad, but I don't know why." B. "Sometimes I just don't want to eat because I ache all over." C. "I feel like I can't ever make the right decision." D. "I can't seem to leave the house without someone with me."

ANS: B When a client diagnosed with depression expresses physical complaints, the client is experiencing somatic symptoms. Somatic symptoms occur with depression because of a general slowdown of the entire body reflected in sluggish digestion, constipation, impotence, anorexia, difficulty falling asleep, and a wide variety of other symptoms.

The nursing staff is discussing the concept of competency. Which information about competency should a nurse recognize as true? A. Competency is determined with a client's compliance with treatment. B. Refusal of medication can initiate an incompetency hearing leading to forced medications. C. A competent client has the ability to make reasonable judgments and decisions. D. Competency is a medical determination made by the client's physician.

ANS: C A competent individual's cognition is not impaired to an extent that would interfere with decision making.

A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out senile dementia D. To rule out a personality disorder

ANS: C A mini-mental status exam should be performed to rule out senile dementia. The elderly are often misdiagnosed with senile dementia when depression is their actual diagnosis. Memory loss, confused thinking, or apathy symptomatic of dementia actually may be the result of depression.

Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? A. A physically healthy client who is dependent on meeting social needs by contact with 15 cats B. A physically healthy client who has a history of depending on intense relationships to meet basic needs C. A physically healthy client who lives with parents and relies on public transportation D. A physically healthy client who is serious, inflexible, perfectionistic, and depends on rules to provide security

ANS: C A physically healthy adult client who lives with parents and relies on public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior.

A 75-year-old client diagnosed with a long history of depression is currently on doxepin (Sinequan) 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell count

ANS: C A side effect of Sinequan is orthostatic hypotension. Dehydration due to fluid loss from a combination of diuretic medication and flu symptoms can also contribute to this problem, putting this client at risk for injury R/T orthostatic hypotension.

A newly admitted client has taken thioridazine (Mellaril) for 2 years with good symptom control. Symptoms exhibited on admission included paranoid delusions and hallucinations. The nurse should recognize which potential cause for the return of these symptoms? A. The client has developed tolerance to the antipsychotic medication. B. The client has not taken the medication with food. C. The client has not taken the medication as prescribed. D. The client has combined alcohol with the medication.

ANS: C Altered thinking can affect a client's insight into the necessity for taking antipsychotic medications consistently. When symptoms are no longer bothersome, clients may stop taking medications that cause disturbing side effects. Clients may miss the connection between taking the medications and an improved symptom profile.

A nursing student finds that she comes down with a sinus infection toward the end of every semester. When this occurs which stage of stress is the student most likely experiencing? A. Alarm reaction stage B. Stage of resistance C. Stage of exhaustion D. Fight-or-flight stage

ANS: C At the stage of exhaustion, the student's exposure to stress has been prolonged and adaptive energy has been depleted. Diseases of adaptation occur more frequently in this stage.

An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressors

ANS: B, C, D The nurse should identify drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November).

Which of the following nursing statements best explains to the client the benefits of pet therapy? (Select all that apply.) A. "Pet therapy allows the therapist to assess the client's social relationships." B. "Pet therapy decreases blood pressure." C. "Pet therapy enhances client mood." D. "Pet therapy improves sensory functioning." E. "Pet therapy mitigates the effects of loneliness."

ANS: B, C, E Pet therapy has been found to decrease blood pressure, enhance client mood, and mitigate the effects of loneliness. Evidence has shown that animals can directly influence a person's mental and physical well-being.

A client is concerned that information given to the nurse remains confidential. Which is the nurse's best response? A. "Your information is confidential. It will be kept just between you and I." B. "I will share the information with staff members only with your approval." C. "If the information impacts your care, I will need to share it with the treatment team." D. "You can make the decision whether your physician needs this information or not."

ANS: C Basic to the psychiatric client's hospitalization is his or her right to confidentiality and privacy. When admitted to an inpatient psychiatric facility, a client gives implied consent for information to be shared with health-care workers specifically involved in the client's care.

Dissociative Identity Disorder

AKA multiple personalities An extreme example of dissociative disorder

A client is admitted to the psychiatric unit with a diagnosis of major depression. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolation

ANS: A A client diagnosed with depression has difficulty concentrating and may be overwhelmed by activity overload or the expectation of independent decision making. A simple, structured daily schedule with limited choices of activities is more appropriate.

Which nursing statement reflects a common characteristic of a client diagnosed with paranoid personality disorder? A. "This client consistently criticizes care and has difficulty getting along with others." B. "This client is shy and fades into the background." C. "This client expects special treatment and setting limits will be necessary." D. "This client is expressive during group and is very pleased with self."

ANS: A A client diagnosed with paranoid personality disorder has a pervasive distrust and suspiciousness of others. Anticipating humiliation and betrayal, the paranoid individual characteristically learns to attack first.

A client diagnosed with major depressive disorder was raised in an excessively religiously based household. Which nursing intervention would be most appropriate to address this client's underlying problem? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills.

ANS: A A client raised in an excessively religiously based household maybe at risk for experiencing guilt to the point of accepting liability in situations for which one is not responsible. The client may view himself or herself as evil and deserving of punishment leading to depression. Assisting the client to bring these feelings into awareness allows the client to realistically appraise distorted responsibility and dysfunctional guilt.

A nurse should recognize which intervention as most appropriate within a behavioral therapy program? A. A child is given a Popsicle for staying dry and clean. B. A child is put in time-out after soiling his or her undergarments. C. A child is allowed to remain in soiled undergarments. D. A child is taught the advantages of staying dry and clean.

ANS: A A stimuli that follows a behavior or response is called a reinforcing stimulus or reinforcer. The reward of a Popsicle is a reinforcer for the child staying dry and clean. This is an example of operant conditioning, a form of behavioral therapy.

A nurse reviews the laboratory data of a client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

ANS: A According to the DSM-IV-TR, symptoms of major depressive disorder cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the client's laboratory results indicate a high TSH level which results from a low thyroid function or hypothyroidism. In hypothyroidism, metabolic processes are slowed leading to depressive symptoms.

An advanced practice nurse is counseling a client diagnosed with generalized anxiety disorder. The nurse plans to use activity scheduling to address this client's concerns. What is the purpose of this nursing intervention? A. To identify important areas needing concentration during therapy B. To increase self-esteem and decrease feelings of helplessness C. To modify maladaptive behaviors by the use of role-play D. To divert away from intrusive thoughts and depressive ruminations

ANS: A Activity scheduling is used to identify recurring daily patterns that may need to be addressed in therapy.

A nursing instructor is teaching about dichotomous thinking. Which student statement indicates that learning has occurred? A. "Dichotomous thinking is when an individual views situations as being 'good or bad' or 'black or white.'" B. "Dichotomous thinking is when an individual takes complete responsibility for situations without considering other circumstances." C. "Dichotomous thinking is when an individual exaggerates the negative significance of an event." D. "Dichotomous thinking is when an individual undervalues the positive significance of an event."

ANS: A An individual who is using dichotomous thinking views situations in terms of "all or nothing," "good or bad," or "black or white."

What is the legal significance of a nurse's action when the nurse threatens a demanding client with restraints? A. The nurse can be charged with assault. B. The nurse can be charged with negligence. C. The nurse can be charged with malpractice. D. The nurse can be charged with beneficence.

ANS: A Assault is an act that results in a person's genuine fear and apprehension that he or she will be touched without consent.

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

ANS: A Because the client, due to a lack of guilt, cannot or will not impose personal limits on maladaptive behaviors, these limits must be delineated and enforced by staff.

Using a cognitive approach, which is an effective nursing intervention for assisting clients to manage their anger without the use of violence? A. Assist the client to identify thoughts that trigger anger and substitute reality-based thinking. B. Provide consequences, such as removal from group therapy, in response to angry outbursts. C. Administer antipsychotic medications and use limit-setting such as a room restriction. D. Administer anti-anxiety medication and encourage participation in a group on medication actions.

ANS: A By assisting the client to identify thoughts that trigger anger and encourage the substitution of more reality-based thinking, the nurse can help the client to alter dysfunctional beliefs that predispose the client to distort experiences.

A client is questioning the nurse about a newly prescribed medication, acamprosate calcium (Campral). Which is the most appropriate reply by the nurse? A. "This medication will help you maintain your abstinence." B. "This medication will cause uncomfortable symptoms if you combine it with alcohol." C. "This medication will decrease the effect alcohol has on your body." D. "This medication will lower your risk of experiencing a complicated withdrawal."

ANS: A Campral has been approved by the U.S. Food and Drug Administration (FDA) for the maintenance of abstinence from alcohol in clients diagnosed with alcohol dependence who are abstinent at treatment initiation.

Which characteristics should a nurse recognize as being exhibited by individuals diagnosed with any personality disorders? A. These clients accept and are comfortable with their altered behaviors. B. These clients understand that their altered behaviors result from anxiety. C. These clients seek treatment to avoid interpersonal discomfort. D. These clients avoid relationships due to past negative experiences.

ANS: A Clients who are diagnosed with personality disorders accept and are comfortable with their altered behaviors. Personalities that develop in a disordered pattern remain somewhat unstable and unpredictable throughout the lifetime.

Which client statement would exemplify the cognitive changes that you would expect to see in mild anxiety? A. "Right now I feel as sharp as a tack." B. "I'm having a tough time focusing." C. "Sometimes I feel like I'm having an out-of-body experience." D. "All I seem to focus on is my anger."

ANS: A Cognitive ability will be enhanced with mild anxiety. Mild anxiety prepares the individual for heightened responses to environmental stimuli.

A nurse working for a large corporation is teaching relaxation therapy to employees. Which relaxation technique should the nurse initially teach? A. Deep-breathing exercises B. Mental imagery C. Biofeedback D. Meditation

ANS: A Deep breathing is a simple skill and is basic to other relaxation techniques and therefore should be taught first.

Which is a nursing intervention to assist a client to achieve Erikson's developmental task of ego integrity? A. Encourage a life review of triumphs and disappointments B. Provide opportunities for success experiences C. Focus on embracing the future D. Foster the development of creativity

ANS: A Erikson believed that between the age of 65 years and death, the goal is to review one's life and derive meaning from both positive and negative events, while achieving a positive sense of self.

When an individual's stress response is sustained over a long period of time, which physiological effect of the endocrine system should a nurse anticipate? A. Decreased resistance to disease B. Increased libido C. Decreased blood pressure D. Increased inflammatory response

ANS: A In a general adaptation syndrome, prolonged exposure to stress leads to the stage of exhaustion, at which time diseases of adaptation occur. A decreased immune response is seen at this stage.

A third-grader feigns illness in order to avoid doing homework. The teacher recommends an educational program that uses a token economy. How should a school nurse explain a token economy to this child's parent? A. "Your child will receive green tokens for completing homework that can be cashed in for desired rewards." B. "Your child will receive red tokens when homework is incomplete and this will result in school suspension." C. "Your child will receive a time out for each homework assignment not completed." D. "Your child, with your assistance, will envision receiving rewards for completed homework."

ANS: A In a token economy, tokens are a form of contingency contracting in that tokens immediately reinforce appropriate behavior (completed homework) and are exchanged later for a desired reward.

A mother states, "You are old enough to clean your own bedroom." Later inspection finds the floor clear, but with everything stacked in a chair. The mother praises the child for clearing the floor. This is consistent with which technique of behavior modification? A. Shaping B. Extinction C. Stimulus generalization D. Reciprocal inhibition

ANS: A In shaping, behavior is molded in a desired direction by reinforcing each small step toward the desired behavior. The child is praised for clearing the floor, the first step toward cleaning the room.

Which action should a nurse take prior to educating clients about relaxation techniques? A. Assisting the client in identifying triggers or sources of stress B. Performing a physical examination to qualify the client as a candidate for this therapy C. Obtaining an order from the physician D. Educating the client's family so they can be active participants in the therapy

ANS: A Initially helping clients to identify triggers and sources of stress will enable the client to anticipate the need for implementing relaxation techniques at appropriate times.

A client diagnosed with schizophrenia receives fluphenazine decanoate (Prolixin Decanoate) from a home health nurse. The client refuses medication at one regularly scheduled home visit. Which nursing intervention is ethically appropriate? A. Allow the client to decline the medication and document. B. Tell the client that if the medication is refused, hospitalization will occur. C. Arrange with a relative to add medication to the client's morning orange juice. D. Call for help to hold the client down while the injection is administered.

ANS: A It is ethically appropriate for the nurse to allow the client to decline the medication and provide accurate documentation. The client's right to refuse treatment should be upheld unless the refusal puts the client or others in harm's way.

Meditation has been shown to be an effective stress management technique. When meditation is effective, what should a nurse expect to assess? A. An achieved state of relaxation B. An achieved insight into one's feelings C. A demonstration of appropriate role behaviors D. An enhanced ability to problem solve

ANS: A Meditation produces relaxation by creating a special state of consciousness through focused concentration.

A successful business executive continually thinks that job accomplishments are not adequate. A nurse recognizes that the client's thinking is reflective of which cognitive error? A. Minimization B. Dichotomous thinking C. Arbitrary inference D. Personalization

ANS: A Minimization is the cognitive error that undervalues positive events and experiences. The client cannot give credit for personal strengths.

An inpatient client, whom the treatment team has determined to be a danger to self, gives notice of intention to leave the hospital. What information should the nurse recognize as having an impact on the treatment team's next action? A. State law determines how long a psychiatric facility can hold a client. B. Federal law determines if the client is competent. C. The client's family involvement will determine if discharge is possible. D. Hospital policies will determine treatment team actions.

ANS: A Most states commonly cite that in an emergency a client who is dangerous to self or others may be involuntarily hospitalized.

According to Peplau, treatment of client symptoms should involve which nursing action? A. Establishing a therapeutic nurse-client relationship B. Using the technique of desensitization C. Challenging clients' negative thoughts D. Uncovering clients' past experiences

ANS: A Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development.

A client diagnosed with major depressive disorder refuses to get out of bed. Which nursing statement appropriately educates the client about the benefits of physical activity? A. "Depression is caused by the lack of certain brain chemicals that can increase with exercise." B. "Physical activity is good for everyone regardless of their diagnosis." C. "Low-intensity exercise is more beneficial than high-impact exercise." D. "When you are physically active, it helps to lower your beta endorphins."

ANS: A Physical activity can stimulate the secretion of norepinephrine and serotonin. Depression has been linked to low levels of these neurotransmitters.

Which client statement should alert a nurse that a client may be responding maladaptively to stress? A. "I've found that avoiding contact with others helps me cope." B. "I really enjoy journaling; it's my private time." C. "I signed up for a yoga class this week." D. "I made an appointment to meet with a therapist."

ANS: A Reliance on social isolation as a coping mechanism is a maladaptive method to relieve stress. It can prevent learning appropriate coping skills and can prevent access to needed support systems.

A nursing instructor is teaching about the correlation between pathological gambling and abnormalities in the neurotransmitter system. What statement by the nursing student indicates that learning has occurred? A. "Pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine." B. "Pathological gamblers present with increased serotonin, increased norepinephrine, and increased dopamine." C. "Pathological gamblers present with decreased serotonin, decreased norepinephrine, and decreased dopamine." D. "Pathological gamblers present with increased serotonin, decreased norepinephrine, and decreased dopamine."

ANS: A Serotonergic function is linked to behavioral initiation, inhibition, and aggression. Noradrenergic function mediates arousal and detects novel and aversive stimuli. Dopaminergic function is associated with reward and reinforcement mechanisms. Thus, pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine.

A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions

ANS: A Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the client's laundry and managing finances, the mother is fostering the client's dependence.

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

ANS: A The ability to identify alternative methods of dealing with isolation will provide the client with effective coping strategies to use instead of bingeing and purging.

Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? A. Being firm, consistent, and empathic, while addressing specific client behaviors B. Promoting client self-expression by implementing laissez-faire leadership C. Using authoritative leadership to help clients learn to conform to society norms D. Overlooking inappropriate behaviors to avoid promoting secondary gains

ANS: A The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals diagnosed with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction such as manipulation and splitting.

A college student was sexually assaulted when out on a date. After several weeks of crisis intervention therapy, which client statement should indicate to a nurse that the student is handling this situation in a healthy manner? A. "I know that it was not my fault." B. "My boyfriend has trouble controlling his sexual urges." C. "If I don't put myself in a dating situation, I won't be at risk." D. "Next time I will think twice about wearing a sexy dress."

ANS: A The client who realizes that sexual assault was not her fault is handling the situation in a healthy manner. The nurse should provide nonjudgmental listening and communicate statements that instill trust and validate self-worth.

After suffering a myocardial infarction, a 37-year-old executive demands premature discharge from the hospital. He tells the nurse, "Just give me my prescriptions and let me get back to work." Which is the most appropriate nursing reply? A. "To ensure improved health, we need to discuss diet, medication, exercise, and lifestyle changes before you are discharged." B. "You will not be allowed to leave the hospital without getting your physician's approval for early discharge." C. "We will discharge you quickly so that the stress you are experiencing will not cause more serious heart damage." D. "Prior to discharge, we will need to discuss job stress, your finances, and the possibility of an early retirement."

ANS: A The client's statements reflect a great deal of stress that can contribute to further cardiovascular disease. Helping him to look at a variety of measures to improve his health would be most beneficial.

Without authorization, a nurse administers an extra dose of narcotic tranquilizer to an agitated client. The nurse's coworker observes this action but does nothing for fear of repercussion. What is the ethical interpretation of the coworker's lack of involvement? A. Taking no action is still considered an unethical action by the coworker. B. Taking no action releases the coworker from ethical responsibility. C. Taking no action is advised when potential adverse consequences are foreseen. D. Taking no action is acceptable because the coworker is only a bystander.

ANS: A The coworker's lack of involvement can be interpreted as an unethical action. The coworker is experiencing an ethical dilemma in which a decision needs to be made between two unfavorable alternatives. The coworker has a responsibility to report any observed unethical actions.

Which statement describes achievement of Erikson's generativity versus stagnation developmental stage? A. "I've been a girl scout leader for troop 259 for 7 years." B. "I feel great that I could pay for my bike with my paper route money." C. "My parents are so pleased that John and I are going to be married." D. "I've had a very full life. I'm not afraid to leave this world."

ANS: A The major task of generativity versus stagnation is to achieve the life goals established for oneself while also considering the welfare of future generations.

A psychiatric nurse working on an inpatient unit receives a call asking if an individual has been a client in the facility. Which nursing response reflects appropriate legal and ethical obligations? A. Refusing to give any information to the caller, citing rules of confidentiality B. Refusing to give any information to the caller by hanging up C. Affirming that the person has been seen at the facility but providing no further information D. Suggesting that the caller speak to the client's therapist

ANS: A The most appropriate action by the nurse is to refuse to give any information to the caller. Admission to the facility would be considered protected health information (PHI) and should not be disclosed by the nurse without prior client consent.

A client diagnosed with chronic alcohol dependency is being discharged from an inpatient treatment facility after detoxification. Which client outcome related to Alcoholics Anonymous (AA) would be most appropriate for a nurse to discuss with the client during discharge teaching? A. After discharge, the client will immediately attend 90 AA meetings in 90 days. B. After discharge, the client will rely on an AA sponsor to help control alcohol cravings. C. After discharge, the client will incorporate family in AA attendance. D. After discharge, the client will seek appropriate deterrent medications through AA.

ANS: A The most appropriate client outcome for the nurse to discuss during discharge teaching is attending 90 AA meetings in 90 days after discharge. AA is a major self-help organization for the treatment of alcoholism. It accepts alcoholism as an illness and promotes total abstinence as the only cure.

A client diagnosed with chronic migraine headaches is considering acupuncture. The client asks a clinic nurse, "How does this treatment work?" Which is the best response by the nurse? A. "Western medicine believes that acupuncture stimulates the body's release of pain-fighting chemicals called endorphins." B. "I'm not sure why he suggested acupuncture. There are a lot of risks, including HIV." C. "Acupuncture works by encouraging the body to increase its development of serotonin and norepinephrine." D. "Your acupuncturist is your best resource for answering your specific questions."

ANS: A The most appropriate response by the nurse is to educate the client on the medical philosophy that acupuncture stimulates the body's release of endorphins. Acupuncture has been found to be effective in the treatment of asthma, insomnia, anxiety, depression, and many other conditions.

Which statement made by an emergency department nurse indicates accurate knowledge of domestic violence? A. "Power and control are central to the dynamic of domestic violence." B. "Poor communication and social isolation are central to the dynamic of domestic violence." C. "Erratic relationships and vulnerability are central to the dynamic of domestic violence." D. "Emotional injury and learned helplessness are central to the dynamic of domestic violence."

ANS: A The nurse accurately states that power and control are central to the dynamic of domestic violence. Battering is defined as a pattern of coercive control founded on physical and/or sexual violence or threat of violence. The typical abuser is very possessive and perceives the victim as a possession.

A nursing student having no knowledge of alternative treatments states, "Aren't these therapies 'bogus' and, like a fad, will eventually fade away?" Which is an accurate nursing reply? A. "Like nursing, complementary therapies take a holistic approach to healing." B. "The American Nurses Association is researching the effectiveness of these therapies." C. "It is important to remain nonjudgmental about these therapies." D. "Alternative therapy concepts are rooted in psychoanalysis."

ANS: A The nurse is accurate when comparing complementary therapies to the holistic approach of nursing. Both complementary therapists and nurses view the person as consisting of multiple, integrated elements. Diagnostic measures are not based on one aspect but include a holistic assessment of the person.

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

ANS: A The nurse recognizes that dental deterioration has resulted from the acidic emesis produced during purging that corrodes the tooth enamel. Excessive vomiting may also lead to dehydration and electrolyte imbalance.

A client has been taking 1,200 mg/day of St. John's wort during the past year for symptoms of depression. Recently, the client complains of side effects from this herbal remedy. What symptom should the nurse expect the client to report? A. Photosensitivity B. Insomnia C. Hirsutism D. Restlessness

ANS: A The nurse should anticipate that photosensitivity will occur when St. John's wort is taken in high doses. The recommended effective dose of St. John's wort is 900 mg/day. This herbal remedy should not be taken in conjunction with other psychoactive medications.

Which underlying concept should a nurse associate with interpersonal theory when assessing clients? A. The effects of social processes on personality development B. The effects of unconscious processes and personality structures C. The effects on thoughts and perceptual processes D. The effects of chemical and genetic influences

ANS: A The nurse should associate interpersonal theory with the underlying concept of effects of social process on personality development. Sullivan developed stages of personality development based on his theory of interpersonal relationships and their effect on personality and individual behavior.

A kindergarten student is frequently violent toward other children. A school nurse notices bruises and burns on the child's face and arms. What other symptom should indicate to the nurse that the child might have been physically abused? A. The child shrinks at the approach of adults. B. The child begs or steals food or money. C. The child is frequently absent from school. D. The child is delayed in physical and emotional development.

ANS: A The nurse should determine that a child who shrinks at the approach of adults in addition to having bruises and burns might be a victim of abuse. Whether or not the adult intended to harm the child, maltreatment should be considered.

Family members of a client ask a nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing reply? A. "Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone." B. "Clients diagnosed with schizoid personality disorder exhibit odd, bizarre, and eccentric behavior, while clients diagnosed with avoidant personality disorder do not." C. "Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant." D. "Clients diagnosed with schizoid personality disorder have a history of psychotic thought processes, while clients diagnosed with avoidant personality disorder remain based in reality."

ANS: A The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone. Avoidant personality disorder is characterized by an extreme sensitivity to rejection which leads to social isolation. Schizoid personality disorder is characterized by a profound deficit in the ability to form personal relationships.

If clozapine (Clozaril) therapy is being considered, the nurse should evaluate which laboratory test to establish a baseline for comparison in order to recognize a potentially life-threatening side effect? A. White blood cell count B. Liver function studies C. Creatinine clearance D. Blood urea nitrogen

ANS: A The nurse should establish a baseline white blood cell count to evaluate a potentially life-threatening side effect if clozapine (Clozaril) is being considering as a treatment option. Clozapine can have a serious side effect of agranulocytosis in which a potentially fatal drop in white blood cells can occur.

After taking chlorpromazine (Thorazine) for 1 month, a client presents to an emergency department (ED) with severe muscle rigidity, tachycardia, and a temperature of 105oF (40.5C). The nurse expects the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing Thorazine and administering dantrolene (Dantrium) B. Neuroleptic malignant syndrome and treat by increasing Thorazine dosage and administering an antianxiety medication C. Dystonia and treat by administering trihexyphenidyl (Artane) D. Dystonia and treat by administering bromocriptine (Parlodel)

ANS: A The nurse should expect that an ED physician would diagnose the client with neuroleptic malignant syndrome and treat the client by discontinuing chlorpromazine (Thorazine) and administering dantrolene (Dantrium). Neuroleptic malignant syndrome is a potentially fatal condition characterized by muscle rigidity, fever, altered consciousness, and autonomic instability. The use of typical antipsychotics is largely being replaced by atypical antipsychotics due to fewer side effects and lower risks.

A client has a history of daily bourbon drinking for the past 6 months. He is brought to an emergency department by family who report that his last drink was 1 hour ago. It is now 12 midnight. When should a nurse expect this client to exhibit withdrawal symptoms? A. Between 3 a.m. and 11 a.m. B. Shortly after a 24-hour period C. At the beginning of the third day D. Withdrawal is individualized and cannot be predicted.

ANS: A The nurse should expect that this client will begin experiencing withdrawal symptoms from alcohol between 3 a.m. and 11 a.m. Symptoms of alcohol withdrawal usually occur within 4 to 12 hours of cessation or reduction in heavy and prolonged alcohol use.

A 16-year-old-client diagnosed with paranoid schizophrenia experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which is the appropriate nursing reply? A. "Your child has a chemical imbalance of the brain which leads to altered thoughts." B. "Your child's hallucinations are caused by medication interactions." C. "Your child has too little serotonin in the brain causing delusions and hallucinations." D. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

ANS: A The nurse should explain that a chemical imbalance of the brain leads to altered thought processes. Hallucinations, or false sensory perceptions, may occur in all five senses. The client who hears voices is experiencing an auditory hallucination.

A female complains that her husband only meets his sexual needs and never her needs. According to Freud, which personality structure should a nurse identify as predominantly driving the husband's actions? A. The id B. The superid C. The ego D. The superego

ANS: A The nurse should identify that the husband's actions are driven by the predominance of the id. According to Freud, the id is the part of the personality that is identified as the pleasure principle. The id is the locus of instinctual drives.

A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

ANS: A The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

A client diagnosed with schizophrenia is prescribed clozapine (Clozaril). Which client symptoms related to the side effects of this medication should prompt a nurse to intervene immediately? A. Sore throat, fever, and malaise B. Akathisia and hypersalivation C. Akinesia and insomnia D. Dry mouth and urinary retention

ANS: A The nurse should intervene immediately if the client experiences a sore throat, fever, and malaise when taking the atypical antipsychotic drug clozapine (Clozaril). Clozapine can have a serious side effect of agranulocytosis, in which a potentially fatal drop in white blood cells can occur. Symptoms of infectious processes would alert the nurse to this potential.

A client requests information on several medications in order to make an informed choice about management of depression. A nurse should provide this information to facilitate which ethical principle? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice

ANS: A The nurse should provide the information to support the client's autonomy. A client who is capable of making independent choices should be permitted to do so. In instances when clients are incapable of making informed decisions, a legal guardian or representative would be asked to give consent.

A 10-year-old child wins the science fair competition and is chosen as a cheerleader for the basketball team. A nurse should recognize that this child is in the process of successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: A The nurse should recognize that a 10-year-old child who is successful in school both academically and socially has successfully accomplished the industry versus inferiority developmental stage of Erikson's psychosocial theory. The industry versus inferiority stage of development usually occurs between 6 to 12 years of age, at which time individuals achieve a sense of self-confidence by learning, competing, performing successfully, and receiving recognition from others.

Which assessment data should a school nurse recognize as signs of physical neglect? A. The child is often absent from school and seems apathetic and tired. B. The child is very insecure and has poor self-esteem. C. The child has multiple bruises on various body parts. D. The child has sophisticated knowledge of sexual behaviors.

ANS: A The nurse should recognize that a child who is often absent from school and seems apathetic and tired might be a victim of neglect. Other indicators of neglect are stealing food or money, lacking medical or dental care, being consistently dirty, lacking sufficient clothing, or stating that there is no one home to provide care.

Which statement should indicate to a nurse that an individual is experiencing a delusion? A. "There's an alien growing in my liver." B. "I see my dead husband everywhere I go." C. "The IRS may audit my taxes." D. "I'm not going to eat my food. It smells like brimstone."

ANS: A The nurse should recognize that a client who claims that an alien is inside his or her body is experiencing a delusion. Delusions are false personal beliefs that are inconsistent with the person's intelligence or cultural background.

A client is exhibiting short-term memory loss and has a slow capillary refill. Which herbal remedy would address this client's symptoms? A. Ginkgo B. Fennel C. Passion flower D. Black cohosh

ANS: A The nurse should recognize that ginkgo would address the client's symptoms of short-term memory loss and slow capillary refill. Ginkgo (Ginkgo biloba) has been used to treat senility, short-term memory loss, and peripheral insufficiency. It has been shown to dilate blood vessels as well.

A client diagnosed with depression and substance abuse has an altered sleep pattern and demands that a psychiatrist prescribe a sedative. Which rationale explains why a nurse should encourage the client to first try nonpharmacological interventions? A. Sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. B. Sedative-hypnotics are expensive and have numerous side effects. C. Sedative-hypnotics interfere with necessary REM (rapid eye movement) sleep. D. Sedative-hypnotics are not as effective to promote sleep as antidepressant medications.

ANS: A The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive and will lose their effectiveness due to tolerance. The effects of central nervous system depressants are additive with one another and are capable of producing physiological and psychological dependence.

A lonely, depressed divorcée has been self-medicating with cocaine for the past year. Which term should a nurse use to best describe this individual's situation? A. The individual is experiencing psychological dependency. B. The individual is experiencing physical dependency. C. The individual is experiencing substance dependency. D. The individual is experiencing social dependency.

ANS: A The nurse should use the term "psychological dependency" to best describe this client's situation. A client is considered to be psychologically dependent on a substance when there is an overwhelming desire to use a substance in order to produce pleasure or avoid discomfort.

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

ANS: A The nursing student statement that clients diagnosed with anorexia nervosa experience nutritional deficits, whereas clients diagnosed with bulimia nervosa do not, indicates that learning has occurred. Anorexia is characterized by low caloric and nutritional intake. Bulimia is characterized by episodic, rapid indigestion of large quantities of food followed by purging.

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

ANS: A The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T suspicious thoughts. Clients diagnosed with paranoid personality disorder have a pervasive distrust and suspiciousness of others that may result in hostile actions to protect self. They are often tense and irritable, which increases the likelihood of violent behavior.

What should be the priority nursing diagnosis for a client experiencing alcohol withdrawal? A. Risk for injury R/T central nervous system stimulation B. Disturbed thought processes R/T tactile hallucinations C. Ineffective coping R/T powerlessness over alcohol use D. Ineffective denial R/T continued alcohol use despite negative consequences

ANS: A The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: course tremors of hands, tongue, or eyelids; seizures; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

A high school basketball player sustains a serious knee injury and states to the school nurse, "I will never get to college if I don't receive a basketball scholarship." Which nursing reply would assist the student to see a broader range of possibilities? A. "Let's look at the alternatives for funding your college education." B. "I know you are feeling helpless now, but you are looking at this from only one perspective." C. "Can your family afford knee surgery?" D. "You now need to prioritize your academics and not focus on basketball."

ANS: A When the nurse helps the student to see a broader range of possibilities, the nurse is using the cognitive technique of generating alternatives

A nursing student evaluates her group project partner as irresponsible because of minimal participation in planning. When told of this situation, the nursing instructor plans to use the cognitive technique of "examining the evidence." Which response exemplifies this technique? A. "Let's look at the potential reasons why your partner has not participated." B. "How would you define irresponsibility?" C. "Has it occurred to you that your partner may be working on the project at home?" D. "Are you telling me that you feel totally responsible for this project?"

ANS: A When using the technique of examining the evidence, the student and nurse review automatic thoughts and study the evidence to support or counter the belief.

A client is admitted for alcohol detoxification. During detoxification, which symptoms should the nurse expect to assess? A. Gross tremors, delirium, hyperactivity, and hypertension B. Disorientation, peripheral neuropathy, and hypotension C. Oculogyric crisis, amnesia, ataxia, and hypertension D. Hallucinations, fine tremors, confabulation, and orthostatic hypotension

ANS: A Withdrawal is defined as the physiological and mental readjustment that accompanies the discontinuation of an addictive substance. Symptoms can include gross tremors, delirium, hyperactivity, hypertension, nausea, vomiting, tachycardia, hallucinations, and seizures.

Which of the following nursing diagnoses could be appropriate for an adult survivor of incest? (Select all that apply.) A. Low self-esteem B. Powerlessness C. Disturbed personal identity D. Knowledge deficit E. Noncompliance

ANS: A, B An adult survivor of incest would most likely have low self-esteem and a sense of powerlessness. Adult survivors of incest are at risk for developing post-traumatic stress disorder, sexual dysfunction, somatization disorders, compulsive sexual behavior disorders, depression, anxiety, eating disorders, and substance abuse disorders. Disturbed personal identity refers to an inability to distinguish between self and nonself and is seen in disorders such as autistic disorders, borderline personality disorders, dissociative disorders, and gender identity disorders.

A nurse should identify topiramate (Topamax) as the drug of choice for which of the following conditions? (Select all that apply.) A. Binge eating with obesity B. Bingeing and purging with a diagnosis of bulimia nervosa C. Weight loss with a diagnosis of anorexia nervosa D. Amenorrhea with a diagnosis of anorexia nervosa E. Emaciation with a diagnosis of bulimia nervosa

ANS: A, B The nurse should identify that topiramate (Topamax) is the drug of choice when treating binge eating with obesity and bingeing and purging with a diagnosis of bulimia nervosa. Topiramate (Topamax) is a novel anticonvulsant used in the long-term treatment of binge-eating disorder with obesity. The use of Topamax results in a significant decline in mean weekly binge frequency and significant reduction in body weight. With the use of this medication, episodes of bingeing and purging were decreased in clients diagnosed with bulimia nervosa.

A nursing instructor is lecturing about cognitive therapy. Which of the following are objectives when implementing this therapy? (Select all that apply.) A. To modify automatic thoughts to promote minimization of negative cognitions B. To apply a variety of methods to create change in an individual's thinking C. To apply cognitive principles in order to change an individual's basic schema D. To modify belief systems in an effort to bring about emotional change E. To modify belief systems in an effort to bring about behavioral change

ANS: B, D, E In cognitive therapy, the therapist's objective is to use a variety of methods to create change in a client's thinking and belief system in an effort to bring about lasting emotional and behavioral change.

A 2-year-old engages in frequent temper tantrums that usually result in the parents giving in to demands. During family therapy, how should a nurse counsel the parents? A. "You are shaping your child's behavior." B. "Your child has modeled your behavior." C. "You are positively reinforcing your child's behavior." D. "You are negatively reinforcing your child's behavior."

ANS: C

A nurse practitioner uses cognitive therapy with depressed clients. The nurse asks clients to keep a daily record of dysfunctional thoughts. Which of the following are appropriate nursing replies to a client questioning the purpose of this exercise? (Select all that apply.) A. "The purpose of this exercise is to identify automatic thoughts." B. "The purpose of this exercise is to identify rational alternatives." C. "The purpose of this exercise is to modify cognitive errors." D. "The purpose of this exercise is to eliminate irrational beliefs." E. "The purpose of this exercise is to monitor thoughts related to self-esteem."

ANS: A, B, C In a daily record of dysfunctional thoughts, clients (1) identify automatic thoughts and (2) generate a more rational response. In this way, the tool serves to help them (3) modify or make changes in their thinking. A daily record of dysfunctional thoughts does not eliminate the occurrence of irrational beliefs or monitor thoughts solely related to self-esteem.

Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) A. The client will relate one empathetic statement toward another client in group by day 2. B. The client will identify one personal limitation by day 1. C. The client will acknowledge one strength that another client possesses by day 2. D. The client will list four personal strengths by day 3. E. The client will list two lifetime achievements by discharge.

ANS: A, B, C The nurse should determine that appropriate outcomes for a client diagnosed with narcissistic personality disorder include relating empathetic statements to other clients, identifying one personal limitation, and acknowledging one strength in another client. An exaggerated sense of self-worth, a lack of empathy, and exploitation of others are characteristics of narcissistic personality disorder.

Laboratory results reveal decreased levels of prolactin in a client diagnosed with schizophrenia. When assessing the client, which symptoms should a nurse expect to observe?(Select all that apply.) A. Apathy B. Social withdrawal C. Anhedonia D. Auditory hallucinations E. Delusions

ANS: A, B, C The nurse should expect that a client with decreased levels of prolactin would experience apathy, social withdrawal, and anhedonia. Decreased levels of prolactin can cause depression which would result in the above symptoms.

A client who prefers to use St. John's wort and psychotherapy in lieu of antidepressant therapy asks for tips on using herbal remedies. Which teaching points should a nurse provide? (Select all that apply.) A. Select a reputable brand. B. Increasing dosage does not lead to improved effectiveness. C. Monitor for adverse reactions. D. Gradually increase dosage to gain maximum effect. E. Most herbal remedies are best absorbed on an empty stomach.

ANS: A, B, C When educating a client on the use of herbal remedies, the nurse should advise the client to select a reputable brand. The nurse should also advise the client to monitor for adverse reactions and to take the recommended dose, as increasing the dose does not lead to improved effectiveness. Herbal remedies are classified as dietary supplements by the U.S. Food and Drug Administration (FDA). Many herbal remedies lack uniform standards of quality control.

A nurse is working with a client who has recently been under a great deal of stress. Which nursing recommendations would be most helpful when assisting the client in coping with stress? (Select all that apply.) A. "Enjoy a pet." B. "Spend time with a loved one." C. "Listen to music." D. "Focus on the stressors." E. "Journal your feelings."

ANS: A, B, C, E Focusing on the stressors is more likely to increase stress in the client's life. However, pets, healthy relationships, music, and, journaling feelings, and have all been shown to decrease amounts of stress.

A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I'll be sure not to stop this medication abruptly."

ANS: A, B, C, E The nurse should evaluate that teaching has been successful when the client states that phenelzine (Nardil) should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is a monoamine oxidase inhibitor (MAOI) that can have negative interactions with other medications. The client needs to tell other physicians about taking MAOIs due to the risk of drug interactions.

Which of the following nursing statements exemplify the cognitive process that must be completed by a nurse prior to caring for clients diagnosed with substance-abuse disorders? (Select all that apply.) A. "I am easily manipulated and need to work on this prior to caring for these clients." B. "Because of my father's alcoholism, I need to examine my attitude toward these clients." C. "I need to review the side effects of the medications used in the withdrawal process." D. "I'll need to set boundaries to maintain a therapeutic relationship." E. "I need to take charge when dealing with clients diagnosed with substance disorders."

ANS: A, B, D The nurse should examine personal bias and preconceived negative attitudes prior to caring for clients diagnosed with substance-abuse disorders. A deficit in this area may affect the nurse's ability to establish therapeutic relationships with these clients.

Which concepts should a nurse identify as being included in the DSM-IV-TR definition of personality? (Select all that apply.) A. Personality is an enduring pattern of perceiving. B. Personality is influenced by relationships between the environment and self. C. Personality is developed in sporadic stages that vary from person to person. D. Personality is influenced by a wide range of social and personal contexts. E. Personality is inborn and cannot be influenced by developmental progression.

ANS: A, B, D The nurse should identify that the following concepts are included in the DSM-IV-TR definition of personality: Personality is an enduring pattern of perceiving, a wide range of social and personal contexts influences it, and it is inborn. Personality disorders are coded on Axis II of the DSM-IV-TR multiaxial diagnosis and include disorders organized into three clusters: odd and eccentric disorders (cluster A); dramatic, emotional, or erratic disorders (cluster B); and anxious or fearful disorders (cluster C).

When planning care for women in abusive relationships, which of the following information is important for the nurse to consider? (Select all that apply.) A. It often takes several attempts before a woman leaves an abusive situation. B. Substance abuse is a common factor in abusive relationships. C. Until children reach school age, they are usually not affected by parental discord. D. Women in abusive relationships usually feel isolated and unsupported. E. Economic factors rarely play a role in the decision to stay in abusive relationships.

ANS: A, B, D When planning care for women who have been victims of domestic abuse, the nurse should be aware that it often takes several attempts before a woman leaves an abusive situation, that substance abuse is a common factor in abusive relationships, and that women in abusive relationships usually feel isolated and unsupported. Children can be affected by domestic violence from infancy, and economic factors often play a role in the victim's decision to stay.

A nurse is teaching principles of mental imagery to a group. On which relaxing environments should the nurse appropriately recommend client focus? (Select all that apply.) A. Visualizing the seashore B. Visualizing a snowy cabin C. Driving home from the beach on Sunday evening D. Floating through the air on a cloud E. Lying at home in front of the fireplace

ANS: A, B, D, E Any environment that the client finds relaxing is appropriate. It is unlikely that a client would consider driving home from the beach on Sunday evening to be a relaxing environment.

Which of the following components should a nurse recognize as an integral part of a rehabilitative program when planning care for clients diagnosed with schizophrenia? (Select all that apply.) A. Group therapy B. Medication management C. Deterrent therapy D. Supportive family therapy E. Social skills training

ANS: A, B, D, E The nurse should recognize that group therapy, medication management, supportive family therapy, and social skills training all play an integral part in rehabilitative programs for clients diagnosed with schizophrenia. Schizophrenia results from various combinations of genetic predispositions, biochemical dysfunctions, physiological factors, and psychological stress. Effective treatment requires a comprehensive, multidisciplinary effort.

A nurse is interviewing a distressed client who relates being fired after 15 years of loyal employment. Which of the following questions would best assist the nurse to determine the client's appraisal of the situation? (Select all that apply.) A. "What resources have you used previously in stressful situations?" B. "Have you ever experienced a similar stressful situation?" C. "Who do you think is to blame for this situation?" D. "Why do you think you were fired from your job?" E. "What skills do you possess that might lead to gainful employment?"

ANS: A, B, E These questions specifically address the client's coping resources and encourage the client to apply learning from past experiences. These questions also encourage the client to consider alternative methods for dealing with stress. Asking who is to blame does not assess coping abilities but, rather, encourages maladaptive behavior. Requesting an explanation is a nontherapeutic block to communication.

A nursing instructor is teaching students about cirrhosis of the liver. Which of the following student statements about the complications of hepatic encephalopathy should indicate that further student teaching is needed? (Select all that apply.) A. "A diet rich in protein will promote hepatic healing." B. "This condition leads to a rise in serum ammonia resulting in impaired mental functioning." C. "In this condition, blood accumulates in the abdominal cavity." D. "Neomycin and lactulose are used in the treatment of this condition." E. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: A, C The nursing instructor should understand that further teaching is needed if the nursing student states that a diet rich in protein will promote hepatic healing and that this condition causes blood to accumulate in the abdominal cavity (ascites), because these are incorrect statements. The treatment of hepatic encephalopathy requires abstention from alcohol, temporary elimination of protein from the diet, and reduction of intestinal ammonia using neomycin or lactulose. This condition occurs in response to the inability of the liver to convert ammonia to urea for excretion.

Which of the following client statements would indicate that teaching about benzodiazepines has been successful? (Select all that apply.) A. "I can't drink alcohol when taking lorazepam (Ativan)." B. "If I abruptly stop taking buspirone (BuSpar), I may have a seizure." C. "Valium can make me drowsy, so I shouldn't drive for awhile." D. "My new diet cannot include aged cheese or pickled herring." E. "When the fluoxetine (Prozac) begins working, I can stop the alprazolam (Xanax)."

ANS: A, C When a nurse teaches about medications the nurse is using a cognitive approach. A core concept of cognitive theory relates to the mental process of thinking and reasoning.

A nurse is caring for a group of clients within the DSM-IV-TR cluster B category of personality disorders. Which factors should the nurse consider when planning client care? (Select all that apply.) A. These clients have personality traits that are deeply ingrained and difficult to modify. B. These clients need medications to treat the underlying physiological pathology. C. These clients use manipulation, making the implementation of treatment problematic. D. These clients have poor impulse control that hinders compliance with a plan of care. E. These clients commonly have secondary diagnoses of substance abuse and depression.

ANS: A, C, D, E The nurse should consider that individuals diagnosed with cluster B-type personality disorders have deeply ingrained personality traits, use manipulation, have poor impulse control, and often have secondary diagnoses of substance abuse and/or depression. This cluster includes antisocial, borderline, histrionic, and narcissistic personality disorders.

A nurse is administering risperidone (Risperdal) to a client diagnosed with schizophrenia. The therapeutic effect of this medication would most effectively address which of the following symptoms? (Select all that apply.) A. Somatic delusions B. Social isolation C. Gustatory hallucinations D. Flat affect E. Clang associations

ANS: A, C, E The nurse should expect that risperidone (Risperdal) would be effective treatment for somatic delusions, gustatory hallucinations, and clang associations. Risperidone is an atypical antipsychotic that has been effective in the treatment of the positive symptoms of schizophrenia and in maintenance therapy to prevent exacerbation of schizophrenic symptoms.

Which of the following practices should a nurse describe to a client as being incorporated during yoga therapy? (Select all that apply.) A. Deep breathing B. Meridian therapy C. Balanced body postures D. Massage therapy E. Meditation

ANS: A, C, E Yoga therapy involves deep breathing, balanced body postures, and meditation. The objective of yoga is to integrate the physical, mental, and spiritual energies to enhance health and well-being.

A client has experienced the death of a close family member and at the same time becomes unemployed. This situation has resulted in a 6-month score of 110 on the Miller and Rahe Recent Life Changes Questionnaire. How should the nurse evaluate this client data? A. The client is experiencing severe distress and is at risk for physical and psychological illness. B. A score of 110 on the Miller and Rahe Recent Life Changes Questionnaire indicates no significant threat of stress-related illness. C. Susceptibility to stress-related physical or psychological illness cannot be estimated without knowledge of coping resources and available supports. D. The client may view these losses as challenges and perceive them as opportunities.

ANS: C The Recent Life Changes Questionnaire is an expanded version of the Schedule of Recent Experiences and the Rahe-Holmes Social Readjustment Rating Scale. A 6-month score of 300 or more, or a year-score total of 500 or more, indicates high stress in a client's life. However, positive coping mechanisms and strong social support can limit susceptibility to stress-related illnesses.

A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) A. Sad mood on most days B. Mood rating of 2/10 for the past 6 months C. Labile mood D. Sad mood for the past 3 years after spouse's death E. Pressured speech when communicating

ANS: A, D The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than 2 years. The essential feature of dysthymia is a chronically depressed mood which can have an early or late onset.

After disturbing the peace, an aggressive, disoriented, unkempt, homeless individual is escorted to an emergency department by police. The client threatens suicide. Which criteria would enable a physician to consider involuntary commitment? (Select all that apply.) A. Being dangerous to others B. Being homeless C. Being disruptive to the community D. Being gravely disabled and unable to meet basic needs E. Being suicidal

ANS: A, D, E The physician could consider involuntary commitment when a client is being dangerous to others, is gravely disabled, or is suicidal. If the client is determined to be mentally incompetent, consent should be obtained from the legal guardian or court-approved guardian or conservator. A hospital administrator may give permission for involuntary commitment when time does not permit court intervention.

A client who has been diagnosed with a sexually transmitted disease (STD) asks that this information not be shared with her family members. Which of the following responses from the nurse would be appropriate?

" ""Your health information is confidential, and I can't talk to anyone about it without your permission.""

(SELECT ALL THAT APPLY) After being examined by the forensic nurse in the emergency department, a rape victim is prepared for discharge. Due to the nature of the attack, this client is at risk for posttraumatic stress disorder (PTSD). Which symptoms are associated with PTSD?

" 1. Recurrent, intrusive recollections or nightmares 3. Sleep disturbances 6. Difficulty concentrating "

(SELECT ALL THAT APPLY) A physician prescribes clomipramine (Anafranil) for a client diagnosed with obsessive-compulsive disorder (OCD). What instructions should the nurse include when teaching the client about this medication?

"1. Avoid hazardous activities that require alertness or good coordination until adverse central nervous system (CNS) effects are known. 2. Avoid alcohol and other depressants. 3. Use saliva substitutes or sugarless candy or gum to relieve dry mouth. "

The nurse notices that a client with obsessive-compulsive disorder washes his hands for long periods each day. How should the nurse respond to this compulsive behavior?

"1. By designating times during which the client can focus on the behavior

The nurse in a psychiatric inpatient unit is caring for a client with obsessive-compulsive disorder. As part of the client's treatment, the psychiatrist orders lorazepam (Ativan), 1 mg by mouth three times per day. During lorazepam therapy, the nurse should remind the client to:

"1. avoid caffeine.

A nurse notices that a client who came to the clinic for treatment of anxiety disorder has a strong body odor. What can the nurse do or say to help this client?

"2. Ask the client basic hygiene questions to determine how frequently he bathes.

The nurse is caring for a client with panic disorder who has difficulty sleeping. Which nursing intervention would best help the client achieve healthy long-term sleeping habits?

"2. Encouraging the use of relaxation exercises

A nurse on the psychiatric unit realizes that she typically fails to administer medications according to schedule. What's the best way for the nurse to improve her medication administration practice?

"2. Evaluate her current practice and devise an improvement plan.

The nurse is formulating a short-term goal for a client suffering from a severe obsessive-compulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will:

"2. participate in a daily exercise group.

Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)?

"3. Fluvoxamine (Luvox) and clomipramine (Anafranil)

A client arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?

"3. Risk for injury

Which nursing intervention would be most helpful for a client experiencing a panic attack?

"3. Staying with the client and remaining calm, confident, and reassuring

A client admitted to the psychiatric unit for treatment of repeated panic attacks comes to the nurses' station in obvious distress. After observing that the client is short of breath, dizzy, trembling, and nauseated, the nurse should first:

"3. escort the client to a quiet area and suggest using a relaxation exercise that he's been taught.

A client who lost her home and dog in an earthquake tells the admitting nurse at the community health center that she finds it harder and harder to "feel anything." She says she can't concentrate on the simplest tasks, fears losing control, and thinks about the earthquake incessantly. She becomes extremely anxious whenever the earthquake is mentioned and must leave the room if people talk about it. The nurse suspects that she has:

"3. posttraumatic stress disorder (PTSD).

While being escorted to an operating room, a client is extremely anxious and says, "I really don't know what they're going to do to me today. The physician said I have a lump in my breast and that's all I know." Which action is appropriate for the nurse to take?

"4. Notify the physician upon arrival at the operating room.

While administering medications to a group of clients admitted with anxiety, a nurse hears someone call for help. The nurse should respond by:

"4. locking the medication cart and responding to the call for help.

A 59-year-old client is scheduled for cardiac catheterization the next morning. His physician prescribed secobarbital sodium (Seconal), 100 mg by mouth at bedtime, for sedation. Before administering the drug, the nurse should know that:

"4. sedatives reduce excitement; hypnotics induce sleep.

THERAPEUTIC COMMUNICATION - BLOCKS Defending

"All of our doctors are great."

Two nurses are discussing a client's condition in the elevator. The employer of the mentioned client overhears the conversation and fires the client. The nurses may be liable for which accusation?

"Breach of confidentiality

A 22-year-old male client diagnosed with antisocial personality disorder asks the nurse if he can have an additional smoke break because he's anxious. Which of the following responses would be best?

"Clients are permitted to smoke at designated times. You'll have to follow the rules."

A 21-year-old college student who has been staying up late at night to study reports that she's been having difficulty concentrating. Which response by the nurse is best?

"Describe your sleep patterns to me."

The physician orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse would be most appropriate?

"Do you have any concerns about taking the medication?"

THERAPEUTIC COMMUNICATION - BLOCKS False Reassurance

"Don't worry."

THERAPEUTIC COMMUNICATION - BLOCKS Belittling

"Everyone feels like that."

On admission to the inpatient psychiatric unit, a client's facial expression indicates severe panic. The client repeatedly states, "I know the police are going to shoot me. They found out that I'm the child of the devil." What should the nurse say to initiate a therapeutic relationship with the client?

"Hello, my name is ___. I'm a nurse, and I'll care for you when I'm on duty. Should I call you ___, or do you prefer something else?"

Which of the following tasks are associated with the orientation phase of relationship development? Select all that apply? -Promoting the client's insight and perception of reality -Creating an environment for the establishment of trust and rapport -Using the problem solving model toward goal fulfillment -Obtaining available information about the client from various sources -Formulating nursing diagnoses and setting goals

Creating an environment for the establishment of trust and rapport, and formulating nursing diagnoses and setting goals

Can classify information Become aware of cause-and-effect relationships

Definition of intuitive thought

Make judgments based on visual appearances (artificialism, animism, imminent justice)

Definition of preconceptual thought

DEFENSE MECHANISMS - Conscious Suppression

Deliberately forgetting or delaying painful acts or thoughts (an individual repeatedly cancels dentist appointments).

Upon returning home from work, a young man discovers that his mother has been in a serious automobile accident. Initially, he responds to the news by stating, "No, I don't believe it. It can't be true." Which defense mechanism is he using?

Denial

Response to Loss

Denial "not me" B. Anger "why me?" C. Bargaining " If only..., I will..." teaching (good time) D. Depression "Woe is me!" E. Acceptance "The situation exists and I will cope,"

Addiction

Dependence with compulsive use and the following characteristics

A decrease in norepinephrine may pay a significant role in: o Bipolar disorder o Schizophrenia o Alzheimer's o Depression

Depression

Paul is the member of an anger management group. He knew that people did not want to be his friend because of his violent temper. In the group, he has learned to control his temper and form satisfactory interpersonal relationships with others. This is an example of which curative factor. -catharsis -altruism -imparting of information -development of socializing techniques

Development of socializing techniques

Which of the following symptoms are seen when a client abruptly stops taking diazepam (Valium)? Select all that apply. 1. Insomnia. 2. Tremor. 3. Delirium. 4. Dry mouth. 5. Lethargy.

Diazepam (Valium) is a benzodiazepine. Benzodiazepines are physiologically and psychologically addictive. If a benzodiazepine is stopped abruptly, a rebound stimulation of the central nervous system occurs, and the client may experience insomnia, increased anxiety, abdominal and muscle cramps, tremors, vomiting, sweating, convulsions, and delirium. 1. Insomnia is correct. 2. Tremor is correct. 3. Delirium is correct. 4. Dry mouth is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. 5. Lethargy is a side effect of taking benzodiazepines and is not related to stopping the medication abruptly. TEST-TAKING HINT: The test taker must distinguish between benzodiazepine side effectsand symptoms of withdrawal to answer this question correctly.

Suicide

Direct statements "I'm going to kill myself" 2. Indirect statements or hints 3. Gestures or half-hearted suicide attempts- lightly cut wrists, taking 5 pills 4. Giving away personal items 5. Major interest in rewriting will- extremely overwhelmed B. Suicide precautions 1. Keep patient under observation 2. Remove harmful objects a. Sharp objects and cutting implements b. Things that could be used for hanging: shoe laces, belts, bed sheets 3. Supervision during use of sharp objects

DEFENSE MECHANISMS - Unconscious Sublimation

Directing unacceptable behaviors into a socially acceptable area (individual with violent thoughts writes a murder mystery novel).

A person loses an important advertising account and has a flat tire while driving home. That evening, the person begins to find fault with everyone. Which defense mechanism is the person using?

Displacement

DEFENSE MECHANISMS - Unconscious Reaction Formation

Displaying behaviors or attitudes directly opposite of unacceptable conscious or unconscious thoughts (being friendly with an individual you dislike).

Based on the last question about Anna, Anna's grieving behavior would most likely be considered to be: -delayed -inhibited -prolonged -distorted

Distorted.

Undifferentiated Schizophrenia

Do not meet the criteria for any other subtypes, or they may meet the criteria for more than one subtype. Behavior is clearly psychotic-evidence of delusions, hallucinations, incoherence, and bizarre behavior.

A client is admitted to a psych unit with a dx of catatonic schizophrenia. Which neurotransmitter should the nurse expect to be elevated in the client? o Dopamine o Serotonin o GABA o Histamine

Dopamine

When should the nurse introduce information about the end of the nurse-client relationship?

During the orientation phase

Who is at particular risk for suicide?

Elderly men

Which nursing intervention is initially most important when restraining a violent client?

Ensuring that the restraints have been applied correctly

Autonomy vs. Shame and Doubt

Erikson stage for 2 to 3 year olds

Trust vs. Mistrust

Erikson stage for infancy (birth to 18 months)

Identity vs. role confusion

Erikson's stage for adolescence (12 to 18 years)

Generativity vs. stagnation

Erikson's stage for middle adulthood (40 to 65 years old)

Initiative vs. Guilt

Erikson's stage for preschool (3 to 5 years)

Industry vs. inferiority

Erikson's stage for school age (6 to 11 years)

Intimacy vs. isolation

Erikson's stage for young adulthood (19 to 40 years)

Ego integrity vs. despair

Erikson's stages for maturity (65 to death)

Delusion Disorder Types

Erotomanic- individual believes that someone of higher status is in love with them Grandiose- irrational ideas regarding the person's worth, talent, knowledge, or power Jealous- centers on the idea that the person's sexual partner is unfaithful. Persecutory- most common; they believe they are malevolently treated in some way, frequently they believe they are being conspired against, cheated, spied on, followed, drugged or poisoned. Somatic- believe they have some physical defect, disorder, or disease

Schizophreniform Disorder

Essential features of this disorder are identical to those of schizophrenia, with the exception that the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months. Thought to have good prognosis if the individual's affect not blunted or flat, if there is a rapid onset of psychotic symptoms from the time the unusual behavior is noticed, or if the premorbid social and occupational functioning was satisfactory.

A nurse places a client in full leather restraints. How often must the nurse check the client's circulation?

Every 15 minutes

MonAmine Oxidase Inhibitors

Examples and dosage a. Isocarboxazid (Marplan) 10-30 mg b. Phenelzine (Nardil) 45-90 mg c. Tranylcypromine (Parnate) 20-30 mg 2. Combination drugs a. Parphenazine (Etrafon) 16-64 mg b. Amitriptyline (Triavil) 100-300 mg 3. Avoid foods containing tyramine hypertensive crisis a. Aged cheese b. Alcohol c. Fermented foods d. Chocolate e. Yeast f. Raisins g. Bananas 4. Side effects a. Anticholinergic severe b. Central nervous system- sedation c. Many drug interactions

All of the following are competing biological theories of depression except: -Dysregulation of limbic system, -Imbalance of neurotransmitters such as serotonin, dopamine, and norepinephrine -Thyroid dysfunction -Excessive amount of inhibitory amino acids such as GABA.

Excessive amount of inhibitory amino acids such as GABA

A client who recently developed paralysis of the arms is diagnosed with conversion disorder after tests fail to uncover a physical cause for the paralysis. Which intervention should the nurse include in the plan of care?

Exercising the client's arms regularly

A client in an acute care setting tells the nurse, "I don't think I can face going home tomorrow." The nurse replies, "Do you want to talk more about it?" The nurse is using which technique?

Exploring

Psychotropic medications that are strong blockers of the D2 receptor are more likely to result in which of the following side effects? -sedation -urinary retention -extrapyramidal symptoms -hypertensive crisis

Extrapyramidal symptoms

Which of therapy is the most appropriate for a client with agoraphobia?

Facing his or her fear in gradual step regression.

A voluntary client in a facility decides to leave the unit before treatment is complete. To detain the client, the nurse refuses to return the client's personal effects. This is an example of which of the following?

False imprisonment

Spouse battering, child abuse, elder abuse, and marital rape are examples of ___________violence

Family

Physical tolerance and withdrawal symptoms can occur with stimulants. Stimulant withdrawal is characterized by which symptoms?

Fatigue, mental depression, and confusion

A client reports losing his job, not being able to sleep at night, and feeling upset with his wife. The nurse responds to the client, "You may want to talk about your employment situation in group today." The nurse is using which therapeutic technique?

Focusing

Which goal is most important for a nurse to concentrate on when leading a group session using a therapeutic milieu?

Focusing on the here and now

Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? -frontal lobe -parietal lobe -temporal lobe -occipital lobe

Frontal Lobe

Mr. J is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J? - Intimacy vs Isolation - Generativity vs. Self-Absorption - Trust vs. Mistrust - Autonomy vs. Shame and Doubt

Generativity vs. Self-Absorption

When there is congruence between what the nurse is feeling and what is being expressed the nurse is conveying: o Genuineness o Respect o Sympathy o Rapport

Genuineness

Sarah is currently living in a shelter with her four children after escaping her abusive husband. Early in her stay, Sarah attends but does not participate in the support group held for the residents. One day, Sarah speaks up and appropriately confronts another peer who had stolen her hairbrush. The group leader states, "I'm so proud of you being assertive. You are so good!!" Which technique has the leader used, and is it therapeutic? o Giving approval; no o Translating words to feelings; yes o Interpreting; no o Offering reassurance; yes

Giving approval; no

A nurse is administering risperidone (Risperdal) to a patient with schizophrenia. Which symptoms should the nurse expect as a therapeutic effect of this medication? -Dystonia -Social Isolation -Glustastory Hallucinations -Flat affect

Glustastory hallucinations

DEFENSE MECHANISMS - Unconscious Regression

Going back to an earlier developmental level (becoming dependent on another for all decisions).

Echolalia

Hear something and they repeat it over and over

Three years ago, Anna's dog Lucky, whom she had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because: - it has been more than 3 years since Lucky died -her grief is too intense just over the loss of a dog -her grief is interfering with her functioning -people in this culture would not comprehend such behavior

Her grief is interfering with her functioning.

The _____phase in the cycle of violence is a period in which the perpetrator expresses remorse and regret

Honeymoon

Dorothy was involved in an automobile accident while under the influence of alcohol. she swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate? -Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again -You know that was a terrible thing you did. That child could have been killed -I'm sure everything is going to be okay now that you understand the possible consequences of such behavior -How are you feeling about what happened?

How are you feeling about what happened?

Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system? It also regulates appetite and temperature. -temporal lobe -parietal lobe -cerebellum -hypothalamus

Hypothalamus

A client on an inpatient psych unit comes to the nurse to complain about another patient (Peter) not cleaning up after himself in the community restroom. The patient is angry and upset. What is the best response by the nurse? -Why don't you go discuss that with Peter -I will go take care of it so Peter does not get upset -I can see that you are angry. Let's discuss ways to approach Peter with your concerns.

I can see that you are angry. Let's discuss ways to approach Peter with your concerns.

A client states: "I refuse to shower in this room. I must be very cautious. The FBI placed a camera in here to monitor my every move." Which of the following is the therapeutic response? -That's not true -I have a hard time believing that's true -Surely you don't believe that -I will help you search this room so that you can see there is no camera

I have a hard time believing that's true

A client is admitted to a psychiatric unit in a state of emotional distress after his wife filed for divorce and he lost his job. Which assessment should take priority for this client?

Identify the client's perception of the event.

The nurse is performing an assessment on a newly admitted client. She asks the client to remember three words: apple, house, and umbrella. Then she asks the client, "What are the three words I want you to remember?" What is the nurse assessing?

Immediate recall

Henry is a member of an AA group. he learned about the effects of alcohol on the body when a nurse from the chemical dependency unit spoke to the group. This is an example of which curative factor? -Catharsis -Altruism -Imparting of information -Universality

Imparting of information

DEFENSE MECHANISMS - Unconscious Introjection

Incorporating the emotions of another (a nurse becomes depressed while caring for a client who is depressed).

Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern? -increased levels of melatonin -decreased levels of oxytocin -decreased levels of prolactin -increased levels of thyrotropin

Increased levels of melatonin

Residual Schizophrenia

Individual has a history of at least one previous episode of schizophrenia. Individual who has a chronic form of the disease and is the stage that follows an acute episode. Residual symptoms may include social isolation, eccentric behavior, impairment in personal hygiene and grooming, blunted or inappropriate affect, poverty of or overly elaborate speech, illogical thinking, or apathy.

Erikson

Infant; 0-2 years: Trust Vs. mistrust 2. Toddler; 2-3 years: Autonomy Vs shame and doubt 3. Preschool; 3-5 years: Initiative Vs guilt 4. School age; 6-12 years: Industry Vs inferiority 5. Adolescent; 12-18 years: Identity Vs identity (or role) confusion 6. Young adult: 18-25 years: Intimacy Vs isolation 7. Middle adult: 25-45 years: Generativity Vs stagnation 8. Older adult: 45-death: Ego integrity Vs despair

Rights of psychiatric clients

Informed consent 2. Unopened mail 3. Phone calls/visits 4. Visits by physicians, attorney, clergy 5. Keep personal possessions 6. Keep and spend money 7. Hold property, vote, and marry 8. Education 9. Treatment in the least restrictive setting 10. Refuse treatment

Lithium

Initially dose regulated by daily monitoring of blood levels 12 hours after last dose 3. Blood levels a. Therapeutic levels: 0.6-1.2 mEq/L b. Toxic levels: >1.5 mEq/L c. Lethal: >2.5 mEq/L 4. Toxicity 1. Gait disturbances 2. Gastrointestinal 3. Cardiac dysrhythmias 4. Cardiac arrest and death 5. Client education a. It takes 1-4 weeks for therapeutic level to be reached b. Take meds as directed c. Avoid driving until lithium dose stable d. Don't reduce sodium in diet e. Avoid: caffeine, thiazide diuretics, NSAIDs f. Get regular blood tests g. May gain weight h. Notify physician if signs of toxicity

Establishing a Nurse Client Relationship

Initiation phase a. Who? b. What? c. Where? d. When? e. Why? 2. Working phase a. Set client goals b. Promote insight c. Work for client independence 3. Termination phase a. Start early b. Expect regression c. Discuss coming separation/termination d. Review progress made e. Promote closure

CONVERSION DISORDERS (HYSTERIA) Client Education

Instruct client that stress-relieving activities such as meditation or yoga may help reduce reactions to the events that prompt symptoms of conversion disorder.

Psychological dependence

Intense craving for the substance

What is the major difference between anger and aggression?

Intent; aggression refers to behavior that is intended to inflict harm or destruction

Rape Interventions

Interventions 1. Provide privacy 2. Gather evidence if needed 3. During acute phase a. Establish priorities b. Stay with victim or arrange for someone to do so c. Allow client to wash after assessment and collection of evidence 4. During outward adjustment phase a. Encourage counseling for victim and family 5. During readjustment phase a. Provide list of resources and information and arrange for follow up

An adolescent, age 17, rarely expresses feelings and usually remains passive. However, when angry, her face becomes flushed and her blood pressure rises to 170/100 mm Hg. Her parents are passive and easygoing. The adolescent may be using which defense mechanism to handle anger?

Introjection

DEFENSE MECHANISMS - Unconscious Repression

Involuntary forgetting of painful memories, feelings, or actions (denying occurrence of child abuse).

PHOBIC DISORDERS Definition

Irrational fear of a specific object, activity, or situation that leads to avoidance (e.g., fear of flying). There's no one specific known cause for phobias, and it's thought that phobias run in families, are influenced by culture and how one is parented, and can be triggered by life events and conditioning.

A client with OCD spends many hours each day washing his hands. The most likely reason he washes his hands so much is that:

It relieves his anxiety.

Nursing Considerations for Alcohol Withdrawal

Keep the light on with DTs walk and talk with them during the stage 1

Which of the following is not part of SOLER acronym for active listening? -Lean away from client -Sit squarely facing the client -Establish eye contact

Lean away from client

Which of the following part of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain"? -frontal lobe -thalamus -hypothalamus -limbic system

Limbic system

Which commonly administered psychiatric medication is prescribed in individualized dosages according to the blood levels of the drug?

Lithium carbonate (Lithane)

Anhedonia

Loss of pleasure in usually pleasurable things

Characteristics of Abuser

Low self-esteem B. Substance abuser C. Projects D. Anxious E. Depressed F. Abused as a child G. Socially isolated H. Impulsive, immature I. Possessive

Which psychological or personality factor is likely to predispose an individual to medication abuse?

Low self-esteem and unresolved rage

OCD Treatment

MEDICATIONS: - Antidepressants (Anafranil, Luvox, Prozac, Paxil, Zoloft) THERAPY: - Cog Behavioral Therapy - Psychotherapy

PHOBIC DISORDERS Treatment

MEDICATIONS: - Antidepressants (SSRIs) - Beta Blockers (Propranolol); decreases the physical symptoms associated with panic by blocking the effects that adrenaline has on the body. - Benzodiazepines THERAPY: - Cognitive Therapy - Behavior Modification

PTSD Treatment

MEDICATIONS: - Antidepressants (Zoloft, Paxil). - Anxiolytics. - If manifestations include nightmares or insomnia, Minipress has been prescribed. (Normally used to treat HTN, Minipress blocks the brain's response to NE and has been effective in suppressing nightmares.) THERAPY: - Cognitive Therapy - Exposure Therapy

GENERALIZED ANXIETY DISORDER (GAD) Medications

MEDICATIONS: - Antidepressants (Zoloft, Prozac, Paxil, Lexapro, Effexor, Tofranil) - Anxiolytics (BuSpar) - Benzodiazepines (Klonopin, Ativan, Valium, Librium, Xanax) [ST basis!]

CONVERSION DISORDERS (HYSTERIA) Treatment

MEDICATIONS: - Antidepressants: can be effective with depression, anger, impulsivity, irritability, or hopelessness, which may be associated with personality disorders. - Mood-stabilizers: can be effective to even out mood swings or reduce irritability, impulsivity, and aggression. - Anxiolytics: may be effective to control anxiety, agitation, or insomnia. Can, in some cases, increase impulsivity. - Antipsychotics: may be effective if symptoms include losing touch with reality (psychosis), anxiety, or anger problems. THERAPY: - Psychotherapy - Physical Therapy - Hypnosis

SCHIZOPHRENIA Treatment

MEDICATIONS: - Atypical Antipsychotics: Abilify, Clozaril, Zyprexa, Invega, Seroquel, Risperdal, Geodon. - Typical Antipsychotics: Thorazine, Haldol THERAPY: - Psychosocial Therapy

Which of the following indications is the appropriate use for electroconvulsive therapy (ECT)?

Major depression with psychotic features

Depression Interventions

Major goal: increase self-esteem 2. Schedule activities of daily living ( structure activities for success) 3. Encourage appropriate amounts of sleep 4. Family or group therapy 5. Unconditional acceptance 6. Encourage expression of feelings

Which therapeutic communication technique is being used in the following example? Patient: "Every time I get angry, I wind up getting into a fistfight with my wife or I take it out on the kids." Nurse: "I notice that you are you are smiling as you talking this physical violence." o Making observations o Restating o Formulating a plan of action

Making Observations

A client in group therapy is restless. His face is flushed and he makes sarcastic remarks to group members. The nurse responds by saying, "You look angry." The nurse is using which technique?

Making observations

Milieu of Therapy

Management of the environment to produce change in personality and behavior. 2. Assumptions a. Clients have strengths b. Clients have abilities to influence their own treatment and the treatment of others c. Clients are responsible and accountable for their own behavior

Schizoaffective Disorder

Manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania). Client may appear depressed, with psychomotor retardation and suicidal ideation, or symptoms may include euphoria, grandiosity, and hyperactivity.

The nurse-client therapeutic relationship includes all of the following characteristics except: -Meeting the social needs of both the nurse and the client -Ensuring therapeutic termination -Promoting client insight into problematic behavior -Collaboration on a set of goals

Meeting the social needs of both the nurse and the client

Levels of anxiety

Mild: Broad perceptual field; a little muscle tension 2. Moderate: Narrowed perceptual field; more physical symptoms 3. Severe: Greatly narrowed perceptual field. Connections between details not perceived. More severe physical symptoms. 4. Panic: Perceptual field closed; details out of proportion; logical thinking impaired.

Laura is a nurse in an inpatient psychiatric unit. Much of her time is spent observing client activity, talking with clients, and striving to maintain a therapeutic environment in collaboration with other health care providers. This specific example of the implementation step of the nursing process is called: o Health teaching o Case management o Milieu therapy o Self care activities

Milieu therapy

A 49-year-old painter who recently fractured his tibia worries about his finances because he can't work. To treat his anxiety, his physician prescribes buspirone (BuSpar), 5 mg by mouth three times per day. During buspirone therapy, the client should avoid which of the following drugs?

Monoamine oxidase (MAO) inhibitors

Anorexia Nervosa

More common in adolescent or young women 2. Eating disorder in which a person a. Experiences hunger but refuses to eat b. Person has a distorted body image and a self-perception of obesity c, Can lead to starvation and death 3. Often high achievers in school and sports. 4. Fascinated with food. 5. May self induce vomiting 6. Management a. Fluid and electrolyte balance b. Observe client for two hours after each meal. c. Weight assessment on a regular (weekly) basis

Alzheimer's

Most common form of chronic organic brain disease 2. Stages a. Stage one 1) Memory loss: names, location of objects 2) Emotionally unstable b. Stage two 1) Lasts 2-12 years 2) Loss of recent memory 3) Disorientation; can't concentrate 4) Inappropriate social actions 5) Agnosia: don't know what an object is for 6) Aphasia 7) Apraxia: can no longer do things they have done for many years such as tie shoes or cook c. Stage three 1) Lasts months to 5 years 2) Severe disorientation 3) Inability to communicate 4) Delusions, hallucinations, paranoia, agitation 5) Loss of physical functioning 3. Keeping mind active may help to prevent symptoms of Alzheimer's 4. "Sun-downer's syndrome" a. Disoriented after dark b. Wander at night 5. Care of person with Alzheimer's a. Physical needs b. Safety c. Do not punish

Nancy, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing makeup and a clean dress and having washed and combed her hair. Which of the following responses by the nurse is most appropriate? -Nancy, I see you have put on a clean dress and combed your hair -Nancy, you look wonderful today! -Nancy, I'm sure everyone will appreciate that you have cleaned up for the group today -Now that you see how important it is, I hope you will do this everyday

Nancy, I see you have put on a clean dress and comber your hair

A patient with physical dependence of opiates is likely to experience which symptoms of withdrawal? o Nausea, vomiting, diarrhea, and piloerection o Tremors, hallucinations, seizures o Incoordination and unsteady gait

Nausea, vomiting, diarrhea, and piloerection

Tolerance

Need for increasing amounts to achieve the same effect

_______is the malicious or ignorant withholding of physical, emotional, or educational necessities to a dependents well-being

Neglect

A family member visiting on an acute care psychiatric unit approaches the nurse's station and reports that an elderly client is walking in the hall without her clothing. The nurse doesn't assist the client and suggests that the family member inform the nurse assigned to that client. Which term describes the nurse's action?

Negligent

At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? -potassium ions -interneurons -neurotransmitters -the myelin sheath

Neurotransmitters

Which of the following are considered to be the chemical messengers of the brain? - Neurotransmitters -Dendrites -Axons -Synapses

Neurotransmitters

Which of the following observations should a nurse identify as a group process when monitoring a group therapy session?

Nonverbal language expressed within the group

A decrease in which of the following neurotransmitters has been implicated in depression? -GABA, acetylcholine, and aspartate -Norepinephrine, serotonin, and dopamine -Somatostatin, substance P, and glycine -Glutamate, histamine, and opioid peptides

Norepinephrine, serotonin, and dopamine

A client doesn't make eye contact with the nurse during an interview. The nurse suspects that the client's behavior has a cultural basis. What should the nurse do first?

Observe how the client and his family and friends interact with each other and with other staff members.

OCD

Obsession: Uncontrollable, recurring thoughts B. Compulsion: Ritualistic act done in an attempt to relieve the anxiety related to the thoughts or to make the thoughts go away. C. Interventions 1. Do not interrupt rituals but set limits 2. Set limits 3. Allow time to complete rituals 4. Distract 5. Desensitization 6. Physical protection from repetitive acts usually washing 7. Help client express feelings in appropriate ways 8. Individual and group therapy 9. Anafranil

Which of the following parts of the brain is concerned with visual reception and interpretation? -frontal lobe -parietal lobe -temporal lobe -occipital lobe

Occipital Lobe

DEFENSE MECHANISMS - Unconscious Rationalization

Offering a socially acceptable explanation for unacceptable impulses ("I failed the exam because it was a bad test.").

GENERALIZED ANXIETY DISORDER (GAD) Symptoms

Often begins at an early age; chronic; symptoms may develop more slowly than other anxiety disorders, substance abuse, and mood disorders; commonly occurs with major depression. SYMPTOMS: Constant worrying or obsession about small or large concerns. Restlessness and feeling keyed up or on edge. Fatigue. Difficulty concentrating. Irritable. Muscle tension or aches. Trembling, feeling twitchy, easily startled. Trouble sleeping. Sweating, N/D. SOB or tachycardia.

Disorganized Schizophrenia

Onset of symptoms before age 25, behavior is markedly regressive and primitive, contact with reality is extremely poor, affect is flat or grossly inappropriate, often with periods of silliness and incongruous giggling. Facial grimaces and bizarre mannerisms are common, and communication is consistently incoherent. Personal appearance is generally neglected.

Stages of psychosexual development

Oral 1) Infancy 2) Explores the world through the mouth b. Anal 1) Toddler 2) Toilet training stage c. Phallic (Oedipal) 1) Preschool 2) Little boy wants to marry his mother; little girl wants to marry her father d. Latent 1) School age 2) Development of conscience or super ego. e. Genital 1) Adolescence 2) Major concern is genital sex

The nurse asks the patient to identify the date, the time of day and the location of the clinic. The nurse is assessing the patient's: o Mental status o Perception o Orientation o Thought

Orientation

ANXIETY Mild

PHYSIOLOGICAL RESPONSE: Slight discomfort, GI "butterflies", restlessness, tension relief, fidgeting, tapping. COG STATE AND BEHAVIORAL CHANGES: Perceptual field can be heightened; learning can occur. RN INTERVENTIONS: Listen to client. Promote insight and problem solving. Discuss alternatives with the client.

ANXIETY Severe

PHYSIOLOGICAL RESPONSE: ↑BP, tachycardia, reports somatic symptoms, hyperventilation, confusion. COG STATE AND BEHAVIORAL CHANGES: Perceptual field greatly reduced; attention scattered and unable to focus; feelings of increasing threat; purposeless activity; feelings of impending doom. RN INTERVENTIONS: Listen to client. Encourage the client to express their feelings. Establish concrete activity with the client. Reduce the client's stimuli with simple tasks.

ANXIETY Moderate

PHYSIOLOGICAL RESPONSE: ↑pulse, ↑RR, shakiness, voice tremors, difficulty concentrating, pacing. COG STATE AND BEHAVIORAL CHANGES: Perceptual field narrows; client is selective in attention, focusing on immediate events; benefits from the guidance of others. RN INTERVENTIONS: Remain calm and rational in discussion. Encourage the client to engage in relaxation exercises.

ANXIETY Panic

PHYSIOLOGICAL RESPONSE:Immobility or severe hyperactivity, cool, clammy skin, pallor, dilated pupils, chest pain and palpitations. COG STATE AND BEHAVIORAL CHANGES: Prolonged anxiety can lead to exhaustion; perceptual field diminished; hallucinations or delusions may occur; effective decision-making is impossible; mute or psychomotor agitation; may strike out physically or withdraw; loss of control. RN INTERVENTIONS: Isolate the client from stimuli. Stay with the client. Remain very calm. Protect the client's safety. Do not touch the client!

Which client dx should a nurse associate with a decrease in GABA? -Depression -Alzheimer's -Panic Disorder -Schizophrenia

Panic disorder

Flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which of these symptoms are correctly placed as negative/positive symptoms of schizophrenia? -(+) Paranoid delusions, anhendonia, anergia -(+) Paranoid delusions, neologisms, echolalia - (-) Paranoid delusions, anergia, echolalia - (-) Paranoid delusions, flat affect, anhedonia

Paranoid delusions, neologisms, echolalia

Which of the following parts of the brain deals with sensory perception and interpretation? -hypothalamus -cerebellum -parietal lobe -hippocampus

Parietal Lobe

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which therapy regimen is most appropriate for John?

Paroxetine and group therapy.

A man at a pizza parlor verbally confronts the waiter for lack of attentiveness. Later, in the back room, the waiter spits on the man's pizza. This is an example of a behavior typical of which disorder?

Passive-aggressive

Bipolar Disorder

Periods of elation alternating with periods of depression B. Manic: Periods of abnormally elevated mood that are persistent and interfere with functioning C. Assessment findings 1. Quick but superficial wit 2. Flight of ideas 3. Aggressive and argumentative 4. Irritable and hypercritical 5. Increased motor activity

Physical dependence

Physical symptoms when the substance is withdrawn

Conservation Sees weight and volume as unchanging Understands simple analogies Understands time Classifies more complex information Becomes self-motivated

Piaget concrete operational stage characteristics

Abstract reasoning and deal with principles Capable of evaluating the quality of their own thinking Able to maintain attention for long periods Highly imaginative and idealistic Future oriented Capable of using deductive reasoning

Piaget formal operational stage characteristics

Have and demonstrate memories of events that relate to them (egocentrism) Domestic mimicry

Piaget preoperational stage characteristics

Separation Object permanence Mental representation

Piaget sensorimotor stage characteristics

Concrete operational

Piaget stage

Formal operational

Piaget stage for 11 years and older

Preoperational

Piaget stage for 2 to 7 years

Sensorimotor

Piaget stage for birth to 2 years

Which statement is a guideline to help nurses effectively avoid liability?

Practice within the scope of the Nurse Practice Act.

With implosion therapy, a client with phobic anxiety would be:

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

Nursing intervention that is most appropriate for caring for an acutely agitated client diagnosed with paranoid schizophrenia? o Provide neon light and soft music o Maintain continual eye contact through interventions o Use therapeutic touch to increase trust and rapport o Provide personal space to respect client boundaries

Provide personal space to respect client boundaries

Depressed divorcee has been self medicating with cocaine for the past year. What should a nurse use to best describe the individual's situation? o Physical dependency o Social dependency o Psychological dependency o Substance dependency

Psychological dependency

Which of the following statements is not true about milieu therapy? o Punishments are used to eliminate negative behaviors o One to one relationship between the patient and the nurse is a major focus o The goal is for the client to eliminate negative behaviors

Punishments are used to eliminate negative behaviors

DEFENSE MECHANISMS - Unconscious Compensation

Putting more effort toward achievements in areas of real or imagined deficiency (a student who fails a class later becomes the valedictorian).

GENERALIZED ANXIETY DISORDER (GAD) Interventions

RN INTERVENTIONS: - Assess for safety concerns and promote client safety. - Encourage the client to discuss concerns. - Assist the client to identify the source of the anxiety. - Help the client to identify personal strengths. - Teach the client how to develop positive coping skills. THERAPEUTIC MEASURES: Cognitive Behavioral Therapy - generally a short-term treatment that focuses on teaching the client specific skills to identify negative thoughts and behaviors and replace them with positive ones.

Lucky sometimes refused to obey Anna and, indeed, did not come back to her when she called to him on the day he was killed. But Anna continues to insist "he was the very best dog. He always minded me. He did everything I told him to do" This represents the defense mechanism of: -sublimation -reaction formation -compensation - undoing

Reaction Formation

From which of the following symptoms might the nurse identify a chronic cocaine user? -Clear, constricted pupils -Red, irritated nostrils -Muscle aches -Conjunctival redness

Red, irritated nostrils

Define Genuineness

Refers to the nurse's ability to be open, honest, and "real" in interactions with the client.

A client asks the nurse, "Do you think I should leave my husband?" The nurse responds, "You aren't sure if you should leave your husband?" The nurse is using which therapeutic technique?

Reflecting

Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living, and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because: -women are less likely to seek help for emotional problems than men are -relatives often try to "normalize" the behavior, rather than label it mental illness -she knows that all older people are expected to be a little depressed -she is afraid that the neighbors "will think her mother is crazy"

Relatives often try to "normalize" the behavior, rather than label it a mental illness

A patient is brought to the E.R after being violently raped. Which nursing action is most appropriate?

Remain nonjudgmental and actively listen to the client's description

The nurse is documenting a plan of care for a client who has undergone electroconvulsive therapy (ECT). The nurse should include which intervention?

Reorienting the client to time and place

The goal of therapeutic touch is to: o Improve circulation by deep circular massage o Repattern the body's energy field by using rhythmic hand motions o Improve breathing by increasing oxygen to the brain and body o Decrease blood pressure by toxin release

Repattern the body's energy field by using rhythmic hand motions

An 8-year-old girl and her 5-year-old sister tell the school nurse that their mother frequently yells and spits in their faces when she is mad at them. The nurse hesitates to intervene because she knows the family personally. Which action by the nurse is appropriate?

Report the information to child protective services.

Anna's dog, Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism? -Rationalization -Denial -Supression -Repession

Repression

Which term refers to the primary unconscious defense mechanism that keeps intense anxiety-producing situations out of a person's conscious awareness?

Repression

Defense mechanisms

Repression a. Unconscious forgetting b. Defense mechanisms in anxiety disorders 2. Suppression: Conscious forgetting 3. Denial a. Refusal to admit there is a problem b. Commonly seen in substance abuse 4. Displacement a. Feelings toward one person or situation are displaced onto something that is safer b. Example: Mad at the boss, yell at your spouse or children 5. Regression a. Behave in ways more appropriate for an earlier stage. b. Example: Six-year old hospitalized patient wets bed. 6. Rationalization a. Makes an excuse and does not admit the real reason b. Very common 7. Projection a. Mechanism of paranoia b. Puts own feelings on someone else 8. Ideas of reference a. Patient thinks everything is about them and it is bad. b. Common in persons with paranoia and Alzheimer's. 9. Reaction formation: Acting opposite underlying drives and desires 10. Transference: The patient transfers feelings they had for someone earlier in life onto the nurse.

Promoting an atmosphere of privacy during therapeutic interactions, always being open and honest, striving to understand motivation behind the client's behavior and calling the client by name all demonstrate what? -Trust -Respect -Genuineness

Respect

A 18 year old female was sexually assaulted while on her way home from work. She is brought to the ER by her mom. Sexual assault is an example of the following type of crisis: o Resulting from traumatic stress o Dispositional o Developmental crisis o Reflecting psychopathology

Resulting from traumatic stress

The nurse considers a client's response to crisis intervention successful if the client is at a minimum: o Returns to his previous level of functioning o Learns to relate better to others o Develops insight into the reasons why the crisis occurred.

Returns to his previous level of functioning

Most anti-depressants work by blocking ___________ of certain neurotransmitters, like serotonin, after they are released into the synaptic cleft: -Reuptake -Regeneration -Recycling -Retransmission

Reuptake

What should be the priority nursing dx for a client experiencing alcohol withdrawal? o Disturbed thought process r/t tactile hallucinations o Ineffective denial e/t continued alcohol despite negative consequence o Risk for injury r/t CNS stimulation

Risk for injury r/t CNS stimulation

A client is diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication administered addresses this positive symptom? -Citalopram -Phenelzine -Risperidone -Sertaline

Risperidone

Depression Characteristics

Sad mood 2. Diminished pleasure 3. Weight loss or gain- change in eating habits and therefore a change in weight 4. Insomnia or hypersomnia 5. Psychomotor agitation or retardation 6. Fatigue 7. Feelings of worthlessness 8. Diminished ability to concentrate 9. Recurrent thoughts of death or suicide

Characteristics of Abused

Same as abuser B. Accepts responsibility for others C. Helpless D. Suicidal at times E. Submissive F. Frightened G. Guilt ridden

An increase in dopamine activity may play a significant role in which of the following illness? o Schizophrenia o Anxiety disorders o Depression o Alzheimer's

Schizophrenia

Bipolar Interventions

Set limits 2. Decrease stimuli 3. Basic needs such as finger foods 4. Pace speech 5. Redirect thoughts 6. Avoid arguing 7. Movement activities 8. Distract

The initial care plan for a client with OCD who washes her hands obsessively would include which nursing intervention?

Sets limitations on the amount of time the client may engage in the ritualistic behavior.

What may be influential in the predisposition to PTSD?

Severity of the stressor and availability of support systems.

Psychotropic medications that block the reuptake of serotonin may result in which of the following side effects? -dry mouth -constipation -blurred vision -sexual dysfunction

Sexual dysfunction

Janet, a psychiatric client diagnosed with Borderline Personality Disorder, has just been hospitalized for threatening suicide. According to Mahler's theory, Janet did not receive the critical "emotional refueling" required during the rapprochement phase of development. That are the consequences of this deficiency? -she has not yet learned to delay gratification -she does not feel guilt about wrong doings to others -she is unable to trust others -she has internalized rage and fears of abandonment

She has internalized rage and fears of abandonment

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?

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

Therapeutic Communication Techniques

Silence B. Offering self 1. "Let me help you." 2. "I will stay with you." C. Reflection/Restatement 1. Reflection: repeating back part of what the patient has just said 2. Restatement: putting what the patient has just said in different words 3. Opens communication D. Empathy 1. Recognizing patient's feelings 2. Opens communication E. Giving information F. Focusing/Exploring 1. Clarify information 2. Focuses patient concerns 3. Not usually initial communication

A women seeking help at a community mental health center complains of fatigue, sensitivity to criticism, decreased libido, and feeling self conscious. She also has aches and pains. A nursing diagnosis for this client might include:

Situational low self-esteem.

A patient diagnosed with schizophrenia is prescribed Clozapine (Clozaril). Which symptoms present should the nurse intervene immediately? -Sore throat, fever, malaise -Akathisia and hypersalivation -Akinesia and insomnia -Dry mouth and urinary retention

Sore throat, fever, malaise

A client with borderline personality disorder dramatically expresses feelings about each nurse on the staff, stating that only one nurse is understanding and trustworthy — the nurse the client is talking to at the time. This client is demonstrating which behavior?

Splitting

Alcoholism Stages of Withdrawal

Stage I: mild tremors Stage II: Increased tremors, hyperactive, nightmares, disorientation, hallucinations, increased pulse, increased BP, DTs Stage III: Most dangerous, severe hallucinations (visual and kinesthetic are most common), grand mal seizures, DTs

________is the repeated and persistent attempts to impose unwanted communication or contact with another person

Stalking

Assertive behavior involves which of the following elements?

Standing up for your rights while respecting the rights of others

THERAPEUTIC COMMUNICATION - TOOLS Showing Empathy

State a feeling implied by the client.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to:

Stay with John and reassure him of his safety.

Freud

Structure of the mind a. Id 1) Unconscious mind 2) The pleasure principle. "I want it now!" b. Super ego 1) "Thou shalt not." 2) Conscience 3) Part conscious and part unconscious c. Ego: balances between Id and superego

Types of group therapy

Structured groups 1) Goal: to accomplish a specific outcome 2) Leader: directive b. Unstructured groups 1) Goal: Express feelings and receive feedback 2) Leader: nondirective 3) Focus: group concerns c. Family groups 1) Change in one family member causes changes in others 2) Goal is to improve communication d. Special problem group: group members share similar problems e. Self-help group: Individuals with common problems who give support to each other

DEFENSE MECHANISMS - Unconscious Identification

Subconsciously adopting the characteristics of an individual who is admired (Elvis impersonator).

Abuse

Substance use that leads to legal, social, and or medical problems

Brief Psychotic Disorder

Sudden onset of symptoms that may or may not be preceded by a sever psychological stressor. Symptoms last at least 1 day but less than 1 month. Individual experiences emotional turmoil or overwhelming perplexity or confusion. Evidence of impaired reality testing may include bizarre behavior, and disorientation.

Kristine is a psychiatric nurse who has been selected to lead a group for women who desire to lose weight. The criterion for membership it that they must be at least 20 lbs overweight. All have tried to lose weight on their own many times in the past without success. At their first meeting, the nurse provides suggestions as the members determine what their goals will be and how they plan to achieve the goals. They decided how often they wanted to meet and what they planned to do at each meeting. Which type of group and style of leadership is described in this situation? -Task/autocratic -Teaching/democratic -Self-help/laissez faire -Supportive-therapeutic/democratic

Supportive-therapeutic/democratic

John, a veteran of the war in Iraq, is diagnosed with PTSD. he says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses that John suffers from:

Survivor's guilt.

CRISIS INTERVENTION

TYPES: Situational (Unanticipated - death, divorce, job loss.) Transitional (Maturational, anticipated - birth, marriage.) Cultural/Social (Disaster, war.) RESPONSES: Physiological (nervous system), Psychological (panic, fear, helplessness), Behavioral (extremes, talkative to withdrawn.) MGMT: Requires prompt intervention in calm, controlled atmosphere. Focus on client strengthens positive coping skills. Time limited (4-8wk). RN INTERVENTIONS: Provide therapeutic interventions to keep client focused on immediate problem. Set specific goals for resolution. Help client develop more adaptive coping behaviors, sense of mastery. Use simple, concrete sentences with step-by-step direction to promote effective communication.

Nursing implications for a client taking central nervous system (CNS) stimulants include monitoring the client for which conditions?

Tachycardia, weight loss, and mood swings

Joyce is the nurse leader of a childbirth preparation group. Each week she shows various films and sets out various reading materials. She expects the participants to utilize their time on a topic of their choice or practice skills they have observed on the films. Two couples have dropped out of the group stating "This is a big waste of time." Which type of group and style of leadership is described int his situation? -Task/democratic -Teaching/laissez-faire -Self-help/democratic -Supportive-therapeutic/autocratic

Teaching/laiseez-faire

A client reports severe pain in the back and joints. Upon reviewing the client's history, the nurse notes a diagnosis of depression and frequent hospitalizations for somatic illnesses. What should the nurse encourage this client to do?

Tell the physician about the pain so that its cause can be determined.

Which of the following parts of the brain is concerned with hearing, short term memory, and sense of smell? -temporal lobe -parietal lobe -cerebellum -hypothalamus

Temporal Lobe

The phase of the nurse patient relationship that may be the most difficult for the patient because of anxieties may reappear and feelings of past losses are triggered is the: o Working phase o Preinteraction o Orientation o Termination

Termination

Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? -temporal lobe -thalamus -limbic system -hypothalamus

Thalamus

Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and box of chocolates to his room. He presents these gifts to Nurse Mary, saying "Thank you for taking care of me." What is a correct response by the nurse? - I don't accept gifts from patients -Thank you so much! It is so nice to be appreciated. -Thank you. I will share these with the rest of the staff. -Hospital Policy forbids me to accept gifts from patients.

Thank you, I will share these with the rest of the staff

DEFENSE MECHANISMS - Unconscious Denial

The avoidance of an unpleasant reality by ignoring or refusing recognition ("I can quit drinking any time I want.").

A client is prescribed alprazolam (Xanax) 2 mg bid and 1.5 mg q6h PRN for agitation. The maximum daily dose of alprazolam is 10 mg/d. The client can receive _____ PRN doses of alprazolam within a 24-hour period.

The client can receive 4 PRN doses. Medications are given four times in a 24-hour period when the order reads q6h: 1.5 mg x 4 = 6 mg. The test taker must factor in 2 mg bid = 4 mg. These two dosages together add up to 10 mg, the maximum daily dose of alprazolam (Xanax), and so the client can receive all 4 PRN doses. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision- making process related to administration of PRN medications. In this case, the client would be able to receive all possible doses of PRN medication because the standing and PRN ordered medications together do not exceed the maximum daily dose.

The patient says the shopatouliens took my shoes! What is the appropriate charting to describe the patient's actions/statements? o The client is experiencing command hallucinations o The client is expressing neologism o The client is experiencing an erotic delusion o The client is verbalizing word salad

The client is expressing neologism

The nurse is administering atropine sulfate to a client who is about to undergo electroconvulsive therapy (ECT). Which data collection finding indicates that the medication is effective?

The client states that his mouth is dry.

In planning care for a suicidal client, which outcome is the first priority? -The client will not physically harm self -The client will verbalize feeling on why he wants to commit suicide - The client's mood and affect will improve over the next 3 days -The client will work well with others

The client will not physically harm self

Andrea's teenage son recently committed suicide. She discovered her son's body and was subsequently diagnosed with post-traumatic stress disorder. Andrea was then admitted to the inpatient psychiatric unit for evaluation and medication stabilization. She is 47 years old. An example of the therapeutic technique of "placing the event in time or sequence" is: -"The day you discovered your son's body, you were arriving home from work. What happened then?" -"Tell me about it" -"I notice you seem uncomfortable"

The day you discovered your son's body, you were arriving home from work. What happened then?

What occurs during the working phase of the nurse-client relationship?

The nurse and client evaluate and modify the goals of the relationship.

Which of the following best describes the role of the nurse in the therapeutic milieu of a psychiatric unit? o The treatment team member who is responsible for management of therapeutic milieu. o The treatment team member who develops the medical diagnosis for all the clients in the unit o The treatment team member who provides for the spiritual and comfot needs of the client and his or her family.

The treatment team member who is responsible for management of therapeutic milieu.

A statement made by a client that indicates the client is experiencing a somatic delusion is: o I see my dead husband everywhere I go o The IRS may audit my taxes o I'm not eating my food, it smells like brimstone o There is an alien growing in my liver

There is an alien growing in my liver.

A client is prescribed lorazepam (Ativan) 0.5 mg qid and 1 mg PRN q8h. The maximum daily dose of lorazepam should not exceed 4 mg QD. This client would be able to receive ______ PRN doses as the maximum number of PRN lorazepam doses.

This client should receive 2 PRN doses. The test taker must recognize that medications are given three times in a 24-hour period when the order reads q8h: 1 mg x 3 = 3 mg. The test taker must factor in the 0.5 mg qid = 2 mg. These two dosages together add up to 5 mg, 1 mg above the maximum daily dose of lorazepam (Ativan). The client would be able to receive only two of the three PRN doses of lorazepam. TEST-TAKING HINT: To answer this question correctly, the test taker must recognize that the timing of standing medication may affect the decision-making process related to administration of PRN medications. In this case, although the PRN medication is ordered q8h, and could be given three times, the standing medication dosage limits the PRN to two doses, each at least 8 hours apart.

Sarah has been living in a shelter with her four children after escaping her abusive husband. Sarah's move-out date is getting closer. Sarah states, I'm afraid to leave here. I'm afraid for my safety and the safety of my children." The nurse's best response is: o This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community. o It's the policy that clients are here only 30 days o You've had a month to come up with a plan o You're husband has probably moved on by now.

This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community.

A despondent client who has just lost her husband of 30 years tearfully states "I'll feel better if I sell my house and move" Which nursing response is appropriate? o I'm confident you know what's best for you. o Tell me why you want to make this change o This may not be the best time for you to make such an important decision

This may not be the best time for you to make such an important decision-crisis situation, requires nurse to be more upfront so no rash decisions are made.

Common Drugs

Thorazine, Haldol, Side effects of drugs 1. Sedation 2. Extrapyramidal- parkinson type symptoms 3. Anticholinergic- red, hot, dry, blind, mad 4. Hypotension- monitor blood pressure 5. Photosensitivity- sensitive to light 6. Agranulocytosis

Preconceptual thought

Thought from 2 to 4 years of age

Intuitive thought

Thought from 4 to 7 years of age

What is the best nursing rationale for holding a debriefing session with client and staff after a take down intervention has taken place on an inpatient unit? o To reinforce the unit rules with the clients o To process the feelings and alleviate fears of undeserved seclusion and restraint o To discuss client problems that led to inappropriate expression of anger

To discuss client problems that led to inappropriate expression of anger

A client is admitted to an inpatient psychiatric unit. After data collection and admission procedures are completed, the nurse states, "I'll try to be available to talk with you when needed and will spend time with you each morning from 10:00 until 10:30 in a specific corner of the dayroom." What is the main rationale for communicating these planned nursing interventions?

To establish a trusting relationship

What is the nurse's most important role in caring for a client with a mental health disorder?

To establish trust and rapport

The client is very hostile toward one of the staff for no apparent reason. The client is probably manifesting: o Transference o Splitting o Countertransference o Resistance

Transference

DEFENSE MECHANISMS - Unconscious Displacement

Transferring feelings to a neutral object (had a bad day at work, go home and yell at family).

Precipitated by unexpected external stressor over which the individual has little or no control and from which he or she feels emotionally overwhelmed and defeated is what kind of crisis? -Dispositional -Psychiatric emergency -Traumatic Stress -Maturational/Developmental

Traumatic stress

Electroconvulsive Therapy (ECT)

Treatment for severe depression B. Pre-procedure preparation 1. Permit 2. NPO after midnight C. Electric current applied to temples; induces grand mal seizure D. Anesthesia and muscle relaxants given E. Patient has no memory of treatment F. ECT safer than medication; more effective than drugs alone G. After procedure 1. Temporary confusion 2. Orient time and place, date and treatment H. Requires many treatments

A patient is diagnosed with schizophrenia. The physician orders Haldol 50 MG BID and Benztropine 1 MG PRN. Which behaviors warrants administration of Benztropine? -Hallucinations -Tremors and shuffling gait - Shouting and screaming

Tremors and shuffling gait

Providing food when the client is hungry, providing a blanket when the client is cold, being consistent in adhering to unit guidelines, and ensuring confidentiality are all ways to enhance __________ with a client. -Trust -Respect -Genuineness

Trust

Mr. J has been diagnosed with Paranoid Schizophrenia. He refuses to eat and told the nurse he knew he was "being poisoned." According to Erikson's theory, in what development stage would you place Mr. J? - Intimacy vs. Isolation - Generativity vs. Self-Absorption -Trust vs. Mistrust -Autonomy vs. Shame and Doubt

Trust vs. Mistrust

Phobia

Types 1. Simple phobia: fear of an object or situation 2. Agoraphobia: fear of open or public places 3. Claustrophobia: fear of enclosed or small places C. Defense mechanisms 1. Repression 2. Displacement D. Interventions 1. Gradual desensitization- step by step 2. Behavior modification- rewarding desired behavior 3. Relaxation techniques 4. Do not force confrontation with objects or situation causing phobia 5. Reasoning doesn't work 6. Administer anti-anxiety meds as ordered

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate. o Universality o Altruism o Imparting of information

Universality

THERAPEUTIC COMMUNICATION - TOOLS Listening

Use nonverbal cues and eye contact, and face the client with proactive body language.

A nurse immediately tells the truth about a medication error that she made. This nurse is following which ethical principle?

Veracity

THERAPEUTIC COMMUNICATION - TOOLS Reflecting

Verbalize ideas back to the client, or feelings conveyed such as, "You say you feel tense when you fight?"

Types of admission

Voluntary a. Any citizen of legal age may seek admission b. Client retains all rights c. Client can refuse treatment 2. Involuntary a. Admission request does not originate with client b. Civil rights may not be retained c. Criteria a. Mentally ill and one or more of the following 1) Danger to self or others 2) Needs treatment 3) Unable to meet basic needs b. Certified by two physicians d. Will be reassessed at regular intervals 3. Criminals who are "not guilty by reason of insanity" do not retain all their rights

Judy has been in the hospital for 3 weeks. she has used Valium "to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse "I don't know if I will make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which of the following is the most appropriate response by the nurse? -Why do you think you have to have drugs to deal with your problems? -Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can. -We will just have to think about some things that you can do to decrease your anxiety without resorting to drugs -Just hang in there. I'm sure everything is going to be okay.

We will just have to think about some things you can do to decrease your anxiety without resorting to drugs

What happens with weight in depression?

Weight gain in mild depression Weight loss in severe depression

Mrs. S asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse? -What do you think would be best for you to do? -Of course you should. Marriage has to be based on truth. -Of course not. That would only make things worse. -I can't tell you what to do. You have to decide for yourself?

What do you think would be best for you to do?

After being diagnosed with pyrophobia, the client states, "I believe this started at the age of 7 when I was trapped in a house fire." When examining theories of phobia etiology, this situation would be reflective of ____________ theory.

When examining theories of phobia etiology, this situation would be reflective of learning theory. Some learning theorists believe that fears are conditioned responses, and they are learned by imposing rewards for certain behaviors. In the instance of phobias, when the individual avoids the phobic object, he or she escapes fear, which is a powerful reward. This client has learned that avoiding the stimulus of fire eliminates fear. TEST-TAKING HINT: To answer this question correctly, the test taker needs to review the different theories of the causation of specific phobias.

Resistance, although potentially present in all stages, is most often found in the following phase: o Preinteraction o Working o Orientation o Termination

Working

Nancy says to the nurse "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which is an empathetic response by the nurse? -You are angry now. This is a normal response to your loss. -I know what you mean. Men can be very insensitive. -I understand completely. My husband divorced me too. -You are depressed now, but you will feel better in time.

You are angry now, this is a normal response to your loss.

Carol, an adolescent, just returned from group therapy and is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse? -What makes you think you will never have any friends? -You're feeling pretty down on yourself right now -I'm sure they didn't mean to hurt your feelings -Why do you feel this way about yourself?

You're feeling pretty down on yourself right now

A recently engaged 22-year-old woman loses her fiancé in a drunken driving accident. She complains of difficulty eating, sleeping, and working. Her reaction is considered:

a crisis caused by traumatic stress.

The nurse enters the room of a client who is visibly shaken. The nurse states, "You seem upset." The client doesn't respond, so the nurse sits down with the client and remains silent. By using this therapeutic communication technique the nurse is exercising her knowledge that silence is:

a means of allowing the client space in which to respond and a way of communicating patience.

What is a crisis?

a sudden event in one's life, during which usual coping mechanisms cannot resolve the problem; the crisis disturbs homeostasis

During a mental status examination, a client may be asked to explain such proverbs as "Don't cry over spilled milk." The purpose is to evaluate the client's ability to think:

abstractly.

Unhealthy personal boundaries are a product of dysfunctional families and a lack of positive role models. Unhealthy boundaries may also be a result of:

abuse and neglect.

Date rape, also known as_______rape, can occur on a first date or when the two individuals have known eachother for some time

acquaintance

which of the following is not considered a characteristic of violent families? -adequate support systems -alcohol abuse -social isolation -abuse of power and control

adequate support system -having adequate support systems is not a characteristic of a violent family. Abuse of power and control, alcohol abuse, and social isolation are characteristics of violent families

The nurse documents, "The client described her husband's abuse in an emotionless tone and with a flat facial expression." This statement describes the client's:

affect.

Define Dispositional Crisis

an acute response to an external situational stressor

Define crisis reflecting psychopathology:

an emotional crisis in which preexisting psychopathology has been instrumental in precipitating the crisis or in which psychopathology significantly impairs or complicates adaptive resolution

which medicaiton classification has been used successfully to treat PTSD?

antidepressants such as Paxil and Zoloft, have been used to treat PTSD

Sedative-hypnotic drugs are indicated for:

anxiety and insomnia.

Nursing care for a client after electroconvulsive therapy (ECT) should include:

assessment of short-term memory loss.

which of the following is a warning indicator form a caregiver that may indicate elder abuse? -inability to manage finances -failure to keep medical appointments -blaming the elder for his or her illness or limitations -lack of toilet facilities

blaming the elder for his or her illness or limitations -indicators of self-neglect are inability to manage finances, failure to keep mecial appointments, and lack of toilet facilites

John has a history of violence and is hospitalized with substance use disorder. One evening, the nurse hears John yelling in the day room. The nurse observes increased agitation, clenched fists, and loud, demanding voice. he is challenging and threatening staff and other clients. The nurse's priority intervention is to: -call for assistance -draw up a syringe of prn haloperidol -ask John if he would like to talk about his anger -tell John that if he does not calm down, he will need to be restrained

call for assistance

Conditions necessary for the development of a positive sense of self-esteem include:

consistent limits.

Amanda's home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions

crisis resulting from traumatic stress

which of the following is the most common trait found in abused wives who stay with their husbands? -dependency -jealousy -emotional immaturity -possessiveness

dependency -dependency is the most common trait seen in abused wives who stay with their husbands. -women often cite personal and financial dependency as reasons why they find leaving an abusive relationship extremely difficult

when the client has a persistnet or recurrent feeling of being detached form his or her mental processes or body, this is documented as which of the following? -dissociative fugue -dissociative identity disorder -dissociative amnesia -depersonalization disorder

depersonalization disorder ---dissociative identity disorder occurs when the client displays two or more distinct identities or personality staes that recurrently take control of his or her behavior. -dissociative fugue occurs when the clients has episodes of suddenly leaving the home or place of work w/o any explanation. -dissociative amnesia occurs when the client cannot remember important personal information. -depersonalization disorder occurs when the client has a persistent or recurrent feeling of being detached from his or her mental processes or body

Jenny reported to the high school nurse that her mother drinks too much. She is drunk every afternoon when Jenny gets home. jenny is afraid to invite friends over because of her mother. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions

dispositional crisis

which type of dissociative disorder involves the clients inability to rememner important personal information

dissociative amnesia --dissociative identity disorder occurs when the client displays two or more distinct identities or personality staes that recurrently take control of his or her behavior. -dissociative fugue occurs when the clients has episodes of suddenly leaving the home or place of work w/o any explanation. -dissociative amnesia occurs when the client cannot remember important personal information. -depersonalization disorder occurs when the client has a persistent or recurrent feeling of being detached from his or her mental processes or body

which of the following dissociative disorders was formerly named multiple personality disorder? -dissociative fugue -dissociative amnesia -dissociative identity disorder -depersonalization disorder

dissociative identity disorder -dissociative identity disorder occurs when the client displays two or more distinct identities or personality staes that recurrently take control of his or her behavior. -dissociative fugue occurs when the clients has episodes of suddenly leaving the home or place of work w/o any explanation. -dissociative amnesia occurs when the client cannot remember important personal information. -depersonalization disorder occurs when the client has a persistent or recurrent feeling of being detached from his or her mental processes or body

Psychotropic medications that block the acetylcholine receptor may result in which of the following side effects? -dry mouth -sexual dysfunction -nausea -priapism

dry mouth

The nurse is caring for a client diagnosed with body dysmorphic disorder. When the client verbalizes disapproval of her physical features, the nurse should:

encourage verbalizations about fears and stressful life situations.

A client is transferred to the locked psychiatric unit from the emergency department after attempting suicide by taking 200 acetaminophen (Tylenol) tablets. Now the client is awake and alert but refuses to speak with the nurse. In this situation, the nurse's first priority is to:

ensure safety by initiating suicide precautions.

which type of male rapist impulsively ices his victims as objects for gratification? -inadequate men -sexual sadists -exploitive predators -men for who anger is displaced

exploitive predators -exploitive predators impulsively use their victims as objects for gratification. -Sexual sadists are aroused by the pain of their victim -inadequate men believe that no woman would voluntarily have sexual relations with them and are obsessed with fantasies about sex

The nurse is using drawing, puppetry, and other forms of play therapy while treating a terminally ill, school-age child. The primary purpose of these techniques is to help the child:

express feelings that he can't articulate.

dissociative amnesia involves episodes of suddenly leaving the home or place of work without any explanation, traveling to another city, and being unable to remember one's past or identity

false

symptoms of posttraumatic stress disorder occur within 1 month after the trauma and do not persist longer than 4 weeks

false

A patient diagnosis with dysthymic disorder. Which symptom should the nurse classify as an affective symptom of this disorder? -Gloomy and pessimistic outlook on life -Low energy level -Difficulty concentration -Social isolation with a focus on self

gloomy, pessimistic outlook on life

An appropriate way for the nurse to set limits for a newly admitted client who puts out cigarettes on the floor of the room designated for smoking is to:

hand the client an ashtray and state that he must use it or he won't be allowed to smoke.

which of the following nursing interventions would be the most appropriate to prevent a client from becoming violent? -leaving the client alone until the client can talk about feelings -palce the client in seclusion -helping the client identify and express feelings of anxiety and anger

helping the client identify and express feelings of anxiety and anger -the most appropriate nursing intervention for a client who may become violent is to help him or her identify and express feelings of anxiety and anger. The other intervention would not be the most appropriate for this client situation

in violent families, which normal sage naven may be the most dangerous place for victims

home -the home, which is normally a safe haven of love and protection, may be the most dangerous place for victims

Functions of a therapeutic group include all of the following except: -support -comaraderie -informational -governance -hope

hope

Mental health laws in each state specify when restraints can be used and which type of restraints are allowed. Most laws stipulate that restraints can be used:

if the client poses a present danger to himself or others.

Define Rapport

implies special feeli8ngs on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yalom's curative group factors does this illustrate? o Instillation of hope o Catharisis o Universality

instillation of hope

Nurse Jones is the leader of a bereavement group for widows. Nancy is a new member. She listens to the group and sees that Jane has been a widow for 5 years now. Jane has adjusted well, and Nancy thinks maybe she can too. This is an example of which curative factor? -universality -imitative behavior -instillation of hope -imparting of information

instillation of hope

Erikson described the psychosocial tasks of the developing person in his theoretical model. He proposed that the primary developmental task of the young adult (ages 18 to 25) is:

intimacy versus isolation.

A client with antisocial personality disorder smokes where it's prohibited and refuses to follow other unit and facility rules. The client gets others to do his laundry and other personal chores, splits the staff, and will work only with certain nurses. The plan of care for this client should focus primarily on:

isolating the client to decrease contact with easily manipulated clients.

Neologism

make up new words

which of the following is a possible indicator of neglect? -hesitance to talk openly -anger -malnourishment not related to a known illness

malnourishment not related to a known illness -malnourishment is a possible indicator of neglect. Helplessness, hesitance to talk openly, and anger are psychological or emotional indicators of abuse

Ginger, age 19 and only child, left 3 months ago to attend college of her choice 500 miles away from home. It is Ginger's first time away. She has difficulty making decisions and will not undertake anything new without first consulting her mother. They talk on the phone almost every day. Ginger has recently started having anxiety attacks. She consults the nurse practitioner in the student health center. This type of crisis is called: -crisis resulting from traumatic stress -maturational/developmental crisis -dispositional crisis -crisis of anticipated life transitions

maturational/developmental crisis

Sandra is the nurse leader of a supportive therapeutic group for individuals with anxiety disorders. In this group, Nancy talks incessantly. When someone else tries to make a comment, she refuses to allow him or her to speak. What type of member role is Nancy assuming in this group? -aggressor -monopolizer -blocker -seducer

monopolizer

Define Maturation/developmental crisis:

occurs in response to a situation that triggers emotions related to unresolved conflicts in one's life

Immediately after ECT, which position is best for the client? -On their side -In high fowler's -Trendelenburg's -Prone position

on side, to prevent aspiration

S/S Bulimia

overeat and then vomit teeth decay laxatives, diuretics strict dieter, fasts, exercises binges are alone and in secret normal weight with both they feel like they are in control

Characteristics of aggression include:

pacing, restlessness, verbal/physical threats, threats of homicide or suicide, loud voice, argumentative, tense facial expression and body language, increased agitation with overreaction to environmental stimuli, panic anxiety, leading to misinterpretation of the environment, disturbed thought process, suspiciousness, and angry mood, often disproportionate to the situation

Nurse discovers clients suicide note that details the time, place and means. What is the priority intervention? -Placing client on one to one suicide precautions -Administer lorazepam (Ativan) prn, because the client is angry at the exposure of the plan -Calling an emergency treatment team meeting, because the client's threat must be addressed -Establishing room restrictions, because the client's threat is an attempt to manipulate the staff

place client on one to one suicide precautions

Touching other people without their permission, reading someone else's mail, and using personal possessions without asking permission are all examples of:

poor boundaries.

The nurse's goal in crisis intervention is to provide:

problem-solving techniques and structured activities.

A crisis situation in which general functioning has been severely impaired and the individual rendered incompetent or unable to assume personal responsibility is called what?

psychiatric emergency

which type of abuse includes name calling and belittling? -physcial abuse -psychological abuse -sexual abuse -sodomy

psychological abuse -name calling and belittling are examples of psychological abuse. -Physical abuse ranges from shoving and pushing to severe battering and choking. -sexual abuse includes assaults during sexual relations such as pulling hair, slapping, hitting, and rape. -Sodomy is anal intercourse

The goal of crisis intervention is:

psychological resolution of the immediate crisis.

a client comes to the emergency department after being attacked and sexually assualted. What is the most accurate nursing diagnosis for this client? -fear -hopelessness -rape-trauma syndrome -anxiety

rape-trauma syndrome -this refers to both the acute and long-term phases experienced by the victim of sexual assault. Specific nursing interventions can be planned based on this diagnosis. The rape victim may experience fear, anxiety, and hopelessness, but these are not specific diagnoses.

The charge nurse in an acute care setting assigns a client, who is on one-to-one suicide precautions, to a psychiatric aide. This assignment is considered:

reasonable nursing practice because one-to-one requires the total attention of a staff member.

Compulsion is...

recurrent acts

Obsession is...

recurrent thoughts

A client with obsessive-compulsive disorder tells the nurse that he must check the lock on his apartment door 25 times before leaving for an appointment. The nurse knows that this behavior represents the client's attempt to:

reduce anxiety.

Antabuse

rehabilitation drug deterrent to drinking -has to sign consent -must stay away from all alcohol including medications like cough syrups, aftershaves, colognes, etc.

A client refuses his evening dose of haloperidol (Haldol) then becomes extremely agitated in the day room while other clients are watching television. He begins cursing and throwing furniture. The nurse's first action is to:

remove all other clients from the day room.

the client is exhibiting intense anger toward the nursing staff after being told that he cannot leave his room. He has previously thrown articles at his family member when he does not get his way. Which of ht e following nursing diagnoses would be the most appropriate to include in the nurisng care plan? -impaired socail interaction -disturbed thought processes -risk for other-directed violence -risk for self-directed violence

risk for other-dirtied violence -a history of violence, threats, violent antisocial behavior, and threatening body language all suggest the nursing diagnosis of risk for other-directed violence

which of the following nursing diagoses has the highest priority for the client diagnosed with PTSD? -ineffective coping -chronic low-self-esteem -risk for self-mutilation -powerlessness

risk of self-mutilation -this is due to the safety issue

A nurse admits an older client with memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini mental status exam? -rule out bipolar disorder -rule out schizophrenia -rule out senile dementia -rule out personality disorder

rule out senile dementia

which of the folowing is a priority intervention when dealing with child abuse or neglect?

safety -the first part of treatment for child abuse or neglect is to ensure the childs safety and well-being

which of the following is a priority intervention in the treatment of the client diagnosed w/ PTSD?

safety of the client -promoting the client safety is the priority intervention for the client diagnosed with PTSD. Thenurse continually must assess the clients potential for self-harm or suicide and take action immediately

The basis for building a strong therapeutic nurse-client relationship begins with the nurse's:

self-awareness and understanding.

in toddler, which injury is most likely the result of child abuse? -a 1-inch forehead laceration -a hematoma on the occipital region of the head -a small, isolated briuse on the right lower extremity -several small, circular burns on the childs back

several small circular burns on the childs back -small circular burns on a childs back are no accidnet and may be from cigarettes. Toddlers are injury prone b/c of their developmental stage, and falls are frequent b/c of their unsteady gait; head injuries are not uncommon. A small area of eccymosis is not suspicious in this age group

exploitation of children is considered which type of abuse? -sexual abuse -neglect -physical abuse -emotional abuse

sexual abuse -sexual abuse can involve exploitation, such as making, promoting, or selling pornography involving minors, and coercion of minors to participate in obscene acts. -neglect is malicious or ignorant withholding of physical, emotional, or educational necessities for the child's well-being. -physical abuse includes burning, biting, or cutting a child -emotional abuse includes verbal assaults, such as blaming, name calling, and using sarcasm

Common adverse effects of electroconvulsive therapy (ECT) include:

short-term memory loss.

Treatment for Bulimia

sit with clients at meals and observe for 1 hour after allow 30 minutes for meals take focus off the food they may be angry that you have taken the control away family problems are usually the cause self-esteem building is important

the majority of perpetrators of elder abuse include which of the following populations?

spouses -nearly 60% of the perpetrators of elder abuse are spouses, 20% are adult children, and 20% are others such as siblings, grandchildren, and boarders

A client comes to the emergency department while experiencing a panic attack. The nurse should respond to a client having a panic attack by:

staying with the client until the attack subsides

Reality therapy emphasizes: - decrease visual and auditory hallucinations - personal responsibility over choices - confronting unconscious conflicts - increasing assertive behavior

tensing and relaxing groups of muscles

According to Freud's psychosexual theory, the ego has several functions. The primary function of the ego is to:

test reality and direct behavior.

a parent brings a preschooler to the emergency department for treatment of a dislocated shoulder, which allegedly happened when the child fell down the stairs. Which action should make the nurse supect that the child was abused? -the child cries uncontrollably throughout the examination -the child pulls away from the contact with the doctor -the child does not cry when the shoulder is examined

the child does not cry when the shoulder is examined -a characteristic behavior of abused children is lack of crying when they undergo a painful procedure or are examined by a health care professional. Therefore, the nurse should suspect child abuse. Crying throughout the examination, pulling away from the physician, and not making eye contact with the nurse are normal behaviors for preschoolers

when interviewing the parents of an injured child, which sign is the strongest indicator that child abuse may be a problem?

the injury is not consistent with the history or the childs age -when the childs injuries are inconsistent witht he history given or impossible b/c of the childs age and development stage, the emergency nurse should be suspicious that child abuse is occuring. - the parents may tell different stories cause their perception may be difference regarding what happended. If they change their stroty when different health care workers ask the same question, this is a clue that child abuse may be a problem. -child abuse happens in all socioeconomic groups. -parents may argue and be demanding b/c of the stress of having an injured child

Which of the following behaviors suggest a possible breach of professional boundaries? Select all that apply. -The nurse repeatedly requests to be assigned to a specific client -The nurse shares the details of her divorce with the client -The nurse makes arrangements to meet the client outside of the therapeutic environment -The nurse shares how she dealt with a similar difficult situation

the nurse repeatedly requests to be assigned to a specific client, the nurse shares details of her divorce with the client, the nurse makes arrangements to meet the client outside the therapeutic environment

to preserve evidence from a possible rape with no report of oral sex, the female victim should avoid all of the following except -shower -brushing her teeth -the victim should avoid all of thses activities prior to physical examination -douching

the victim should avoid all of these activities prior to physical examination

Depression and suicidal behavior are common in surveyors of abuse

true

Intergenerational transmission process suggests that family violence is a pattern of behavior learned form on generation to the next

true

the classification of sodomy as a crime can impede same-sex victims reporting partner abuse?

true

what percentage of victims of intimate violence report that alcohol was involved in the violent incident? -75% -1/4 -2/3 1/2

two thirds of victims of intimate violence report that alcohol was involved in the violent incident

The terms "judgment" and "insight" are sometimes used incorrectly. Insight is the ability to:

understand the nature of one's problem or situation.

The nurse leader is explaining about group "curative factors" to members of the group. She tells the group that group situations are beneficial because members can see that they are not alone in their experiences. This is an example of which curative factor? -alturism -imitative behavior -universality -imparting of information

universality

the rate or PTSD- post traumatic stress disorder occurs in rape victims at a rate of -80% -70% -50% -60%

victims of rape have one of the highest rates of PTSD, approximately 70%

which of the following is an inaccurate picture of the cycle of abuse that occurs over time? -severity of the injuries worsen -violent episodes are less frequent -violent episodes are more frequent -the period of remorse disappears

violent episodes are less frequent -over time, the violent episodes are more frequent, the period of remorse disappears altogether, and the level of violence and severity of injuries worsen

A client in the emergency department expresses suicidal ideation and feelings of worthlessness. He has a family history of suicide. The nurse is collecting data on the client. The most important factor to consider is:

whether the client has an active suicide plan and the means to carry it out.

A nurse would expect a client diagnosed with schizotypal personality disorder to exhibit which characteristic? A. The client keeps to self and has few, if any relationships. B. The client has many brief but intense relationships. C. The client experiences incorrect interpretations of external events. D. The client exhibits lack of tender feelings toward others.

ANS: C Clients who are diagnosed with schizotypal personality disorder experience odd beliefs or magical thinking that influences behavior and is inconsistent with cultural norms. This results in incorrect interpretations of external events.

A mother tells her teenager that in order for college tuition to be paid, the teenager must quit smoking. They develop a written agreement stipulating time frames and consequences. This is an example of which technique of behavior modification? A. Shaping B. Modeling C. Contracting D. Premack principle

ANS: C Contracting occurs when the mother and teenager together develop a written agreement related to desired behavior (smoking cessation) and positive reinforcement (paid college tuition).

Which response is known to be a physiological manifestation of relaxation? A. Increased levels of norepinephrine B. Pupil dilation C. Reduced metabolic rate D. Increased levels of blood sugar

ANS: C During relaxation, the metabolic rate decreases.

An unemployed college graduate is experiencing severe anxiety over not finding a teaching position and has difficulty with independent problem solving. During a routine physical examination, the graduate confides in the clinic nurse. Which is the most appropriate nursing intervention? A. Encourage the student to use the alternative coping mechanism of relaxation exercises. B. Complete the problem-solving process for the client. C. Work through the problem-solving process with the client. D. Encourage the client to keep a journal.

ANS: C During times of high anxiety and stress, clients will need more assistance in problem solving and decision making.

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

ANS: C Excessive vomiting and laxative or diuretic abuse may lead to problems with dehydration and electrolyte imbalance. The nurse should attribute this client's fainting to the loss of alkaline stool due to laxative abuse which would lead to a relative metabolic acidotic condition.

During hospitalization, an attention-seeking client has repeatedly cut self. After threatening to cut self again, the nurse states, "Here are some Band-Aids so you won't bleed on the sheets." Which is the underlying reason for this nurse's response? A. The nurse is using an aversive stimulus in response to the client's manipulative cutting behavior. B. The nurse is using negative reinforcement in response to the client's behavior. C. The nurse is minimizing reinforcement of the client's manipulative behavior with the goal of extinction. D. The nurse lacks empathy for the client's recurring self-injurious behavior.

ANS: C Extinction is the gradual decrease in frequency or disappearance of a response when a positive reinforcement is withheld. The nurse is withholding attention to the client who is exhibiting manipulative, attention-seeking behavior. The lack of positive response (attention) should cause extinction of the undesired behavior.

A nursing student states, "The instructor gave me a failing grade on my research paper. I know it's because the instructor doesn't like me." Which cognitive error does a nurse recognize in this student's statement? A. Dichotomous thinking B. Catastrophic thinking C. Magnification D. Overgeneralization

ANS: C In magnification, negative events are exaggerated. It is irrational to assume that there is a relationship between failing a paper and being personally disliked by the instructor.

A client asks a nurse what is the difference between modified (or passive) progressive relaxation and progressive relaxation. Which is the most appropriate nursing reply? A. "There is an increased focus on deep breathing in the modified version." B. "Only large muscle groups are targeted in the modified version." C. "There is no muscle contraction in the modified version." D. "The modified version is for clients with preexisting cardiovascular disease."

ANS: C In modified (or passive) progressive relaxation, the muscles are not tensed before relaxing them.

A labor and delivery nurse listens to a new mother relate thoughts regarding her healthy, 8-pound baby girl. Which statement by the mother indicates to the nurse the use of the cognitive error, selective abstraction? A. "My baby is refusing to nurse, and I know it's because she hates me." B. "My baby needs to be under the 'bilirubin lights,' but I resent her time away from me." C. "My baby is wonderful, but I'm upset and depressed because I wanted twins." D. "My baby has an elevated bilirubin, and I know it will get worse and she will die."

ANS: C In selective abstraction the individual focuses attention on evidence that is viewed as a failure (not having twins) rather than any successes (a healthy baby) that have occurred.

A recovering alcoholic relapses and drinks a glass of wine. The client presents in the emergency department (ED) experiencing severe throbbing headache, tachycardia, flushed face, dyspnea, and continuous vomiting. What may these symptoms indicate to the ED nurse? A. Alcohol poisoning B. Cardiovascular accident (CVA) C. A reaction to disulfiram (Antabuse) D. A reaction to tannins in the red wine

ANS: C Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can produce a good deal of discomfort for the individual. Symptoms may include but are not limited to flushed skin, throbbing in the head and neck, respiratory difficulty, dizziness, nausea and vomiting, confusion, hypotension, and tachycardia.

A client states, "I hear voices that tell me that I am evil." Which outcome related to these symptoms should the nurse expect this client to accomplish by discharge? A. The client will verbalize the reason the voices make derogatory statements. B. The client will not hear auditory hallucinations. C. The client will identify events that increase anxiety and illicit hallucinations. D. The client will positively integrate the voices into the client's personality structure.

ANS: C It is unrealistic to expect the client to completely stop hearing voices. Even when compliant with antipsychotic medications, clients may still hear voices. It would be realistic to expect the client to associate stressful events with an increase in auditory hallucinations. By this recognition the client can anticipate symptoms and initiate appropriate coping skills.

The nurse should recognize that improvement in concentration and attention occurs with which relaxation technique? A. Biofeedback B. Physical exercise C. Meditation D. Mental imagery

ANS: C Meditation has been found to improve concentration and attention.

Which positive physical benefit would relaxation provide for a client who has experienced stress-related asthma? A. Decreased neurotransmitters B. Decreased blood pressure C. Increased oxygen saturation levels D. Decreased alpha brain waves

ANS: C Relaxation results in increased lung capacity and stable respiratory rate leading to increased oxygen saturation levels.

A client reports, "My friend panicked at the site of spiders. Her therapist used gradual exposure to spiders that initially made her increasingly more anxious." Which technique was the friend's therapist most likely using? A. Extinction B. Covert sensitization C. Systematic desensitization D. Reciprocal inhibition

ANS: C Systematic desensitization is a treatment for phobias in which a phobic individual is gradually exposed to increasing amounts of the phobic stimulus while practicing relaxation techniques. Eventually, the phobic stimulus causes little or no anxiety.

The nurse believes that a client being admitted for a surgical procedure may have a drinking problem. How should the nurse further evaluate this possibility? A. By asking directly if the client has ever had a problem with alcohol B. By holistically assessing the client using the CIWA scale C. By using a screening tool such as the CAGE questionnaire D. By referring the client for physician evaluation

ANS: C The CAGE questionnaire is a screening tool used to determine the diagnosis of alcoholism. This questionnaire is composed of four simple questions. Scoring two or three "yes" answers strongly suggests a problem with alcohol.

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which is the appropriate nursing response? A. "Why do you assume responsibility for his behaviors?" B. "Codependency is a typical behavior of spouses of alcoholics." C. "Your husband needs to deal with the consequences of his drinking." D. "Do you understand what the term 'enabler' means?"

ANS: C The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Partners of clients with substance abuse must come to realize that the only behavior they can control is their own.

When questioned about bruises, a woman states, "It was an accident. My husband just had a bad day at work. He's being so gentle now and even brought me flowers. He's going to get a new job, so it won't happen again." This client is in which phase of the cycle of battering? A. Phase I: The tension-building phase B. Phase II: The acute battering incident phase C. Phase III: The honeymoon phase D. Phase IV: The resolution and reorganization phase

ANS: C The client is in the honeymoon phase of the cycle of battering. In this phase, the batterer becomes extremely loving, kind, and contrite. Promises are often made that the abuse will not happen again.

There is one bed available on an inpatient psychiatric unit. For which client should a nurse advocate emergency commitment? A. An individual who is persistently mentally ill and evicted from an apartment B. An individual treated in the emergency department (ED) for generalized anxiety disorder C. An individual who is delusional and has a plan to kill his wife D. An individual who rates mood 4/10 and is participating in a no-harm safety plan

ANS: C The criteria for involuntary emergency commitment include danger to self and/or others. Of the four clients considered, the client who is delusional and has a plan to kill his wife meets this criterion as a danger to others.

A client diagnosed with alcohol abuse joins a community 12-step program and states, "My life is unmanageable." How should the nurse interpret this client's statement? A. The client is using minimization as an ego defense. B. The client is ready to sign an Alcoholics Anonymous contract for sobriety. C. The client has accomplished the first of 12 steps advocated by Alcoholics Anonymous. D. The client has met the requirements to be designated as an Alcoholics Anonymous sponsor.

ANS: C The first step of the 12-step program advocated by Alcoholics Anonymous is that clients must admit powerlessness over alcohol and that their lives have become unmanageable.

A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? A. Provide objective evidence, that violence is unwarranted. B. Initially restrain the client to maintain safety. C. Use clear, calm statements and a confident physical stance. D. Empathize with the client's paranoid perceptions.

ANS: C The most appropriate nursing intervention is to use clear, calm statements and to assume a confident physical stance. A calm attitude avoids escalating the aggressive behavior and provides the client with a feeling of safety and security. It may also be beneficial to have sufficient staff on hand to present a show of strength.

A client diagnosed with schizophrenia states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing reply? A. "Did you take your medicine this morning?" B. "You are not going to hell. You are a good person." C. "I'm sure the voices sound scary. The devil is not talking to you. This is part of your illness." D. "The devil only talks to people who are receptive to his influence."

ANS: C The most appropriate reply by the nurse is to reassure the client with an accepting attitude while not reinforcing the hallucination. Reminding the client that "the voices" are a part of his or her illness is a way to help the client accept that the hallucinations are not real.

A woman comes to an emergency department with a broken nose and multiple bruises after being beaten by her husband. She states, "The beatings have been getting worse, and I'm afraid that next time he might kill me." Which is the appropriate nursing reply? A. "Leopards don't change their spots, and neither will he." B. "There are things you can do to prevent him from losing control." C. "Let's talk about your options so that you don't have to go home." D. "Why don't we call the police so that they can confront your husband with his behavior?"

ANS: C The most appropriate reply by the nurse is to talk with the client about options so that the client does not have to return to the abusive environment. It is essential that clients make decisions independently without the nurse being the "rescuer." Imposing judgments and giving advice is nontherapeutic.

Parents ask a nurse how they should reply when their child, diagnosed with paranoid schizophrenia, tells them that voices command him to harm others. Which is the appropriate nursing reply? A. "Tell him to stop discussing the voices." B. "Ignore what he is saying, while attempting to discover the underlying cause." C. "Focus on the feelings generated by the hallucinations and present reality." D. "Present objective evidence that the voices are not real."

ANS: C The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should maintain an attitude of acceptance to encourage communication but should not reinforce the hallucinations by exploring details of content. It is inappropriate to present logical arguments to persuade the client to accept the hallucinations as not real.

A client diagnosed with antisocial personality disorder comes to a nurses' station at 11:00 p.m. requesting to phone a lawyer to discuss filing for a divorce. The unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing reply is most appropriate? A. "Go ahead and use the phone. I know this pending divorce is stressful." B. "You know better than to break the rules. I'm surprised at you." C. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." D. "The decision to divorce should not be considered until you have had a good night's sleep."

ANS: C The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. Because of the probability of manipulative behavior in this client population, it is imperative to maintain consistent application of rules.

An aging client diagnosed with chronic schizophrenia takes an antipsychotic and a beta-adrenergic blocking agent (propranolol) for hypertension. Understanding the combined side effects of these drugs, which statement by a nurse is most appropriate? A. "Make sure you concentrate on taking slow, deep, cleansing breaths." B. "Watch your diet and try to engage in some regular physical activity." C. "Rise slowly when you change position from lying to sitting or sitting to standing." D. "Wear sunscreen and try to avoid midday sun exposure."

ANS: C The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, this side effect places the client at risk for developing orthostatic hypotension.

A brother calls to speak to his sister who has been admitted to the psychiatric unit. The nurse connects him to the community phone and the sister is summoned. Later the nurse realizes that the brother was not on the client's approved call list. What law has the nurse broken? A. The National Alliance for the Mentally Ill Act B. The Tarasoff Ruling C. The Health Insurance Portability and Accountability Act D. The Good Samaritan Law

ANS: C The nurse has violated the Health Insurance Portability and Accountability Act (HIPAA) by revealing that the client had been admitted to the psychiatric unit. The nurse should not have provided any information without proper consent from the client.

A nursing instructor is presenting content on the provisions of the nurse practice act as it relates to their state. Which student statement indicates a need for further instruction? A. "The nurse practice act provides a list of definitions of important terms including the definition of nursing." B. "The nurse practice act lists education requirements for licensure and reciprocity." C. "The nurse practice act contains detailed statements that describe the scope of practice for registered nurses (RNs)." D. "The nurse practice act lists the general authority and powers of the state board of nursing."

ANS: C The nurse practice act contains broad, not detailed, statements that describe the scope of practice for various levels of nursing (APN, RN, LPN), not just for the RN. This student statement indicates a need for further instruction.

A client with chronic lower back pain states, "My nurse practitioner told me that acupuncture may enhance the effect of the medications and physical therapy prescribed." What type of therapy is the nurse practitioner recommending? A. Alternative therapy B. Physiotherapy C. Complementary therapy D. Biopsychosocial therapy

ANS: C The nurse practitioner is recommending a type of complementary therapy. Acupuncture is a healing technique based on ancient Chinese philosophies which has gained wide acceptance in the United States by both patients and physicians.

Family dynamics are thought to be a major influence in the development of anorexia nervosa. Which information related to a client's home environment should a nurse associate with the development of this disorder? A. The home environment maintains loose personal boundaries. B. The home environment places an overemphasis on food. C. The home environment is overprotective and demands perfection. D. The home environment condones corporal punishment.

ANS: C The nurse should assess that a home environment that is overprotective and demands perfection may be a major influence in the development of anorexia nervosa. In adolescence, distorted eating patterns may represent a rebellion against controlling and demanding parents.

Upon admission for symptoms of alcohol withdrawal a client states, "I haven't eaten in 3 days." Assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97F (36C) with dry skin, dry mucous membranes, and poor skin turgor. What should be the priority nursing diagnosis? A. Knowledge deficit B. Fluid volume excess C. Imbalanced nutrition: less than body requirements D. Ineffective individual coping

ANS: C The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements. The client is exhibiting signs and symptoms of malnutrition as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? A. According to psychoanalytic theory, depression is a result of anger turned inward. B. According to object-loss theory, depression is a result of abandonment. C. According to learning theory, depression is a result of repeated failures. D. According to cognitive theory, depression is a result of negative perceptions.

ANS: C The nurse should assess that this client's depressive symptoms may have resulted from repeated failures. This assessment was based on the principles of learning theory. Learning theory describes a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed.

A highly emotional client presents at an outpatient clinic appointment wearing flamboyant attire, spiked heels, and theatrical makeup. Which personality disorder should a nurse associate with this assessment data? A. Compulsive personality disorder B. Schizotypal personality disorder C. Histrionic personality disorder D. Manic personality disorder

ANS: C The nurse should associate histrionic personality disorder with this assessment data. Individuals diagnosed with histrionic personality disorder tend to be self-dramatizing, attention seeking, overly gregarious, and seductive. They often use manipulation and exhibitionism as a means of gaining attention.

A client diagnosed with paranoid schizophrenia states, "My psychiatrist is out to get me. I'm sad that the voice is telling me to stop him." What symptom is the client exhibiting, and what is the nurse's legal responsibility related to this symptom? A. Magical thinking; administer an antipsychotic medication B. Persecutory delusions; orient the client to reality C. Command hallucinations; warn the psychiatrist D. Altered thought processes; call an emergency treatment team meeting

ANS: C The nurse should determine that the client is exhibiting command hallucinations. The nurse's legal responsibility is to warn the psychiatrist of the potential for harm. A client who is demonstrating a risk for violence could potentially become physically, emotionally, and/or sexually harmful to others or to self.

A client diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication should a nurse expect a physician to order to address this type of symptom? A. Haloperidol (Haldol) to address the negative symptom B. Clonazepam (Klonopin) to address the positive symptom C. Risperidone (Risperdal) to address the positive symptom D. Clozapine (Clozaril) to address the negative symptom

ANS: C The nurse should expect the physician to order risperidone (Risperdal) to address the positive symptoms of schizophrenia. Risperidone (Risperdal) is an atypical antipsychotic used to reduce positive symptoms, including disturbances in content of thought (delusions), form of thought (neologisms), or sensory perception (hallucinations).

A nursing student asks an emergency department nurse, "Why does a rapist use a weapon during the act of rape?" Which nursing reply is most accurate? A. "A weapon is used to increase the victimizer's security." B. "A weapon is used to inflict physical harm." C. "A weapon is used to terrorize and subdue the victim." D. "A weapon is used to mirror learned family behavior patterns."

ANS: C The nurse should explain that a rapist uses weapons to terrorize and subdue the victim. Rape is the expression of power and dominance by means of sexual violence. Rape can occur over a broad spectrum of experience from violent attack to insistence on sexual intercourse by an acquaintance or spouse.

A client has flashbacks of sexual abuse by her uncle. She had not been aware of these memories until recently, when she became sexually active with her boyfriend. A nurse should identify this experience as which part of Sullivan's concept of the self-system? A. The "good me" B. The "bad me" C. The "not me" D. The "bad you"

ANS: C The nurse should identify a client remembering sexual abuse when becoming sexually active with her boyfriend as experiencing the "not me" part of the personality. According to Sullivan, the "not me" part of the personality develops in response to situations that produced intense anxiety in childhood.

Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? A. Interpreting the compliment as a secret code used to increase personal power B. Feeling the compliment was well deserved C. Being grateful for the compliment but fearing later rejection and humiliation D. Wondering what deep meaning and purpose are attached to the compliment

ANS: C The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the comment but would fear later rejection and humiliation. Individuals with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

A lethargic client is diagnosed with major depressive disorder. After taking antidepressant therapy for 6 weeks, the symptoms have not resolved. Which nutritional deficiency should a nurse identify as potentially contributing to the client's symptoms? A. Vitamin A deficiency B. Vitamin C deficiency C. Iron deficiency D. Folic acid deficiency

ANS: C The nurse should identify that an iron deficiency could contribute to depression. Iron deficiencies can result in feelings of chronic fatigue. Iron should be consumed by eating meat, fish, green leafy vegetables, nuts, eggs, and enriched bread and pasta.

A client's altered body image is evidenced by claims of "feeling fat" even though the client is emaciated. Which is the appropriate outcome criterion for this client's problem? A. The client will consume adequate calories to sustain normal weight. B. The client will cease strenuous exercise programs. C. The client will perceive an ideal body weight and shape as normal. D. The client will not express a preoccupation with food.

ANS: C The nurse should identify that the appropriate outcome for this client is to perceive an ideal body weight and shape as normal. Additional goals include accepting self based on self-attributes instead of appearance and to realize that perfection is unrealistic.

A father of a 5-year-old demeans and curses at his child for disobedience. In turn, when upset, the child uses swear words in kindergarten. A school nurse recognizes this behavior as unsuccessful completion of which stage of development according to Peplau? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: C The nurse should identify that the child using swear words in kindergarten has not successfully completed the "Identifying oneself" stage according to Peplau's interpersonal theory. During this stage of early childhood, a child learns to structure self-concept by observing how others interact with him or her.

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

ANS: C The nurse should identify that when a client uses healthy coping mechanisms that decrease anxiety, positive behavioral change is demonstrated. Stress and anxiety can increase bingeing which is followed by inappropriate compensatory behaviors.

Looking at a slightly bleeding paper cut, the client screams, "Somebody help me, quick! I'm bleeding. Call 911!" A nurse should identify this behavior as characteristic of which personality disorder? A. Schizoid personality disorder B. Obsessive-compulsive personality disorder C. Histrionic personality disorder D. Paranoid personality disorder

ANS: C The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals diagnosed with this disorder tend to be self-dramatizing, attention seeking, over gregarious, and seductive.

A 6-year-old boy uses his father's flashlight to explore his 3-year-old sister's genitalia. According to Freud, in which stage of psychosocial development should a nurse identify this behavior as normal? A. Oral B. Anal C. Phallic D. Latency

ANS: C The nurse should identify this behavior as normal because the 6-year-old client who focuses on genital organs is in the phallic stage of Freud's stages of psychosexual stages of development. Children in the phallic stage of development focus on genital organs and develop a sense of sexual identity. Identification with the same-sex parent also occurs at this stage.

During group therapy, a client diagnosed with chronic alcohol dependence states, "I would not have boozed it up if my wife hadn't been nagging me all the time to get a job. She never did think that I was good enough for her." How should a nurse interpret this statement? A. The client is using denial by avoiding responsibility. B. The client is using displacement by blaming his wife. C. The client is using rationalization to excuse his alcohol dependence. D. The client is using reaction formation by appealing to the group for sympathy.

ANS: C The nurse should interpret that the client is using rationalization to excuse his alcohol dependence. Rationalization is the defense mechanism by which people avoid taking responsibility for their actions by making excuses for the behavior.

A client diagnosed with schizoaffective disorder is admitted for social skills training. Which information should be taught by the nurse? A. The side effects of medications B. Deep breathing techniques to decrease stress C. How to make eye contact when communicating D. How to be a leader

ANS: C The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients in communicating needs and maintaining connectedness.

A client diagnosed with psychosis NOS (not otherwise specified) tells a nurse about voices telling him to kill the president. Which nursing diagnosis should the nurse prioritize for this client? A. Disturbed sensory perception B. Altered thought processes C. Risk for violence: directed toward others D. Risk for injury

ANS: C The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices telling him to kill someone is at risk for responding and reacting to the command hallucination. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

A client who will be receiving electroconvulsive therapy (ECT) must provide informed consent. Which situation should cause a nurse to question the validity of the informed consent? A. The client is paranoid. B. The client is 87 years old. C. The client incorrectly reports his or her spouse's name, date, and time of day. D. The client relies on his or her spouse to interpret the information.

ANS: C The nurse should question the validity of informed consent when the client incorrectly reports the spouse's name, date, and time of day. This indicates that this client is disoriented and may not be competent to make informed choices.

A married, 26-year-old client works as a schoolteacher. She and her husband have just had their first child. A nurse should recognize that this client is successfully accomplishing which stage of Erikson's developmental theory? A. Industry versus inferiority B. Identity versus role confusion C. Intimacy versus isolation D. Generativity versus stagnation

ANS: C The nurse should recognize that a 26-year-old client who is married and has a child has successfully accomplished the intimacy versus isolation stage of Erikson's developmental theory. The intimacy versus isolation stage of young adulthood involves forming lasting relationships. Achievement of this tasks results in the capacity for mutual love and respect.

Herbs and plants can be useful in treating a variety of conditions. Which herbal treatment should a nurse determine as appropriate for a client experiencing frequent migraine headaches? A. Saint John's wort combined with an antidepressant B. Ginger root combined with a beta-blocker C. Feverfew, used according to directions D. Kava-kava added to a regular diet

ANS: C The nurse should recognize that the appropriate herbal treatment for a client experiencing frequent migraine headaches is feverfew. Feverfew is effective in either fresh leaf or freeze-dried form. It is considered to be safe in reasonable doses.

A client who has been raped is crying, pacing, and cursing her attacker in an emergency department. Which behavioral defense should a nurse recognize? A. Controlled response pattern B. Compounded rape reaction C. Expressed response pattern D. Silent rape reaction

ANS: C The nurse should recognize that this client is exhibiting an expressed response pattern. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension. In the controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen.

Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? A. The client experiences unwanted, intrusive, and persistent thoughts. B. The client experiences unwanted, repetitive behavior patterns. C. The client experiences inflexibility and lack of spontaneity when dealing with others. D. The client experiences obsessive thoughts that are externally imposed.

ANS: C The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

A morbidly obese client is prescribed an anorexiant medication. The nurse should prepare to teach the client about which medication? A. Diazepam (Valium) B. Dexfenfluramine (Redux) C. Sibutramine (Meridia) D. Pemoline (Cylert)

ANS: C The nurse should teach the client that sibutramine (Meridia) is an anorexiant medication prescribed for morbidly obese clients. The mechanism of action in the control of appetite appears to occur by inhibiting the neutotransmitters serotonin and norepinephrine. Withdrawal from anorexiants can result in rebound weight gain, lethargy, and depression.

A group of nurses are discussing how food is used in their families and the effects this might have on their ability to work with clients diagnosed with eating disorders. Which of these nurses will probably be most effective with these clients? A. The nurse who understands the importance of three balanced meals a day B. The nurse who permits children to have dessert only after finishing the food on their plate C. The nurse who refuses to engage in power struggles related to food consumption D. The nurse who grew up poor and frequently did not have enough food to eat

ANS: C The nurse who refuses to engage in power struggles related to food consumption will probably be most effective when dealing with clients diagnosed with eating disorders. Because of this attitude the nurse recognizes that the real issues have little to do with food or eating patterns. The nurse will be able to focus on the control issues that precipitated these behaviors.

Which situation reflects the ethical principle of veracity? A. A nurse provides a client with outpatient resources to benefit recovery. B. A nurse refuses to give information to a physician who is not responsible for the client's care. C. A nurse tricks a client into seclusion by asking the client to carry linen to the seclusion room. D. A nurse treats all of the clients equally regardless of illness severity.

ANS: C The nurse who tricks a client into seclusion has violated the ethical principle of veracity. The principle of veracity refers to one's duty to always be truthful and not intentionally deceive or mislead clients.

A client diagnosed with schizophrenia refuses to take medication, citing the right of autonomy. Under which circumstance would a nurse have the right to medicate the client against the client's wishes? A. When the client makes inappropriate sexual innuendos to a staff member B. When the client constantly demands inappropriate attention from the nurse C. When the client physically attacks another client after being confronted in group therapy D. When the client refuses to bathe or perform hygienic activities

ANS: C The nurse would have the right to medicate a client against his or her wishes if the client physically attacks another client. This client poses a significant risk to safety and is incapable of making rational choices. The client's refusal to accept treatment can be challenged because the client is endangering the safety of others.

When planning care for clients diagnosed with personality disorders, what should be the anticipated treatment outcome? A. To stabilize pathology with the correct combination of medications B. To change the characteristics of the dysfunctional personality C. To reduce inflexibility of personality traits that interfere with functioning and relationships D. To decrease the prevalence of neurotransmitters at receptor sites

ANS: C The outcome of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships. Personality disorders are often difficult and, in some cases, seem impossible to treat.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? A. Strongly encourage the client to attend 90 Alcoholics Anonymous meetings in 90 days. B. Educate the client about the biopsychosocial consequences of alcohol abuse. C. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. D. Administer vitamin B1 to prevent Wernicke-Korsakoff syndrome.

ANS: C The priority nursing intervention for this client should be to administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. Chlordiazepoxide (Librium) is a benzodiazepine and is often used for substitution therapy in alcohol withdrawal. Substitution therapy may be required to reduce life-threatening effects of the rebound stimulation of the central nervous system that occurs during withdrawal.

A client recovering from alcohol toxicity is using minimization. Which statement reflects this cognitive distortion? A. "I can't give up alcohol right now because I just gave up smoking." B. "I just read that red wine has health benefits." C. "I may have a minor problem, but I can handle it." D. "I don't drink as much as my wife and nobody thinks she has a problem."

ANS: C The statement, "I may have a minor problem, but I can handle it." is an example of the use of the cognitive distortion of minimization. Minimization is the undervaluing of the positive significance of an event.

A client is diagnosed with schizophrenia. A physician orders haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg HS. Which client behavior would warrant the nurse to administer benztropine? A. Tactile hallucinations B. Tardive dyskinesia C. Restlessness and muscle rigidity D. Reports of hearing disturbing voices

ANS: C The symptom of tactile hallucinations and reports of hearing disturbing voices would be addressed by an antipsychotic medication such as haloperidol. Tardive dyskinesia, a potentially irreversible condition, would warrant the discontinuation of an antipsychotic medication such as haloperidol. An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptoms of restlessness and muscle rigidity.

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

ANS: C The symptoms of anorexia nervosa do not include purging. Correctly written outcomes must be client centered, specific, realistic, measurable, and also include a time frame.

What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular blood work B. The client's mood and affect score, using the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment

ANS: C There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.

In the emergency department, a raped client appears calm and exhibits a blunt affect. The client answers a nurse's questions in a monotone using single words. How should the nurse interpret this client's responses? A. The client may be lying about the incident. B. The client may be experiencing a silent rape reaction. C. The client may be demonstrating a controlled response pattern. D. The client may be having a compounded rape reaction.

ANS: C This client is most likely demonstrating a controlled response pattern. In a controlled response pattern, the client's feelings are masked or hidden, and a calm, composed, or subdued affect is seen. In the expressed response pattern, feelings of fear, anger, and anxiety are expressed through crying, sobbing, smiling, restlessness, and tension.

A client with a history of insomnia has been taking chlordiazepoxide (Librium) 15 mg at night for the past year. The client currently reports getting to sleep. Which nursing diagnosis appropriately documents this problem? A. Ineffective coping R/T unresolved anxiety AEB substance abuse B. Anxiety R/T poor sleep AEB difficulty falling asleep C. Disturbed sleep pattern R/T Librium tolerance AEB difficulty falling asleep D. Risk for injury R/T addiction to Librium

ANS: C Tolerance is defined as the need for increasingly larger or more frequent doses of a substance in order to obtain the desired effects originally produced by a lower dose.

A client diagnosed with bulimia nervosa is to receive fluoxetine (Prozac) by oral solution. The medication is supplied in a 100 mL bottle. The label reads 20 mg/5 mL. The doctor orders 60 mg q day. Which dose of this medication should the nurse dispense? A. 25 mL B. 20 mL C. 15 mL D. 10 mL

ANS: C Twenty mg of Prozac multiplied by three results in the calculated 60 mg daily dose ordered by the physician. Each 5 mL contains 20 mg. Five mL multiplied by three equals the liquid dosage of 15 mL.

When a client's husband comes home late from work, the wife immediately fears infidelity. The advanced practice nurse therapist encourages the wife to consider other explanations for her husband's tardiness. What technique is the nurse using? A. Examination of the evidence B. Decatastrophizing C. Generating alternatives D. Reattribution

ANS: C Using the technique of generating alternatives will assist the client to recognize a wider range of possible explanations for her husband's behavior.

A client is in therapy with a nurse practitioner for the treatment of arachnophobia. The nurse practitioner decides to use the technique of "flooding." Which intervention best exemplifies this technique? A. Giving rewards for demonstrating a decrease in fear of spiders B. Encouraging the client to sit through the movie "Spiderman" C. Accompanying the client to a 1-hour visit to the local zoo's spider room D. Offering a computer program that progressively presents anxiety-producing spider scenarios

ANS: C Visiting the spider room would flood the client with the phobic stimuli of real spiders. This would continue until the stimulus no longer creates anxiety.

A client diagnosed with borderline personality disorder states, "Get out of here. No one cares about me or my situation!" Which nursing reply is an example of a cognitive intervention? A. "You have an anti-anxiety medication ordered. It may make you feel better." B. "It sounds like you are feeling really frustrated." C. "Can you explain further your thinking about your situation?" D. "No one cares about you?"

ANS: C When a nurse asks for an explanation about a client's thinking, the nurse is using a cognitive approach to assessment. The focus of cognitive interventions is on the modification of distorted cognitions and maladaptive behaviors.

The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to assess and attempt to modify the negative thought patterns of these clients. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

ANS: C When a nurse assesses and attempts to modify negative thought patterns related to depressive symptoms, the nurse is using a cognitive theory framework.

When using a cognitive approach, which point would a nurse include when teaching a client about panic disorder? A. "You might want to stay in the house when you notice the symptoms beginning." B. "Medications such as lorazepan (Ativan) should be taken when symptoms start." C. "Remind yourself that symptoms of a panic attack are time limited and will end." D. "Keep a journal in order to note feelings surrounding the panic attacks."

ANS: C When a nurse reminds a client that symptoms of a panic attack are time limited and will end, the nurse is using the cognitive approach of presenting rational thinking.

A client diagnosed with schizophrenia takes an antipsychotic agent daily. Which assessment finding should a nurse immediately report to the client's attending psychiatrist? A. Respirations of 22 beats/minute B. Weight gain of 8 pounds in 2 months C. Temperature of 104F (40C) D. Excessive salivation

ANS: C When assessing a client diagnosed with schizophrenia who takes an antipsychotic agent daily, the nurse should immediately address a temperature of 104F (40C). A temperature this high can be a symptom of the rare but life-threatening neuroleptic malignant syndrome.

A nurse is evaluating a client's response to stress. What would indicate to the nurse that the client is experiencing a secondary appraisal of the stressful event? A. When the individual judges the event to be benign B. When the individual judges the event to be irrelevant C. When the individual judges the resources and skills needed to deal with the event D. When the individual judges the event to be pleasurable

ANS: C When the individual judges the resources and skills needed to deal with the event, the individual is conducting a secondary appraisal. There are three types of primary appraisals: irrelevant, benign-positive, and stressful.

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

ANS: C When the nurse schedules group therapy immediately after meals, the nurse is addressing the emotional issues related to eating disorders that must be resolved if these maladaptive responses are to be eliminated.

Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice? A. Zoloft is less expensive for the client. B. Zoloft is extremely sedating and will help with sleep disturbances. C. Zoloft has less adverse side effects than other antidepressants. D. Zoloft begins to improve depressive symptoms quickly.

ANS: C Zoloft is a selective serotonin reuptake inhibitor (SSRI) that has a relatively benign side effect profile as compared with other antidepressants.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant during alcohol withdrawal? A. Antagonist therapy B. Deterrent therapy C. Codependency therapy D. Substitution therapy

ANS: D A CNS depressant such as Ativan is used during alcohol withdrawal as substitution therapy to prevent life-threatening symptoms that occur because of the rebound reaction of the central nervous system.

Which client statement demonstrates positive progress toward recovery from substance abuse? A. "I have completed detox and therefore am in control of my drug use." B. "I will faithfully attend Narcotic Anonymous (NA) when I can't control my carvings." C. "As a church deacon, my focus will now be on spiritual renewal." D. "Taking those pills got out of control. It cost me my job, marriage, and children."

ANS: D A client who takes responsibility for the consequences of substance abuse/dependence is making positive progress toward recovery. This client would most likely be in the working phase of the counseling process in which acceptance of the fact that substance abuse causes problems occurs.

Parents decide to try the nurse practitioner's suggestion of time out when their child misbehaves. What teaching should the nurse practitioner provide the parents? A. "Correct your child's behavior by using social isolation." B. "Ignore the child's negative behavior." C. "Add positive reinforcement for acceptable behavior." D. "Temporarily move your child to an area where behavior is not being reinforced."

ANS: D A time out is an aversive stimulus or punishment during which the client is removed from the environment where the unacceptable behavior is occurring. Usually during a time out, the person is temporarily isolated so there is no reinforcing attention. This discourages a reoccurrence of the undesired behavior.

A psychiatric nurse is counseling a client who has thought patterns consisting of rapid responses to a situation without rational analysis. What assessment data will the nurse document on this client? A. "Thought patterns are triggered by specific stressful stimuli." B. "Thought patterns contain the client's fundamental beliefs and assumptions." C. "Thought patterns are flexible and based on personal experience." D. "Thought patterns include a predominance of automatic thoughts."

ANS: D According to Beck, automatic thoughts consist of rapid responses to a situation without rational analysis. These thoughts are often negative and based on erroneous logic.

When asked to identify principles that define the term "maladaptive behavior," which nursing student statement indicates that further teaching is needed? A. "Behavior is maladaptive when it is age inappropriate." B. "Behavior is maladaptive when it interferes with adaptive functioning." C. "Behavior is maladaptive when others misunderstand it related to cultural inappropriateness." D. "Behavior is maladaptive when there is environmental interaction with genetic endowment."

ANS: D Adaptive, not maladaptive, behaviors occur through learning processes or, more correctly, through the interaction of the environment with an individual's genetic endowment.

Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? A. Altered thought processes R/T increased stress B. Risk for suicide R/T loneliness C. Risk for violence: directed toward others R/T paranoid thinking D. Social isolation R/T inability to relate to others

ANS: D An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. Clients diagnosed with schizoid personality disorder appear cold, aloof, and indifferent to others. They prefer to work in isolation and are unsociable.

Which client statement would demonstrate a common characteristic of Cluster "B" personality disorder? A. "I wish someone would make that decision for me." B. "I built this building by using materials from outer space." C. "I'm afraid to go to group because it is crowded with people." D. "I didn't have the money for the ring, so I just took it."

ANS: D Antisocial personality disorder is included in the Cluster "B" personality disorders. In this disorder there is a pervasive pattern of disregard for and violation of the rights of others.

A distraught, single, first-time mother cries and says to a nurse, "How can I go to work if I can't afford childcare!" What is the nurse's initial action in assisting the client with the problem-solving process? A. Determine the risks and benefits for each alternative B. Formulate goals for resolution of the problem C. Evaluate the outcome of the implemented alternative D. Assess the facts of the situation

ANS: D Before any other steps can be taken, accurate information about the situation must be gathered and assessed.

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

ANS: D Behavior modification programs are the treatment of choice for clients diagnosed with eating disorders because these programs allow clients to maintain control. Issues of control are central to the etiology of these disorders. Behavior modification techniques aid in restoring healthy body weight.

A nurse understands that when a practitioner corrects subluxation by manipulating the vertebrae of the spinal column the practitioner is employing which therapy? A. Allopathic therapy B. Therapeutic touch therapy C. Massage therapy D. Chiropractic therapy

ANS: D Chiropractic therapy involves the correction of subluxations by manipulating the vertebrae of the spinal column. The theory behind chiropractic medicine is that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves.

A welder has been selected as employee of the year. The welder wants to ask for a promotion but is hampered by poor self-esteem. The employee health nurse provides assistance. Which technique should the nurse use to help the employee request the promotion? A. Socratic questioning B. Activity scheduling C. Distraction D. Cognitive rehearsal

ANS: D Cognitive rehearsal allows the employee to uncover potential automatic thoughts in advance of his or her meeting to request a promotion. This allows the employee to develop strategies to modify any dysfunctional thinking.

An advanced practice nurse recommends that a client participate in cognitive therapy. The client asks, "What's cognitive therapy and how can it help me?" Which is the nurse's most appropriate reply? A. "It is a system of techniques in which you use positive thinking to improve your mood." B. "It is a long-term interpersonal approach that emphasizes the role of early childhood experiences." C. "It is a interpersonal treatment approach that specifically targets magical thinking." D. "It is a type of psychotherapy that focuses treatment on the modification of distorted thinking and maladaptive behaviors."

ANS: D Cognitive therapy is meant to be a time-limited intervention in which the therapist works in collaboration with the client to modify thinking to eliminate cognitive errors that reinforce emotional disturbances.

Which is an accurate description of a common law? A. A common law would be invoked to deal with a nurse who, without justification, threatens a client with restraints. B. A common law would be invoked to deal with a nurse who touches a client without the client's consent. C. A common law would be invoked to deal with a hospital employee who steals drugs, hospital equipment, or both. D. A common law would be invoked to deal with a nurse's refusal to provide care for a specific client.

ANS: D Common laws apply to a body of principles that evolve from court decisions resolving various controversies. Common law may vary from state to state. Assault (threats) and battery (touch) are governed by civil law. Stealing is governed by criminal law.

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

ANS: D During phase 3 (5 to 36 months) of Margaret Mahler's individuation theory, there should be a strengthening of the ego and an acceptance of "self" with independent ego boundaries. Inconsistency by the maternal figure during individuation may in later years result in feelings of helplessness when the client is alone because of exaggerated fears of being unable to care for self.

A nursing instructor is teaching about diseases of adaptation and when they are likely to occur. When questioned about situations that precipitate these diseases, which student statement indicates that learning has occurred? A. "When an individual has limited experience dealing with stress" B. "When an individual inherits maladaptive genes" C. "When an individual experiences existing conditions that exacerbate stress" D. "When an individual's physiological and psychological resources have become depleted"

ANS: D During the stage of exhaustion of the general adaptation syndrome, the individual loses the capacity to adapt effectively because physiological and psychological resources have become depleted. This is the time when diseases of adaptation may occur.

A client admitted to a Veterans Administration (VA) hospital with a diagnosis of major depressive disorder tells the nurse, "I failed my battalion by giving the wrong order. Fortunately, no one was injured." Which nursing diagnosis should the nurse assign to this client? A. Chronic low self-esteem B. Risk for self-directed violence C. Powerlessness D. Situational low self-esteem

ANS: D Emotional responses are largely dependent on cognitive appraisals of the significance of environmental cues. The nursing diagnosis of situational low self-esteem is used for individuals who have a negative perception of self-worth in response to a current situation. This client's cognitive appraisal of the situation has led to the diagnosis of major depression and low self-esteem.

A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

ANS: D Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

The nurse practitioner plans to use a psychoanalytical framework when treating a client diagnosed with an anxiety disorder. Which would be the focus of this nursing intervention? A. Correcting inappropriate learning patterns B. Changing a dysfunctional social environment C. Exploring the "here-and-now" with the client and family D. Dealing with issues of physical abuse at an early age

ANS: D Freud, a psychoanalytic theorist, considered the first 5 years of a child's life to be the most important, because he believed that an individual's basic character had been formed by the age of five.

According to psychoanalytic theory, treatment of symptoms should involve which nursing action? A. Modifying client behaviors by manipulating the environment B. Expressing empathy and presenting reality C. Encouraging the client to note cause and effects of actions D. Recognizing and discussing the client's use of ego defense mechanisms

ANS: D From a psychoanalytic perspective, understanding the use of ego defense mechanisms is important in making determinations about maladaptive behaviors, in planning care for clients to assist in creating change, or in helping clients accept themselves as unique individuals.

Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "I deserve to feel this way."

ANS: D Hopelessness and helplessness are typical symptoms of clients diagnosed with major depressive disorder. Depressive symptoms are often described as anger turned inward.

A nurse is caring for four clients taking various medications including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate

ANS: D Hypertensive crisis occurs in clients receiving monoamine oxidase inhibitor (MAOI) who consume foods or drugs high in tyramine content.

A nurse is caring for a client who has been prescribed disulfiram (Antabuse) as a deterrent to alcohol relapse. Which information should the nurse include when teaching the client about this medication? A. "Only oral ingestion of alcohol will cause a reaction when taking this drug." B. "It is safe to drink beverages that have only 12% alcohol content." C. "This medication will decrease your cravings for alcohol." D. "Reactions to combining Antabuse with alcohol can occur 2 weeks after stopping the drug."

ANS: D If Antabuse is discontinued, it is important for the client to understand that the sensitivity to alcohol may last for as long as 2 weeks.

Research undertaken by Miller and Rahe in 1997 demonstrated a correlation between the effects of life change and illness. This research led to the development of the Recent Life Changes Questionnaire (RLCQ). Which principle most limits the effectiveness of this tool? A. Specific illnesses are not identified. B. Individual coping abilities are not assessed. C. Stress is viewed as only a physiological response. D. Personal perception of the event is excluded.

ANS: D Individuals differ in response to life events. The RLCQ uses a scale that does not take these differences into consideration.

A client who has been undergoing stress management training asks a nurse how long practicing stress reduction should last. Which is the most appropriate nursing reply? A. "Until this stressor has resolved." B. "Usually it takes several months before stress is eliminated." C. "Whenever you feel better, you can stop." D. "Managing stress is a lifelong function."

ANS: D Management of stress must be considered a lifelong function. Nurses can help individuals recognize the sources of stress in their lives and identify methods of adaptive coping.

During a psychoeducational group on stress management, a client asks about meditation. Which nursing statement is most accurate regarding meditation? A. "It is a procedure whereby various muscle groups are contracted and relaxed, bringing about an overall sense of relaxation." B. "The procedure is one whereby you use your imagination to relax and reduce the tension in your body." C. "The purpose is to become aware of one's bodily processes and to bring them under conscious control." D. "The goal is to gain mastery and control over one's attention, bringing about a special state of consciousness."

ANS: D Meditation creates a special state of consciousness because attention is concentrated on one thought or object.

A kindergarten rule states that if unacceptable behavior occurs, a child's personalized fish will be moved to the sea grass. Children who behave keep their fish out of the sea grass. The school nurse should identify this intervention as based on which principle of behavior therapy? A. Classical conditioning B. Conditioned response C. Positive reinforcement D. Negative reinforcement

ANS: D Negative reinforcement is increasing the probability that behavior (appropriate classroom behavior) will recur by removal of an undesirable reinforcing stimulus (personalized fish in sea grass).

A nursing instructor is teaching about the application of Peplau's theory to nursing care. Which student statement indicates that learning has occurred? A. "The nurse assumes the role of a parenting figure instructing the client in good health practices." B. "The nurse is concerned more about psychosocial functioning than physiological functioning." C. "The nurse bases the client care plan on standardized nursing approaches and physician orders." D. "The nurse applies principles of human relations to the problems that arise at all levels of experience."

ANS: D Peplau applied interpersonal theory to nursing practice and, most specifically, to nurse-client relationship development.

Which should a nurse recognize as the reason that physical exercise is an effective relaxation technique? A. Physical exercise stresses and strengthens the cardiovascular system. B. Physical exercise decreases the metabolic rate. C. Physical exercise decreases levels of norepinephrine in the brain. D. Physical exercise provides a natural outlet for releasing muscle tension.

ANS: D Physical exercise is an effective relaxation technique because it provides a natural outlet for releasing muscle tension produced by the body when stressed.

A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder? A. The 60-year-old because of memory deficits B. The 60-year-old because of decreased cognitive processing ability C. The 20-year-old because of limited cognitive experiences D. The 20-year-old because of lack of developmental maturity

ANS: D Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity. By comparison, the 20-year-old does not have the developmental maturity, life experiences, and coping mechanisms that the 60-year-old might possess.

A school nurse is assessing a female high school student who is overly concerned about her appearance. The client's mother states, "That's not something to be stressed about!" Which is the most appropriate nursing response? A. "Teenagers! They don't know a thing about real stress." B. "Stress occurs only when there is a loss." C. "When you are in poor physical condition, you can't experience psychological well-being." D. "Stress can be psychological. A threat to self-esteem may result in high stress levels."

ANS: D Stress can be physical or psychological in nature. A perceived threat to self-esteem can be as stressful as a physiological change.

Which assumption is most reflective of a behavioral theory model? A. Mental illness is characterized by structural and biochemical alterations. B. Thought processes influence behaviors. C. All personality development has a social context. D. There is a basic relationship between stimulus and response.

ANS: D That there is a basic relationship between stimulus and response is an assumption of a behavioral theory model. The connection between a stimulus and a response is strengthened or weakened by the consequences of the response.

A physically and emotionally healthy client has just been fired. During a routine office visit he states to a nurse: "Perhaps this was the best thing to happen. Maybe I'll look into pursuing an art degree." How should the nurse characterize the client's appraisal of the job loss stressor? A. Irrelevant B. Harm/loss C. Threatening D. Challenging

ANS: D The client perceives the situation of job loss as a challenge and an opportunity for growth.

Which client situation should a nurse identify as reflective of the impulsive behavior that is commonly associated with borderline personality disorder? A. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and whispers, "The night nurse is evil. You have to stay." B. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." C. As the day shift nurse leaves the unit, the client suddenly hugs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." D. As the day shift nurse leaves the unit, the client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

ANS: D The client who states, "I cut myself because you are leaving me" reflects impulsive behavior that is commonly associated with the diagnosis of borderline personality disorder. Repetitive, self-mutilative behaviors are common and are generated by feelings of abandonment following separation from significant others.

A client is experiencing auditory hallucinations. Using a cognitive strategy, which should the nurse encourage the client to do? A. "Try singing Happy Birthday until the voices are gone." B. "Document what the voices are saying to note cause and effect." C. "Try listening to music using headphones for distraction." D. "Remind yourself that the voices are symptoms of your disease."

ANS: D The focus of cognitive therapy is on the modification of distorted cognitions and maladaptive behaviors.

A geriatric client is confused and wandering in and out of every door. Which scenario reflects the least restrictive alternative for this client? A. The client is placed in seclusion. B. The client is placed in a geriatric chair with tray. C. The client is placed in soft Posey restraints. D. The client is monitored by an ankle bracelet.

ANS: D The least restrictive alternative for this client would be monitoring by an ankle bracelet. The client does not pose a direct dangerous threat to self or others, so neither physical restraints nor seclusion would be justified.

An involuntarily committed client is verbally abusive to the staff and repeatedly threatening to sue. The client records the full names and phone numbers of the staff. Which nursing action is most appropriate to decrease the possibility of a lawsuit? A. Verbally redirect the client, and then limit one-on-one interaction. B. Involve the hospital's security division as soon as possible. C. Notify the client that documenting personal staff information is against hospital policy. D. Continue professional attempts to establish a positive working relationship with the client.

ANS: D The most appropriate nursing action is to continue professional attempts to establish a positive working relationship with the client. The involuntarily committed client should be respected and has the right to assert grievances if rights are infringed.

Which nursing intervention would be most appropriate when caring for an acutely agitated client diagnosed with paranoid schizophrenia? A. Provide neon lights and soft music. B. Maintain continual eye contact throughout the interview. C. Use therapeutic touch to increase trust and rapport. D. Provide personal space to respect the client's boundaries.

ANS: D The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence.

A nurse is assessing a client diagnosed with paranoid schizophrenia. The nurse asks the client, "Do you receive special messages from certain sources, such as the television or radio?" Which potential symptom of this disorder is the nurse assessing? A. Thought insertion B. Paranoid delusions C. Magical thinking D. Delusions of reference

ANS: D The nurse is assessing for the potential symptom of delusions of reference. A client who believes that he or she receives messages through the radio is experiencing delusions of reference. When a client experiences these delusions, he or she interprets all events within the environment as personal references.

A nurse holds the hand of a client who is withdrawing from alcohol. What is the nurse's rationale for this intervention? A. To assess for emotional strength B. To assess for Wernicke-Korsakoff syndrome C. To assess for tachycardia D. To assess for fine tremors

ANS: D The nurse is most likely assessing the client for fine tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, coarse tremors, and seizure activity.

A client diagnosed with seasonal affective disorder (SAD) states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's symptoms. A. "Have you been diagnosed with any physical disorder within the last 3 months?" B. "Have you experienced any traumatic events that triggered this mood change?" C. "People who have seasonal mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"

ANS: D The nurse is using a clarifying statement in order to gather more details related to this client's mood. The diagnosis of SAD is not associated with a traumatic event.

Which medication orders should a nurse anticipate for a client who has a history of complicated withdrawal from benzodiazepines? A. Haloperidol (Haldol) and fluoxetine (Prozac) B. Carbamazepine (Tegretol) and donepezil (Aricept) C. Disulfiram (Antabuse) and lorazepan (Ativan) D. Chlordiazepoxide (Librium) and phenytoin (Dilantin)

ANS: D The nurse should anticipate that a physician would order chlordiazepoxide (Librium) and phenytoin (Dilantin) for a client who has a history of complicated withdrawal from benzodiazepines. It is common for long-lasting benzodiazepines to be prescribed for substitution therapy. Phenytoin (Dilantin) is an anticonvulsant that would be indicated for a client who has experienced a complicated withdrawal. Complicated withdrawals may progress to seizure activity.

A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

ANS: D The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms. According to the DSM-IV-TR, these symptoms would rule out the diagnosis of major depressive disorder.

During an interview, which client statement indicates to a nurse that a potential diagnosis of schizotypal personality disorder should be considered? A. "I really don't have a problem. My family is inflexible, and every relative is out to get me." B. "I am so excited about working with you. Have you noticed my new nail polish: 'Ruby Red Roses'?" C. "I spend all my time tending my bees. I know a whole lot of information about bees." D. "I am getting a message from the beyond that we have been involved with each other in a previous life."

ANS: D The nurse should assess that a client who states that he or she is getting a message from the beyond indicates a potential diagnosis of schizotypal personality disorder. Individuals with schizotypal personality disorder are aloof and isolated and behave in a bland and apathetic manner. The individual experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life.

A physically healthy, 35-year-old single client lives with parents who provide total financial support. According to Erikson's theory, which developmental task should a nurse assist the client to accomplish? A. Establishing the ability to control emotional reactions B. Establishing a strong sense of ethics and character structure C. Establishing and maintaining self-esteem D. Establishing a career, personal relationships, and societal connections

ANS: D The nurse should assist the client in establishing a career, personal relationships, and societal connections. According to Erikson, non-achievement in the generativity versus stagnation stage results in self-absorption, including withdrawal from others and having no capacity for giving of the self to others.

A client is diagnosed with dysthymic disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

ANS: D The nurse should classify a gloomy and pessimistic outlook on life as an affective symptom of dysthymic disorder. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological.

Which client statement indicates a knowledge deficit related to substance abuse? A. "Although it's legal, alcohol is one of the most widely abused drugs in our society." B. "Tolerance to heroin develops quickly." C. "Flashbacks from LSD use may reoccur spontaneously." D. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

ANS: D The nurse should determine that the client has a knowledge deficit related to substance abuse when the client compares marijuana to smoking cigarettes and claims it to be harmless. Cannabis is the second most widely abused drug in the United States.

An inpatient psychiatric physician refuses to treat clients without insurance and prematurely discharges those whose insurance benefits have expired. Which violation of an ethical principle should a nurse recognize in this situation? A. Autonomy B. Beneficence C. Nonmaleficence D. Justice

ANS: D The nurse should determine that the ethical principle of justice has been violated by the physician's actions. The principle of justice requires that individuals should be treated equally regardless of race, sex, marital status, medical diagnosis, social standing, economic level, or religious belief.

A client diagnosed with chronic schizophrenia presents in an emergency department (ED) with uncontrollable tongue movements, stiff neck, and difficulty swallowing. The nurse would expect the physician to recognize which condition and implement which treatment? A. Neuroleptic malignant syndrome and treat by discontinuing antipsychotic medications B. Agranulocytosis and treat by administration of clozapine (Clozaril) C. Extrapyramidal symptoms and treat by administration of benztropine (Cogentin) D. Tardive dyskinesia and treat by discontinuing antipsychotic medications

ANS: D The nurse should expect that an ED physician would diagnose the client with tardive dyskinesia and discontinue antipsychotic medications. Tardive dyskinesia is a condition of abnormal involuntary movements of the mouth, tongue, trunk, and extremities that can be an irreversible side effect of typical antipsychotic medications.

A client asks a nurse to explain the difference between complementary and alternative medicine. Which is an appropriate nursing reply? A. "Alternative medicine is a more acceptable practice than complementary medicine." B. "Alternative and complementary medicine are terms that essentially mean the same thing." C. "Complementary medicine disregards traditional medical approaches." D. "Complementary therapies partner alternative medicine with traditional medical practice."

ANS: D The nurse should explain to the client that complementary therapies partner alternative medicine with traditional medical practice. Alternative medicine refer to interventions that are used instead of conventional treatment. More than $27 billion a year is spent on complementary and alternative therapies.

A nurse tells a client that the nursing staff will start alternating weekend shifts. Which response should a nurse identify as characteristic of clients diagnosed with obsessive-compulsive personality disorder? A. "You really don't have to go by that schedule. I'd just stay home sick." B. "There has got to be a hidden agenda behind this schedule change." C. "Who do you think you are? I expect to interact with the same nurse every Saturday." D. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

ANS: D The nurse should identify that a client diagnosed with obsessive-compulsive personality disorder would have a difficult time accepting change. This disorder is characterized by inflexibility and lack of spontaneity. Individuals diagnosed with this disorder are very serious, formal, over disciplined, perfectionistic, and preoccupied with rules.

During an admission assessment, a nurse notes that a client diagnosed with schizophrenia has allergies to penicillin, prochlorperazine (Compazine), and bee stings. Based on this assessment data, which antipsychotic medication would be contraindicated? A. Haloperidol (Haldol), because it is used only in elderly patients B. Clozapine (Clozaril), because of a cross-sensitivity to penicillin C. Risperidone (Risperdal), because it exacerbates symptoms of depression D. Thioridazine (Mellaril), because of cross-sensitivity among phenothiazines

ANS: D The nurse should know that thioridazine (Mellaril) would be contraindicated because of cross-sensitivity among phenothiazines. Prochlorperazine (Compazine) and thioridazine are both classified as phenothiazines.

Which teaching should the nurse in an employee assistance program provide to an employee who exhibits symptoms of domestic physical abuse? A. Have ready access to a gun and learn how to use it B. Research lawyers who can aid in divorce proceedings C. File charges of assault and battery D. Have ready access to the number of a safe house for battered women

ANS: D The nurse should provide information about safe houses for battered women when working with a client who has symptoms of domestic physical abuse. Many women feel powerless within the abusive relationship and may be staying in the abusive relationship out of fear for their lives.

A confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

ANS: D The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

A woman describes a history of physical and emotional abuse in intimate relationships. Which additional factor should a nurse suspect? A. The woman may be exhibiting a controlled response pattern. B. The woman may have a history of childhood neglect. C. The woman may be exhibiting codependent characteristics. D. The woman might be a victim of incest.

ANS: D The nurse should suspect that this client might be a victim of incest. Women in abusive relationships often grew up in abusive homes.

Which statement should a nurse identify as correct regarding a client's right to refuse treatment? A. Clients can refuse pharmacological but not psychological treatment. B. Clients can refuse any treatment at any time. C. Clients can refuse only electroconvulsive therapy (ECT). D. Professionals can override treatment refusal if the client is actively suicidal or homicidal.

ANS: D The nurse should understand that health-care professionals can override treatment refusal when a client is actively suicidal or homicidal. A suicidal or homicidal client who refuses treatment may be a danger to self or others. This situation should be treated as an emergency, and treatment may be performed without informed consent.

A client who is in a severely abusive relationship is admitted to a psychiatric inpatient unit. The client fears for her life. A staff nurse asks, "Why doesn't she just leave him?" Which is the nursing supervisor's most appropriate reply? A. "These clients don't know life any other way, and change is not an option until they have improved insight." B. "These clients have limited KEY: Cognitive skills and few vocational abilities to be able to make it on their own." C. "These clients often have a lack of financial independence to support themselves and their children, and most have religious beliefs prohibiting divorce and separation." D. "These clients are paralyzed into inaction by a combination of physical threats and a sense of powerlessness."

ANS: D The nursing supervisor is accurate when stating that clients in severely abusive relationships are paralyzed into inaction by a combination of physical threats and a sense of powerlessness. Women often choose to stay with an abusive partner for some of the following reasons: for the children, for financial reasons, fear of retaliation, lack of a support network, religious reasons, and/or hopelessness.

During a smoking cessation group, the community health nurse explains that in their effort to quit smoking, a reciprocal inhibition approach will be used. The nurse should give the group which example of this technique? A. "Before you can smoke, you must first take a half-hour walk." B. "When you have the urge to smoke, imagine being short of breath." C. "You'll receive $1 for each cigarette not smoked and forfeit $2 for each cigarette smoked." D. "When you have the urge to smoke, hold your breath, then rhythmically breathe."

ANS: D These breathing exercises cannot be done while the client smokes. Therefore, they decrease or eliminate the undesired behavior (smoking) that is incompatible with the desired behavior (smoking cessation). This is an example of the behavior therapy of reciprocal inhibition.

A child always chooses to ask mother over father when seeking special privileges. The father is more apt to disagree than agree with the child's requests while the mother usually consents. The child's choice is the result of which component of operant conditioning? A. Conditioned stimuli B. Unconditioned stimuli C. Aversive stimuli D. Discriminative stimuli

ANS: D This child is able to discriminate between stimuli. This child can predict with assurance that asking mother (not father) will result in a desired response.

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

ANS: D This client statement reflects the underlying etiology of anorexia nervosa. The client is expressing feelings about family dynamics that may have influenced the development of this disorder. Families who are overprotective and perfectionistic can contribute to a family member's development of anorexia nervosa.

A nurse is caring for a client who has suffered a stress-related myocardial infarction. Which client statement indicates that the client is ready to learn about the relationship of stress to physical illness? A. "I just need to take my blood pressure medication religiously." B. "The first thing I will do, will be to cut down on my smoking." C. "My father had six heart attacks and survived them all. I plan to do the same." D. "I eat well and exercise. What else do you think could have led to my heart attack?"

ANS: D This response shows that the client is seeking information to improve his health and signals openness to change.

A nurse is interviewing a client in an outpatient substance-abuse clinic. To promote success in the recovery process, which outcome should the nurse expect the client to initially accomplish? A. The client will identify one person to turn to for support. B. The client will give up all old drinking buddies. C. The client will be able to verbalize the effects of alcohol on the body. D. The client will correlate life problems with alcohol use.

ANS: D To promote the recovery process the nurse should expect that the client would initially correlate life problems with alcohol use. Acceptance of the problem is the first step of the recovery process.

The nurse plans to confront a client about secondary gains related to extreme dependency on spouse. Which nursing statement would be most appropriate? A. "Do you believe dependency issues have been a lifelong concern for you?" B. "Have you noticed any anxiety during times when your husband makes decisions." C. "What do you know about individuals who depend on others for direction?" D. "How have the specifics of your relationship with your spouse benefited you?"

ANS: D When a client goes to excessive lengths to obtain nurturance and support from others, the client is seeking secondary gains. Secondary gains provide clients the support and attention that the client might not otherwise receive.

A client diagnosed with anorexia nervosa stopped eating 5 months ago and lost 25% of total body weight. Which subjective client response would the nurse assess to support this medical diagnosis? A. "I do not use any laxatives or diuretics to lose weight." B. "I am losing lots of hair. It's coming out in handfuls." C. "I know that I am thin, but I refuse to be fat!" D. "I don't know why people are worried. I need to lose this weight."

ANS: D When the client states, "I don't know why people are worried. I need to lose this weight," the client is exhibiting the subjective response of ineffective denial. This client is minimizing symptoms and is unable to admit impact of the disease on life patterns. The client does not perceive personal relevance of symptoms or danger.

A client states, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Using a cognitive approach, which nursing reply would be most therapeutic? A. "Are other issues from your past affecting your ability to move on?" B. "Describe your current feelings about your loss." C. "Let's talk about something that will help you move on." D. "Can anyone predict when a car accident will happen?"

ANS: D When the nurse attempts to encourage the client to reframe thoughts, the nurse is using a cognitive approach.

Disulfiram (Antabuse)

Action 1. Interferes with the breakdown of alcohol 2. In presence of alcohol causes a. Nausea and vomiting b. Hypotension, rapid pulse c. Flushing d. Confusion e. Respiratory and circulatory collapse and death B. Patient education 1. No alcohol in any form 2. Abstain from alcohol for 12 hours before taking Antabuse 3. No alcohol for 2 weeks after last dose 4. Carry ID re: Antabuse 5. Side effects: headache, dry mouth, and flushing

Delirium

Acute b. Rapid onset c. Reversible d. Might occur with: high fevers or substance withdrawal

On the 1st day of a clients alcohol detox, which nursing intervention should take priority? o Administer chloiazepoxide (Librium) in a dosage according to protocol. o Strongly encourage the client to attend 90 AA meetings in 90 days o Educate the client about the biopsychosocial consequences of alcohol abuse

Administer chloiazepoxide (Librium) in a dosage according to protocol

A client is admitted to the acute psychiatric care unit after 2 weeks of increasingly erratic behavior. The client has been sleeping poorly, has lost 8 lb (3.6 kg), is poorly groomed, exhibits hyperactivity, and loudly denies the need for hospitalization. Which nursing intervention takes priority for this client?

Administering a sedative as prescribed

Barriers to Communication

Advising: Nurse gives opinion B. Devaluing: Example "Don't cry." C. Disapproval D. Focus on nurse E. Asking "Why?" F. Clichés and false reassurance G. Defending H. Changing the subject I. Verbs that encourage sharing are better than "nurse as authority verbs 1. Suggest or discuss better than demand or request 2. Better to involve patient

In group therapy, a client angrily speaks up and responds to a peer, "You're always whining, and I'm getting tired of listening to you! Here is the world's smallest violin playing for you." Which of the following roles is the client playing?

Aggressor

A client is taking clozapine (Clozaril) and complains of a sore throat. This symptom may be an indication of which adverse reaction?

Agranulocytosis

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply. -unresolved grief over the loss of her husband -loss of several relatives and friends over the last few years -repressed feelings of guilt over the way in which Lucky died -inability to prepare in advance for the loss

All answers are correct. Unresolved grief over the loss of her husband; loss of several relatives and friends of the last few years; repressed feelings of guilt over the way in which Lucky died; inability to prepare in advance for the loss.

Which principle of the psychoanalytic model is particularly useful to psychiatric nurses?

All behavior has meaning.

An aging patient with a dx of chronic schizophrenia takes an antipsychotic and beta blocker for HTN. Which statement made by the nurse is the most important? -Make sure you concentrate on taking slow, deep, cleansing breaths - Rise slowing after sitting or laying down -Watch your diet and try to engage in physical activity -Wear sunscreen when outside

All of these side effects are true for antipsychotic medications. However, with consideration of the beta blocker, rising slowing from a sitting or lying position is most important.

CONVERSION DISORDERS (HYSTERIA) Define

Alteration in physical function that is an expression of an unconscious psychological need. Freud suggested that the emotional charge of painful experiences are consciously repressed as a way of managing the pain; the emotional charge is then "converted" into the neurological symptoms. Both somatoform and conversion disorders are used to suppress emotional pain and anxiety.

A decrease in acetylcholine may play a significant role in which of the following illnesses? - Alzheimer's disease - Schizophrenia -Anxiety Disorder -Depression

Alzheimer's disease

A client rates anxiety at 8 out of 10 on a scale of 1 to 10, is restless, and has narrowed perceptions. Which of the following medications would appropriately be prescribed to address these symptoms? Select all that apply. 1. Chlordiazepoxide (Librium). 2. Clonazepam (Klonopin). 3. Lithium carbonate (lithium). 4. Clozapine (Clozaril). 5. Oxazepam (Serax).

An anxiety rating of 8 out of 10, restlessness, and narrowed perceptions all are symptoms of increased levels of anxiety. 1. Chlordiazepoxide (Librium) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 2. Clonazepam (Klonopin) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. 5. Oxazepam (Serax) is a benzodiazepine. Benzodiazepines are classified as antianxiety medications and would be appropriately prescribed to address signs and symptoms of anxiety. TEST-TAKING HINT: The test taker first must recognize the signs and symptoms presented in the question as an indication of increased levels of anxiety. Next, the test taker must recognize the medications that address these symptoms. Also, it is common to confuse lithium carbonate (lithium) and Librium and clozapine and clonazepam. To answer this question correctly, the test taker needs to distinguish between medications that are similar in spelling.

An overuse or ineffective use of ego defense mechanisms, which results in a maladaptive response to anxiety, is an example of the ___________________ theory of generalized anxiety disorder development.

An overuse or ineffective use of ego defense mechanisms, which results in a maladaptiveresponse to anxiety, is an example of thepsychodynamic theory of generalized anxiety disorder development. TEST-TAKING HINT: To answer this question correctly, the test taker should review the various theories related to the development of generalized anxiety disorder.

George is diagnosed with Major Depression. She is most likely fixed in which stage of the grief process? -denial -depression -anger -acceptance

Anger

A nurse understands that abnormal secretion of growth hormone may play a role in which illness? -Schizophrenia -Anorexia -Schizophrenia -Anxiety Disorder

Anorexia

Tricyclic side effects

Anticholinergic b. Cardiovascular c. Photosensitivity d. Two to four weeks to be effective- tricyclics; triweeks

A normal life cycle transition that may be anticipated but over which the individual may feel a lack of control is what type of crisis? -Crisis reflecting psychopathology -Anticipated Life Transitions -Traumatic Stress -Maturational/Developmental

Anticipated Life Transitions

A client is brought to the facility in an agitated state and is admitted to the psychiatric unit for observation and treatment. While putting personal items away, the client talks rapidly and folds and unfolds garments several times. The client can't seem to settle down. Which nursing diagnosis is most applicable at this time?

Anxiety

The nurse is caring for a client who continually has paranoid thoughts. How should the nurse interact with this client?

Approach him in a nonthreatening way.

Chronic Organic Brain Syndrome

Assessment findings include changes in: 1. Judgment 2. Orientation 3. Confabulation 4. Affect 5. Memory

Schizophrenia Interventions

Assist with activities of daily living as needed B. Structured noncompetitive activities- no winners or losers because of aggressive behaviors C. Establish relationship- D. Short frequent contacts E. Clarify 1. Be specific- no double meanings 2. Use short phrases F. Hallucinations: present reality; I don't see these things G. Delusions 1. Do not attack 2. Express doubt H. Provide individually packaged or canned food- don't suggest family bring in food I. Illusions: explain stimuli; misinterpretation of reality

Schizophrenia Characteristics

Associative looseness 1. Illogical thought progression 2. Bizarre thinking B. Affective looseness 1. Apathy 2. Inconsistent with speech C. Ambivalence 1. Simultaneously conflicting feelings 2. Poor interpersonal relations D. Autism 1. Delusions- false fixed beliefs 2. Hallucinations 3. Ideas of reference- everything is about them and it is bad 4. Depersonalization

Which of the following statements describes how elderly clients react to medications?

At risk for increased adverse effects

During a therapeutic group, 2 clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both the clients from the group. Which leadership style has the nurse demonstrated? -Autocratic -Democratic -Bureaucratic

Autocratic

During an initial assessment, a client reports the following behaviors: social inhibition, hypersensitivity to negative evaluation, fear of criticism, and social ineptitude. The nurse suspects which of the following personality disorders?

Avoidant

Which of the following statements accurately describes therapeutic communication?

Avoiding judgment and false reassurance

Compliments? with depression

Be careful with these and the depressed patient, it may make them feel worse.

A community mental health nurse recognizes that one of the primary roles of her position is advocacy. Which action is most important when fulfilling an advocacy role?

Being politically involved

David, who is 72 years old is of the age at which she may have experienced many losses coming close together. What is this called? -Bereavement overload -isolation -Normal mourning - cultural relativity

Bereavement overload

A client has a hx of drinking one pint of bourbon per day for the past 6 months. He is brought to an ER by family who report that his last drink was 1 hour ago. It is now 12 am. When should a nurse expect this client to begin experiencing withdrawal symptoms? o Shortly after 24 hours o Between 3am and 11am o At the beginning of the 3rd day

Between 3am and 11am

DEFENSE MECHANISMS - Unconscious Projection

Blaming one's own thoughts or actions on another person ("You made me angry; you made me hit you.").

On admission to the mental health unit, a client tells the nurse she's afraid to leave the house for fear of criticism. She informs the nurse "My nose is so big. I know everyone is looking at me and making fun of me. I had plastic surgery and it still looks awful!" These symptoms are an indication of which disorder?

Body dysmorphic disorder

Chronic Problems caused by Alcohol Abuse

Both are caused by thiamine/niacin deficiencies (B vitamin deficiencies -Korsakoff's syndrome: disoriented to time, confabulate -Wernicke's Syndrome: labile emotions, moody, tire easily

Crisis Intervention

Brief intense therapy 2. Goal: To return to the level of functioning before the crisis 3. Assess: a. Level of functioning b. Precipitating event c. Past coping mechanisms d. Available support systems 4. Plan a. Consistent b. Appropriate c. Collaborative 5. Intervention a. Here and now b. Time limited: 6-8 weeks

GENERALIZED ANXIETY DISORDER (GAD) Client Education

CLIENT EDUCATION: Teach s/s anxiety. Notify MD of worsening symptoms; don't stop/alter meds. Methods of alternative stress relief and effective coping mechanisms.

Major Tranquilizers

CNS depression 2. Anticholinergic 3. Parkinson's symptoms 4. Dystonia 5. Photosensitivity 6. Agranulocytosis 7. Neuroleptic malignant syndrome

SSRI

CNS depression 2. Anticholinergic It takes tri weeks for SSRIs to be effective

Minor Tranquilizers (Anti-Anxiety)

CNS depression 2. Anticholinergic These drugs are addicting with prolonged use

All psychiatric drugs have two side effects in common

CNS depression: drowsiness, hypotension, especially when given IM 2. Anticholinergic: Dry mouth, difficulty voiding

Drug Withdrawal

Central nervous system depressants: sedatives, hypnotics, and opiates 1. Detoxification regime includes administering the same or a similar drug in gradually decreasing amounts to prevent seizures 2. May have constricted pupils when using the substance B. Central nervous system stimulants: cocaine, amphetamines, and hallucinogens 1. May have dilated pupils when using the substance 2. Person can stop these substances abruptly. C. Nursing care 1. Set limits when client demonstrates manipulative behavior 2. Confront patient when behavior is not acceptable 3. Safety during withdrawal 4. Referral for continued care after discharge

Childhood Autism

Characteristics 1. Bizarre behavior 2. No awareness of others 3. No awareness of feelings of others 4. Stereotyped body movements B. Interventions 1. Communication 2. Minimize holding 3. Structured activities

Antisocial Personality

Characteristics 1. Conflicts with society and its rules 2. Unreliable 3. Self-centered 4. Blames others 5. Normal to superior intelligence 6. Poor judgment and insight 7. Unsatisfactory social adjustment 8. Charming Homicidal 9. Difficulty maintaining lasting relationships B. Interventions 1. Set limits 2. Give positive feedback for acceptable behavior 3. Maintain staff communication

Borderline Personality

Characteristics 1. Manipulates others 2. Impulsive 3. Suicidal 4. Poor self-image 5. Bored, trouble being alone 6. Mood swings 7. Anger expressed without control B. Interventions 1. Suicide assessment 2. Set limits 3. Give positive feedback for acceptable behavior 4. Confront inappropriate behavior 5. Encourage expression of feelings, not acting on feelings 6. Don't make decisions for client

Trust that their feeding, comfort, stimulation, and caring needs will be met

Characteristics of Trust vs. Mistrust stage

Independence, develop a sense of personal control over physical skills Toilet training

Characteristics of autonomy vs. shame and doubt

Reflection on life Look back on life and feel a sense of fulfillment Success-wisdom Failure-regret, bitterness, despair

Characteristics of ego integrity vs. despair

Work and parenthood Create or nurture things that will outlast them, often by having children or creating change that benefits other people Usefulness and accomplishment

Characteristics of generativity vs. stagnation

Develop a sense of self and personal identity Influenced by expectations and peer groups

Characteristics of identity vs. role confusion

Advancements in learning-sense of competence Motivated by tasks that increase self-worth

Characteristics of industry vs. inferiority

Assert control and power over the environment Success-sense of purpose Unable to accomplish a task/believe they have misbehaved-guilt

Characteristics of initiative vs. guilt

Forming intimate, loving relationships with other people

Characteristics of intimacy vs. isolation

Bulimia

Characterized by a. Uncontrollable binge eating b. Self induced vomiting c. Laxative abuse d. Excessive exercise 2. Bulimia differs from anorexia in that the person may maintain a normal weight and is aware that her behavior is abnormal.

Catatonic Schizophrenia

Characterized by marked abnormalities in motor behavior and may be manifested in the form of stupor or excitement.

Paranoid Schizophrenia

Characterized mainly by the presence of delusions of persecution or grandeur and auditory hallucinations related to a single theme. Individual is often tense, suspicious, guarded, and my be argumentative, hostile, and aggressive. Onset of symptoms is usually later, (20-30s) and less regression of mental faculties, emotional response, and behavior is seen than in the other subtypes of schizophrenia.

Which task may be delegated to a nursing assistant in an acute mental health setting?

Checking for sharp objects

John is on the alcohol treatment unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel and says, "That's a stupid program! I want to watch something else!" In what stage of development is John fixed according to Sullivan's interpersonal theory? -Juvenile because he is learning to form satisfactory peer relationships. -Childhood because he has not learned to delay gratification. -Early adolescence because he is struggling to form an identity. -Late adolescence because he is working to develop a lasting relationship.

Childhood because he has not learned to delay gratification.

Correcting subluxation by manipulating vertebra of spinal column is what kind of therapy? o Allopathic therapy o Therapeutic touch o Massage therapy o Chiropractic therapy

Chiropractic therapy

Dementia

Chronic b. Gradual onset c. Irreversible

When planning group therapy, which configuration should a nurse identify as most optimal for a therapeutic group? o Circle of chairs, 5-10 people o Members choose chair placement o Chairs around a table, 5-10 people

Circle of chairs, 5-10 people

The most essential task for a nurse to conduct before forming a therapeutic relationship with a client is: o Clarifying one's attitudes, values, and beliefs o Ensuring therapeutic termination o Promoting client insight

Clarifying one's attitudes, values, and beliefs

THERAPEUTIC COMMUNICATION - BLOCKS Approving

Classify an action as good or bad.

A nurse evaluates a client PCA pump and notices 100 attempts within a 30 min period. Which is the best rationale for assessing this client for substance dependence? o Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control o Narcotic pain medication is contraindicated for all clients with active substance abuse problems o There is no need to assess the client o The client is experiencing symptoms of withdrawal, and needs to be accurately assed for lorazepam dosage

Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control

A patient with back pain says "my nurse practitioner told me acupuncture may enhance the effect of the medications and physical therapy prescribed." What type of therapy is being recommended? -Alternative therapy -Physiotherapy -Complementary therapy -Biophsycosocial therapy

Complementary therapy

A client admitted to the facility continually acts out a preoccupation with hand washing. What term should the nurse use to document this behavior?

Compulsion

DEFENSE MECHANISMS - Unconscious Undoing

Compulsive, unconscious act meant to reverse previous unacceptable impulses (mother spanks child, then begins to bake cookies).

The nurse collecting data on a client asks the client the meaning of the proverb "People in glass houses shouldn't throw stones." What is the nurse assessing by asking this question?

Concept formation

An extremely manipulative client is evoking angry feelings in a nurse. Which action should the nurse take first?

Confront the client about his manipulative behavior.

A client in an acute care mental health program refuses his morning dose of an oral antipsychotic medication and believes he's being poisoned. The nurse should respond by taking which action?

Consulting with the physician about a plan of care

THERAPEUTIC COMMUNICATION - TOOLS Silence

Convey interest through the use of body language.

A co-manager of a convenience store was taking the daily receipts to the bank when she was robbed at gun point. She did not report the robbery and could not be found for 2 days. In a city 100 miles away, a hotel manager called the police because the woman gave a false name and address. After learning that the robbery was confirmed by the bank cameras, she was admitted to the hospital with a diagnosis of Dissociative Fugue. The nurse should include which of the following in the client's care plan? Select all that apply. 1. Develop trust and rapport to provide safety and support. 2. Rule out possible physical and neurological causes for the fugue. 3. Help the client discuss what she can remember about the trip to the bank. 4. Seclude the client from the other clients because of her lack of memory. 5. Question her repeatedly about the robbery and how she responded. 6. Encourage the client to talk about her feelings about what has been happening.

1, 2, 3, 6. A client experiencing a Dissociate Fugue needs to feel safe and supported as well as evaluated medically and neurologically. Then it is appropriate to discuss what she can remember about the trip to the bank and her feelings about all that has happened to her since then. It is not appropriate to seclude her from others or to apply pressure to get details about the crime at this time. The police and the bank will ask these questions during their investigations.

A client is diagnosed with Generalized Anxiety Disorder (GAD) and given a prescription for venlafaxine (Effexor). Which of the following information should the nurse include in a teaching plan for this client? Select all that apply. 1. Various strategies for reducing anxiety. 2. The benefits and mechanisms of actions of Effexor in treating GAD. 3. How Effexor will eliminate his anxiety at home and work. 4. The management of the common side effects of Effexor. 5. Substituting adaptive coping strategies for maladaptive ones. 6. The positive effects of Effexor being evident in 4 to 5 days.

1, 2, 4, 5. It is appropriate to provide education on medication mechanisms, benefits, and managing side effects. No medication will eliminate all anxiety, so teaching about anxiety reduction and adaptive coping is needed. Effexor is a serotonin-norepinephrine reuptake inhibitor antidepressant and it will take 2 to 4 weeks to feel the effects.

A client diagnosed with Post Traumatic Stress Disorder is readmitted for suicidal thoughts and continued trouble sleeping. She states that when she closes her eyes, she has vivid memories about being awakened at night. "My dad would be on top of me trying to have sex with me. I couldn't breathe." Which of the following suggestions would be appropriate for the nurse to make for the insomnia? Select all that apply. 1. Trying relaxation techniques to help decrease her anxiety before bedtime. 2. Taking the quetiapine (Seroquel) 25 mg as needed as ordered by the physician. 3. Staying in the dayroom and trying to sleep in the recliner chair near staff. 4. Listening to calming music as she tries to fall asleep. 5. Processing the content of her flashbacks no less than hour before bedtime. 6. Leaving her door slightly open to decrease noise during the nightly checks.

1, 2, 4, 6. Relaxation techniques and listening to calming music decrease anxiety and promote sleep. Seroquel is often effective in decreasing nightmare and flashbacks and has a beneficial side effect of drowsiness. Leaving her door slightly open will decrease the noise of making 15 minute checks at night. Staying in the dayroom in a recliner with all the noise and lights is not likely to help. Processing memories an hour or two before bedtime doesn't allow enough time to calm down before sleep.

The nurse is developing a long term care plan for an outpatient client diagnosed with Dissociative Identity Disorder. Which of the following should be included in this plan? Select all that apply. 1. Learning how to manage feelings, especially anger and rage. 2. Joining several outpatient support groups that are process-oriented. 3. Identifying resources to call when there is a risk of suicide or self-mutilation. 4. Selecting a method for alter personalities to communicate with each other, such as journaling. 5. Trying different medicines to find one that eliminates the dissociative process. 6. Helping each alter accept the goal of sharing and integrating all their memories.

1, 3, 4, 6. Managing suicidal thought, urges to self-mutilate and the intense anger are critical safety issues. Then the focus can switch to communication methods for each alter and the integration issues. Process groups can be overwhelming when too much is revealed or when child alters are unable to understand the group content. There are no known medicines to stop the process of dissociating.

A client is taking diazepam (Valium) for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply. 1. To consult with his health care provider before he stops taking the drug. 2. To avoid eating cheese and other tyramine-rich foods. 3. To take the medication on an empty stomach. 4. Not to use alcohol while taking the drug. 5. To stop taking the drug if he experiences swelling of the lips and face and difficulty breathing.

1, 4, 5. The nurse should instruct the client who is taking diazepam to take the medication as prescribed; stopping the medication suddenly can cause withdrawal symptoms. This medication is used for a short term only. The drug dose can be potentiated by alcohol and the client should not drink alcoholic beverages while taking this drug. Swelling of the lips and face and difficulty breathing are signs and symptoms of an allergic reaction. The client should stop taking the drug and seek medical assistance immediately. The client does not need to avoid eating foods containing tyramine; tyramine interacts with monoamine oxidase inhibitors, not Valium. The client can take the medication with food.

A client with obsessive-compulsive disorder reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I can't stop until I do it just right." The nurse interprets the client's behavior as most likely representing an effort to obtain which of the following? 1. Relief from anxiety. 2. Control of his thoughts. 3. Attention from others. 4. Safe expression of hostility.

1. A client who is exhibiting compulsive behavior is attempting to control his anxiety. The compulsive behavior is performed to relieve discomfort and to bind or neutralize anxiety. The client must perform the ritual to avoid an extreme increase in tension or anxiety even though the client is aware that the actions are absurd. The repetitive behavior is not an attempt to control thoughts; the obsession or thinking component cannot be controlled. It is not an attention-seeking mechanism or an attempt to express hostility.

Which of the following statements by a client who has been taking buspirone (BuSpar) as prescribed for 2 days indicates the need for further teaching? 1. "This medication will help my tight, aching muscles." 2. "I may not feel better for 7 to 10 days." 3. "The drug does not cause physical dependence." 4. "I can take the medication with food."

1. Buspirone, a nonbenzodiazepine anxiolytic, is particularly effective in treating the cognitive symptoms of anxiety, such as worry, apprehension, difficulty with concentration, and irritability. BuSpar is not effective for the somatic symptoms of anxiety (muscle tension). Therapeutic effects may be experienced in 7 to 10 days, with full effects not occurring for 3 to 4 weeks. This drug is not known to cause physical or psychological dependence. It can be taken with food or small meals to reduce gastrointestinal upset.

The nurse should warn a client who is taking a benzodiazepine about using which of the following medications in combination with his current medication? 1. Antacids. 2. Acetaminophen (Tylenol). 3. Vitamins. 4. Aspirin.

1. Combining a benzodiazepine with an antacid impairs the absorption rate of the benzodiazepine. Acetaminophen, vitamins, and aspirin are safe to take with a benzodiazepine because no major drug interactions occur.

A 3-year-old child with a history of being abused has blood drawn. The child lies very still and makes no sound during the procedure. Which of the following comments by the nurse would be most appropriate? 1. "It's okay to cry when something hurts." 2. "That really didn't hurt, did it?" 3. "We're mean to hurt you that way, aren't we?" 4. "You were very good not to cry with the needle."

1. It is not normal for a preschooler to be totally passive during a painful procedure. Typically a preschooler reacts to a painful procedure by crying or pulling away because of the fear of pain. However, an abused child may become "immune" to pain and may find that crying can bring on more pain. The child needs to learn that appropriate emotional expression is acceptable. Telling the child that it really didn't hurt is inappropriate because it is untrue. Telling the child that nurses are mean does not build a trusting relationship. Praising the child will reinforce the child's response not to cry, even though it is acceptable to do so.

A young child who has been sexually abused has difficulty putting feelings into words. Which of the following should the nurse employ with the child? 1. Engaging in play therapy. 2. Role-playing. 3. Giving the child's drawings to the abuser. 4. Reporting the abuse to a prosecutor.

1. The dolls and toys in a play therapy room are useful props to help the child remember situations and reexperience the feelings, acting out the experience with the toys rather than putting the feelings into words. Role-playing without props commonly is more difficult for a child. Although drawing itself can be therapeutic, having the abuser see the pictures is usually threatening for the child. Reporting abuse to authorities is mandatory, but doesn't help the child express feelings.

A client is brought to the emergency department by his brother. The client is perspiring profusely, breathing rapidly, and complaining of dizziness and palpitations. Problems of a cardiovascular nature are ruled out, and the client's diagnosis is tentatively listed as a panic attack. After the symptoms pass, the client states, "I thought I was going to die." Which of the following responses by the nurse is best? 1. "It was very frightening for you." 2. "We would not have let you die." 3. "I would have felt the same way." 4. "But you're okay now."

1. The nurse responds with the statement, "It was very frightening for you," to express empathy, thus acknowledging the client's discomfort and accepting his feelings. The nurse conveys respect and validates the client's self-worth. The other statements do not focus on the client's underlying feelings, convey active listening, or promote trust.

The client, a veteran of the Vietnam war who has posttraumatic stress disorder, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which of the following responses by the nurse is appropriate? 1. "You did what you had to do at that time." 2. "Maybe you didn't kill as many people as you think." 3. "How many people did you kill?" 4. "War is a terrible thing."

1. The nurse states, "You did what you had to do at that time," to help the client evaluate past behavior in the context of the trauma. Clients commonly feel guilty about past behaviors when viewing them in the context of current values. The other statements are inappropriate because they do not help the client to evaluate past behavior in the context of the trauma.

A client diagnosed with obsessive-compulsive disorder arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which of the following statements by the nurse best deals with the client's feelings of "going crazy?" 1. "What do you mean when you say you think you're going crazy?" 2. "Most people feel that way occasionally." 3. "I don't know you well enough to judge your mental state." 4. "You sound perfectly sane to me."

1. When the client says he thinks he is "going crazy," it is best for the nurse to ask him what "crazy" means to him. The nurse must have a clear idea of what the client means by his words and actions. Using an open-ended question facilitates client description to help the nurse assess his meaning. The other statements minimize and dismiss the client's concern and do not give him the opportunity to openly discuss his feelings, possibly leading to increased anxiety.

The nurse is to administer Xanax (alprazolam) to help a client of Japanese descent calm down. The order reads Xanax 0.25 to 1 mg by mouth as needed for agitation. What is the best dose for the nurse to give this client? ________________________ mg.

2 mg. Asians have a greater sensitivity to psychotropic medication and generally require much less than other cultural groups to achieve positive results. The smallest dose is safest to start; the dosage can always be increased. However, a dose that is too high for the client is likely to cause unpleasant or even serious side effects. Those side effects likely would lead to distress and noncompliance in the future.

A nurse is assessing a client who is being abused. The nurse should assess the client for which characteristic? Select all that apply. 1. Assertiveness. 2. Self-blame. 3. Alcohol abuse. 4. Suicidal thoughts. 5. Guilt.

2, 3, 4, 5. The victim of abuse is usually compliant with the spouse and feels guilt, shame, and some responsibility for the battering. Self-blame, substance abuse, and suicidal thoughts and attempts are possible dysfunctional coping methods used by abuse victims. The victim of abuse is not likely to demonstrate assertiveness.

When working with a group of adult survivors of childhood sexual abuse, dealing with anger and rage is a major focus. Which strategy should the nurse expect to be successful? Select all that apply. 1. Directly confronting the abuser. 2. Using a foam bat while symbolically confronting the abuser. 3. Keeping a journal of memories and feelings. 4. Writing letters to the abusers that are not sent. 5. Writing letters to the adults who did not protect them that are not sent.

2, 3, 4, 5. Using a foam bat while symbolically confronting the abuser, keeping a journal of memories and feelings, and writing letters about the abuse but not sending them are appropriate strategies because they allow anger to be expressed safely. Directly confronting the abuser is likely to result in further harm because the abusers commonly deny the abuse, rationalize about it, or blame the victim.

A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which of the following responses by the nurse is most therapeutic? 1. "You need to sit down and relax." 2. "Are you feeling anxious?" 3. "Is something bothering you?" 4. "You must be experiencing a problem now."

2. Asking, "Are you feeling anxious?" helps the client to specifically label the feeling as anxiety so that he can begin to understand and manage it. Some clients need assistance with identifying what they are feeling so they can recognize what is happening to them. Stating, "You need to sit down and relax," is not appropriate because the client needs to continue his pacing to feel better. Asking if something is bothering the client or saying that he must be experiencing a problem is vague and does not help the client identify his feelings as anxiety.

A client diagnosed with Obsessive-Compulsive Disorder has been taking sertraline (Zoloft) but would like to have more energy every day. At his monthly checkup, he reports that his massage therapist recommended he take St. John's Wort to help his depression. The nurse should tell the client: 1. "St. John's Wort is a harmless herb that might be helpful in this instance." 2. "Combining St. John's Wort with the Zoloft can cause a serious reaction called Serotonin Syndrome." 3. "If you take St. John's, we'll have to decrease the dose of your Zoloft." 4. "St. John's Wort isn't very effective for depression, but we can increase your Zoloft dose."

2. The effectiveness of St. John's Wort with depression is unconfirmed. The critical issue is that the combination of St. John's Wort and Zoloft (an SSRI antidepressant) can produce Serotonin Syndrome which can be fatal. The client should not take the St. John's Wort while taking Zoloft.

A client tells the nurse that she has been raped but has not reported it to the police. After determining whether the client was injured, whether it is still possible to collect evidence, and whether to file a report, the nurse's next priority is to offer which of the following to the client? 1. Legal assistance. 2. Crisis intervention. 3. A rape support group. 4. Medication for disturbed sleep.

2. The experience of rape is a crisis. Crisis intervention services, especially with a rape crisis nurse, are essential to help the client begin dealing with the aftermath of a rape. Legal assistance may be recommended if the client decides to report the rape and only after crisis intervention services have been provided. A rape support group can be helpful later in the recovery process. Medications for sleep disturbance, especially benzodiazepines, should be avoided if possible. Benzodiazepines are potentially addictive and can be used in suicide attempts, especially when consumed with alcohol.

A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she's going crazy. Which of the following actions should the nurse use first? 1. Explain the effects of stress on the mind and body. 2. Reassure the client that her feelings are typical reactions to serious trauma. 3. Reassure the client that her symptoms are temporary. 4. Acknowledge the unfairness of the client's situation.

2. The nurse initially reassures the client that her feelings and behaviors are typical reactions to serious trauma to help decrease anxiety and maintain self-esteem. Explaining the effects of stress on the body may be helpful later. Telling the client that her symptoms are temporary is less helpful. Acknowledging the unfairness of the client's situation does not address the client's needs at this time.

After months of counseling, a client abused by her husband tells the nurse that she has decided to stop treatment. There has been no abuse during this time, and she feels better able to cope with the needs of her husband and children. In discussing this decision with the client, the nurse should: 1. Tell the client that this is a bad decision that she will regret in the future. 2. Find out more about the client's rationale for her decision to stop treatment. 3. Warn the client that abuse commonly stops when one partner is in treatment, only to begin again later. 4. Remind the client of her duty to protect her children by continuing treatment.

2. The nurse needs more information about the client's decision before deciding what intervention is most appropriate. Judgmental responses could make it difficult for the client to return for treatment should she want to do so. Telling the client that this is a bad decision that she will regret is inappropriate because the nurse is making an assumption. Warning the client that abuse commonly stops when one partner is involved in treatment may be true for some clients. However, until the nurse determines the basis for the client's decision, this type of response is an assumption and therefore inappropriate. Reminding the client about her duty to protect the children would be appropriate if the client had talked about episodes of current abuse by her partner and the fear that her children might be hurt by him.

A client with obsessive-compulsive disorder, who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. Because of his behavior, the client missed having breakfast yesterday with the other clients. Which of the following actions should the nurse institute to help the client be on time for breakfast? 1. Tell the client to make his bed one time only. 2. Wake the client an hour earlier to perform his ritual. 3. Insist that the client stop his activity when it's time for breakfast. 4. Advise the client to have breakfast first before making his bed.

2. The nurse should wake the client an hour earlier to perform his ritual so that he can be on time for breakfast with the other clients. The nurse provides the client with time needed to perform rituals because the client needs to keep his anxiety in check. The nurse should never take away a ritual, because panic will ensue. The nurse should work with the client later to slowly set limits on the frequency of the action.

1. A married female client has been referred to the mental health center because she is depressed. The nurse notices bruises on her upper arms and asks about them. After denying any problems, the client starts to cry and says, "He didn't really mean to hurt me, but I hate for the kids to see this. I'm so worried about them." Which of the following is the most crucial information for the nurse to determine? 1. The type and extent of abuse occurring in the family. 2. The potential of immediate danger to the client and her children. 3. The resources available to the client. 4. Whether the client wants to be separated from her husband.

2. The safety of the client and her children is the most immediate concern. If there is immediate danger, action must be taken to protect them. The other options can be discussed after the client's safety is assured.

A preadolescent child is suspected of being sexually abused because he demonstrates the self-destructive behaviors of self-mutilation and attempted suicide. Which common behavior should the nurse also expect to assess? 1. Inability to play. 2. Truancy and running away. 3. Head banging. 4. Over-control of anger.

2. Truancy and running away are common symptoms for young children and adolescents. The stress of the abuse interferes with school success, leading to the avoidance of school. Running away is an effort to escape the abuse and/ or lack of support at home. Rather than an inability to play or a lack of play, play is likely to be aggressive with sexual overtones. Children tend to act out anger rather than control it. Head banging is a behavior typically seen with very young children who are abused.

Which of the following client statements indicates the need for additional teaching about benzodiazepines? 1. "I can't drink alcohol while taking diazepam (Valium)." 2. "I can stop taking the drug anytime I want." 3. "Valium can make me drowsy, so I shouldn't drive for a while." 4. "Valium will help my tight muscles feel better."

2. Valium, like any benzodiazepine, cannot be stopped abruptly. The client must be slowly tapered off of the medication to decrease withdrawal symptoms, which would be similar to withdrawal from alcohol. Alcohol in combination with a benzodiazepine produces an increased central nervous system depressant effect and therefore should be avoided. Valium can cause drowsiness, and the client should be warned about driving until tolerance develops. Valium has muscle relaxant properties and will help tight, tense muscles feel better.

A client with acute stress disorder has avoided feelings of anger toward her rapist and cannot verbally express them. The nurse suggests which of the following activities to assist the client with expressing her feelings? 1. Working on a puzzle. 2. Writing in a journal. 3. Meditating. 4. Listening to music.

2. Writing in a journal can help the client safely express feelings, particularly anger, when the client cannot verbalize them. Safely externalizing anger by writing in a journal helps the client to maintain control over her feelings.

Which of the following observations by the nurse should suggest that a 15-month-old toddler has been abused? 1. The child appears happy when personnel work with him. 2. The child plays alongside others contentedly. 3. The child is underdeveloped for his age. 4. The child sucks his thumb.

3. An almost universal finding in descriptions of abused children is underdevelopment for age. This may be reflected in small physical size or in poor psychosocial development. The child should be evaluated further until a plausible diagnosis can be established. A child who appears happy when personnel work with him is exhibiting normal behavior. Children who are abused often are suspicious of others, especially adults. A child who plays alongside others is exhibiting normal behavior, that of parallel play. A child who sucks his thumb contentedly

During the third session with the nurse, a client who is being abused states, "I don't know what to do anymore. He doesn't want me to go anywhere while he's at work, not even to visit my friends." Which nursing diagnosis should the nurse formulate regarding this information? 1. Risk for other-directed violence related to an abusive husband, as evidenced by the victim's statement of being battered. 2. Situational low self-esteem related to victimization, as evidenced by not being able to leave the house. 3. Powerlessness related to control by husband, as evidenced by the inability to make decisions. 4. Ineffective coping related to victimization, as evidenced by crying.

3. Based on the client's statements, such as "I don't know what to do anymore," the data here best support the nursing diagnosis of Powerlessness related to control by husband, as evidenced by inability to make decisions. A nursing diagnosis of Risk for other-directed violence would be appropriate if the client had talked about being beaten up the previous night. A nursing diagnosis of Situational low self-esteem would be appropriate if the client verbalized feelings of embarrassment in leaving the house and worthlessness. A nursing diagnosis of Ineffective coping would be appropriate if the client was crying or talked about crying herself to sleep at night.

Adolescents and adults who were sexually abused as children commonly mutilate themselves. The nurse interprets this behavior as: 1. The need to make themselves less sexually attractive. 2. An alternative to bingeing and purging. 3. Use of physical pain to avoid dealing with emotional pain. 4. An alternative to getting high on drugs.

3. Dealing with the physical pain associated with mutilation is viewed as easier than dealing with the intense anger and emotional pain. The client fears an aggressive outburst when anger and emotional pain increase. Self-mutilation seems easier and safer. Additionally, self-mutilation may occur if the client feels unreal or numb or is dissociating. Here, the mutilation proves to the client that he or she is alive and capable of feeling. The client may want to be less sexually attractive, but this aspect usually is not related to self-mutilation. Bingeing and purging is commonly done in addition to, not instead of, self-mutilation. Although a few clients report an occasional high with self-mutilation, usually the experience is just relief from anger and rage.

In working with a rape victim, which of the following is most important? 1. Continuing to encourage the client to report the rape to the legal authorities. 2. Recommending that the client resume sexual relations with her partner as soon as possible. 3. Periodically reminding the client that she did not deserve and did not cause the rape. 4. Telling the client that the rapist will eventually be caught, put on trial, and jailed.

3. Guilt and self-blame are common feelings that need to be addressed directly and frequently. The client needs to be reminded periodically that she did not deserve and did not cause the rape. Continually encouraging the client to report the rape pressures the client and is not helpful. In most cases, resuming sexual relations is a difficult process that is not likely to occur quickly. It is not necessarily true that the rapist will be caught, tried, and jailed. Most rapists are not caught or convicted.

Which of the following points should the nurse include when teaching a client about panic disorder? 1. Staying in the house will eliminate panic attacks. 2. Medication should be taken when symptoms start. 3. Symptoms of a panic attack are time limited and will abate. 4. Maintaining self-control will decrease symptoms of panic.

3. It is important for the nurse to teach the client that the symptoms of a panic attack are time limited and will abate. This helps decrease the client's fear about what is occurring. Clients benefit from learning about their illness, what symptoms to expect, and the helpful use of medication. A simple biologic explanation of the disorder can convince clients to take their medication. Telling the client to stay in the house to eliminate panic attacks is not correct or helpful. Panic attacks can occur "out of the blue," and clients with panic disorder can become agoraphobic because of fear of having a panic attack where help is not available or escape is impossible. Medication should be taken on a scheduled basis to block the symptoms of panic before they start. Taking medication when symptoms start is not helpful. Telling the client to maintain self-control to decrease symptoms of panic is false information because the brain and biochemicals may account for its development. Therefore, the client cannot control when a panic attack will occur.

When planning interventions for parents who are abusive, the nurse should incorporate knowledge of which factor as a common parental indicator? 1. Lower socioeconomic group. 2. Unemployment. 3. Low self-esteem. 4. Loss of emotional family attachments.

3. Parents who are abusive often suffer from low self-esteem, commonly because of the way they were parented, including not being able to develop trust in caretakers and not being encouraged or offered emotional support by parents. Therefore, the nurse works to bolster the parents' self-esteem. This can be achieved by praising the parents for appropriate parenting. Employment and socioeconomic status are not indicators of abusive parents. Abusive parents usually are attached to their children and do not want to give them up to foster care. Parents who are abusive love their children and feel close to them emotionally.

A client named Jana, with a long history of experiencing Dissociative Identity Disorder, is admitted to the unit after the cuts on her legs were sutured in the Emergency Department. During the admission interview, Jana tearfully states that she does not know what happened to her legs. Then a stronger, alter personality named Jason emerges. Jason states that Jana is useless, weak, and needs to be eliminated completely. The nurse should do which of the following first? 1. Explore Jason's attitudes toward Jana more thoroughly. 2. Place Jana in restraints when Jason emerges. 3. Contract with Jason to tell the nurse when he has the urge to harm Jana and the body they both share. 4. Keep Jana in a stress-free environment so that the stronger Jason does not get a chance to emerge.

3. The No Harm Contract with any destructive alters is essential along with the reminder that the alters share the same body. Later, Jason's attitudes about Jana can be explored in more depth. When alter personalities emerge, their behaviors are not predictable. Restraints could not be placed on the client soon enough. There are no behaviors to justify restraints at this point. Creating a stress-free environment is not possible.

After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient clinic for follow-up. Which of the following is most important for the client to use for continued alleviation of anxiety? 1. Recognizing when she is feeling anxious. 2. Understanding reasons for her anxiety. 3. Using adaptive and palliative methods to reduce anxiety. 4. Describing the situations preceding her feelings of anxiety.

3. The client with anxiety may be able to learn to recognize when she is feeling anxious, understand the reasons for her anxiety, and be able to describe situations that preceded her feelings of anxiety. However, she is likely to continue to experience symptoms unless she has also learned to use adaptive and palliative methods to reduce anxiety.

A third-grade child is referred to the mental health clinic by the school nurse because he is fearful, anxious, and socially isolated. After meeting with the client, the nurse talks with his mother, who says, "It's that school nurse again. She's done nothing but try to make trouble for our family since my son started school. And now you're in on it." The nurse should respond by saying: 1. "The school nurse is concerned about your son and is only doing her job." 2. "We see a number of children who go to your son's school. He isn't the only one." 3. "You sound pretty angry with the school nurse. Tell me what has happened." 4. "Let me tell you why your son was referred, and then you can tell me about your concerns."

3. The mother's feelings are the priority here. Addressing the mother's feelings and asking for her view of the situation is most important in building a relationship with the family. Ignoring the mother's feelings will hinder the relationship. Defending the school nurse and the school puts the client's mother on the defensive and stifles communication.

The nurse notices that a client diagnosed with Major Depression and Social Phobia must get up and move to another area when someone sits next to her. Which of the following actions by the nurse is appropriate? 1. Ignore the client's behavior. 2. Question the client about her avoidance of others. 3. Convey awareness of the client's anxiety about being around others. 4. Tell the other clients to follow the client when she moves away.

3. The nurse conveys empathy and awareness of the client's need to reduce anxiety by showing acceptance and understanding to the client, thereby promoting trust. Ignoring the behavior, questioning the client about her avoidance of others, or telling other clients to follow her when she moves are not therapeutic or appropriate.

When developing the plan of care for a client with acute stress disorder who lost her sister in a boating accident, which of the following should the nurse initiate? 1. Helping the client to evaluate her sister's behavior. 2. Telling the client to avoid details of the accident. 3. Facilitating progressive review of the accident and its consequences. 4. Postponing discussion of the accident until the client brings it up.

3. The nurse should facilitate progressive review of the accident and its consequences to help the client integrate feelings and memories and to begin the grieving process. Helping the client to evaluate her sister's behavior, telling the client to avoid details of the accident, or postponing the discussion of the accident until the client brings it up is not therapeutic and does not facilitate the development of trust in the nurse. Such actions do not facilitate review of the accident, which is necessary to help the client integrate feelings and memories and begin the grieving process.

A client is diagnosed with agoraphobia without panic disorder. Which type of therapy is most effective for this illness? 1. Insight therapy. 2. Group therapy. 3. Behavior therapy. 4. Psychoanalysis.

3. The nurse should suggest behavior therapy, which is most successful for clients with phobias. Systematic desensitization, flooding, exposure, and self-exposure treatments are most therapeutic for clients with phobias. Self-exposure treatment is being increasingly used to avoid frequent therapy sessions. Insight therapy, exploration of the dynamics of the client's personality, is not helpful because the process of anxiety underlies the disorder. Group therapy or psychoanalysis, which deals with repressed, intrapsychic conflicts, is not helpful for the client with phobias because it does not help to manage the underlying anxiety or disorder.

While a client is taking alprazolam (Xanax), which of the following should the nurse instruct the client to avoid? 1. Chocolate. 2. Cheese. 3. Alcohol. 4. Shellfish.

3. Using alcohol or any central nervous system depressant while taking a benzodiazepine, such as alprazolam, is contraindicated because of additive depressant effects. Ingestion of chocolate, cheese, or shellfish is not problematic.

Which parental characteristic is least likely to be a risk factor for child abuse? 1. Low self-esteem. 2. History of substance abuse. 3. Inadequate knowledge of normal growth and development patterns. 4. Being a member of a large family.

4. From documented cases of child abuse, a profile has emerged of a high-risk parent as a person who is isolated, impulsive, impatient, and single with low self-esteem, a history of substance abuse, a lack of knowledge about a child's normal growth and development, and multiple life stressors. Just because a parent comes from a large family, there is no increase in the incidence of the parent abusing their own children unless they possess the other risk factors.

The mother of a school-aged child tells the nurse that, "For most of the past year my husband was unemployed and I worked a second job. Twice during the year I spanked my son repeatedly when he refused to obey. It has not happened again. Our family is back to normal." After assessing the family, the nurse decides that the child is still at risk for abuse. Which of the following observations best supports this conclusion? 1. The parents say they are taking away privileges when their son refuses to obey. 2. The child has talked about family activities with the nurse. 3. The parent's are less negative toward the nurse. 4. The child wears long sleeve shirts and long pants, even in warm weather.

4. Parental use of nonviolent discipline, the child's talk about what the family is doing and the easing of the parent's negativity toward the school nurse are all signs of progress. Avoidance and wearing clothes inappropriate for the weather implies that the child has something to hide, likely signs of physical abuse.

When obtaining a nursing history from parents who are suspected of abusing their child, which of the following characteristics about the parents should the nurse particularly assess? 1. Attentiveness to the child's needs. 2. Self-blame for the injury to the child. 3. Ability to relate the child's developmental achievements. 4. Difficulty with controlling aggression.

4. Parents of an abused child have difficulty controlling their aggressive behaviors. They may blame the child or others for the injury, may not ask questions about treatment, and may not know developmental information.

The client diagnosed with a fear of eating in public places or in front of other people has finished eating lunch in the dining area in the nurse's presence. Which of the following statements by the nurse should reinforce the client's positive action? 1. "It wasn't so hard, now was it?" 2. "At supper, I hope to see you eat with a group of people." 3. "You must have been hungry today." 4. "It is progress for you to eat in the dining room with me."

4. Saying, "It's a sign of progress to eat in the dining area with me," conveys positive reinforcement and gives the client hope and confidence, thus reinforcing the adaptive behavior. Stating, "It wasn't so hard, now was it," decreases the client's self-worth and minimizes his accomplishment. Stating, "At supper, I hope to see you eat with a group of people," will overwhelm the client and increase anxiety. Stating, "You must have been hungry today," ignores the client's positive behavior and shows the nurse's lack of understanding of the dynamics of the disorder.

A client with acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Which of the following responses by the nurse is most therapeutic? 1. "Don't keep torturing yourself with such horrible thoughts." 2. "Stop blaming yourself. It's only hurting you." 3. "Let's talk about something that is a bit more pleasant." 4. "The accident just happened and could not have been predicted."

4. Saying, "The accident just happened and could not have been predicted," provides the client with an objective perception of the event instead of the client's perceived role. This type of statement reflects active listening and helps to reduce feelings of blame and guilt. Saying, "Don't keep torturing yourself," or "Stop blaming yourself," is inappropriate because it tells the client what to do, subsequently delaying the therapeutic process. The statement, "Let's talk about something that is a bit more pleasant," ignores the client's feelings and changes the subject. The client needs to verbalize feelings and decrease feelings of isolation.

116.A newly admitted 20-year-old client, diagnosed with Post Traumatic Stress Disorder (PTSD), reluctantly reveals that she escaped from a satanic cult 2 years ago. The mother has been in the cult since the client was 3 years old and refused to leave with the client. The client says, "Nobody will ever believe the horrible things the men did to me and my mother never stopped them." Which of the following responses is appropriate for the nurse to make? 1. "I'll believe anything you tell me. You can trust me." 2. "I can't understand why your mother didn't protect you. It's not right." 3. "Tell me about the cult. I didn't know there were any near here." 4. "It must be difficult to talk about what happened. I'm willing to listen."

4. Survivors of trauma/ torture have a lot of difficulty with trust and do not readily talk about the horrible events. Therefore, empathy and a willingness to listen without pressuring the client are crucial. Option 1 may or may not be possible and does not convey the empathy. It is sometimes difficult to believe what satanic cults can do to children. Option 2 diverts attention from the client to the mother. Option 3 shows more interest in the cult than the client.

The client diagnosed with agoraphobia refuses to walk down the hall to the group room. Which of the following responses by the nurse is appropriate? 1. "I know you can do it." 2. "Try holding onto the wall as you walk." 3. "You can miss group this one time." 4. "I'll walk with you."

4. The nurse should walk with the client to activate adaptive coping for the client experiencing high anxiety and decreased motivation and energy. Stating, "I know you can do it," "Try holding on to the wall," or "You can miss group this one time," maintains the client's avoidance, thus reinforcing the client's behavior, and does not help the client begin to cope with the problem.

When planning the care for a client who is being abused, which of the following measures is most important to include? 1. Being compassionate and empathetic. 2. Teaching the client about abuse and the cycle of violence. 3. Explaining to the client her personal and legal rights. 4. Helping the client develop a safety plan.

4. The client's safety, including the need to stay alive, is crucial. Therefore, helping the client develop a safety plan is most important to include in the plan of care to ensure the client's safety. Being empathetic, teaching about abuse, and explaining the person's rights are also important after safety is ensured.

A client with posttraumatic stress disorder needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. The nurse interprets this action as which of the following? 1. A method of avoidance. 2. A detriment to progress. 3. The end of treatment. 4. A necessary break in treatment.

4. The nurse judges the client's request for an interruption in treatment as a necessary break in treatment. A "time-out" is common and necessary to enable the client to focus on pressing problems and solutions. It is not necessarily a method of avoidance, a detriment to progress, or the end of treatment. A problem like housing can be very stressful and require all of the client's energy and attention, with none left for the emotional stress of treatment.

After a client reveals a history of childhood sexual abuse, the nurse should ask which of the following questions first ? 1. "What other forms of abuse did you experience?" 2. "How long did the abuse go on?" 3. "Was there a time when you did not remember the abuse?" 4. "Does your abuser still have contact with young children?"

4. The safety of other children is a primary concern. It is critical to know whether other children are at risk for being sexually abused by the same perpetrator. Asking about other forms of abuse, how long the abuse went on, and if the victim did not remember the abuse are important questions after the safety of other children is determined.

When caring for a client who was a victim of a crime, the nurse is aware that recovery from any crime can be a long and difficult process depending on the meaning it has for the client. Which of the following should the nurse establish as a victim's ultimate goal in reconstructing his or her life? 1. Getting through the shock and confusion. 2. Carrying out home and work routines. 3. Resolving grief over any losses. 4. Regaining a sense of security and safety.

4. Ultimately, a victim of a crime needs to move from being a victim to being a survivor. A reasonable sense of safety and security is key to this transition. Getting through the shock and confusion, carrying out home and work routines, and resolving grief over any losses represent steps along the way to becoming a survivor.

In the process of dealing with the intense feelings about being raped, victims commonly verbalize that they were afraid they would be killed during the rape and wish that they had been. The nurse should decide that further counseling is needed if the client voices which of the following? 1. "I didn't fight him, but I guess I did the right thing because I'm alive." 2. "Suicide would be an easy escape from all this pain, but I couldn't do it to myself." 3. "I wish they gave the death penalty to all rapists and other sexual predators." 4. "I get so angry at times that I have to have a couple of drinks before I sleep."

4. Use of alcohol reflects unhealthy coping mechanisms. A client's report of needing alcohol to calm down needs to be addressed. Survival is the most important goal during a rape. The client's acknowledging this indicates that she is aware that she made the right choice. Although suicidal thoughts are common, the statement that suicide is an easy escape but the client would be unable to do it indicates low risk. Fantasies of revenge, such as giving the death penalty to all rapists, are natural reactions and are a problem only if the client intends to carry them out directly.

When assessing clients, a psychiatric nurse should understand that psychoanalytic theory is based on which underlying concept? A. A possible genetic basis for the client problems B. The structure and dynamics of the personality C. Behavioral responses to stressors D. Maladaptive cognitions

ANS: B The nurse should understand that psychoanalytic theory is based on the underlying concepts of the structure and dynamics of personality. Psychoanalytic theory was developed by Sigmund Freud and explains the structure of personality in three different components: the id, ego, and superego.

After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept? A. Differentiation of self B. Triangulation C. Fusion D. Emotional cutoff

ANS: B Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couple's marital problems.

A 15-year-old who is angry about not being chosen as the basketball team's captain, spray paints obscene words on the newly chosen captain's car. What information would cause a school nurse to consider a diagnosis of intermittent explosive disorder? A. The destruction of property is grossly out of proportion to the precipitating factor. B. The destruction of property is not a pattern of failure to resist aggressive impulses. C. The teenager has a diagnosis of conduct disorder. D. The teenager has previously been diagnosed with Tourette's syndrome.

ANS: A The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that several discrete episodes of destruction of property must occur, and the aggressive episode can not be better accounted for by another mental disorder such as conduct disorder or Tourette's syndrome. The degree of aggressiveness must be grossly out of proportion to the precipitating factor.

An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well-differentiated parent and adult child relationship. Which student example meets the instructor requirement? A. An adult child considers, but is not governed by, the advice of his or her parents. B. An adult child appears to listen, but ignores, the advice of his or her parents. C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents.

ANS: A The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed.

In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits.

ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence.

A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? A. Triangulation B. Pseudohostility C. Double-bind communication D. Pseudomutuality

ANS: A Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior.

A client diagnosed with an adjustment disorder asks the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing replies? (Select all that apply.) A. "Medications can interfere with your ability to find a more permanent problem solution." B. "Medications may mask the real problem at the root of this diagnosis." C. "Adjustment disorders are not commonly treated with medications." D. "Psychoactive drugs carry the potential for physiological and psychological dependence." E. "Psychoactive drugs will be prescribed only if your problems persist for more than 3 months."

ANS: A, B, C, D Adjustment disorder is not commonly treated with medications because of temporary effects, masking the real problem, interfering with finding a permanent solution, and the potential for addiction.

A client has been diagnosed with pathological gambling. The client's family inquires about their brother's behavior that led to this diagnosis. Which of the following information should the clinic nurse provide? (Select all that apply.) A. Your brother has been preoccupied with thoughts about gambling. B. Your brother has been gambling with increased amounts of money to gain excitement. C. Your brother has tried but failed to control his gambling. D. Your brother's gambling is a result of manic behavior. E. Your brother has lied to you about the extent of his gambling.

ANS: A, B, C, E The DSM-IV-TR criteria for the diagnosis of pathological gambling include all and more of the behaviors presented. The gambling behavior cannot be better accounted for by a manic episode.

In evaluating nursing interventions, which of the following types of questions would a nurse use to gather information from a client diagnosed with an impulse control disorder? (Select all that apply.) A. Can the client demonstrate the ability to delay gratification? B. Does the client demonstrate evidence of progression along the grief response? C. Can the client accomplish activities of daily living independently? D. Does the client verbalize symptoms of tension preceding unacceptable behavior? E. Does the client verbalize the unacceptability of maladaptive behaviors?

ANS: A, D, E A client diagnosed with an impulse control disorder should not have difficulty accomplishing activities of daily living or progressing through the grief process. These types of questions would be appropriate for clients diagnosed with adjustment disorders, not impulse control disorders.

A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of adjustment disorder, within what timeframe should the nurse expect the client to exhibit these symptoms? A. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident. B. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident. C. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident. D. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident.

ANS: B According to the DSM-IV diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within 3 months of the onset of the stressor.

A nurse is caring for a client who is suspected of having the diagnosis of trichotillomania. What condition must be ruled out prior to a definitive diagnosis of this disorder? A. Bipolar disorder B. Alopecia areata C. Post-traumatic stress disorder D. Body dysmorphic disorder

ANS: B Alopecia areata is a dermatological condition that, according to the DSM-IV diagnostic criteria for trichotillomania, must be ruled out to establish this diagnosis.

A client is diagnosed with intermittent explosive disorder. The clinic nurse should rrrrrrrkanticipate teaching about which medication? A. Citalopram (Celexa) B. Risperidone (Risperdal) C. Fluvoxamine (Luvox) D. Isocarboxazid (Marplan)

ANS: B An antipsychotic like Risperdal can be prescribed for intermittent explosive disorder. An antidepressant is not the usual drug of choice for this disorder.

A nursing instructor is teaching about the importance of healthy family member expectations for newly blended families. Which student statement indicates a need for further instruction? A. "Healthy family member expectations should be flexible." B. "Healthy family member expectations should be conforming." C. "Healthy family member expectations should be individual." D. "Healthy family member expectations should be realistic."

ANS: B Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family member expectations.

After a spouse dies, a client is diagnosed with adjustment disorder with depressed mood. Client symptoms include chronic migraines, feelings of hopelessness, social isolation, and self-care deficit. Which outcome would be most appropriate to direct the focus of this client's care? A. The client will not cope with stress by impulsive behaviors by discharge. B. The client will accomplish activities of daily living independently by discharge. C. The client will be able to cope effectively by delaying gratification by discharge. D. The client will verbalize a positive body image by discharge.

ANS: B Impulsive behaviors and the inability to delay gratification are symptoms of impulse control, not adjustment disorders. There is no evidence presented that the client has a body image distortion. Setting an outcome of independent self-care will direct nursing interventions toward encouraging the client to meet self-care needs.

Which individual would most likely be diagnosed with intermittent explosive disorder? A. A client diagnosed with antisocial personality disorder who attacks the nursing staff B. A client diagnosed with diabetes mellitus who has a history of multiple severe assaultive acts C. A client diagnosed with schizophrenia who sets fires because of command hallucinations D. A client diagnosed with alcohol dependence who severely beats wife while intoxicated

ANS: B The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that the aggressive episodes are not better accounted for by another mental disorder like antisocial personality disorder or schizophrenia. Also, the aggressive episodes are not due to the direct physiological effect of a substance such as alcohol.

During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? A. Multigenerational transmission B. Disengagement C. Mother-child subsystem D. Emotional cutoff

ANS: C In this situation, the mother and child have formed a subsystem in which they have aligned themselves against the father.

During her aunt's wake, before a mother can stop her 4-year-old child, the child runs up to the casket. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? A. Complicated grieving B. Altered family processes C. Ineffective coping D. Body image disturbance

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

An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? A. "Your son should be consistently disciplined by only one parent." B. "You should not have any more children because your son will need your full attention." C. "You need to keep the lines of communication open between all of you." D. "Allow your son to make his own choices because this new situation will be stressful."

ANS: C Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure.

Which task should the nurse recognize as appropriate to stage IV of the family life cycle? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship

ANS: C Stage IV of the family life cycle is described as the "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs.

A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home? A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing.

ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture.

A client has discovered that her husband is having an affair with a neighbor. During a visit to the neighbor's home, the wife steals the neighbor's diamond ring from the kitchen windowsill. What information would cause a nurse to rule out a diagnosis of kleptomania? A. The wife did not experience a sense of relief when she took the ring. B. The wife did not experience a sense of tension immediately before stealing the ring. C. The stealing was committed to express the wife's anger. D. The ring is desired by the wife for her personal use.

ANS: C The DSM-IV-TR criteria for the diagnosis of kleptomania state that an individual diagnosed with this disorder experiences a sense of tension before committing theft and relief at the time of the theft. The theft cannot be committed as an act of anger or vengeance, and the object stolen cannot be needed for personal use.

A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures.

ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal.

A jilted college student is admitted to a hospital following a suicide attempt and states, "No one will ever love a loser like me." According to Erikson's theory of personality development, a nurse should recognize a deficit in which developmental stage? A. Trust versus mistrust B. Initiative versus guilt C. Intimacy versus isolation D. Ego integrity versus despair

ANS: C The nurse should recognize that the client who states, "No one will ever love a loser like me." has not adequately completed the intimacy versus isolation stage of development. The intimacy versus isolation stage is presumed to occur in young adulthood between the ages of 20 and 30 years. The major developmental task in this stage is to establish intense, lasting relationships or commitment to another person, cause, institution, or creative effort.

When a mother brings her 9-month-old to daycare, the child smiles and reaches for the daycare caregiver. The nurse should determine that according to Mahler's developmental theory, this child's development is at which phase? A. The autistic phase B. The symbiotic phase C. The differentiation subphase of the separation-individuation phase D. The rapprochement subphase of the separation-individuation phase

ANS: C The nurse should understand that this client is in the differentiation subphase of the separation-individuation phase. This subphase begins with the child's initial physical movements away from the mothering figure. A primary recognition of separateness commences.

According to Peplau, a nurse who provides an abandoned child with parental guidance and praise following small accomplishments is serving which therapeutic role? A. The role of technical expert B. The role of resource person C. The role of surrogate D. The role of leader

ANS: C The nurse who provides an abandoned child with parental guidance and praise is serving the role of the surrogate according to Peplau's interpersonal theory. A surrogate serves as a substitute for another person—in this case, the child's parent.

A 13-year-old client's father has recently been deployed to Afghanistan. Since deployment, the client has begun to participate in isolative behaviors, truancy, vandalism, and fighting. The pediatric nurse practitioner should identify this behavior with which adjustment disorder? A. An adjustment disorder with anxiety B. An adjustment disorder with disturbance of conduct C. An adjustment disorder with mixed disturbance of emotions and conduct D. An adjustment disorder unspecified

ANS: C The predominant features of an adjustment disorder with mixed disturbance of emotions and conduct include symptoms of anxiety or depression as well as behaviors to include violations of rights of others, truancy, vandalism, and fighting.

A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? A. Coping by attacking B. Coping by surrendering C. Coping by avoiding D. Coping by belittling

ANS: C When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper.

A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged.

ANS: C With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt.

A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session, the nurse documents "Marital schism." What does the nurse mean by this documentation? A. The couple has a compatible marriage relationship. B. The husband has a dominant relationship over the wife. C. The couple has an enmeshed relationship. D. The couple has an incompatible marriage relationship.

ANS: D A marital schism is a state of chronic disequilibrium and discord. This describes this couple's marriage.

A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? A. All family members should use past incidents to make their point. B. One family member should act as a gatekeeper in order to avoid family confrontation. C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation.

ANS: D Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise.

During family counseling a husband states, "Every time my wife and I discuss child discipline, we get into shouting matches." The nurse instructs the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using? A. Reframing B. Restructuring the family C. Expressive psychotherapy D. Paradoxical intervention

ANS: D In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change.

A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication.

ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no-win situation because his mother has given a mixed message—a double-bind communication.

A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis? A. The client worries continually and appears nervous and jittery. B. The client complains of a depressed mood, is tearful, and feels hopeless. C. The client is belligerent, violates the rights of others, and defaults on legal responsibilities. D. The client complains of many physical ailments, refuses to socialize, and quits her job.

ANS: D The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, social withdrawal, or work or academic inhibition, without significant depressed or anxious mood.

According to Erikson's developmental theory, when planning care for a 47-year-old client, which developmental task should a nurse identify as appropriate for this client? A. To develop a basic trust in others B. To achieve a sense of self-confidence and recognition from others C. To reflect back on life events to derive pleasure and meaning D. To achieve established life goals and consider the welfare of future generations

ANS: D The nurse should identify that an appropriate developmental task for a 47-year-old client would be to achieve established life goals and consider the welfare of future generations. According to Erikson, the client would be in the generativity versus stagnation stage of development.

A 12-year-old girl becomes hysterical every time she strikes out in softball, falls down when roller-skating, or loses when playing games. According to Peplau's interpersonal theory, in which stage of development should the nurse identify a need for improvement? A. "Learning to count on others" B. "Learning to delay satisfaction" C. "Identifying oneself" D. "Developing skills in participation"

ANS: D The nurse should identify that this client needs to improve in the "Developing skills in participation" stage of Peplau's interpersonal theory. Older children in this phase learn the skills of compromise, competition, and cooperation with others.

A nurse directs the client interaction and plans for interventions to achieve client goals. According to Peplau's framework for psychodynamic nursing, what therapeutic role is this nurse assuming? A. The role of technical expert B. The role of resource person C. The role of teacher D. The role of leader

ANS: D The nurse who directs client interaction and plans for interventions is assuming the role of leader. According to Peplau, a leader directs the nurse-client interaction and ensures that actions are taken to achieve goals.