Mental Health Exam 2 Varcarolis & ATI bipolar, substance abuse, eating disorders, stress, diverse practice settings

Q19. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with paranoid personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

1

Q5. Which nursing approach should be used to maintain a therapeutic relationship with a client diagnosed with borderline personality disorder? 1. Being firm, consistent, and empathic, while addressing specific client behaviors 2. Promoting client self-expression by implementing laissez-faire leadership 3. Using authoritative leadership to help clients learn to conform to society norms 4. Overlooking inappropriate behaviors to avoid providing secondary gains

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Q8. Family members of a client ask the nurse to explain the difference between schizoid and avoidant personality disorders. Which is the appropriate nursing response? 1. Clients diagnosed with avoidant personality disorder desire intimacy but fear it, and clients diagnosed with schizoid personality disorder prefer to be alone. 2. Clients diagnosed with schizoid personality disorder exhibit delusions and hallucinations, while clients diagnosed with avoidant personality disorder do not. 3. Clients diagnosed with avoidant personality disorder are eccentric, and clients diagnosed with schizoid personality disorder are dull and vacant. 4. Clients diagnosed with schizoid personality disorder have a history of psychosis, while clients diagnosed with avoidant personality disorder remain based in reality.

1

Q26. Which statements represent positive outcomes for clients diagnosed with narcissistic personality disorder? (Select all that apply.) 1. The client will relate one empathetic statement to another client in group by day two. 2. The client will identify one personal limitation by day one. 3. The client will acknowledge one strength that another client possesses by day two. 4. The client will list four personal strengths by day three. 5. The client will list two lifetime achievements by discharge.

1,2,3

Q 28. A client is being assessed for antisocial personality disorder. According to the DSM-5, which of the following symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Ego-centrism and goal setting based on personal gratification. 2. Incapacity for mutually intimate relationships. 3. Frequent feelings of being down miserable and/or hopeless. 4. Disregard for and failure to honor financial and other obligations. 5, Intense feelings of nervousness, tenseness, or panic.

1,2,4

Q27. A nurse is caring for a client diagnosed with antisocial personality disorder. Which factors should the nurse consider when planning this client's care? (Select all that apply.) 1. This client has personality traits that are deeply ingrained and difficult to modify. 2. This client needs medication to treat the underlying physiological pathology. 3. This client uses manipulation, making the implementation of treatment problematic. 4. This client has poor impulse control that hinders compliance with a plan of care. 5. This client is likely to have secondary diagnoses of substance abuse and depression.

1,3,4,5

Q25. A nurse is admitting a client with a new diagnosis of a personality disorder. Which of the following would make the nurse question this diagnosis? (Select all that apply.) 1. The client has been diagnosed with sickle cell anemia. 2. The client has an inflated self-appraisal and feels a sense of entitlement. 3. The client has a history of a substance use disorder. 4. The client is odd and eccentric but not delusional. 5. The client has an intellectual developmental disorder.

1,3,5

Q 1. During an assessment interview, a client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions. Which is the appropriate nursing response to this behavior? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "What anti-personality disorder medications have helped you in the past?"

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Q 21. A highly emotional client presents at an outpatient clinic appointment and states, "My dead husband returned to me during a séance." Which personality disorder should a nurse associate with this behavior? 1. Obsessive-compulsive personality disorder 2. Schizotypal personality disorder 3. Narcissistic personality disorder 4. Borderline personality disorder

2

Q 22. 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? 1. "Their dramatic style tends to make their interpersonal relationships quite interesting and fulfilling." 2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." 3. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." 4. "They pay particular attention to details, which can interfere with the development of relationships."

2

Q 4. 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? 1. Allow the clients to apply the democratic process when developing unit rules. 2. Maintain consistency of care by open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of autocratic leadership.

2

Q11. When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? 1. The use of highly lethal methods to commit suicide 2. The use of suicidal gestures to elicit a rescue response from others 3. The use of isolation and starvation as suicidal methods 4. The use of self-mutilation to decrease endorphins in the body

2

Q16. Which client is a nurse most likely to admit to an inpatient facility for self-destructive behaviors? 1. A client diagnosed with antisocial personality disorder 2. A client diagnosed with borderline personality disorder 3. A client diagnosed with schizoid personality disorder 4. A client diagnosed with paranoid personality disorder

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Q20. From a behavioral perspective, which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Contract with the client to reinforce positive behaviors with unit privileges. 3. Teach the purpose of anti-anxiety medications to improve medication compliance. 4. Encourage the client to journal feelings to improve awareness of abandonment issues.

2

Q7. A client expresses low self-worth, has much difficulty making decisions, avoids positions of responsibility, and has a behavioral pattern of "suffering" in silence. Which statement best explains the etiology of this client's personality disorder? 1. Childhood nurturance was provided from many sources, and independent behaviors were encouraged. 2. Childhood nurturance was provided exclusively from one source, and independent behaviors were discouraged. 3. Childhood nurturance was provided exclusively from one source, and independent behaviors were encouraged. 4. Childhood nurturance was provided from many sources, and independent behaviors were discouraged.

2

Q 10. 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? 1. Schizoid personality disorder 2. Obsessive-compulsive personality disorder 3. Histrionic personality disorder 4. Paranoid personality disorder

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Q 13. Which reaction to a compliment from another client should a nurse identify as a typical response from a client diagnosed with avoidant personality disorder? 1. Interpreting the compliment as a secret code used to increase personal power 2. Feeling the compliment was well deserved 3. Being grateful for the compliment but fearing later rejection and humiliation 4. Wondering what deep meaning and purpose is attached to the compliment

3

Q 14. Which factors differentiate a client diagnosed with social phobia from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with social phobia are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with social phobia experience generalized anxiety. 3. Clients diagnosed with social phobia avoid attending birthday parties, whereas clients diagnosed with schizoid personality disorder would isolate self on a continual basis. 4. Clients diagnosed with schizoid personality disorder avoid attending birthday parties, whereas clients diagnosed with social phobia would isolate self on a continual basis.

3

Q 17. When planning care for clients diagnosed with personality disorders, what should be the goal of treatment? 1. To stabilize the client's pathology by using the correct combination of psychotropic medications 2. To change the characteristics of the dysfunctional personality 3. To reduce personality trait inflexibility that interferes with functioning and relationships 4. To decrease the prevalence of neurotransmitters at receptor sites

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Q 6. Which adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. A physically healthy client who is dependent on meeting social needs by contact with 15 cat 2. A physically healthy client who has a history of depending on intense relationships to meet basic needs 3. A physically healthy client who lives with parents and depends on public transportation 4. A physically healthy client who is serious, inflexible, perfectionistic, lacks spontaneity, and depends on rules to provide security

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Q15. Which client symptoms should lead a nurse to suspect a diagnosis of obsessive-compulsive personality disorder? 1. The client experiences unwanted, intrusive, and persistent thoughts. 2. The client experiences unwanted, repetitive behavior patterns. 3. The client experiences inflexibility and lack of spontaneity when dealing with others. 4. The client experiences obsessive thoughts that are externally imposed.

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Q2. At 11:00 p.m. a client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10:00 p.m. Which nursing response is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10:00 p.m. phone curfew. You will be able to call tomorrow." 4. "A divorce shouldn't be considered until you have had a good night's sleep."

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Q3. A client diagnosed with paranoid personality disorder becomes violent on a unit. Which nursing intervention is most appropriate? 1. Provide objective evidence that reasons for violence are unwarranted. 2. Initially restrain the client to maintain safety. 3. Use clear, calm statements and a confident physical stance. 4. Empathize with the client's paranoid perceptions.

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Q 12. 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? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

4

Q18. Which client situation would reflect the impulsive behavior that is commonly associated with borderline personality disorder? 1. 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." 2. 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." 3. 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." 4. 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."

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Q23. During an interview, which client statement should indicate to a nurse a potential diagnosis of schizotypal personality disorder? 1. "I don't have a problem. My family is inflexible, and relatives are out to get me." 2. "I am so excited about working with you. Have you noticed my new nail polish, 'Ruby Red Roses'?" 3. "I spend all my time tending my bees. I know a whole lot of information about bees." 4. "I am getting a message from the beyond that we have been involved with each other in a previous life."

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Q24. Which nursing diagnosis should be prioritized when providing nursing care to a client diagnosed with avoidant personality disorder? 1. Risk for violence: directed toward others R/T paranoid thinking 2. Risk for suicide R/T altered thought 3. Altered sensory perception R/T increased levels of anxiety 4. Social isolation R/T inability to relate to others

4

Q9. Which nursing diagnosis should a nurse identify as appropriate when working with a client diagnosed with schizoid personality disorder? 1. Altered thought processes R/T increased stress 2. Risk for suicide R/T loneliness 3. Risk for violence: directed toward others R/T paranoid thinking 4. Social isolation R/T inability to relate to others

4

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the nurse notes that the lithium blood level is 1.2 mEq/L. Which of the following is an appropriate action by the nurse? A. Administer the next dose of lithium carbonate as scheduled. B. Prepare for administration of aminophylline. C. Notify the provider for a possible increase in the dosage of lithium carbonate. D. Request a stat repeat of the client's lithium blood level.

A

A nurse is discussing routine follow-up needs for a client who has a new prescription for valproic acid (Depakote). The nurse should inform the client of the need for routine monitoring of which of the following? A. AST/ALT and LDH B. Creatinine and BUN C. WBC and granulocyte counts D. Serum sodium and potassium

A

A nurse is preparing to provide an educational seminar on stress to other nursing staff. Which of the following is appropriate to include in the discussion? A. Excessive stressors cause the client to experience distress. B. The body's initial adaptive response to stress is denial. C. The absence of stressors results in homeostasis. D. Negative, rather than positive, stressors produce a biological response.

A

A nurse is teaching a client about stress-reduction techniques. Which of the following client statements indicates understanding of the teaching? A. "Cognitive reframing will help me change my irrational thoughts to something positive." B. "Progressive muscle relaxation uses a mechanical device to help me gain control over my pulse rate." C. "Biofeedback causes my body to release endorphins so that I feel less stress and anxiety." D. "Mindfulness allows me to prioritize the stressors that I have in my life so that I have less anxiety."

A

In the DSM-5, the major change in how culture is viewed within each disorder is that: A. Issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes. B. Issues related to culture and mental illness are markedly absent in the discussion of each disorder C. it is noted that it is impossible for health practitioners to be expected to be culturally aware with the increasing diversity of the United States. D. issues related to culture and mental illness are less important than previously thought in diagnostic criteria.

A

The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate? a. Patient will visit with spiritual healer once weekly. b. Patient will experience rebalance of yin-yang by discharge. c. Patient will identify sources that increase "cold wind" within 24 hours of admission. d. Patient will contact "singer" to provider healing ritual within 3 days of admission.

A

A nurse is discussing acute vs. prolonged stress with a client. Which of the following should the nurse identify as an acute stress response? (Select all that apply.) A. Decreased appetite B. Depressed immune system C. Increased blood pressure D. Panic attacks E. Unhappiness

A, B, C, E

A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? (SATA) A. Priority restructuring B. Monitoring thoughts C. Diaphramatic breathing D. Journal keeping E. Meditation ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

A, B, D: Others are behavioral therapy. Surprise: Journal keeping is a cognitive reframing technique. ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

Which idea held by the nurse would best promote the provision of culturally competent care? A. Western biomedicine is one of several established healing systems. B. Some individuals will profit from use of both Western and folk healing practices. C. Use of cultural translators will provide valuable information into health-seeking behaviors. D. Need for spiritual healing is a concept that crosses cultural boundaries.

A. A nurse who holds this belief would be likely be open to a variety of established interventions. In truth, nurses cannot apply a standard model of assessment, diagnosis, and intervention to all clients with equal confidence. This leads to culturally irrelevant interventions.

The nurse assesses the wellness beliefs and values of a client from another culture best when asking A. "What do you think is making you ill?" B. "When did you first feel ill?" C. "How can I help you get better?" D. "Did you do something to cause the illness?"

A. Asking the client to suggest reasons for the illness will best provide an opportunity to become familiar with general beliefs and values the client holds regarding his wellness.

According to the Western scientific view of health, illness is the result of A. pathogens. B. energy blockage. C. spirit invasion. D. soul loss.

A. Disease has a cause (e.g., pathogens, toxins) that creates the effect; disease can be observed and measured.

The psychiatric nurse planning and implementing care for culturally diverse clients should understand A. holistic theory. B. systems theory. C. adaptation theory. D. political power theory.

A. In most cultures a holistic perspective prevails, one without separation of mind and body.

In the Eastern tradition, disease is believed to be caused by A. fluctuations in opposing forces. B. outside influences. C. members' disobedience. D. adoption of Western beliefs.

A. In the Eastern tradition, disease is believed to be caused by fluctuations in opposing forces, the yin-yang energies.

Which statement best explains the term "worldview"? A. Beliefs and values held by people of a given culture about what is good, right, and normal. B. Ideas derived from the major health care system of the culture about what causes illness. C. Cultural norms about how, when, and to whom illness symptoms may be displayed. D. Valuing one's beliefs and customs over those of another group.

A. A worldview is a system of thinking about how the world works and how people should behave in the world and toward each other. It is from this view that people develop beliefs, values, and the practices that guide their lives.

A teen says to you, "What's the big deal about using pot? How can it hurt me?" the most accurate reply you could make is: A. "If you're high, you won't be able to remember what you just learned." B. "THC in your body can produce dangerous flashbacks when you get older." C. "even a moderate dose of THC can produce perceptual distortions and coma." D. "you're right - it really own't affect you much in school."

A. "If you're high, you won't be able to remember what you just learned."

A client is being discharged from an alcohol treatment program. The client's wife states, "I'm so afraid that when my husband leaves here, he'll relapse. How can I deal with this?" Which nursing statement would be most appropriate? A. "Many family members of alcoholics find the Al-Anon support group to be helpful." B. "You could try going out and having a few beers with him when he gets the urge to drink." C. "Just make sure he doesn't drink at home. Find all of his hidden bottles and empty them." D. "Tell your husband that if he drinks again, you will leave him."

A. "Many family members of alcoholics find the Al-Anon support group to be helpful." This therapeutic response addresses the wife's concerns by giving information about Al-Anon. Al-Anon is a nonprofit organization that provides group support for the family and close friends of alcoholics.

Paula is attending an education class on addictive disorders. She suspects that her husband may be abusing opiates since he has been taking pills given to him by his brother and she knows the brother had been taking oxycodone for back pain. She asks the nurse how to interpret her husband's behaviors. Which of the following observations by Paula are consistent with opioid intoxication? (Select all that apply). A. "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." B. "Last night he went out without a coat on and it was 15 degrees outside." C. "While we were talking at dinner his speech was rapid and he seemed hyperalert to everything in the environment." D. "He's been having trouble remembering things." E. "Sometimes, it looks like his pupils are very small."

A. "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." B. "Last night he went out without a coat on and it was 15 degrees outside." D. "He's been having trouble remembering things." E. "Sometimes, it looks like his pupils are very small." Feedback 1: One manifestation of opioid intoxication is an initial period of euphoria followed by apathy, which is indicated by her statement that "sometimes he acts like he doesn't care about anything." Feedback 2: Going outside without a coat in subfreezing weather could be inferred as impaired judgment, which is consistent with opioid intoxication. Feedback 4: Impairment in attention and memory is consistent with opioid intoxication. Feedback 5: Paula is describing pupillary constriction, which is consistent with opioid intoxication

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The defense mechanism that Dan is using is A. Denial B. Projection C. Displacement D. Rationalization

A. Denial

A nurse is working in a community mental health facility. Which of the following services are appropriate for clients to receive? (Select all that apply.) A. Educational groups B. Medication dispensing programs C. Individual counseling programs D. Detoxification programs E. Crisis intervention

A. Educational groups B. Medication dispensing programs C. Individual counseling programs

Paul, a 65-year old Caucasian, is being seen at the health clinic for hypertension and has a history of alcohol use disorder. Which of the following observations by the nurse are consistent with physical complications associated with chronic alcohol use disorders? (Select all that apply) A. His skin is yellow B. He has a butterfly-shaped rash on his cheeks and nose. C. His abdomen is distended D. He is coughing up blood E. He complains of acute pain in his left eye.

A. His skin is yellow C. His abdomen is distended D. He is coughing up blood Feedback 1: Yellowish skin is evidence of jaundice, which is secondary to cirrhosis of the liver. Cirrhosis of the liver is a common manifestation of end-stage alcoholic liver disease Feedback 3: Abdominal distention can be a manifestation of alcoholic hepatitis, cirrhosis of the liver, and pancreatitis, all of which are complications of alcohol use disorder. Further assessment is warranted. Feedback 4: Coughing up blood may be evidence of several complications of alcoholism, including esophageal varices, which can culminate in potentially fatal hemorrhage. Further assessment is warranted to evaluate for these as well as other potential causes of coughing up blood.

The ED nurse assesses a confused client diagnosed with alcohol use disorder and notes the use of confabulation. Which complication of alcohol use disorder would the nurse suspect? A. Korsakoff's psychosis B. Vascular neurocognitive disorder C. Wernicke's encephalopathy D. esophageal varices

A. Korsakoff's psychosis The symptoms described are those associated with Korsakoff's psychosis. Korsakoff's psychosis is identified by a syndrome of confusion, loss of memory, and confabulation. Confabulation is the creating of imaginary events to fill in memory gaps.

Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? A. They claim they will help me stay sober. B. I'll dry out in AA, then i can have a social drink now and then. C. AA is only for people who have reached the bottom D. If I lose my job, AA will help me find another.

A. They claim they will help me stay sober.

A nurse is caring for a client who has a new prescription for valproic acid (Depakote). The nurse should instruct the client that while taking this medication he will need which of the following laboratory tests periodically? (Select all that apply) A. thrombocyte count B. Hematocrit C. Amylase D. Liver function tests E. Potassium

A. Thrombocyte count C. Amylase D. Liver function test

Ralph has been a serious drinker for many years. in the past year, the has started having huge memory lapses. He will use made up stories to fill in the gaps. This is a syndrome called: A. confabulation B. Korsakoff's syndrome C. fictional memory D. Wernicke's encephalopathy

A. confabulation

Which issues influence an individual's predisposition to substance-related disorders? (Select all that apply) A. genetic history B. fixation at the oral stage of psychosexual development C. punitive ego D. personality traits E. behavior modeling

A. genetic history B. fixation at the oral stage of psychosexual development D. personality traits E. behavior modeling Feedback 1: Research has indicated that an apparent hereditary factor is involved in the development of substance-use disorders. This is especially evident with alcoholism Feedback 2: theories of psychosexual development state that anxiety in people fixated at the oral stage may be reduced by their consumption of substances such as alcohol. Feedback 4: Certain personality traits, such as low self-esteem, depression and passivity are thought to increase a tendency toward addictive behavior Feedback 5: Studies have shown that children and adolescents are more likely to use substances if they have parents who provide a model for substance abuse.

Which of the following has been implicated in the predisposition to substance abuse? A. hereditary factor B. fixation in the adolescent stage of psychosexual development C. punitive ego D. narcissistic and dependent personality traits

A. hereditary factor

George stopped taking his regular amount of cocaine after using it for months. He will probably experience: A. letdown, depressed feelings, and fatigue B. pain, sweating, mania, and nausea C. excitement, insomnia and hallucinations D. dramatic tremors of the hands and face, rapid heart rate and convulsions

A. let down, depressed feelings, and fatigue

One of the features of Alcoholics Anonymous is: A. peer support B. residential services C. alcohol maintenance D. antagonistic

A. peer support

Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Lab reports reveal has has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? A. several hours after the last drink B. 2-3 days after the last drink C. 4-5 days after the last drink D. 6-7 days after the last drink

A. several hours after the last drink

A polysubstance abuser makes the statement, "The green and whites do me good after speed." how might the nurse interpret the statement? A. the client abuses amphetamines and anxiolytics B. the client abuses alcohol and cocaine C. the client is psychotic D. the client abuses narcotics and marijuana.

A. the client abuses amphetamines and anxiolytics

Julie began by taking on amphetamine a day to control her appetite. After a month or so it did not work as well but two pills did. This is an example of: A. tolerance B. resistance C. withdrawal D. dependence

A. tolerance

A nurse is reviewing laboratory findings and notes that a client's plasma lithium level is 2.1 mEq/L. Which of the following is an appropriate action by the nurse? A. Perform immediate gastric lavage B. Prepare the client for hemodialysis C. Administer an additional oral dose of lithium D. Request a stat repeat of the laboratory test

A.Perform immediate gastric lavage.

A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol This form of treatment is an example of which of the following? A. Aversion therapy B. Flooding C. Biofeedback D. Dialectical behavior therapy ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

A: Aversion therapy pairs a maladaptive behavior with unpleasant stimuli to promote a change in behavior. Flooding: planned exposure to an undesirable stimulus in an attempt to turn off the anxiety response. Biofeedback is a behavioral therapy to control pain, tension, and anxiety. Dialectical behavior therapy is a cognitive-behavioral therapy for clients who have a personality disorder and exhibit self-injurious behavior. ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

Which nursing actions demonstrate cultural competence? (SATA) a. Planning meal time around the patient's prayer schedule b. Advising a patient to visit with the hospital chaplain c. Researching foods that a lacto-ovo-vegetarian patient will eat d. Providing time for a patient's spiritual healer to visit e. Ordering standard meal trays to be delivered three times daily

ABCD

Which is true of pharmacological therapies for treatment of personality disorders? a. Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. b. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. c. Patients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors. d. Patients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these patients.

ANS: A

16. Which features should be present in a therapeutic milieu for a patient with a hallucinogen overdose? a. Simple and safe b. Active and bright c. Stimulating and colorful d. Confrontational and challenging

ANS: A Because the individual who has ingested a hallucinogen is probably experiencing feelings of unreality and altered sensory perceptions, the best environment is one that does not add to the stimulation. A simple, safe environment is a better choice than an environment with any of the characteristics listed in the other options. The other options would contribute to a "bad trip."

18. At a meeting for family members of alcoholics, a spouse says, "I did everything I could to help. I even requested sick leave when my partner was too drunk to go to work." The nurse assesses these comments as: a. codependence. b. assertiveness c. role reversal d. homeostasis.

ANS: A Codependence refers to participating in behaviors that maintain the addiction or allow it to continue without holding the user accountable for his or her actions. The other options are not supported by information given in the scenario. See relationship to audience response question.

13. During the third week of treatment, the spouse of a patient in a rehabilitation program for substance abuse says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? a. "While sobriety solves some problems, new ones may emerge as one adjusts to living without drugs and alcohol." b. "It will be important for you to structure life to avoid as much stress as you can and provide social protection." c. "Addiction is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully." d. "It is good that you are supportive of your spouse's sobriety and want to help maintain it."

ANS: A During recovery, patients identify and use alternative coping mechanisms to reduce reliance on substances. Physical adaptations must occur. Emotional responses were previously dulled by alcohol but are now fully experienced and may cause considerable anxiety. These changes inevitably have an effect on the spouse and children, who need anticipatory guidance and accurate information.

11. A patient admitted to an alcoholism rehabilitation program tells the nurse, "I'm actually just a social drinker. I usually have a drink at lunch, two in the afternoon, wine with dinner, and a few drinks during the evening." The patient is using which defense mechanism? a. Denial b. Projection c. Introjection d. Rationalization

ANS: A Minimizing one's drinking is a form of denial of alcoholism. The patient is more than a social drinker. Projection involves blaming another for one's faults or problems. Rationalization involves making excuses. Introjectioninvolves incorporating a quality of another person or group into one's own personality.

23. Select the priority nursing intervention when caring for a patient after an overdose of amphetamines. a. Monitor vital signs. b. Observe for depression. c. Awaken the patient every 15 minutes. d. Use warmers to maintain body temperature.

ANS: A Overdose of stimulants, such as amphetamines, can produce respiratory and circulatory dysfunction as well as hyperthermia. Concentration is impaired. This patient will be hypervigilant; it is not necessary to awaken the patient.

15. Select the most therapeutic manner for a nurse working with a patient beginning treatment for alcohol addiction. a. Empathetic, supportive b. Skeptical, guarded c. Cool, distant d. Confrontational

ANS: A Support and empathy assist the patient to feel safe enough to start looking at problems. Counseling during the early stage of treatment needs to be direct, open, and honest. The other approaches will increase patient anxiety and cause the patient to cling to defenses.

28. A nurse wants to research epidemiology, assessment techniques, and best practices regarding persons with addictions. Which resource will provide the most comprehensive information? a. Substance Abuse and Mental Health Services Administration (SAMHSA) b. Institute of Medicine - National Research Council (IOM) c. National Council of State Boards of Nursing (NCSBN) d. American Society of Addictions Medicine

ANS: A The Substance Abuse and Mental Health Services Administration (SAMHSA) is the official resource for comprehensive information regarding addictions. The other resources have relevant information, but they are not as comprehensive.

30. Select the priority outcome for a patient completing the fourth alcohol-detoxification program in the past year. Prior to discharge, the patient will: a. state, "I know I need long-term treatment." b. use denial and rationalization in healthy ways. c. identify constructive outlets for expression of anger. d. develop a trusting relationship with one staff member.

ANS: A The key refers to the need for ongoing treatment after detoxification and is the best goal related to controlling relapse. The scenario does not give enough information to determine whether anger has been identified as a problem. A trusting relationship, while desirable, should have occurred earlier in treatment.

17. When a patient first began using alcohol, two drinks produced relaxation and drowsiness. After 1 year, four drinks are needed to achieve the same response. Why has this change occurred? a. Tolerance has developed. b. Antagonistic effects are evident. c. Metabolism of the alcohol is now delayed. d. Pharmacokinetics of the alcohol have changed.

ANS: A Tolerance refers to needing higher and higher doses of a drug to produce the desired effect. The potency of the alcohol is stable. Neither hypomagnesemia nor antagonistic effects account for this change.

A patient diagnosed with acute mania has distributed pamphlets about a new business venture on a street corner for 2 days. Which nursing diagnosis has priority? a. Risk for injury b. Ineffective coping c. Impaired social interaction d. Ineffective therapeutic regimen management

ANS: A Although each of the nursing diagnoses listed is appropriate for a patient having a manic episode, the priority lies with the patient's physiological safety. Hyperactivity and poor judgment put the patient at risk for injury.

Four new patients were admitted to the behavioral health unit in the past 12 hours. The nurse directs a psychiatric technician to monitor these patients for safety. Which patient will need the most watchful supervision? A patient diagnosed with: a. bipolar I disorder b. bipolar II disorder. c. dysthymic disorder d. cyclothymic disorder

ANS: A Bipolar I is a mood disorder characterized by excessive activity and energy. Psychosis (hallucinations, delusions, and dramatically disturbed thoughts) may occur during manic episodes. A patient with bipolar I disorder is more unstable than a patient diagnosed with bipolar II, cyclothymic disorder, or dysthymic disorder.

A patient diagnosed with bipolar disorder will be discharged tomorrow. The patient is taking a mood stabilizing medication. What is the priority nursing intervention for the patient as well as the patient's family during this phase of treatment? a. Attending psychoeducation sessions b. Decreasing physical activity c. Increasing food and fluids d. Meeting self-care needs

ANS: A During the continuation phase of treatment for bipolar disorder, the physical needs of the patient are not as important an issue as they were during the acute episode. After hospital discharge, treatment focuses on maintaining medication compliance and preventing relapse, both of which are fostered by ongoing psychoeducation.

2. Which intervention is appropriate for an individual diagnosed with an antisocial personality disorder who frequently manipulates others? a. Refer requests and questions related to care to the case manager. b. Encourage the patient to discuss feelings of fear and inferiority. c. Provide negative reinforcement for acting-out behavior. d. Ignore, rather than confront, inappropriate behavior.

ANS: A Manipulative people frequently make requests of many different staff, hoping one will give in. Having one decision maker provides consistency and avoids the potential for playing one staff member against another. Positive reinforcement of appropriate behaviors is more effective than negative reinforcement. The behavior should not be ignored; judicious use of confrontation is necessary. Patients with antisocial personality disorders rarely have feelings of fear and inferiority. REF: Page 463 (Table 24-2) | Page 465 | Page 469 (Table 24-4)

The nurse receives a laboratory report indicating a patient's serum level is 1 mEq/L. The patient's last dose of lithium was 8 hours ago. This result is: a. within therapeutic limits. b. below therapeutic limits. c. above therapeutic limits. d. invalid because of the time lapse since the last dose.

ANS: A Normal range for a blood sample taken 8 to 12 hours after the last dose of lithium is 0.4 to 1 mEq/L.

21. What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder? a. Respect the patient's need for periods of social isolation. b. Prevent the patient from violating the nurse's rights. c. Teach the patient how to select clothing for outings. d. Engage the patient in community activities.

ANS: A Patients with schizotypal personality disorder are eccentric and often display perceptual and cognitive distortions. They are suspicious of others and have considerable difficulty trusting. They become highly anxious and frightened in social situations, thus the need to respect their desire for social isolation. Teaching the patient to match clothing is not the priority intervention. Patients with schizotypal personality disorder rarely engage in behaviors that violate the nurse's rights or exploit the nurse. REF: Page 458-459 | Page 463 (Table 24 - 2)

15. A patient diagnosed with borderline personality disorder was hospitalized several times after self-mutilating episodes. The patient remains impulsive. Which nursing diagnosis is the initial focus of this therapy? a. Risk for self-directed violence b. Impaired skin integrity c. Risk for injury d. Powerlessness

ANS: A Risk for self-mutilation is a nursing diagnosis relating to patient safety needs and is therefore of high priority. Impaired skin integrity and powerlessness may be appropriate foci for care but are not the priority related to this therapy. Risk for injury implies accidental injury, which is not the case for the patient with borderline personality disorder. REF: Page 476 (Fig 24 - 1)

A health teaching plan for a patient taking lithium should include instructions to: a. maintain normal salt and fluids in the diet. b. drink twice the usual daily amount of flu-id. c. double the lithium dose if diarrhea or vomiting occurs. d. avoid eating aged cheese, processed meats, and red wine.

ANS: A Sodium depletion and dehydration increase the chance for development of lithium toxicity. The other options offer inappropriate information.

An outpatient diagnosed with bipolar disorder takes lithium carbonate 300 mg three times daily. The patient reports nausea. To reduce the nausea most effectively, the nurse suggests that the lithium be taken with: a. meals. b. an antacid. c. an antiemetic. d. a large glass of juice.

ANS: A Some patients find that taking lithium with meals diminishes nausea. The incorrect options are less helpful.

The exact cause of bipolar disorder has not been determined; however, for most patients: a. several factors, including genetics, are implicated. b. brain structures were altered by stress early in life. c. excess sensitivity in dopamine receptors may trigger episodes. d. inadequate norepinephrine reuptake disturbs circadian rhythms.

ANS: A The best explanation at this time is that bipolar disorder is most likely caused by interplay of complex independent variables. Various theories implicate genetics, endocrine imbalance, environmental stressors, and neurotransmitter imbalances.

Which documentation indicates that the treatment plan for a patient diagnosed with acute mania has been effective? a. "Converses with few interruptions; clothing matches; participates in activities." b. "Irritable, suggestible, distractible; napped for 10 minutes in afternoon." c. "Attention span short; writing copious notes; intrudes in conversations." d. "Heavy makeup; seductive toward staff; pressured speech."

ANS: A The descriptors given indicate the patient is functioning at an optimal level, using appropriate behavior, and thinking without becoming overstimulated by unit activities. The incorrect options reflect manic behavior.

A patient diagnosed with bipolar disorder commands other patients, "Get me a book. Take this stuff out of here," and other similar demands. The nurse wants to interrupt this behavior without entering into a power struggle. Which initial approach should the nurse select? a. Distraction: "Let's go to the dining room for a snack." b. Humor: "How much are you paying servants these days?" c. Limit setting: "You must stop ordering other patients around." d. Honest feedback: "Your controlling behavior is annoying others."

ANS: A The distractibility characteristic of manic episodes can assist the nurse to direct the patient toward more appropriate, constructive activities without entering into power struggles. Humor usually backfires by either encouraging the patient or inciting anger. Limit setting and honest feed-back may seem heavy-handed and may incite anger.

A patient diagnosed with bipolar disorder is dressed in a red leotard and bright scarves. The patient twirls and shadow boxes. The patient says gaily, "Do you like my scarves? Here; they are my gift to you." How should the nurse document the patient's mood? a. Euphoric b. Irritable c. Suspicious d. Confident

ANS: A The patient has demonstrated clang associations and pleasant, happy behavior. Excessive happiness indicates euphoria. Irritability, belligerence, excessive happiness, and confidence are not the best terms for the patient's mood. Suspiciousness is not evident.

14. A patient says, "I get in trouble sometimes because I make quick decisions and act on them." Select the nurse's most therapeutic response. a. "Let's consider the advantages of being able to stop and think before acting." b. "It sounds as though you've developed some insight into your situation." c. "I bet you have some interesting stories to share about overreacting." d. "It's good that you're showing readiness for behavioral change."

ANS: A The patient is showing openness to learning techniques for impulse control. One technique is to teach the patient to stop and think before acting impulsively. The patient can then be taught to evaluate outcomes of possible actions and choose an effective action. The incorrect responses shift the encounter to a social level or are judgmental. REF: Page 465-466

9. What is the priority nursing diagnosis for a patient diagnosed with antisocial personality disorder who has made threats against staff, ripped art off the walls, and thrown objects? a. Risk for other-directed violence b. Risk for self-directed violence c. Impaired social interaction d. Ineffective denial

ANS: A Violence against property, along with threats to harm staff, makes this diagnosis the priority. Patients with antisocial personality disorders have impaired social interactions, but the risk for harming others is a higher priority. They direct violence toward others; not self. When patients with antisocial personality disorders use denial, they use it effectively. REF: Page 465-467 (Table 24-3)

2. For which patients diagnosed with personality disorders would a family history of similar problems be most likely? Select all that apply. a. Obsessive-compulsive b. Antisocial c. Borderline d. Schizotypal e. Narcissistic

ANS: A, B, C, D Some personality disorders have evidence of genetic links, so the family history would show other members with similar traits. Heredity plays a role in schizotypal, antisocial, borderline, and obsessive-compulsive personality disorder. REF: Page 459-460 | Page 465-466

Which suggestions are appropriate for the family of a patient diagnosed with bipolar disorder who is being treated as an outpatient during a hypomanic episode? Select all that apply. a. Limit credit card access. b. Provide a structured environment. c. Encourage group social interaction. d. Suggest limiting work to half-days. e. Monitor the patient's sleep patterns.

ANS: A, B, E A patient with hypomania is expansive, grandiose, and labile; uses poor judgment; spends inappropriately; and is over-stimulated by a busy environment. Providing structure would help the patient maintain appropriate behavior. Financial irresponsibility may be avoided by limiting access to cash and credit cards. Continued decline in sleep patterns may indicate the condition has evolved to full mania. Group socialization should be kept to a minimum to reduce stimulation. A full leave of absence from work will be necessary to limit stimuli and prevent problems associated with poor judgment and inappropriate decision making that accompany hypomania.

A patient tells the nurse, "I'm ashamed of being bipolar. When I'm manic, my behavior embarrasses everyone. Even if I take my medication, there are no guarantees. I'm a burden to my family." These statements support which nursing diagnoses? Select all that apply. a. Powerlessness b. Defensive coping c. Chronic low self-esteem d. Impaired social interaction e. Risk-prone health behavior

ANS: A, C Chronic low self-esteem and powerlessness are interwoven in the patient's statements. No data support the other diagnoses.

2. The nurse can assist a patient to prevent substance abuse relapse by: (select all that apply) a. rehearsing techniques to handle anticipated stressful situations. b. advising the patient to accept residential treatment if relapse occurs. c. assisting the patient to identify life skills needed for effective coping. d. advising isolating self from significant others until sobriety is established. e. informing the patient of physical changes to expect as the body adapts to functioning without substances.

ANS: A, C, E Nurses can be helpful as a patient assesses needed life skills and in providing appropriate referrals. Anticipatory problem solving and role-playing are good ways of rehearsing effective strategies for handling stressful situations and helping the patient evaluate the usefulness of new strategies. The nurse can provide valuable information about physiological changes expected and ways to cope with these changes. Residential treatment is not usually necessary after relapse. Patients need the support of friends and family to establish and maintain sobriety.

Alicia, a 31 year old patient, is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a back rub in exchange receiving her 10:00 pm Xanax an hour early. Which responses to such behaviors would be themes therapeutic? Select all that apply. a. label the behavior as undesirable, and explore with alicia more effective ways to meet her needs. b. by role playing, demo other approaches alicia could use to meet her needs c. advise the other patients that alicia is being manipulative and that they should ignore her when she behaves this way d. bargain with alicia to determine a reasonable compromise regarding how much of such behavior is acceptable before she crosses the line e. explain that such behavior is unacceptable, and give alicia specific examples of consequences that will be enacted if the behavior continues f. ignore the behavior for the time being so alicia will find it unrewarding and in turn seek other, and hopefully more adaptive, ways to meet her needs

ANS: A,B,E

A patient becomes frustrated and angry and when trying to get hi MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which interventions would be the most therapeutic. Select all that apply. a. place the pt in seclusion for an hour to allow him to deescalate b. tell the pt that any further outbursts will result in a loss of privileges c. offer to help the pt learn how to operate his music player and headset d. explore with the pt how he was feeling as he worked with the music player e. point out the consequences of such behavior and note that it cannot be tolerated f. limit the pts exposure to frustrating experiences until he attains improved coping skills g. encourage the pt to recognize signs of escalating tension and seek assistance

ANS: A,D,E,G

Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD? a. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" b. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." c. "I will never again speak to any of my messed up family members. I know that this will help me be more functional." d. "I promise I am not feeling suicidal. I won't hurt myself."

ANS: B

Josie, a 27 year old patient complains that the most of the staff do not like her or care what happens to her, but you are special and she can tell you that you are a caring person. She talks with you about being unsure of what she want to do with her life and her "mix-up feelings" about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it "makes the numbness stops." Given the presentation, which personality disorder would you suspect? a. obsessive compulsive b. borderline c. antisocial d. schizotypal

ANS: B

Which statement about persons with personality disorders is accurate? a. they, unlike those with mood or psychotic disorders, are at very low risk of suicide b. they tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them c. they are believed to be purely psychological disorders, that is, disorders arising from psychological rather than neurological or other other physiological abnormalities d. their symptoms are not as disabling as most other mental disorders, therefore their care tends to be less challenging and complicated for staff

ANS: B

10. Police bring a patient to the emergency department after an automobile accident. The patient demonstrates ataxia and slurred speech. The blood alcohol level is 500 mg%. Considering the relationship between the behavior and blood alcohol level, which conclusion is most probable? The patient: a. rarely drinks alcohol. b. has a high tolerance to alcohol. c. has been treated with disulfiram (Antabuse). d. has ingested both alcohol and sedative drugs recently.

ANS: B A non-tolerant drinker would be in coma with a blood alcohol level of 500 mg%. The fact that the patient is moving and talking shows a discrepancy between blood alcohol level and expected behavior and strongly indicates that the patient's body is tolerant. If disulfiram and alcohol are ingested together, an entirely different clinical picture would result. The blood alcohol level gives no information about ingestion of other drugs.

1. A patient diagnosed with alcoholism asks, "How will Alcoholics Anonymous (AA) help me?" Select the nurse's best response. a. "The goal of AA is for members to learn controlled drinking with the support of a higher power." b. "An individual is supported by peers while striving for abstinence one day at a time." c. "You must make a commitment to permanently abstain from alcohol and other drugs." d. "You will be assigned a sponsor who will plan your treatment program."

ANS: B Admitting to being an alcoholic, making an attempt to remain alcohol-free for a day at a time, and receiving support from peers are basic aspects of AA. The other options are incorrect.

9. A patient asks for information about Alcoholics Anonymous. Select the nurse's best response. "Alcoholics Anonymous is a: a. form of group therapy led by a psychiatrist." b. self-help group for which the goal is sobriety." c. group that learns about drinking from a group leader." d. network that advocates strong punishment for drunk drivers."

ANS: B Alcoholics Anonymous (AA) is a peer support group for recovering alcoholics. Neither professional nor peer leaders are appointed.

2. A nurse reviews vital signs for a patient admitted with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings at the times listed: 0200: 118/78 mm Hg and 72 beats/min 0400: 126/80 mm Hg and 76 beats/min 0600: 128/82 mm Hg and 72 beats/min 0800: 132/88 mm Hg and 80 beats/min 1000: 148/94 mm Hg and 96 beats/min What is the nurse's priority action? a. Force fluids. b. Consult the health care provider. c. Obtain a clean-catch urine sample. d. Place the patient in a vest-type restraint.

ANS: B Elevated pulse and blood pressure may indicate impending alcohol withdrawal and the need for medical intervention. No indication is present that the patient may have a urinary tract infection or is presently in need of restraint. Hydration will not resolve the problem.

7. A hospitalized patient diagnosed with an alcohol abuse disorder believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? a. Check the patient every 15 minutes b. One-on-one supervision c. Keep the room dimly lit d. Force fluids

ANS: B One-on-one supervision is necessary to promote physical safety until sedation reduces the patient's feelings of terror. Checks every 15 minutes would not be sufficient to provide for safety. A dimly lit room promotes perceptual disturbances. Excessive fluid intake can cause overhydration, because fluid retention normally occurs when blood alcohol levels fall.

3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a. Cardiovascular b. Respiratory c. Neurologic d. Hepatic

ANS: B Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority. See relationship to audience response question.

6. A hospitalized patient diagnosed with an alcohol abuse disorder believes the window blinds are snakes trying to get in the room. The patient is anxious, agitated, and diaphoretic. The nurse can anticipate the health care provider will prescribe a(n): a. narcotic analgesic, such as hydromorphone (Dilaudid). b. sedative, such as lorazepam (Ativan) or chlordiazepoxide (Librium). c. antipsychotic, such as olanzapine (Zyprexa) or thioridazine (Mellaril). d. monoamine oxidase inhibitor antidepressant, such as phenelzine (Nardil).

ANS: B Sedation allows for safe withdrawal from alcohol. Benzodiazepines are the drugs of choice in most regions because of their high therapeutic safety index and anticonvulsant properties.

19. In the emergency department, a patient's vital signs are BP 66/40 mm Hg; pulse 140 beats/min; respirations 8 breaths/min and shallow. The nursing diagnosis is Ineffective breathing pattern related to depression of respiratory center secondary to narcotic intoxication. Select the priority outcome. a. The patient will demonstrate effective coping skills and identify community resources for treatment of substance abuse within 1 week of hospitalization. b. Within 4 hours, vital signs will stabilize, with BP above 90/60 mm Hg, pulse less than 100 beats/min, and respirations at or above 12 breaths/min. c. The patient will correctly describe a plan for home care and achieving a drug-free state before release from the emergency department. d. Within 6 hours, the patient's breath sounds will be clear bilaterally and throughout lung fields.

ANS: B The correct short-term outcome is the only one that relates to the patient's physical condition. It is expected that vital signs will return to normal when the CNS depression is alleviated. The patient's respirations are slow and shallow, but there is no evidence of congestion.

27. An adult in the emergency department states, "Everything I see appears to be waving. I am outside my body looking at myself. I think I'm losing my mind." Vital signs are slightly elevated. The nurse should suspect: a. a schizophrenic episode. b. hallucinogen ingestion. c. opium intoxication. d. cocaine overdose.

ANS: B The patient who is high on a hallucinogen often experiences synesthesia (visions in sound), depersonalization, and concerns about going "crazy." Synesthesia is not common in schizophrenia. CNS stimulant overdose more commonly involves elevated vital signs and assaultive, grandiose behaviors. Phencyclidine (PCP) use commonly causes bizarre or violent behavior, nystagmus, elevated vital signs, and repetitive jerking movements.

24. Symptoms of withdrawal from opioids for which the nurse should assess include: a. dilated pupils, tachycardia, elevated blood pressure, and elation. b. nausea, vomiting, diaphoresis, anxiety, and hyperreflexia. c. mood lability, incoordination, fever, and drowsiness. d. excessive eating, constipation, and headache.

ANS: B The symptoms of withdrawal from opioids are similar to those of alcohol withdrawal. Hyperthermia is likely to produce periods of diaphoresis. See relationship to audience response question. (Educators may alter this question to multiple answers if desired.)

23. A patient diagnosed with borderline personality disorder has self-inflicted wrist lacerations. The health care provider prescribes daily dressing changes. The nurse performing this care should: a. maintain a stern and authoritarian affect. b. provide care in a matter-of-fact manner. c. encourage the patient to express anger. d. be very rigid and challenging.

ANS: B A matter-of-fact approach does not provide the patient with positive reinforcement for self-mutilation. The goal of providing emotional consistency is supported by this approach. The distracters provide positive reinforcement of the behavior or fail to show compassion. REF: Page 473

A patient experiencing acute mania dances around the unit, seldom sits, monopolizes conversations, interrupts, and intrudes. Which nursing intervention will best assist the patient with energy conservation? a. Monitor physiological functioning. b. Provide a subdued environment. c. Supervise personal hygiene. d. Observe for mood changes.

ANS: B All the options are reasonable interventions with a patient with acute mania, but providing a subdued environment directly relates to the outcome of energy conservation by decreasing stimulation and helping to balance activity and rest.

The spouse of a patient diagnosed with bipolar disorder asks what evidence supports the possibility of genetic transmission of bipolar disorders. Which response should the nurse provide? a. "A high proportion of patients with bipolar disorders are found among creative writers." b. "A higher rate of relatives with bipolar disorder is found among patients with bi-polar disorder." c. "Patients with bipolar disorder have higher rates of relatives who respond in an exaggerated way to daily stress." d. "More individuals with bipolar disorder come from high socioeconomic and educational backgrounds."

ANS: B Evidence of genetic transmission is supported when twins or relatives of patients with a particular disorder also show an incidence of the disorder that is higher than the incidence in the general public. The incorrect options do not support the theory of genetic transmission and other factors involved in the etiology of bipolar disorder.

This nursing diagnosis applies to a patient with acute mania: Imbalanced nutrition: less than body requirements related to insufficient caloric intake and hyperactivity as evidenced by 5-pound weight loss in 4 days. Select an appropriate outcome. The patient will: a. ask staff for assistance with feeding with-in 4 days. b. drink six servings of a high-calorie, high-protein drink each day. c. consistently sit with others for at least 30 minutes at meal time within 1 week. d. consistently wear appropriate attire for age and sex within 1 week while on the psychiatric unit.

ANS: B High-calorie, high-protein food supplements will provide the additional calories needed to offset the patient's extreme hyperactivity. Sitting with others or asking for assistance does not mean the patient ate or drank. The other indicator is unrelated to the nursing diagnosis.

12. What is the most challenging nursing intervention with patients diagnosed with personality disorders who use manipulation? a. Supporting behavioral change suicide attempts b. Maintaining consistent limits c. Monitoring d. Using aversive therapy

ANS: B Maintaining consistent limits is by far the most difficult intervention because of the patient's superior skills at manipulation. Supporting behavioral change and monitoring patient safety are less difficult tasks. Aversive therapy would probably not be part of the care plan because positive reinforcement strategies for acceptable behavior seem to be more effective than aversive techniques. See relationship to audience response question. REF: Page 463 (Table 24-2) | Page 469 (Table 24-4) | Page 473-474

A patient demonstrating characteristics of acute mania relapsed after discontinuing lithium. New orders are written to resume lithium twice daily and begin olanzapine (Zyprexa). What is the rationale for the addition of olanzapine to the medication regimen? It will: a. minimize the side effects of lithium. b. bring hyperactivity under rapid control. c. enhance the antimanic actions of lithium. d. be used for long-term control of hyperactivity.

ANS: B Manic symptoms are controlled by lithium only after a therapeutic serum level is attained. Because this takes several days to accomplish, a drug with rapid onset is necessary to reduce the hyperactivity initially. Antipsychotic drugs neither enhance lithium's antimanic activity nor minimize the side effects. Lithium will be used for longterm control.

7. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type of medication would the nurse expect to be prescribed? a. Benzodiazepine b. Mood stabilizing medication c. Monoamine oxidase inhibitor (MAOI) d. Serotonin norepinephrine reuptake inhibitor (SNRI)

ANS: B Mood stabilizing medications have been effective for many patients with borderline personality disorder. Serotonin norepinephrine reuptake inhibitors (SNRI) or anxiolytics are not supported by data given in the scenario. MAOIs require great diligence in adherence to a restricted diet and are rarely used for patients who are impulsive. REF: Page 468-469

A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's appropriate response. a. "You will be able to stop the medication in about 1 month." b. "Taking the medication every day helps reduce the risk of a relapse." c. "Usually patients take medication for approximately 6 months after discharge." d. "It's unusual that the health care provider hasn't already stopped your medication."

ANS: B Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication compliance.

Which nursing diagnosis would most likely apply to both a patient diagnosed with major depression as well as one experiencing acute mania? a. Deficient diversional activity b. Disturbed sleep pattern c. Fluid volume excess d. Defensive coping

ANS: B Patients with mood disorders, both depression and mania, experience sleep pattern disturbances. Assessment data should be routinely gathered about this possible problem. Deficient diversional activity is more relevant for patients with depression. Defensive coping is more relevant for patients with mania. Fluid volume excess is less relevant for patients with mood disorders than is deficient fluid volume.

To best assure safety, the nurse's first intervention is to: a. tell the patient, "You need to be secluded." b. clear the room of all other patients. c. help the patient down from the table. d. assemble a show of force.

ANS: B Safety is of primary importance. Once other patients are out of the room, a plan for managing this patient can be implemented.

A patient waves a newspaper and says, "I must have my credit card and use the computer right now. A store is having a big sale, and I need to order 10 dresses and four pairs of shoes." Select the nurse's appropriate intervention. The nurse: a. suggests the patient have a friend do the shopping and bring purchases to the unit. b. invites the patient to sit together and look at new fashion magazines. c. tells the patient computer use is not allowed until self-control improves. d. asks whether the patient has enough money to pay for the purchases.

ANS: B Situations such as this offer an opportunity to use the patient's distractibility to staff's advantage. Patients become frustrated when staff deny requests that the patient sees as entirely reasonable. Distracting the patient can avoid power struggles. Suggesting that a friend do the shopping would not satisfy the patient's need for immediacy and would ultimately result in the extravagant expenditure. Asking whether the patient has enough money would likely precipitate an angry response.

24. A nurse set limits while interacting with a patient demonstrating behaviors associated with borderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was wrong. You're evil." This outburst can be assessed as: a. denial. b. splitting. c. defensive. d. reaction formation.

ANS: B Splitting involves loving a person, then hating the person because the patient is unable to recognize that an individual can have both positive and negative qualities. Denial is unconsciously motivated refusal to believe something. Reaction formation involves unconsciously doing the opposite of a forbidden impulse. The scenario does not indicate defensiveness. See relationship to audience response question. REF: Page 463 (Table 24 - 2) | Page 470-471

Outcome identification for the treatment plan of a patient experiencing grandiose thinking associated with acute mania will focus on: a. developing an optimistic outlook. b. distorted thought self-control. c. interest in the environment. d. sleep pattern stabilization.

ANS: B The desired outcome is that the patient will be able to control the grandiose thinking associated with acute mania as evidenced by making realistic comments about self, abilities, and plans. Patients with acute mania are already unduly optimistic as a result of their use of denial, and they are overly interested in their environment. Sleep stability is a desired outcome but is not related to distorted thought processes.

At a unit meeting, the staff discusses decor for a special room for patients with acute mania. Which suggestion is appropriate? a. An extra-large window with a view of the street b. Neutral walls with pale, simple accessories c. Brightly colored walls and print drapes d. Deep colors for walls and upholstery

ANS: B The environment for a manic patient should be as simple and non-stimulating as possible. Manic patients are highly sensitive to environmental distractions and stimulation.

28. Personality traits most likely to be documented regarding a patient demonstrating characteristics of an obsessive-compulsive personality disorder are: a. affable, generous. b. perfectionist, inflexible. c. suspicious, holds grudges. d. dramatic speech, impulsive.

ANS: B The individual with obsessive-compulsive personality disorder is perfectionist, rigid, preoccupied with rules and procedures, and afraid of making mistakes. The other options refer to behaviors or traits not usually associated with OCPD. See relationship to audience response question. REF: Page 463 (Table 24 - 2) | Page 471-472

30. A patient says, "The other nurses won't give me my medication early, but you know what it's like to be in pain and don't let your patients suffer. Could you get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic? a. "I'm not comfortable doing that," and then ignore subsequent requests for early medication. b. "I understand that you have pain, but giving medicine too soon would not be safe." c. "I'll have to check with your doctor about that; I will get back to you after I do." d. "It would be unsafe to give the medicine early; none of us will do that."

ANS: B The patient is attempting to manipulate the nurse. Empathetic mirroring reflects back to the patient the nurse's understanding of the patient's distress or situation in a neutral manner that does not judge it and helps elicit a more positive response to the limit that is being set. The other options would not be nontherapeutic; they lack the empathetic mirroring component that tends to elicit a more positive response from the patient. REF: Page 467-468

An outpatient diagnosed with bipolar disorder is prescribed lithium. The patient telephones the nurse to say, "I've had severe diarrhea for 4 days. I feel very weak and unsteady when I walk. My usual hand tremor has gotten worse. What should I do?" The nurse will advise the patient to: a. restrict food and fluids for 24 hours and stay in bed. b. have someone bring the patient to the clinic immediately. c. drink a large glass of water with 1 tea-spoon of salt added. d. take one dose of an over-the-counter anti-diarrheal medication now.

ANS: B The symptoms described suggest lithium toxicity. The patient should have a lithium level drawn and may require further treatment. Because neurological symptoms are present, the patient should not drive and should be accompanied by another person. The incorrect options will not ameliorate the patient's symptoms.

When a hyperactive patient diagnosed with acute mania is hospitalized, what is the initial nursing intervention? a. Allow the patient to act out feelings. b. Set limits on patient behavior as necessary. c. Provide verbal instructions to the patient to remain calm. d. Restrain the patient to reduce hyperactivity and aggression.

ANS: B This intervention provides support through the nurse's presence and provides structure as necessary while the patient's control is tenuous. Acting out may lead to loss of behavioral control. The patient will probably be unable to focus on instructions and comply. Restraint is used only after other interventions have proved ineffective.

A patient demonstrating behaviors associated with acute mania has exhausted the staff by noon. Staff members are feeling defensive and fatigued. Which action will the staff take initially? a. Confer with the health care provider to consider use of seclusion for this patient. b. Hold a staff meeting to discuss consistency and limit-setting approaches. c. Conduct a meeting with all staff and patients to discuss the behavior. d. Explain to the patient that the behavior is unacceptable.

ANS: B When staff members are at their wits' end, the patient has succeeded in keeping the environment unsettled and avoided outside controls on behavior. Staff meetings can help minimize staff split-ting and feelings of anger, helplessness, confusion, and frustration.

26. A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is: a. noncompliance. b. impaired social interaction. c. disturbed personal identity. d. diversional activity deficit.

ANS: B Without exception, individuals with personality disorders have problems with social interaction with others, hence, the diagnosis of "impaired social interaction." For example, some individuals are suspicious and lack trust, others are avoidant, and still others are manipulative. None of the other diagnoses are universally applicable to patients with personality disorders; each might apply to selected clinical diagnoses, but not to others. REF: Page 458 | Page 467 (Table 24-3)

A nurse prepares the plan of care for a patient experiencing an acute manic episode. Which nursing diagnoses are most likely? Select all that apply. a. Imbalanced nutrition: more than body requirements b. Disturbed thought processes c. Sleep deprivation d. Chronic confusion e. Social isolation

ANS: B, C People with mania are hyperactive and often do not take time to eat and drink properly. Their high levels of activity consume calories, so deficits in nutrition may occur. Sleep is reduced. Their socialization is impaired but not isolated. Confusion may be acute but not chronic.

1. A patient undergoing alcohol rehabilitation decides to begin disulfiram (Antabuse) therapy. Patient teaching should include the need to: (select all that apply) a. avoid aged cheeses. b. avoid alcohol-based skin products. c. read labels of all liquid medications. d. wear sunscreen and avoid bright sunlight. e. maintain an adequate dietary intake of sodium. f. avoid breathing fumes of paints, stains, and stripping compounds.

ANS: B, C, F The patient must avoid hidden sources of alcohol. Many liquid medications, such as cough syrups, contain small amounts of alcohol that could trigger an alcohol-disulfiram reaction. Using alcohol-based skin products such as aftershave or cologne, smelling alcohol-laden fumes, and eating foods prepared with wine, brandy, or beer may also trigger reactions. The other options do not relate to hidden sources of alcohol.

MULTIPLE RESPONSE 1. A nurse plans care for an individual diagnosed with antisocial personality disorder. Which characteristic behaviors will the nurse expect? Select all that apply. a. Reclusive behavior b. Callous attitude c. Perfectionism d. Aggression e. Clinginess f. Anxiety

ANS: B, D Individuals with antisocial personality disorders characteristically demonstrate manipulative, exploitative, aggressive, callous, and guilt-instilling behaviors. Individuals with antisocial personality disorders are more extroverted than reclusive, rarely show anxiety, and rarely demonstrate clinging or dependent behaviors. Individuals with antisocial personality disorders are more likely to be impulsive than to be perfectionists. REF: Page 463 (Table 24 - 2) | Page 465-466

14. The treatment team discusses the plan of care for a patient diagnosed with schizophrenia and daily cannabis abuse who is having increased hallucinations and delusions. To plan effective treatment, the team should: a. provide long-term care for the patient in a residential facility. b. withdraw the patient from cannabis, then treat the schizophrenia. c. consider each diagnosis primary and provide simultaneous treatment. d. first treat the schizophrenia, then establish goals for substance abuse treatment.

ANS: C Both diagnoses should be considered primary and receive simultaneous treatment. Comorbid disorders require longer treatment and progress is slower, but treatment may occur in the community.

25. A patient has smoked two packs of cigarettes daily for many years. When the patient tries to reduce smoking, anxiety, craving, poor concentration, and headache occur. This scenario describes: a. cross-tolerance. b. substance abuse c. substance addiction. d. substance intoxication.

ANS: C Nicotine meets the criteria for a "substance," the criterion for addiction is present, and withdrawal symptoms are noted with abstinence or reduction of dose. The scenario does not meet criteria for substance abuse, intoxication, or cross-tolerance.

4. A patient admitted for injuries sustained while intoxicated has been hospitalized for 48 hours. The patient is now shaky, irritable, anxious, diaphoretic, and reports nightmares. The pulse rate is 130 beats/min. The patient shouts, "Bugs are crawling on my bed. I've got to get out of here." Select the most accurate assessment of this situation. The patient: a. is attempting to obtain attention by manipulating staff. b. may have sustained a head injury before admission. c. has symptoms of alcohol-withdrawal delirium. d. is having an acute psychosis.

ANS: C Symptoms of agitation, elevated pulse, and perceptual distortions indicate alcohol withdrawal delirium. The findings are inconsistent with manipulative attempts, head injury, or functional psychosis.

31. A nurse prepares for an initial interaction with a patient with a long history of methamphetamine abuse. Which is the nurse's best first action? a. Perform a thorough assessment of the patient. b. Verify that security services are immediately available. c. Self-assess personal attitude, values, and beliefs about this health problem. d. Obtain a face shield because oral hygiene is poor in methamphetamine abusers.

ANS: C The nurse should show compassion, care, and helpfulness for all patients, including those with addictive diseases. It is important to have a clear understanding of one's own perspective. Negative feelings may occur for the nurse; supervision is an important resource. The activities identified in the distracters occur after self-assessment.

10. When a patient diagnosed with a personality disorder uses manipulation to get needs met, the staff applies limit-setting interventions. What is the correct rationale for this action? a. It provides an outlet for feelings of anger and frustration. b. It respects the patient's wishes, so assertiveness will develop. c. External controls are necessary due to failure of internal control. d. Anxiety is reduced when staff assumes responsibility for the patient's behavior.

ANS: C A lack of internal controls leads to manipulative behaviors such as lying, cheating, conning, and flattering. To protect the rights of others, external controls must be consistently maintained until the patient is able to behave appropriately. REF: Page 468 (Box 24 - 2) | Page 473-474

A nurse assesses a patient who takes lithium. Which findings demonstrate evidence of complications? a. Pharyngitis, mydriasis, and dystonia b. Alopecia, purpura, and drowsiness c. Diaphoresis, weakness, and nausea d. Ascites, dyspnea, and edema

ANS: C Diaphoresis, weakness, and nausea are early signs of lithium toxicity. Problems mentioned in the incorrect options are unrelated to lithium therapy.

25. Which characteristic of personality disorders makes it most necessary for staff to schedule frequent team meetings in order to address the patient's needs and maintain a therapeutic milieu? a. Ability to achieve true intimacy b. Flexibility and adaptability to stress c. Ability to provoke interpersonal conflict d. Inability to develop trusting relationships

ANS: C Frequent team meetings are held to counteract the effects of the patient's attempts to split staff and set them against one another, causing interpersonal conflict. Patients with personality disorders are inflexible and demonstrate maladaptive responses to stress. They are usually unable to develop true intimacy with others and are unable to develop trusting relationships. Although problems with trust may exist, it is not the characteristic that requires frequent staff meetings. See relationship to audience response question. REF: Page 473-474

A person was online continuously for over 24 hours, posting rhymes on official government web-sites and inviting politicians to join social networks. The person has not slept or eaten for 3 days. What features of mania are evident? a. Increased muscle tension and anxiety b. Vegetative signs and poor grooming c. Poor judgment and hyperactivity d. Cognitive deficits and paranoia

ANS: C Hyperactivity (activity without sleep) and poor judgment (posting rhymes on government web-sites) are characteristic of manic episodes. The distracters do not specifically apply to mania.

A person was directing traffic on a busy street, rapidly shouting, "To work, you jerk, for perks" and making obscene gestures at cars. The person has not slept or eaten for 3 days. Which assessment findings will have priority concern for this patient's plan of care? a. Insulting, aggressive behavior b. Pressured speech and grandiosity c. Hyperactivity; not eating and sleeping d. Poor concentration and decision making

ANS: C Hyperactivity, poor nutrition, hydration, and not sleeping take priority in terms of the needs listed above because they threaten the physical integrity of the patient. The other behaviors are less threatening to the patient's life.

6. A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting? a. Flattering the nurse b. Lying to other patients c. Verbal abuse of another patient d. Detached superficiality during counseling

ANS: C Limits must be set in areas in which the patient's behavior affects the rights of others. Limiting verbal abuse of another patient is a priority intervention and particularly relevant when interacting with a patient diagnosed with an antisocial personality disorder. The other concerns should be addressed during therapeutic encounters. REF: Page 468 (Box 24-2) | Page 469 (Table 24-4)

5. Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as: a. seductive. b. detached. c. manipulative. d. guilt-producing.

ANS: C Patients manipulate and control staff in various ways. By keeping staff off balance or fighting among themselves, the person with an antisocial personality disorder is left to operate as he or she pleases. Seductive behavior has sexual connotations. The patient is displaying the opposite of detached behavior. Guilt is not evident in the comments. REF: Page 459-460 | Page 469 (Table 24 - 4)

A patient experiencing acute mania undresses in the group room and dances. The nurse intervenes initially by: a. quietly asking the patient, "Why don't you put your clothes on?" b. firmly telling the patient, "Stop dancing and put on your clothing." c. putting a blanket around the patient and walking with the patient to a quiet room. d. letting the patient stay in the group room and moving the other patients to a different area.

ANS: C Patients must be protected from the embarrassing consequences of their poor judgment whenever possible. Protecting the patient from public exposure by matter-of-factly covering the patient and removing him or her from the area with a sufficient number of staff to avoid argument and provide control is an effective approach.

20. Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a. Narcissistic b. Histrionic c. Avoidant d. Paranoid

ANS: C Patients with avoidant personality disorder are timid, socially uncomfortable, withdrawn, and avoid situations in which they might fail. They believe themselves to be inferior and unappealing. Individuals with histrionic personality disorder are seductive, flamboyant, shallow, and attention-seeking. Paranoia and narcissism are not evident. REF: Page 461-463 (Table 24 - 2)

16. Which statement made by a patient diagnosed with borderline personality disorder indicates the treatment plan is effective? a. "I think you are the best nurse on the unit." b. "I'm never going to get high on drugs again." c. "I felt empty and wanted to hurt myself, so I called you." d. "I hate my mother. I called her today, and she wasn't home."

ANS: C Seeking a staff member instead of impulsively self-mutilating shows an adaptive coping strategy. The incorrect responses demonstrate idealization, devaluation, and wishful thinking. REF: Page 470-471 | Page 473-474 (Case Study and Nursing Care Plan 24-1)

13. The history shows that a newly admitted patient is impulsive. The nurse would expect behavior characterized by: a. adherence to a strict moral code. b. manipulative, controlling strategies. c. acting without thought on urges or desires. d. postponing gratification to an appropriate time.

ANS: C The impulsive individual acts in haste without taking time to consider the consequences of the action. None of the other options describes impulsivity. REF: Page 465-466

3. As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, "Just leave it on the table. I'll take it when I finish combing my hair." What is the nurse's best response? a. Reinforce this assertive action by the patient. Leave the medication on the table as requested. b. Respond to the patient, "I'm worried that you might not take it. I'll come back later." c. Say to the patient, "I must watch you take the medication. Please take it now." d. Ask the patient, "Why don't you want to take your medication now?"

ANS: C The individual with a borderline personality disorder characteristically demonstrates manipulative, splitting, and self-destructive behaviors. Consistent limit setting is vital for the patient's safety, but also to prevent splitting other staff. "Why" questions are not therapeutic. See relationship to audience response question. REF: Page 463 (Table 24 - 2) | Page 466-467 | Page 469 (Table 24 - 4)

11. One month ago, a patient diagnosed with borderline personality disorder and a history of self-mutilation began dialectical behavior therapy. Today the patient phones to say, "I feel empty and want to hurt myself." The nurse should: a. arrange for emergency inpatient hospitalization. b. send the patient to the crisis intervention unit for 8 to 12 hours. c. assist the patient to choose coping strategies for triggering situations. d. advise the patient to take an anti-anxiety medication to decrease the anxiety level.

ANS: C The patient has responded appropriately to the urge for self-harm by calling a helping individual. A component of dialectical behavior therapy is telephone access to the therapist for "coaching" during crises. The nurse can assist the patient to choose an alternative to self-mutilation. The need for a protective environment may not be necessary if the patient is able to use cognitive strategies to determine a coping strategy that will reduce the urge to mutilate. Taking a sedative and going to sleep should not be the first-line intervention because sedation may reduce the patient's ability to weigh alternatives to mutilating behavior. REF: Page 460 | Page 476

27. A new psychiatric technician says, "Schizophrenia...schizotypal! What's the difference?" The nurse's response should include which information? a. A patient diagnosed with schizophrenia is not usually overtly psychotic. b. In schizotypal personality disorder, the patient remains psychotic much longer. c. With schizotypal personality disorder, the person can be made aware of misinterpretations of reality. d. Schizotypal personality disorder causes more frequent and more prolonged hospitalizations than schizophrenia.

ANS: C The patient with schizotypal personality disorder might have problems thinking, perceiving, and communicating and might have an odd, eccentric appearance; however, they can be made aware of misinterpretations and overtly psychotic symptoms are usually absent. The individual with schizophrenia is more likely to display psychotic symptoms, remain ill for longer periods, and have more frequent and prolonged hospitalizations. REF: Page 457-458 | Page 463 (Table 24 - 2)

Consider these three anticonvulsant medications: divalproex (Depakote), carbamazepine (Tegretol), and gabapentin (Neurontin). Which medication also belongs to this classification? a. clonazepam (Klonopin) b. risperidone (Risperdal) c. lamotrigine (La-mictal) d. aripiprazole (Abilify)

ANS: C The three drugs in the stem of the question are all anticonvulsants. Lamotrigine is also an anticonvulsant. Clonazepam is an anxiolytic; aripiprazole and risperidone are antipsychotic drugs. See relationship to audience response question.

Which dinner menu is best suited for a patient with acute mania? a. Spaghetti and meatballs, salad, and a banana b. Beef and vegetable stew, a roll, and chocolate pudding c. Broiled chicken breast on a roll, an ear of corn, and an apple d. Chicken casserole, green beans, and flavored gelatin with whipped cream

ANS: C These foods provide adequate nutrition, but more important they are finger foods that the hyperactive patient could "eat on the run." The foods in the incorrect options cannot be eaten without utensils.

4. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will: a. identify when feeling angry. b. use manipulation only to get legitimate needs met. c. acknowledge manipulative behavior when it is called to his or her attention. d. accept fulfillment of his or her requests within an hour rather than immediately.

ANS: C This is an early outcome that paves the way for later taking greater responsibility for controlling manipulative behavior. Identifying anger relates to anger and aggression control. Using manipulation to get legitimate needs is an inappropriate outcome. The patient would ideally use assertive behavior to promote need fulfillment. Accepting fulfillment of requests within an hour rather than immediately relates to impulsivity control. REF: Page 463 (Table 24-5) | Page 466-467 | Page 469 (Table 24-4)

A patient diagnosed with bipolar disorder becomes hyperactive after discontinuing lithium. The patient threatens to hit another patient. Which comment by the nurse is appropriate? a. "Stop that! No one did anything to provoke an attack by you." b. "If you do that one more time, you will be secluded immediately." c. "Do not hit anyone. If you are unable to control yourself, we will help you." d. "You know we will not let you hit anyone. Why do you continue this behavior?"

ANS: C When the patient is unable to control his or her behavior and violates or threatens to violate the rights of others, limits must be set in an effort to deescalate the situation. Limits should be set in simple, concrete terms. The incorrect responses do not offer appropriate assistance to the patient, threaten the patient with seclusion as punishment, and ask a rhetorical question.

4. A new patient beginning an alcoholism rehabilitation program says, "I'm just a social drinker. I usually have one drink at lunch, two in the afternoon, wine at dinner, and a few drinks during the evening." Select the nurse's most therapeutic responses. Select all that apply. a. "I see," and use interested silence. b. "I think you are drinking more than you report." c. "Social drinkers have one or two drinks, once or twice a week." d. "You describe drinking steadily throughout the day and evening." e. "Your comments show denial of the seriousness of your problem."

ANS: C, D The correct answers give information, summarize, and validate what the patient reported but are not strongly confrontational. Defenses cannot be removed until healthier coping strategies are in place. Strong confrontation does not usually take place so early in the program.

The plan of care for a patient in the manic state of bipolar disorder should include which inter-ventions? Select all that apply. a. Touch the patient to provide reassurance. b. Invite the patient to lead a community meeting. c. Provide a structured environment for the patient. d. Ensure that the patient's nutritional needs are met. e. Design activities that require the patient's concentration.

ANS: C, D People with mania are hyperactive, grandiose, and distractible. It's most important to ensure the patient receives adequate nutrition. Structure will support a safe environment. Touching the patient may precipitate aggressive behavior. Leading a community meeting would be appropriate when the patient's behavior is less grandiose. Activities that require concentration will produce frustration.

Lacey, a 19 year old, shows you multiple fresh, serious (but non life threatening) self-inflicted cuts on her forearms. Which response would bet he most therapeutic? a. im so sorry you felt so bad that you cut yourself lets discuss what led up to this action while i take care of your wounds b. i will take care of your wounds first then you will have to be searched for anything else you could injure yourself with c. i can give you some bandaids for you to put on your cuts, but you need to stop this attention seeking behavior d. after i care for your wounds i would like you to write down what you were feeling and thinking before you cut yourself. then we will discuss it.

ANS: D

Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect: a. obsessive-compulsive personality disorder. b. narcissistic personality disorder. c. avoidant personality disorder. d. schizotypal personality disorder (STPD).

ANS: D

26. Which assessment findings are likely for an individual who recently injected heroin? a. Anxiety, restlessness, paranoid delusions b. Muscle aching, dilated pupils, tachycardia c. Heightened sexuality, insomnia, euphoria d. Drowsiness, constricted pupils, slurred speech

ANS: D Heroin, an opiate, is a CNS depressant. Blood pressure, pulse, and respirations will be decreased, and attention will be impaired. The distracters describe behaviors consistent with amphetamine use, symptoms of narcotic withdrawal, and cocaine use. (Educators may alter this question to multiple answers if desired.)

12. Which medication to maintain abstinence would most likely be prescribed for patients with an addiction to either alcohol or opioids? a. Bromocriptine (Parlodel) b. Methadone (Dolophine) c. Disulfiram (Antabuse) d. Naltrexone (ReVia)

ANS: D Naltrexone (ReVia) is useful for treating both opioid and alcohol addiction. An opioid antagonist blocks the action of opioids and the mechanism of reinforcement. It also reduces or eliminates alcohol craving.

20. Family members of an individual undergoing a residential alcohol rehabilitation program ask, "How can we help?" Select the nurse's best response. a. "Alcoholism is a lifelong disease. Relapses are expected." b. "Use search and destroy tactics to keep the home alcohol free." c. "It's important that you visit your family member on a regular basis." d. "Make your loved one responsible for the consequences of behavior."

ANS: D Often, the addicted individual has been enabled when others picked up the pieces for him or her. The individual never faced the consequences of his or her own behaviors, all of which relate to taking responsibility. Learning to face those consequences is part of the recovery process. The other options are codependent behaviors or are of no help.

22. A patient with an antisocial personality disorder was treated several times for substance abuse, but each time the patient relapsed. Which treatment approach is most appropriate? a. 1-week detoxification program b. Long-term outpatient therapy c. 12-step self-help program d. Residential program

ANS: D Residential programs and therapeutic communities help patients change lifestyles, abstain from drugs, eliminate criminal behaviors, develop employment skills, be self-reliant, and practice honesty. Residential programs are more effective for patients with antisocial tendencies than outpatient programs.

8. A patient diagnosed with an alcohol abuse disorder says, "Drinking helps me cope with being a single parent." Which therapeutic response by the nurse would help the patient conceptualize the drinking objectively? a. "Sooner or later, alcohol will kill you. Then what will happen to your children?" b. "I hear a lot of defensiveness in your voice. Do you really believe this?" c. "If you were coping so well, why were you hospitalized again?" d. "Tell me what happened the last time you drank."

ANS: D The correct response will help the patient see alcohol as a cause of the problems, not a solution, and begin to take responsibility. This approach can help the patient become receptive to the possibility of change. The other responses directly confront and attack defenses against anxiety that the patient still needs. They reflect the nurse's frustration with the patient.

21. Which goal for treatment of alcoholism should the nurse address first? a. Learn about addiction and recovery. b. Develop alternate coping strategies. c. Develop a peer support system. d. Achieve physiologic stability.

ANS: D The individual must have completed withdrawal and achieved physiologic stability before he or she is able to address any of the other treatment goals.

5. A patient admitted yesterday for injuries sustained while intoxicated believes bugs are crawling on the bed. The patient is anxious, agitated, and diaphoretic. What is the priority nursing diagnosis? a. Disturbed sensory perception b. Ineffective coping c. Ineffective denial d. Risk for injury

ANS: D The patient's clouded sensorium, sensory perceptual distortions, and poor judgment predispose a risk for injury. Safety is the nurse's priority. The other diagnoses may apply but are not the priorities of care.

29. A patient is thin, tense, jittery, and has dilated pupils. The patient says, "My heart is pounding in my chest. I need help." The patient allows vital signs to be taken but then becomes suspicious and says, "You could be trying to kill me." The patient refuses further examination. Abuse of which substance is most likely? a. PCP b. Heroin c. Barbiturates d. Amphetamines

ANS: D The physical symptoms are consistent with CNS stimulation. Suspicion and paranoid ideation are also present. Amphetamine use is likely. PCP use would probably result in bizarre, violent behavior. Barbiturates and heroin would result in symptoms of CNS depression.

A patient with acute mania has disrobed in the hall three times in 2 hours. The nurse should: a. direct the patient to wear clothes at all times. b. ask if the patient finds clothes bothersome. c. tell the patient that others feel embarrassed. d. arrange for one-on-one supervision.

ANS: D A patient who repeatedly disrobes despite verbal limit setting needs more structure. One-on-one supervision may provide the necessary structure. Directing the patient to wear clothes at all times has not proven successful, considering the behavior has continued. Asking if the patient is bothered by clothing serves no purpose. Telling the patient that others are embarrassed will not make a difference to the patient whose grasp of social behaviors is impaired by the illness.

22. A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to: a. an inherited disorder that manifests itself as an incapacity to tolerate stress. b. use of projective identification and splitting to bring anxiety to manageable levels. c. a constitutional inability to regulate affect, predisposing to psychic disorganization. d. fear of abandonment associated with progress toward autonomy and independence.

ANS: D Fear of abandonment is a central theme for most patients with borderline personality disorder. This fear is often exacerbated when patients with borderline personality disorder experience success or growth. REF: Page 465 | Page 472 (Evidence Based Practice Box)

19. The nurse caring for an individual demonstrating symptoms of schizotypal personality disorder would expect assessment findings to include: a. arrogant, grandiose, and a sense of self-importance. b. attention seeking, melodramatic, and flirtatious. c. impulsive, restless, socially aggressive behavior. d. socially anxious, rambling stories, peculiar ideas.

ANS: D Individuals with schizotypal personality disorder do not want to be involved in relationships. They are shy and introverted, speak little, and prefer fantasy and daydreaming to being involved with real people. The other behaviors would characteristically be noted in narcissistic, histrionic, and antisocial personality disorder. (The educator may reformat this question as multiple response.) REF: Page 458-459 | Page 463 (Table 24 - 2)

1. A health care provider recently convicted of Medicare fraud says to a nurse, "Sure I overbilled. Everyone takes advantage of the government. There are too many rules to follow and I should get the money." These statements show: a. shame. b. suspiciousness. c. superficial remorse. d. lack of guilt feelings.

ANS: D Rationalization is being used to explain behavior and deny wrongdoing. The individual who does not believe he or she has done anything wrong will not manifest anxiety, remorse, or guilt about the act. The patient's remarks cannot be assessed as shameful. Lack of trust and concern that others are determined to do harm is not shown. REF: Page 469 (Table 24 - 4)

29. A nurse determines desired outcomes for a patient diagnosed with schizotypal personality disorder. Select the best outcome. The patient will: a. adhere willingly to unit norms. b. report decreased incidence of self-mutilative thoughts. c. demonstrate fewer attempts at splitting or manipulating staff. d. demonstrate ability to introduce self to a stranger in a social situation.

ANS: D Schizotypal individuals have poor social skills. Social situations are uncomfortable for them. It is desirable for the individual to develop the ability to meet and socialize with others. Individuals with schizotypal PD usually have no issues with adherence to unit norms, nor are they self-mutilative or manipulative. REF: Page 457-458 | Page 463 (Table 24 - 2)

A patient diagnosed with bipolar disorder has rapidly changing mood cycles. The health care provider prescribes an anticonvulsant medication. To prepare teaching materials, which drug should the nurse anticipate will be prescribed? a. phenytoin (Dilantin) b. clonidine (Catapres) c. risperidone (Risperdal) d. carbamazepine (Tegretol)

ANS: D Some patients with bipolar disorder, especially those who have only short periods between episodes, have a favorable response to the anticonvulsants carbamazepine and valproate. Carbamazepine seems to work better in patients with rapid cycling and in severely paranoid, angry manic patients. Phenytoin is also an anticonvulsant but not used for mood stabilization. Risperidone is not an anticonvulsant. See relationship to audience response question.

17. When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include: a. preoccupation with minute details; perfectionist. b. charm, drama, seductiveness; seeking admiration. c. difficulty being alone; indecisive, submissiveness. d. grandiosity, self-importance, and a sense of entitlement.

ANS: D The characteristics of grandiosity, self-importance, and entitlement are consistent with narcissistic personality disorder. Charm, drama, seductiveness, and admiration seeking are seen in patients with histrionic personality disorder. Preoccupation with minute details and perfectionism are seen in individuals with obsessive-compulsive personality disorder. Patients with dependent personality disorder often express difficulty being alone and are indecisive and submissive. REF: Page 460-461 | Page 463 (Table 24 - 2)

A patient with diagnosed bipolar disorder was hospitalized 7 days ago and has been taking lithium 600 mg tid. Staff observes increased agitation, pressured speech, poor personal hygiene, and hyperactivity. Which action demonstrates that the nurse understands the most likely cause of the patient's behavior? a. Educate the patient about the proper ways to perform personal hygiene and coordinate clothing. b. Continue to monitor and document the patient's speech patterns and motor activity. c. Ask the health care provider to prescribe an increased dose and frequency of lithium. d. Consider the need to check the lithium level. The patient may not be swallowing medications.

ANS: D The patient is continuing to exhibit manic symptoms. The lithium level may be low from "cheeking" (not swallowing) the medication. The prescribed dose is high, so one would not expect a need for the dose to be increased. Monitoring the patient does not address the problem.

8. A patient's spouse filed charges after repeatedly being battered. The patient sarcastically says, "I'm sorry for what I did. I need psychiatric help." Which statement by the patient supports an antisocial personality disorder? a. "I have a quick temper, but I can usually keep it under control." b. "I've done some stupid things in my life, but I've learned a lesson." c. "I'm feeling terrible about the way my behavior has hurt my family." d. "I hit because I am tired of being nagged. My spouse deserves the beating."

ANS: D The patient with an antisocial personality disorder often impulsively acts out feelings of anger and feels no guilt or remorse. Patients with antisocial personality disorders rarely seem to learn from experience or feel true remorse. Problems with anger management and impulse control are common. REF: Page 463 (Table 24-2) | Page 465-466 | Page 469 (Table 24-4)

A newly diagnosed patient is prescribed lithium. Which information from the patient's history indicates that monitoring of serum concentrations of the drug will be challenging and critical? a. Arthritis b. Epilepsy c. Psoriasis d. Heart failure

ANS: D The patient with congestive heart failure will likely need diuretic drugs, which will complicate the maintenance of the fluid balance necessary to avoid lithium toxicity.

18. For which behavior would limit setting be most essential? The patient who: a. clings to the nurse and asks for advice about inconsequential matters. b. is flirtatious and provocative with staff members of the opposite sex. c. is hypervigilant and refuses to attend unit activities. d. urges a suspicious patient to hit anyone who stares.

ANS: D This is a manipulative behavior. Because manipulation violates the rights of others, limit setting is absolutely necessary. Furthermore, limit setting is necessary in this case because the safety of at least two other patients is at risk. Limit setting may occasionally be used with dependent behavior (clinging to the nurse) and histrionic behavior (flirting with staff members), but other therapeutic techniques are also useful. Limit setting is not needed for a patient who is hypervigilant and refuses to attend unit activities; rather, the need to develop trust is central to patient compliance. REF: Page 468-469 (Box 24 - 2)

3. A patient took a large quantity of bath salts. Priority nursing and medical measures include: (select all that apply) a. administration of naloxone (Narcan). b. vitamin B12 and folate supplements. c. restoring nutritional integrity. d. management of heart rate. e. environmental safety.

ANS: D, E Care of patients who have taken bath salts is similar to those who have used other stimulants. Tachycardia and chest pain are common when a patient has used bath salts. These problems are life-threatening and take priority. Patients who have used these substances commonly have bizarre behavior and/or paranoia; therefore, safety is a priority concern. Nutrition is not a priority in an overdose situation. Vitamin replacements and naloxone apply to other drugs of abuse.

Which of the following are true of antisocial personality disorder (APD)? (select all that apply): a. It is the least studied of the personality disorders. b. It is characterized by rigidity and inflexible standards of self and others. c. Persons with APD display magical thinking. d. Persons with APD are concerned with personal pleasure and power. e. It is characterized by deceitfulness, disregard for others, and manipulation. f. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. g. Frontal lobe dysfunction is a brain change identified in APD.

ANS: D,E,G

Difference between PTSD and Acute Stress Disorder

Acute Stress Disorder symptoms are the Same as PTSD However, in Acute Stress Disorder, Symptoms resolve in less than 1 month.

A compulsive or chronic requirement. The need is so strong as to generate distress (either physical or psychological) if left unattended.

Addiction

A client says she is experiencing increased stress because her significant other is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." She also states that her significant other "keeps nagging at my oldest son, which makes me mad, since he's my son, not his." Which of the following should the nurse recommend to promote a change in the client's situation? A. Learn to practice mindfulness. B. Use assertiveness techniques. C. Exercise regularly. D. Rely on the support of a close friend.

B

A nurse is caring for a client who is on lithium therapy. The client states that he wants to take ibuprofen for osteoarthritis pain relief. Which of the following statements by the nurse is appropriate? A. "That is a good choice. Ibuprofen does not interact with lithium." B. "Regular aspirin would be a better choice than ibuprofen." C. "Lithium decreases the effectiveness of ibuprofen." D. "The ibuprofen will make your lithium level fall too low."

B

You are caring for Maria, a patient who states that she has "ghost sickness." Which is the appropriate nursing response? a. "I have no idea what 'ghost sickness' is." b. "How does 'ghost sickness' make you feel?" c. "'Ghost sickness' is not listed in the manual of psychiatric disorders." d. "Let's talk about why you believe in evil spirits?"

B

A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following in the teaching? (Select all that apply.) A. Constipation B. Polyuria C. Rash D. Muscle weakness E. Tinnitus

B, D

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture? A. "Is there someone in your community who usually cures your illness?" B. "What usually helps people who have the same type of illness you have?" C. "What questions would you like to ask about your condition?" D. "What sorts of stress are you presently experiencing?"

B. Asking about typical treatment seeks information about the "usual" cultural treatment of the disorder experienced by the client.

Ms. Wong, aged 52 years, comes to the emergency room with severe anxiety. She was raised in China but immigrated to the United States at age 40 years. She was recently fired from her job because of a major error in the accounting department that she managed. Ms. Wong's aged parents live with her. Ms. Wong states, "I am a failure." Which of the following statements may accurately assess the basis for Ms. Wong's anxiety and feelings of failure? A. Ms. Wong may feel that she has let herself down since she did not achieve her personal goals in the workplace. B. Ms. Wong may feel that she has shamed the family by being fired and may no longer be able to provide for them. C. Ms. Wong may feel personally inadequate since she failed in her quest for independence and self-reliance. D. Ms. Wong may be feeling anxiety because in her family's traditions her failure may result in a changed fate.

B. Eastern tradition, such as in China, where Ms. Wong is from, sees the family as the basis for one's identity, and family interdependence as the norm. The views expressed in options a and c demonstrate Western tradition where self-reliance, individuality, and autonomy are highly valued. In the Eastern view one is born into an unchangeable fate.

A client reporting gastric pain, tells the nurse, "I think my symptoms started when a neighbor cast a spell on me." The assessment the nurse can make is that the client A. has a major mental illness. B. is expressing a culture-bound illness. C. requires hospitalization to protect the neighbor. D. will probably not respond to Western medical treatment.

B. Many culture-bound illnesses, such as ghost illness, or hwa byung, seem exotic or irrational to American nurses. Many of these illnesses cannot be understood within a Western medicine framework. Their causes, manifestations, and treatments do not make sense to nurses whose understanding is limited to a Western perspective on disease and illness.

Data concerning client age, sex, education, and income should be the focus of an assessment in order to best understand cultural issues related to A. health practices. B. power and control. C. psychological stability. D. assimilation and conformity.

B. Power and control are often products of culturally determined beliefs about who should hold power. In many cultures the elderly are venerated. In other cultures women are virtually powerless. For some cultures, higher education equates with power.

Josefina Juarez, aged 36 years, comes to the mental health clinic where you work after being referred by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. She is now a single mother to 6 children, ages 2 to 15, following the death of her husband last year. During the initial intake assessment, Josefina tells you her problem is that she has headaches and backaches "almost every day" and "can't sleep at night." She shakes her head no and looks away when asked about anxiety or depression and states she does not know why she was referred to the mental health clinic. You recognize that Josefina may be exhibiting: A. regression. B. somatization. C. enculturation. D. assimilation.

B. Somatization is described as experiencing and expressing emotional or psychological distress as physical symptoms. Regression is a defense mechanism meaning to begin to function at a lower or previous level of functioning. Enculturation refers to how cultural beliefs, practices, and norms are communicated to its members. Assimilation refers to a situation in which immigrants adapt to and absorb the practices and beliefs of a new culture until these customs are more natural than the ones they learned in their homeland.

The Eastern world view can be identified by the belief that A. one's identity is found in individuality. B. holds responsibility to family as central. C. time waits for no one. D. disease is a lack of harmony with the environment.

B. The Eastern traditional world view is sociocentric. Individuals experience their selfhood and their lives as part of an interdependent web of relationships and expectations.

Janice is a nurse whose husband is in rehab for alcohol use disorder. While attending a family group, Janice makes several statements about their relationship. Which of these statements would suggest Janice is exhibiting codependent behavior? (Select all that apply) A. "My husband has to accept responsibility for his behavior and the consequences of his drinking." B. "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." C. "May father was the same way and i learned its better just to keep your mouth shut so you don't get hit." D. "If he didn't have me monitoring his every move he'd probably be dead already." E. "I need to make sure I'm protecting myself and my children."

B. "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." C. "May father was the same way and i learned its better just to keep your mouth shut so you don't get hit." D. "If he didn't have me monitoring his every move he'd probably be dead already." Feedback 2: People-pleasing, fear of abandonment, and neediness, as evidenced in this statement, are all consistent with codependency. Feedback 3: The sense of helplessness and a history of abuse or neglect as a child are consistent with codependency. Feedback 4: This statement suggests an unrealistic need to be in control and may also suggest that Janice's self-worth is rooted in her need to be needed. Both of these statements are evidence of codependency

The duration of most of the panic reactions from cannabis is about: A. 1 hour B. 3-6 hours C. a day D. a week

B. 3-6 hours

A nurse is caring for a group of clients. Which of the following clients should a nurse consider for referral to an assertive community treatment (ACT) group? A. A client in an acute care mental health facility who has fallen several times while running down a hallway. B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia. C. A client in a day treatment program who says he is becoming more anxious during group therapy. D. A client in a weekly grief support group who says she still misses her deceased husband who has been dead for 3 months.

B. A client who lives at home and keeps "forgetting" to come in for his monthly antipsychotic injection for schizophrenia.

Which client and family teaching is most important regarding the cause of substance addiction? A. an individual's social and cultural environment can be implicated in the cause of substance addiction. B. Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction. C. Evidence of a genetic link accounts for most cases of substance addiction. D. Reinforcing properties of the substance encourages progression from use to addiction.

B. Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction. The development of substance addiction is multifactorial and may include biological, psychological, and/or sociological factors

Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? A. Haloperidol (Haldol) B. Chlordiazepoxide (Librium) C. Methadone (Dolophine) D. Phenytoin (Dilantin)

B. Chlordiazepoxide (Librium)

A nurse in a primary care clinic is collecting data from a client who takes lithium carbonate (Lithobid) for the treatment of bipolar disorder. The nurse should recognize which of the following findings as a possible indication of toxicity from this medication? A. Severe hypertension B. Coarse tremmors C. Constipation D. Urinary retention

B. Coarse tremmors

Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." The nurse's best response is: A. Maybe your boss is mistaken, Dan. B. You are here because your drinking was interfering with your work, Dan C. Get real, Dan! Youre a boozer and you know it! D. Why do you think your boss sent you here, Dan?

B. You are here because your drinking was interfering with your work, Dan

Adoption studies of alcoholics' children have uncovered: A. no genetic predisposition to alcoholism B. a significant genetic component to alcoholism C. a significant environmental component to alcoholism D. a significant genetic-environment interaction in the etiology of alcoholism.

B. a significant genetic component to alcoholism

Which would the nurse consider a priority intervention when planning care for a medically unstable client diagnosed with alcohol use disorder? A. simplifying the environment B. addressing physical needs C. providing opportunities for success experiences D. establishing a trusting interpersonal relationship

B. addressing physical needs Physical problems must be addressed prior to meeting any psychosocial needs of a client who is medically unstable. According to Maslow's hierarchy of needs, physiological needs should be prioritized over all other needs.

A client who is unable to control binge drinking requires increased amounts of alcohol to achieve the same level of intoxication. The client is experiencing marital strife and legal problems. The client's behaviors meet the criteria for which DSM-5 diagnostic category? A. dual diagnosis B. alcohol use disorder C. neurocognitive disorder D. Alcohol intoxication

B. alcohol use disorder This client has developed tolerance, cannot control alcohol intake, and has continued use despite persistent problems related to drinking. These symptoms meet the criteria for the diagnosis of alcohol use disorder in the DSM-5.

Jeremy took a pill to help cure his alcoholism. He later drank a glass of wine and felt very nauseous. The drug was a(n) ______ drug, such as ______. A. antianxiety; benzodiazepine B. antagonist; disulfiram C. partial antagonist; naltrexone D. detoxification; buspar

B. antagonist; disulfiram

The purpose of an antagonist drug is to: A. stimulate the client to care about becoming drug-free B. block the effect of an addictive drug C. reduce withdrawal effects as one goes off a drug D. provide a placebo effect to replace the drug effect

B. block the effect of an addictive drug

A person's hands and eyelids are shaking, and that person is experiencing visual and tactile hallucinations. Of the following, that person is most likely experiencing: A. Korsakoff's Syndrome B. delirium tremens C. narcotic attraction D. cannabis toxicity

B. delirium tremens

The nurse is assessing a client who is a substance abuser. the client states, "I use every day, but it rarely interferes with my work.". The nurse determines that the client is using which defense mechanism? A. projection B. denial C. reaction formation D. displacement

B. denial Denial is characterized by avoidance of disagreeable realities and unconscious refusal to acknowledge a thought, feeling, need or desire. By stating that alcohol use rarely interferes with his or her work, the client is denying a substance abuse problem.

The most powerful form of cannabis is: A. ganja B. hashish C. marijuana D. free-based THC

B. hashish

Which primary factor is critical in maintaining abstinence for the client diagnosed with alcohol use disorder? A. attendance at Alcoholics Anonymous (AA) meetings B. personal commitment to change C. Family involvement D. compliance with pharmacological therapy

B. personal commitment to change The first step in the recovery process necessitates that the client accept ownership of the problem and establish a behavioral change commitment to continued abstinence

From which of the following symptoms might the nurse identify a chronic cocaine user? A. Clear, constricted pupils B. red, irritated nostrils C. muscle aches D. conjunctival redness

B. red, irritated nostrils

Pamela has sought treatment for ongoing substance use disorder. She asks the nurse what treatment options are available to help her combat this problem. Which of these options would be accurate for the nurse to include in patient education? (Select all that apply) A. ECT B. self-help groups C. deterrent therapy D. Substitution pharmacotherapy E. Vitamin supplements

B. self-help groups C. deterrent therapy D. Substitution pharmacotherapy Feedback 2: self-help groups such as Alcoholics Anonymous are commonly recommended as a treatment option for substance use disorders. Feedback 3: Deterrent therapy, such as Antabuse to deter alcohol use, is a recognized option for some substance use disorders. Feedback 4: Substitution therapy, such as methadone for heroin users, is a recognized option for some substance use disorders.

The chief danger of LSD use is: A. the risk of developing drug tolerance B. the possibility of very powerful, sometimes negative reactions C. the severity of withdrawal symptoms among even occasional users D. the universal occurrence of "flashbacks" among former users

B. the possibility of very powerful, sometimes negative reactions

A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A. "Even if my anxiety improves, I will need to continue this therapy for 6 weeks." B. "The therapists will focus on my past relationships during our sessions." C. "Psychoanalysis will help me reduce my anxiety by changing my behaviors." D. "This therapy will address my conscious feelings about stressful experiences." ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

B: Classical psychoanalysis : - many sessions, months to years. - focuses on past relationships to identify the cause of the anxiety disorder. - assesses unconscious thoughts and feelings. ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

Eustress

Beneficial stress

Julio is a 31-year-old patient who comes to your mental health out- patient clinic. Which of the following would alert you to the potential for somatization? a. Julio states, "I have been feeling sad for weeks." b. Julio shows you bottles of medication he has been prescribed for anxiety. c. Julio presents with concerns involving headaches, dizziness, and fatigue. d. Julio states, "I have been sleeping all the time."

C

The psychiatric mental health nurse working with depressed clients of the Eastern culture must realize that a useful outcome criterion might be if client reports A. increased somatic expressions of distress. B. disruption of energy balance. C. appeasement of the spirits. D. increased anxiety.

C. Appeasement of spirits might be a viable outcome criterion if the client believes the illness was caused by angry spirits. In each of the other options useful outcomes would be decreased somatic symptoms, reinstatement of energy balance, and decreased anxiety.

Which of the following best explains the concept of cultural competence? A. Nurses have enough knowledge about different cultures to be assured they are delivering culturally sensitive care. B. Nurses are able to educate their patients from other cultures appropriately about the cultural norms of the United States. C. Nurses adjust their own practices to meet their patients' cultural preferences, beliefs, and practices. D. Nurses must take continuing education classes on culture in the process of becoming culturally competent.

C. Cultural competence means that nurses adjust and conform to their patients' cultural needs, beliefs, practices, and preferences rather than their own. This option does not describe cultural competence. Although nurses are continually learning regarding culture, it is a career-long process. The goal is not to educate patients about our own culture but rather to adjust to their cultural preferences. Although nurses may take continuing education regarding culture, this does not describe the term cultural competence. The other options do not describe cultural competence.

A peer asks you to help him differentiate between culture and ethnicity for clarification. Which statement by the peer would acknowledge that you had appropriately helped him clarify the difference between the two terms? A. "So, ethnicity refers to having the same life goals whereas culture refers to race." B. "So, ethnicity refers to norms within a culture, and culture refers to shared likes and dislikes." C. "So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values." D. "So, ethnicity refers to race, and culture refers to having the same worldview."

C. Ethnicity is sharing a common history and heritage. Culture comprises the shared beliefs, values, and practices that guide a group's members in patterned ways of thinking and acting. The other options are all incorrect definitions of ethnicity and culture.

Clients of another culture are at greatest risk for misdiagnosis of a psychiatric problem because of A. biased assessment tools. B. insensitive practitioners. C. insensitive interviewing techniques. D. lack of the availability of cultural translators.

C. Inaccurate information or insufficient information may be obtained if the interviewer is not culturally sensitive. Only when assessment data are accurate can effective treatment be planned.

When members of a group are introduced to the culture's worldview, beliefs, values, and practices, it is called A. acculturation. B. ethnocentrism. C. enculturation. D. cultural encounters.

C. Members of a group are introduced to the culture's worldview, beliefs, values, and practices in a process called enculturation. Ethnocentrism is the universal tendency of humans to think that their way of thinking and behaving is the only correct and natural way. Acculturation is learning the beliefs, values, and practices of a new cultural setting, which sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact.

Which source of healing might be most satisfactory to a client who believes his illness is caused by spiritual forces? A. Acupuncture B. Dietary change C. Cleansings D. Herbal medicine

C. Rituals, cleansings, prayer, and even witchcraft may be the treatment expectation of a client who believes his illness is caused by spiritual forces.

Exclusive use of Western psychological theories by nurses making client assessments will result in A. a high level of care for all clients. B. standardization of nomenclature for psychiatric disorders. C. inadequate assessment of clients of diverse cultures. D. greater ease in selecting appropriate treatment interventions.

C. Unless clients have faith in a particular healing modality, the treatment may not be effective. When nurses make assessments on the basis of Western theories, treatments consistent with those assessments follow. Clients of other cultures may find the treatment modalities unacceptable or not useful. Treatments consistent with the client's cultural beliefs as to what will provide a cure are better.

A client who is going through alcohol detoxification states, "I see bugs crawling on the wall." Which is the best nursing response? A. "I'll remove the bugs from the wall." B. "You are confused because of your alcoholism." C. "There are no bugs on the wall. I'll stay with you until you feel less anxious." D. "You do not see any bugs on the wall."

C. "There are no bugs on the wall. I'll stay with you until you feel less anxious." This response presents objective reality and may help decrease the client's anxiety by the nurse's therapeutic offering of self.

A nurse is caring for several clients who are attending community-based mental health programs. Which of the following clients should the nurse plan to visit first? A. A client who recently burned her arm while using a hot iron at home. B. A client who requests that her antipsychotic medication be changed due to some new side effects. C. A client who says he is hearing a voice that tells him he is not worthy of living anymore. D. A client who tells the nurse he experienced symptoms of severe anxiety before and during a job interview.

C. A client who says he is hearing a voice that tells him he is not worthy of living anymore.

A nurse in an acute mental health facility is caring for a client who has a severe mental illness and soon will be ready for discharge but still requires supervision much of the time. The client's wife works all day but is home by late afternoon. Which of the following should the nurse suggest as appropriate follow-up care? A. Receiving daily care from a home health aide. B. Having a weekly visit from a nurse case worker. C. Attending a partial hospitalization program. D. Visiting a community mental health center on a daily basis.

C. Attending a partial hospitalization program.

A client with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? A. carbamazepine (Tegretol) B. clonidine (Catapres) C. Disulfiram (Antabuse) D. folic acid (Folvite)

C. Disulfiram (Antabuse) Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high enough. It is important that the client understands that all alcohol, oral or topical, and medications that contain alcohol are strictly prohibited when taking this drug.

A client, diagnosed with chronic alcoholism, says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information? A. Carbamazepine (Tegretol) B. Clonidine (Catapres) C. Disulfiram (Antabuse) D. Folic acid (Folvite)

C. Disulfiram (Antabuse) Disulfiram is used as a deterrent to drinking. Ingestion of alcohol while disulfiram is in the body results in a syndrome of symptoms that can cause varying degrees of discomfort. It can even result in death if blood alcohol levels are high. It is important that the client understands that all alcohol, oral, and topical, and medications that contain alcohol, are strictly prohibited when taking this drug.

A client diagnosed with chronic alcohol use disorder complains of feeling tremulous. The client's BP is now 170/110, P 116, R 30, T 97F. The nurse anticipates which medication would give the client the most immediate relief from these symptoms? A. Benztropine (Cogentin), 2 mg PO B. Oxazepam (Serax), 30 mg PO C. Lorazepam (Ativan), 1 mg IM D. Meperidine (Demerol), 100 mg IM

C. Lorazepam (Ativan), 1 mg IM Ativan is frequently used to treat the symptoms of alcohol withdrawal. Because Ativan is ordered parenterally, this medication would give the client the most immediate relief of symptoms

When teaching a client diagnosed with alcoholism about nutritional needs, which nutritional concept should the nurse emphasize? A. eat a high-protein, low-carbohydrate diet to promote lean body mass. B. increase sodium-rich foods to increase iodine levels C. Provide multivitamin supplements, including thiamine and folic acid. D. Restrict fluid intake to decrease renal load.

C. Provide multivitamin supplements, including thiamine and folic acid. Vitamin B deficiencies contribute to the nervous system disorders seen in chronic alcohol abuse. Supplements of these vitamins are important to prevent complications. It is important that vitamin supplements include both thiamine (vitamin B1) and folic acid.

Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? A. Search his room for evidence B. Ask, "Have you been drinking alcohol, Dan?" C. Send a urine specimen from Dan to the lab for drug screening D. Tell Dan, "These guys cannot come to the unit to visit you again."

C. Send a urine specimen from Dan to the lab for drug screening

A nurse is reinforcing teaching with a female client who has bipolar disorder about her new prescription for lithium carbonate (Lithobid). Which of the following is appropriate for the nurse to include? (Select all that apply) A. Expect amenorrhea as an adverse effect of this medication B. Take an antidepressant with lithium during phases of mania C. Take this medication with food or a glass of milk D. Avoid pregnancy while taking this medication E. Have thyroid function tests prior to lithium therapy

C. Take this medication with food or glass of milk D. Avoid pregnancy while taking this medication E. Have thyroid function tests prior to lithium therapy

A nurse is working on promotion of healthy coping skills with older adult clients who had all previously been hospitalized for severe depression and are now in a residential care facility. The nurse should recognize that this an example of which of the following? A. Primary prevention B. Secondary prevention C. Tertiary prevention D. Mental status examination

C. Tertiary prevention

A client is diagnosed with stimulant use disorder; cocaine and antisocial personality disorder. The client eagerly participates in therapy and becomes charming and ingratiating to the primary nurse. Which best describes these client behaviors? A. The client has not completed the cocaine withdrawal process B. The client is probably hiding something C. The client is exhibiting characteristics of antisocial personality disorder D. The client is exhibiting symptoms of cocaine dependence.

C. The client is exhibiting characteristics of antisocial personality disorder Charming and ingratiating behaviors are characteristic traits of clients diagnosed with antisocial personality disorder.

In a popular approach to treatment of alcoholism, clients keep track of their own drinking behavior. They are then taught coping strategies and learn to set limits. This is called: A. alcoholics anonymous B. forced abstinence C. behavioral self-control training D. aversive conditioning

C. behavioral self-control training

Daniel, an intravenous heroin user, feels intense cravings when he sees hypodermic needles. This might be an example of: A. modeling B. operant conditioning C. classical conditioning D. observational learning

C. classical conditioning

Symptoms of alcohol withdrawal include: A. euphoria, hyperactivity and insomnia B. depression, suicidal ideation, and hypersomnia C. diaphoresis, N/V, and tremors D. unsteady gait, nystagmus, and profound disorientation

C. diaphoresis, N/V, and tremors

This dangerous drug has qualities of a stimulant and a hallucinogen. It produces undesired immediate effects, including confusion, depression anxiety, sleep difficulties and paranoia: It is called: A. methamphetamine B. psilocybin C. ecstasy D. mescaline

C. esctasy

Drinking alcohol during pregnancy can damage the developing embryo and fetus, resulting in: A. excessively large babies B. Sudden Infant Death Syndrome C. fetal alcohol syndrome D. all of the above

C. fetal alcohol syndrome

The use of methadone in drug maintenance programs is controversial because methadone: A. use increases the risk of contracting AIDS B. costs over $50/day per person treated C. produces withdrawal more difficult than from heroin D. needs to be taken several times per day in a rigid schedule

C. produces withdrawal more difficult than from heroin

An impaired nurse is admitted to an inpatient substance abuse treatment facility. Which applies to this situation? A. the nurse must relinquish his driver's license to the office of motor vehicles. B. The nurse is mandated to comply with treatment and prescribed therapies. C. the nurse is not mandated to meet specific requirements, because all civil rights are ensured. D. The nurse must relinquish his registered nurse (RN) license to the state board of nursing.

C. the nurse is not mandated to meet specific requirements, because all civil rights are ensured. Although some variations occur from state to state, currently psychiatric clients maintain all of their civil rights. This nurse is not mandated by law to meet specific requirements, because all civil rights are ensured.

A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy? A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes. ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

C: A=modeling B=thought stopping D=flooding ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

MOst effective treatment for PTSD

Cognitive Behavioral Therapy (CBT)

Primary stress hormone

Cortisol

A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's adult daughter, which of the following statements is the highest priority to report to the provider? A. "My mother has diabetes that is controlled by her diet." B. "My mother recently completed a course of prednisone for acute bronchitis." C. "My mother received her flu vaccine last month." D. "My mother is currently on furosemide for her congestive heart failure."

D

A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. He expects me to finish his work because he's too lazy!" When discussing appropriate communication, which of the following statements by the client to his coworker indicates client understanding? A. "You really should complete your own work. I don't think it's right to expect me to complete your responsibilities." B. "Why do you expect me to finish your work? You must realize that I have my own responsibilities." C. "It is not fair to expect me to complete your work. If you continue, then I will report your behavior to our supervisor." D. "When I have to pick up extra work, I feel very overwhelmed. I need to focus on my own responsibilities."

D

People who have an indigenous worldview A. see themselves as spiritual and believe that they are linked with all other living things. B. focus on the articulation of individual needs and ideas. C. view the self as an extension of cosmic energy that is repeatedly reborn. D. are concerned with being part of a harmonious community.

D. Clients with an indigenous worldview are interested in connectedness and being in harmony with others. They have little interest in personal goals and autonomy.

Deviation from cultural expectations is considered by members of the cultural group as a demonstration of A. hostility. B. lack of self-will. C. variation from tradition. D. illness.

D. Deviation from cultural expectations is considered by others in the culture to be a problem and is frequently defined by the cultural group as "illness."

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects A. supernatural causes. B. negative forces. C. inheritance. D. imbalance.

D. Many Eastern cultures explain illness as a function of imbalance.

Which healing practice is least used in the Western health system of healing practices? A. Antibiotic medication B. Surgery C. Targeted cellular destruction D. Restoring lost balance or harmony

D. The best treatment perspectives of various cultures include regaining lost balance and harmony. This perspective is not used in Western culture.

The question that would give data of least value to the assessment of family dynamics is A. "What changes have occurred recently at work?" B. "Are your wife and children conforming to your expectations?" C. "Are you experiencing stress associated with conforming to family expectations?" D. "Do you expect others to shun or avoid you because you are seeing a therapist?"

D. The question about others' reaction to seeking help from a psychotherapist will not provide data about family dynamics.

You are working on the psychiatric unit and assisting with the care for Mr. Tran, a refugee from Darfur, who came to the United States 1 year ago. Although Mr. Tran understands and speaks some very limited English, he is much more comfortable conversing in his native language. Mike, the nurse working directly with Mr. Tran, says to you, "I am so frustrated trying to communicate with Mr. Tran! He insists on speaking his language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which of the following responses you could make promotes culturally competent care? (select all that apply): A. "You are right that Mr. Tran needs to speak English, but all patients do have a right to an interpreter, so you need to comply." B. "I agree that it is frustrating trying to communicate with Mr. Tran. Maybe we could see if his family members can help convince him to try speaking English." C. "Mr. Tran will have to learn to speak English eventually to live and work successfully in this country. Just try to be patient and encourage him to try speaking English." D. "What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." E. "Mr. Tran's ability to speak and understand English is very limited. He needs to have an interpreter to make sure he can make his needs and feelings known."

D. E. Cultural imposition is imposing our own cultural norms onto those from another cultural group. By obtaining an interpreter for Mr. Tran, the nurse is promoting culturally competent care, ensuring the patient can communicate his feelings and needs thoroughly to the staff. Patients do have a right to an interpreter, but stating that Mike is right is not promoting culturally competent care and is instead confirming his opinion. Asking family members to convince the patient to speak English is not promoting culturally competent care and also undermines the trust between nurse and patient. Instead of encouraging the patient to speak English an interpreter should be obtained for the patient.

On admission, a client experienced severe alcohol withdrawal symptoms. Four days later, the nurse notes a decrease in withdrawal symptoms. Which nursing intervention is most appropriate? A. withhold potentially addictive as needed PRN medications B. Increase PRN medications because potentially fatal complications can still occur. C. Ask the doctor to prescribe a less addictive medication to reduce potential for dependence. D. Monitor for withdrawal complications and administer medications on the basis of client symptoms.

D. Monitor for withdrawal complications and administer medications on the basis of client symptoms The nurse must remain vigilant because withdrawal complications can occur days after initial withdrawal symptoms appear. Medication dosages for withdrawal should be based on an objective assessment of symptoms. This is usually done by the use of an assessment tool such as Clinical Institute Withdrawal Assessment (CIWA)

An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? A. increased heart rate and BP B. tremors, insomnia, and seizures C. incoordination and unsteady gait D. N/V, diarrhea and diaphoresis

D. N/V, diarrhea and diaphoresis

A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician's orders is thiamine. Which is the rationale for this intervention? A. to prevent nutritional deficits B. to prevent pancreatitis C. to prevent alcoholic hepatitis D. to prevent Wernicke's encephalopathy

D. To prevent Wernicke's encephalopathy

Nan took the drug she was handed and in a few minutes felt calm and drowsy, and then went to sleep. She probably took: A. heroin B. cocaine C. cannabis D. a barbiturate

D. a barbiturate

Research indicates that the most important neurotransmitter in the "pleasure pathway" of the rain is probably: A. acetylcholine B. anandamide C. endorphins D. dopamine

D. dopamine

Which nursing intervention relates to rehabilitative care or a recovering alcoholic? A. Providing a safe and supportive environment during alcohol withdrawal B. teaching about physical symptoms C. Providing client and family education and assistance during treatment D. encouraging continued participation in AA

D. encouraging continued participation in AA Encouraging continued participation in AA is a nursing intervention during rehabilitative care. Because recovery is a long-term process, it is critical that the nurse encourage continuous participation in outpatient support systems such as AA.

Which symptom would the nurse expect to observe in a client experiencing opioid intoxication? A. insomnia B. abdominal cramps C. muscle aches D. impaired judgment

D. impaired judgment impaired judgment; initial euphoria followed by apathy; dysphoria; and psychomotor agitation or retardation are all symptoms of opioid intoxication.

Behaviorists argue that the temporary reduction of tension or raising of spirits produced by a drug has a rewarding effect. This gives evidence that _____ may play a role in substance abuse. A. extinction B. negative reinforcement C. classical conditioning D. operant conditioning

D. operant conditioning

What is the greatest risk coming from cocaine use? A. being assaulted in drug-related crimes B. contracting AIDS C. damage to mucus membranes D. overdose effects

D. overdose effects

Which is the most serious symptom experienced during alcohol withdrawal? A. blackout B. acute withdrawal delirium C. hypotension D. seizure

D. seizure During alcohol withdrawal, the CNS rebounds from the effects of suppression caused by alcohol intake. This excitation of the CNS can lead to grand mal seizures and other complications, which are life threatening. This is the most serious complication of alcohol withdrawal syndrome.

Probably the worst thing one who has "partied hard" with alcohol could do right after drinking would be to: A. drink 4 or more cups of coffee B. eat a small to medium-sized meal C. sleep it off without taking drugs to minimize after effects D. take some barbiturates to fall asleep

D. take some barbiturates to fall asleep

A client is brought to the ED. The client is aggressive, has slurred speech, and impaired motor coordination. Blood alcohol level is 347 mg/dl. Among the physician's orders is thiamine. Which is the rationale for this intervention? A. to prevent nutritional deficits B. to prevent pancreatitis C. to prevent alcoholic hepatitis D. to prevent Wernicke's encephalopathy

D. to prevent Wernicke's encephalopathy Wernicke's encephalopathy is the most serious form of thiamine deficiency in clients diagnosed with alcoholism. if thiamine replacement therapy is not undertaken quickly, death will ensue.

A nurse is caring for a client who has a new prescription for lithium carbonate (Lithobid). When reinforcing teaching about ways to prevent lithium toxicity, the nurse should advise the client to do which of the following? A. Avoid the use of acetaminophen for headaches B. Restrict intake of foods rich in sodium C. Decrease fluid intake to less than 1,500 mL daily D. Limit aerobic activity in hot weather

D.Limit aerobic activity in hot weather

2. A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? A. "I will write down my dreams as soon as I wake up." B. "I may begin to associate my therapists with important people in my life." C. "I can learn to express myself in a nonaggressive manner." D. "This therapy will address my conscious feelings about stressful experiences." ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

D: Free association is the spontaneous, uncensored verbalization of whatever comes to the client's mind. ATI RN Mental Health Nursing Modules Ch. 7 Application Exercises

Q 31. ________________________________ personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive and clinging behavior and fears of separation.

Dependent

ways to combat stress

Elicit the relaxation response Perform physical activity Seek social support

Q 30. _____________________ personality disorder is characterized by colorful, dramatic, and extraverted behavior in excitable, emotional people.

Histrionic

Response of the body to stress

Increased mental activity, Dilated Pupils, Bronchiolar dilation, increased respiratory rate, increased heart rate, increased glucose, increased cardiac output, increased fatty acids, increased arterial blood pressure, increased blood flow to skeletal muscles

A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.

Intoxication

Patients with borderline personality disorder (BPD) exhibit negative effect, which includes emotional _____________, described as rapidly moving from one emotional extreme to another.

Lability

Distress

Negative experience thaat can drain our energy

32. _____________________ personality disorder is a pervasive distrust and suspiciousness of others, such that their motives are interpreted as malevolent.

Paranoid

Q 29. _______________________ personality disorder is characterized by a profound defect in the ability to form personal relationships or to respond to others in any meaningful emotional way.

Schizoid

Different types of stress

Stress can be Psychological (anxiety, guilt , or joy) or physical (stressful environment, such as loud noises, extreme heat or cold, or other disturbing physical condition) and Spiritual (such as an existential crisis)

Initial response to stress activates the

Sympathetic Nervous System

Stressor

That which triggers stress

Secondary Stress Trauma and Compassion Fatigue

The terms used when health care workers are indirectly traumatized when they cannot help the patient going through a devastating illness or sever trauma

The physiological and mental readjustment that accompanies the discontinuation of an addictive substance.

Withdrawal

A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? a. "life isn't worth living if I gain weight." b. "don't pretend like you don't know how fat I am." c. "if i could be skinny, I know I'd be popular." d. "when I look in the mirror, I see myself as obese."

a. "life isn't worth living if I gain weight."

A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? SELECT ALL THAT APPLY a. "what is your relationship like with your family?" b. "why do you want to lose weight?" c. "would you describe your current eating habits?" d. "at what weight do you believe you will look better?" e. "can you discuss you feelings about your appearance?"

a. "what is your relationship like with your family?" c. "would you describe your current eating habits?" e. "can you discuss you feelings about your appearance?"

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? SELECT ALL THAT APPLY a. amenorrhea b. hypokalemia c. mottling of the skin d. slightly elevated body weight e. presence of lanugo on the face

b. hypokalemia d. slightly elevated body weight

A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following response should the nurse make? a. "many clients are concerned about their weight. However, the dietician will ensure that you don;t get too many calories in your diet." b. "Instead of worrying about your weight, try to focus on other problems at this time." c. "I understand you have concerns about you weight, but first, let's talk about your recent accomplishments." d. "you are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you."

c. "I understand you have concerns about you weight, but first, let's talk about your recent accomplishments." this statement acknowledges the client's concern and then focuses the conversation on the client's accomplishments which can promote client self-esteem and self-image

People who regularly take amphetamines to lower their appetite and lose weight, find that, over time: A. they must take more of the drug to get the same effect. B. they are as hungry as ever C. both a and b. D. none of the above.

c. both a and b They must take more of the drug to get the same effect and they are as hungry as ever.

A stressor

can be real or percieved

Allostatic load

chronic arousal with the presence of powerful hormones causes excessive wear and tear on bodily organs

A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following nursing actions should the nurse include in the client's plan of care? a. allow the client to select preferred meal times b. establish consequences for purging behavior c. provide the client with a high-fat diet at the start of treatment d. implement one-to-one observation during meal times

d. implement one-to-one observation during meal times

Stress response also called

fight or flight response

Stress can be

psychological or physical