mental health hesi

Which supplement may be helpful in managing the symptoms of depression? a. lavender b. St Johns Wort c. Melatonin d. Fish oil e. SAMe

B,D,E St Johns Wort, fish oil, and SAMe have been identified as having some possible positve effect on the symptoms of depression. Melatonin and lavender are associated w insomnia

What term is used to identify the quantitative study of the distribution of mental disorders in human populations? a. mortality b. prevalence c.epidemiology d. clinical epidemiology

C. Epidemiology. Epidemiology is the quantitative study of the distribution of mental disorders in human populations. Mortality refers to deaths. Prevalence refers to the proportion of a population with a mental dx at a given time. Clinical epidemiology deals with what happens to people with illness who are seen by providers.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement? a. "I do like you, but I don't like it when you grab my pen" b. "Liking you has nothing to do with whether I will loan you my pen" c. "It sounds as though you are feeling helpless and insecure" d. "You must ask for permission before taking someone else's things"

a This reply shows positive regard for the child while describing the behavior as undesirable. Feedback such as this helps the child feel accepted while making her aware of the effect her behavior has on others. None of the other options provide the necessary degree of positive regard

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? a. suddenly trembling severely b. exhibit stoic behavior c.report both nausea and vomiting d.laugh inappropriatley

a ataque de nervios is a culture bound syndrome that is seen in undereducated, disadvantaged females of hispanic ethnicity. None of the other options are associated w cultural response to stress

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply). of, inattention, and impulsivity have to be apparent: a. low frustration tolerance b.poor school performance c.impulsive behavior d.easily intimidated e. mood swings

a, b, c, e Individuals w ADHD show an inappropraite degree of inattention, impulsiveness, and hyperactivity. Attention problems and hyperactivity contribute to low frustration tolerance, temper outburts, labile moods, poor school performance, peer rejection, and low self esteem. ADHD is not generally characterized by meekness or by being easily intimidated

The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal what common assessment data? a. a hx of childhood trauma b. a sibling w the dx c. a history of sexual abuse d. a previous suicide attempt e. an eating dx

a, b, c, e Sexual and physical abuse in childhood trauma increases the risk of this dx. Genetics are strongly associated w this dx. First degree relatives have twice the risk. OCD tends to occur along w anxiety dx 76% of the time. Othr comorbid conditions include depression, bipolar, and eating dx. Suicide while a concern is not among the most common issues for the client diagnosed w OCD

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? a. unable to explain the phrase "raining cats and dogs" b. reads below age level c. is capable of providing effective oral self care d. enjoy interacting w developmentally similar peers e. physically lashes out while frustrated

a, b,e IDD is characterized by severe deficits in three major areas of fxn: intellectual, social, and managing daily life. These children demonstrate difficulty with self care and with almost any social interactions.

Based on current understanding of brain physiology, which neurotransmitter would be the expected target of med prescribed to manage depression? Select all that apply a. dopamine b.GABA c.serotonin d.norepinephrine e. acetylcholine

a, c, d Antidepressant meds target serotonin and norepinephrine. While dopamine is implicated in schizophrenia (increase) and parkinson's dx (decrease), it is also believed to be a factor in depression. GABA is implicated in anxiety dx. Acetylcholine is implicated in Alzheimer's as well has Huntingtons and Parkinsons

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? a. In a social relationship, both parties needs are met; in a therapeutic relationship, only the patient's needs are to be considered b. A social relationship is instituted for the main purupose of exploring one member's feelings and issues; a therapeutic relationship is instituted for the purpose of friendship c. giving advice is done in social relationsips; in therapeutic relationships giving advice is not usually therapeutic d. in a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend money, etc); in a therapeutic relationship solutions are discussed but are only implemented by the pt e. In a social relationship, communication is usually deep and evaluated; in a therapeutic relationship, communication remains on a more superficial level, allowing pts to feel comfortable

a, c, d, The other options describe the opposite meanings of social and therapeutic relationships

Which of the following statements represent a nontherapeutic communication technique? a. "Why didnt you attend group this morning?" b. "From what you have said, you have great difficulty sleeping at night" c. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way? d. "If I were you, I would quit the stressful job and find something else" e. "I'm really proud of you for the way you stood up to your brother when he visited today" f. "You mentioned that you never had friends. Tell me more about that" g. "It sounds like you have been having a very hard time at home lately"

a, c, d, e All these options reflect nontherapeutic techniques of asking "why questions", using excessive questioning, giving advice, and giving approval. The other options describe therapeutic techniques of restating, exploring, and reflecting

According to the DSM-V, which statement made by an adult client supports the criteria for generalized anxiety disorder? a. Ive been really anxious for at least 2 years b. My anxiety has to be genetic; my mom was a terrible worrier too c.my marriage is in trouble because I'm always so irritable d. I've had a good physical and my HCP says I'm in good health e. Its hard falling asleep and even harder staying asleep; I'm restless all night

a, c, d, e the DSM-V criteria for GAD include excessive anxiety and worry (apprehensive expectation), occuring more days than not for at least 6 months; sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep) and irritability; the anxiety, worry, or physical symptoms cause significant distress or impairment in social, occupational, or other important areas of functioning; the disturbance is ot attributable to the physiological effects of a substance (e.g. drug abuse, medication) or another medical condition. Family hx is not a recognized criterion for GAD

Which of the following describe the symptoms of the manic phase of bipolar disorder? a. excessive energy b. fatigue and increased sleep c.low self esteem d. pressured speech e. purposeless movement f. racing thoughts g. withdrawal from enviro h.distractibility

a, d,e, f, h All of these options describe mania. The other options more aptly describe the opposite of what happens in mania.

What is the expected outcome for an individual who has successful resolved all the maturational crises they have been presented with? Select all that apply a. the development of basic human qualities b. the elimination of future maturational crises c.the development of new, effective coping mechanisms d.the elimination to specific barriers of psychosocial growth e. the ability to pass through subsequent developmental stages

a,c, e Successful resolution of the maturational tasks leads to development of basic human qualities. Erikson believed that the way these crises are resolved at one stage affects the person's ability to pass through subsequent stages. Each crisis provides the starting point for movement toward the next stage with the opportunity to learn new coping mechanisms and experience personal psychosocial growth. Each new stage of development represents a maturational crisis

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? Select all that apply a. insulin resistance b. high resting HR c. digestive problems d. chronic muscle tension e. obesity

a,e Insulin resistance and obesity are considered long term sequelae of the high blood glucose levels incurred when the body responds to stress. None of the other options are related to the HPA axis

A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best address this cognitive distortion with which response? a. "Let's look at what you just said, that you can 'never do anything right'" b. "tell me what things you think you are not able to do correctly" c. "Is this part of the reason you think no one likes you?" d. "That is the most unrealistic thing I have ever heard"

a. Cognitive distortions can be refuted by examining them, but to examine them the nurse must gain the client's willingness to participate. None of the other options examines the underlying cause of the feeling

Which of the following classifications of medication may be prescribed in intermittent explosive disorder? a. anticonvulsants b.psychostimulants c.antianxiety agents such as benzos d.MAOIs

a. although considered off label use, anticonvulsants may reduce outbursts and contribute to mood stabilization. The other options are incorrect for use in intermittent explosive dx

When considering mental illness, recovery is best described to a client by which statement? a. Working, living, and participating in the community b. never having to visit a mental health provider again c. being able to understand the nature of the diagnosed illness d. a period of time when signs and symptoms are being managed

a. recovery is described as the ability of the individual to work, live, and participate in the community. Never having to visit a mental health provider is unrealistic. WHile important to recovery understanding of the disorder is not a demonstration of recovery. Remission is a period of time when signs and symptoms are being managed

Which side effects of lithium can be expected at therapeutic levels? a. fine hand tremors and polyuria b. nausea and thirst c. coarse hand tremor and GI upset d. ataxia and hypotension

a. Fine hand tremors and polyuria the fact that fine hand tremors and polyuria are present at therapeutic levels is quite annoying to some clients. These and other side effects are factors in noncompliance

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. Western biomedicine is one of several established healing systems A nurse who holds this belief would 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 case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? a. arranging for the client to have a screening for prostate cancer b.notifying the family that the client will need a wheelchair when discharged c. providing the client with organizations that help defray the cost of prescribed drug d. arranging for respite care when the client's family needs to attend an out of state affair

a. arranging for the client to have a screening for prostate cancer The goal of managed care is to provide coordination of all health services with an emphasis on preventive care. While appropriate interventions, none of the remaining options focus on preventive care

Currently what is understood to be the causation of schizophrenia? a. a combo of inherited and nongenetic factors b. deficient amounts of the neurotransmitter dopamine c. excessive amounts of the neurotransmitter serotonin d. stress related and ineffective stress management skills

a. causation is a complicated matter. Schizo most likely occurs as a result of a combo of inherited genetic factors and extreme nongenetic factors (eg viral infection, birth injuries, nutritional factors) that can effect the genes governing the brain or directly injure the brain

The nurse caring for a client prescribed risperidone observes the client carefully for which possible side effects? a. day time sleepiness b. reports of heartburn c. a rapid heartbeat d.sexual dysfunction e. weight gain

a. daytime sleepiness d. sexual dysfunction e. weight gain Risperidone is a D2 antagonist that has the potential to produce sedation, weight gain, and sexual dysfunction. None of the other side effects are generally associated w the med

Which psychosocial disorder is more often initially seen in late life? a. depression b.bipolar c. schizophrenia d. dissociative e. anxiety

a. depression e. anxiety Depression, risk for suicide, alcohol abuse, and anxiety are all disorders seen in mental illness in late life. Although it may be possible to experience these other disorders in older age, they are not usually first diagnosed in this age group; patients diagnosed w these disorders earlier in life may in fact have some symptom remission as they age

A client states "That nurse never seems comfortable being with me." The nurse can be described as a. not seeming genuine to the client b. transmitting fear of clients c. unfriendly and aloof d. controlling

a. not seeming genuine to client Hiding behind a role, using stiff or formal interactions, and creating distance bw self and client suggest a nurse is lacking genuineness, or the ability to interact in a person to person fashion. This characteristic is not associated w any other option

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? a. nurses b. social workers c. clinical psychologists d. chemical dependency counselors

a. nurses Nurses are the only caregivers listed who can provide both physical and psychological care for mental health clients

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? a. private insurance b. medicare c. medicaid e. private pay

a. private insurance Because most health insurance is employer based, few chronically ill clients have private insurance. The other options are examples of ways patients pay for their needed mental health services

The most common course of schizophrenia is an initial episode followed by what course of events? a. recurrent acute exacerbations and deterioration b. recurrent acutre exacerbations c. continuous deterioration d. complete recovery

a. recurrent acute exacerbations and deterioration Schizo is usually a dx marked by an initial episode followed by recurrent acute exacerbations. W each relapse of psychosis, an increase in residual dysfunction and deterioration occurs

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic? a. temperament b. resilience c.vulnerability d. cultural assimilation

a. temperament This is the behavior the child habitually uses to cope w the enviro. It is a constitutional factor thought to be genetically determined. It may be modified by the parent child relationship

A client states, "I will always be alone because nobody could ever love me." The nurse recognizes that the client is expressing what cognitive-behavioral concept? a. emotional consequences b. schema c.actualization d. aversion

b Schemas are unique assumptions about ourselves, according to Beck's theory. This statement is an example of a negative schema. Emotional consequence is the end result of a negative thinking process, as described by Ellis. Actualization is a level of Maslow's Heirarchy of Needs. Aversion is a therapy characterized by punishment.

A 55-year-old patient recently came to the United States from England on a work visa. The patient was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the patient shows little emotion. Which of the following explanations is most plausible for this lack of emotion? a. the patient is in denial b.the response may reflect cultural norms c.the response may reflect personal guilt d. the patient may have antisocial PD

b Showing little emotion while in distress may be a cultural phenomenon. Some cultures, such as the british and German cultures, tend to value highly the concept of self control and may show little facial emotion in the presence of emotional turmoil. There is no evidence to suggest the pt's lack of emotion is a result of of any of the other options

A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure? a. The inability to achieve her personal goals in the workplace b. shaming the family by being responsible for the error c.feeling personally inadequate regarding dependability d. traditional belief that failure may result in changed fate

b eastern tradition, such as in China, sees the family as the basis for one's identity, and family interdependace 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 to an unchangeable fate

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? a. mood stabilizers b.antianxiety agents c. anticholinesterase inhibitors d.first gen antipsychotics e. second gen antipsychotics

b, d, e Drugs w food and drug administration approval for treating tics are the first gen antipsychotics haloperidol and pimozide, and the second gen antipsychotic aripiprazole. Clonidine can also be prescribed. While less effective and far slower acting, it has fewer SE. The antianxiety drug clonazepam is used as a supplement to other meds. It may work by reducing anxiety and resultant tics. The other options are not used or approved for the tx of tourretes

What is the focus of the SAFE-T assessment tool? a. facilitate hospitalization b.identify level of suicide risk c. development of client focused care d. introduce antidepressant med therapy e. stress collaboration w the client

b,c,e The suicide assessment five step evaluation and triage (SAFE-T) is an assessment tool that allows the clinician to benchmark relative risk (high, moderate, or low) and to develop a treatment plan, in consultation w the patient, to reduce current risk. The tool does not provide for specific interventions

A recent Hispanic immigrate comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization? a. impaired sleep patterns b. denial of anxiety or depression c.unexplained physical pain d.recent immigration to the US

b. Somatizatin is described as experiencing and expressing emotional or psychological distress as physical symptoms. The client's behavior associated with the denial of any mental illness or understanding of the possible connection bw the symptoms/signs and a mental illness presents a need to explore the possibility of somatization. Non of the other options support this possibility as directly

What older concept of care is being used currently to help in violence reduction in disruptive clients? a. aired grievances b.trauma informed care c.shared governance d.learned helplessness

b. This is an older concept of providing care that has been reintroduced. It is based on the notion that disruptive pts often have histories that include violence and victimization. These traumatic hx can impede pts ability to self soothe, result in negative coping responses, and create a vulnerability to coercive interventions (ex restraints) by staff. Trauma informed care focuses on the pts past experiences of violence or trauma and the role it currently plays in their lives. None of the other options refer to a concept that helps reduce violence

A 17-year-old patient is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this patient? a. engages in appropriate coping skills to manage stressors b. expresses feelings c.maintains self control during hospitalization d.mother will improve communication skills to interact w Eli

b. expressing feelings is an appropriate short term outcome and would be a good start to working with the patient to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skill sand maintaing self control are desired outcomes. Outcomes for this pt are being discussed, not outcomes for the pts mother

When approaching a client who is acting out aggressively, what interventions should the nurse implement to assure personal safety? a. stand close to the client for reassurance and to convey caring b. have other staff as backup, and stay out of the client's personal space c.take the client to his or her room so that his or her privacy will be protected d.call security and wait until they arrive before approaching the client

b. safety considerations for staff include enlisting otehr staff to be present, keeping a safe distance from the patient, and approaching the patient in a nonthreatening or nonconfrontational manner. None of the other options focus on staff safety; security may escalate the patient's behavior and should be kept in the background unless needed for assistance

Which assessment data describes a client in phase IV of Caplan's phases of crisis? a. the client reports experiencing increased anxiety and feelings of extreme discomfort the day after the tornado b. the client comes to the crisis clinic reporting depression and expresses that he does not want to go on living c. the client reports experiencing a panic attack d.the client reports experiencing anxiety symptoms the day after being fired

b. this describes that phase IV, which, if coping is ineffective, may lead to depression, confusion, violence, or suicidality. The other options describe phase II, phase III, and phase I in caplans phases of crisis

When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" The nurse's response is based on what fact concerning hostility? a. the client is getting better and is able to be assertive b.the client may be at high risk for self harm c. the client is probably experiencing transference d. the client may be angry at someone else and is projecting that anger to staff

b. overt hostility is highly correlated with suicide; therefore the patient may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? a. "we will help you make decisions that we keep you safe" b. "I am going to help you shower so you will not smell so bad" c. "Your pocket knife and nail clippers will be kept in the nurses station" d. "You will be having a number of tests to help us learn about your condition"

b. "I am going to help you shower so you will not smell so bad"

How can a nurse best differentiate whether an Asian client is demonstrating a mental illness after having attempted suicide? a. Ask the client whether he views himself as being depressed b. identify the client's culture's view regarding suicide c.explain that suicide is often regarded as a desperate act d.assess the client for other examples of depressive behavior

b. Identify the client's culture's view regarding suicide One approach to differentiating mental health from mental illness is to consider what a particular culture regards as acceptable and unacceptable. In this view, the mentally ill are those who violate social norms and thus threaten (or make anxious) those observing them. While the remaining options are appropriate interventions, they fail to address the possible cultural components of the client's behavior.

When educating a client diagnosed with bulimia nervosa about the medication fluoxetine, the nurse should include what information about this medication? a. it will reduce the need for cognitive therapy b. it will be prescribed at a higher than typical dose c. there are a variety of meds to prescribe if fluoxetine proves to be ineffective d. long term management of symptoms is best achieved w TCAs

b. It will be prescribed at a higher than normal dose Research has shown that antidepressant medication together w CBT brings about improvement in bulimic symptoms. Fluoxetine, an SSRI, has FDA approval for acute and maintentance tx of bulimia in adults. When fluoxetine is used for bulimia, it is typically at a higher dose than is used for depression. Although no other drugs have FDA approval for this dx, TCAs help reduce binge eating and vomiting over short terms

A 78-year-old patient diagnosed with Alzheimer's disease picks up a glass from the bedside table but does not recognize the purpose of the object. This inability is associated with which characteristic of the disorder? a. apraxia b. agnosia c.aphasia d. agraphia

b. agnosia this is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absense of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write

Using Maslow's model of needs, the nurse providing care for an anxious client identifies which intervention as being a priority? a. Assessing the client's ability to fulfill appropriate developmental level tasks b. Assessing the client for strengths upon which a nurse-client relationship can be built c.planning one on one time to assist in identifying the fears triggering the client's anxiety d. evaluating the client's ability to learn and retain essential information regarding their current condition

b. assessing the client for strengths upon which a nurse-client relationship can be based The value of Maslow's model is twofold. First, the emphasis on human potential and the client's strengths is key to successful nurse-client relationships. The second value lies in establishing what is most important in sequencing of nursing actions in the nurse client relationship

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? a. eustress b. fight or flight c. resistance d. exhaustion

b. fight or flight The initial adaptive response of GAS prepares the individual to fight or flee in the face of acute stress. None of the other options are associated w the initial stage of GAS

A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat a. avocado salad plate b. fruit and cottage cheese plate c.kielbasa and sauerkraut d. liver and onion sandwich

b. fruit and cottage cheese plate Fruit and cottage cheese do not contain tyramine. Avocados, fermented foods such as sauerkraut, processed meat, and organ meat, contain tyramine. MOAIs inhibit the breakdown of tyramine, which can lead to HTN, a hypertensive crisis, and eventually a CVA. This info makes other options incorrect.

A 38-year-old patient referred for sleep studies reports frequent daytime lethargy, unintended lapses into sleep, and never feeling rested on awakening in the morning. These symptoms support which sleep-related diagnosis? a. circadian rhythm disorder b. hypersomnolence c.REM sleep behavior dx d.breathing related sleep dx

b. hypersomnolence The pt w hypersomnolence resports recurrent periods of sleep or unintended lapses into sleep, frequent napping, nonrefreshing nonrestorative sleep regardless of the amount of time slept, and difficulty with full alertness during the wake period. Circadian rhythm sleep dx occur when there is a misalignment bw the timining of the individual's normal circadian rhythm and external factors that affect the timing and duration of sleep. Pts w REM sleep dx display elaborate motor activity associated w dream mentation. Breathing related sleep dx is characterized by frequent upper airway obstruction

Which organ secretes hormones that are a normal component of the body's general response to stress? select all that apply a. thyroid gland b. hypothalamus c. pituitary d. adrenal glands e. parathyroid glands

b. hypothalamus c. pituitary gland d. adrenal glands The hypothalamus, pituitary, and adrenal glands act as a system that responds to mental and physical stress. The organs secrete corticotropin-releasing hormone, corticotropin, and cortisol; all influence the function of the nerve cells of the brain. None of the remaining options secrete hormones associated with general stress.

What term is used to describe care that places the attention on a patient's physical, mental, and spiritual needs while focusing on prevention and wellness? a. orthodox b. integrative c. allopathic d. mainstream

b. integrative Integrative care is holistic and focuses on the patient and on prevention and wellness. The other options all refer to conventional HC systems in the US

Selective inattention is first noted when experiencing which level of anxiety? a. mild b. moderate c. severe d.panic

b. moderate when moderate anxiety is present, the individual's perceptual field is reduced and the client is not able to see the entire picture of events. This is not an initial characteristic of any of the other levels of anxiety

Which severe mental illness is recognized across cultures? Select all that apply a. antisocial dx b. schizophrenia c. anorexia d. social phobia e. bipolar dx f. borderline personality dx

b. schizophrenia e. bipolar Worldwide studies indicate that both schizophrenia and bipolar dx are recognized cross culturally

The preferred seating arrangement for a nurse-client interview should incorporate which positioning? a. the nurse behind a desk and the client in a chair in front of the desk b. the nurse and client sitting at a 90 degree angle to each other c. the client sitting in a chair and the nurse standing a few feet away d. the nurse and client sitting facing each other

b. the nurse and client sitting at a 90 degree angle to each other This arrangement allows the nurse to observe the client but places no barriers between the principals. The two are at the same height, so neither in in an inferior position. Face to face seating is a more confrontational arrangement and therefore more anxiety producing.

Which assessment should the nurse perform to evaluate the pharmacokinetic affect of a monoamine oxidase inhibitors (MAOIs) antidepressant medication? a. the status of the client's depression b. the results of liver fxn test c.the level of depression exhibited by the client d. the client's current sleep patterns

b. the results of the liver function test pharmacokinetics refer to the movement of a drug on the body. Four basic processes of pharmacokinetics which determine the concentration of a drug at its sites of action are easily remembered with the acronym ADME: absorption, distribution, metabolism, and excretion. MAOIs can affect liver fxn and require monitoring. The other options are related to the meds pharmacodynamic effects

When a nurse and client meet informally or have an otherwise limited but helpful relationship, what term is used to identify this relationship? a. crisis intervention b. therapeutic encounter c. autonomous interaction d. preorientation phenomenon

b. therapeutic encounter A therapeutic encounter is a short but helpful interaction between the nurse and client. None of the other options reflect this formal relationship

A dying client's family is concerned that the opioid pain medication being prescribed will hasten the client's death. Why? a. The rule of double effect (RDE) prevents the use of opioids to facilitate a client's death b. there is little research evidence to support that appropriate opioid management will result in an earlier death c. pain management for the terminally ill is the primary concern of the HC team d. addition to the opioid is a greater risk than is the possibility of premature death

b. there is little research evidence to support that appropriate opioid management will result in an earlier death Pain is sometimes undertreated bc the pt or the family is concern about sedation, addiction, and or hastening the demise of their loved one. The RDE is a bioethical principal that allows a physician or APRN to make a decision, such as prescribing adequate pain med, even though the pain med might cause the pt to die sooner. There is little evidence, however, to support the concern that appropriate use of opioids will hasten death

A new nurse has accepted a position as staff nurse on a psychiatric unit. Which statement made by the new nurse requires additional instructions regarding the therapies provided on the unit? a. "You will participate in unit activities and groups daily" b. "You will be given a schedule daily of the groups we would like you to attend" c. "You will attend a psychotherapy group that I lead that will help you care for yourself d. "You will see your provider daily in a one- to -one session

c Basic level RNs cannot perform psychotherapy. The other options are all appropriate expectations of a pts schedule on a psychiatric unit

The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention? a. having the client repeatedly touch dirty objects b. not allowing the client to seek reassurance from staff c.not allowing the client to wash hands after touching a dirty object d. telling the client that he or she must relax whenever tension mounts

c Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken w/o physicaian approval. None of the other options reflect accurate info regarding this form of therapy.

A Gulf War veteran is entering treatment for post-traumatic stress disorder. What assessment is of importance to this particular client? a. Ascertain how long ago the trauma occured b. Find out if the client uses acting out behaviors c. Determine the use of chemical substances for anxiety relief d. establish whether the client has chronic hypertensio related to high anxiety

c Substance abuse often coexists with PTSD. It is often the clients way of self medicating to gain relief of symptoms

The nurse is planning long-term goals for a 17-year-old male client recently diagnosed with schizophrenia. Which statement should serve as the basis for the goal-setting process? a. if treated quickly following diagnosis, schizophrenia can be cured b.schizophrenia can be managed by recieving treatment only at the time of acute exacerbations c.patients w schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability d. if patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms

c unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. the other options are all untrue of schizophrenia

Which of the following symptoms would lead a provider to suspect that a client is experiencing PTSD? a. visiting the scene of the accident over and over b. talking with strangers about the events of the accident c. flashbacks of the accident d.hypervigilance e.irritability f. difficulty concentrating g.mania

c, d, e, g All of these symptoms are signs of ptsd.

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? a. parents may initiate a lawsuit if injury occurs b. staff have conflicted feelings leading to ineffectiveness c.research suggests both are psychologically and physically harmful d. staff tend to be undertrained in use of restraints in children e. the principle of least restrictive intervention is a primary concern

c, e Restraint and seclusion have been shown to be psychologically harmful and may also be physically harmful and result in injury or death. To ensure that the civil and legal rights of individuals are maintained, techniques are selected according to the principle of least restrictive intervention. This principle requires that you use more restrictive interventions only after attempting less restrictive interventions to manage the behavior that have been unsuccessful. The other options are not correct reasons why restraint and seclusion are controversial in children.

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should a. question the physicians order bc the dose is excessive b. explain the long term nature of benzo therapy c. teach the client to limit caffeine intake d. Tell the client to expect mild insomnia

c. Caffeine is an antagonist of antianxiety medication. None fo the other options present accurate information regarding lorazapam

When considering the functions of a forensic psychiatric nurse, which statement regarding the role of hostage negotiator is true? a. it is not within the forensic psychiatric nurse's scope of practice b. it is not covered by malpractice insurance c. it is a function of a forensic psychiatric nurse d. it is performed only by forensic psychiatric nurses with special training

c. This is a sanctioned fx and therefore would be covered by malpractice insurance

What assumption can be made about the client who has been admitted on an involuntary basis? a. The client can be discharged from the unit on demand of next of kin b. for the first 48 hrs, the client can be given medication over injection c. the client has failed to agree to fully participate in treatment care planning d. the client is a danger to self or others or unable to meet basic needs e. the commitment was court ordered

c. d. e. Involuntary admission which is court ordered implies that the client did not consent to the admissoin. The usual reason for admitting the client over his or her objection is if the client presents a clear danger to self or thers or is unable to meet even basic needs independently. neither of the remaining options is accurate assumption regarding an involuntary admission

Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met? a. "I purge only once a day now instead of twice" b."I feel a lot calmer lately, just like when I used to eat four or five cheeseburgers" c. "I am a hard worker and I am very compassionate toward others" d. "I always purge when I'm alone so that I'm not a bad role model for my younger sister"

c. An appropriate overall goal for the bulimic pt would include that the pt be able to ID personal strengths, leading to improved self esteem. Purging only once a day instead of two is incorrect bc the goal is to refrain from purging altogether. A goal is for the pt to express feelings w/o food references. Purging when alone is incorrect bc the pt is still purging

Beck's cognitive theory suggests that the etiology of depression is related to what factor? a. sleep abnormalities b. serotonin circuit dysfunction c. negative processing of info d. belief that one has no control over outcomes

c. Beck is a cognitive theorist who developed the theory of the cognitive triad of 3 automatic thoughts responsible for people becoming depressed: 1. a negative, self depricating view of onesself, 2. a pessimistic view of the world, 3. the belief that negative reinforcement will continue

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture? a. "Ethnicity refers to having the same life goals whereas culture refers to race" b. "Ethinicity refers to norms within a culture, and culture refers to shared likes and dislikes" c. "Ethinicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values" d. "Ethnicity refers to race, and culture refers to having the same worldview"

c. Ethnicity is sharing a common history and heritage. Culture compromises the shared beliefs, values, and practices that guide a group members in patterned ways of thinking and acting. The other options are all incorrect

A nurse's identification badge includes the term, "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" Keeping in mind the diagnosis of the patient, how should the nurse respond to this question? A. "Don't be afraid; it means I'm here to help not hurt you" b. "Psychiatric mental health nurses care for people with mental illness" c. "We have specialized skills needed to care for those with mental illness" d. "the nurses who work in mental health facilities have that title"

c. "We have specialized skills needed to care for those with mental illness" A psychiatric mental health nurse has specialized nursing skills and implements the nursing process to manage and deliver nursing care to the mentally ill. The remaining options either do not effectively answer the client's question or assume that the question is the result of the client's paranoia

Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture? a. "where can I find information on the concept of Yin-Yang?" B. "How do I arrange for a chinese translator?" c. "What can I do to provide ethnic foods that are still low in fat?" d.How can I explain why we can't provide for his request for acupuncture?"

c. "What can I do to provide ethnic foods that are still low in fat?" Cultural desire is a genuine interst in the patient's unique perspective; it enables nurses to provide considerate, flexible, and respectful care to patients of all cultures.Attempting to incorporate ethnic foods into the client's prescribed diet demonstrates all these characteristics. None of the other options are focused on providing such care.

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual? a. confidentiality is now reserved to the immediate family b. only HIV status continues to be protected and privileged c. Nothing may be discloed that would have been kept confidential before death d. The nurse must confer with the next of kin before divulging confidential, sensitive information

c. Nothing may be disclosed that would have been kept confidential before death Confidentiality extends to death and beyond. Nurses should never disclose information after the death of a client that they would have kept confidential while the client was alive. None of the other statements are accurate

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? a. Visiting a homeless shelter to provide mental health screenings for its clients b. Discussing the need for proper nutrition with a depressed new mother c. Providing stress reduction seminars at the local senior center d. visiting the home of a client currently displaying manic behavior

c. Providing stress reduction seminars at the local senior center. Secondary prevention is aimed at reducing the prevalence of psychiatric dx. Early identification of problems, screening, and promp and effective treatment are hallmarks of this level. while it does not stop the actual dx from beginning, it is intended to delay or avert progression. None of the other options are focused on early identification of problems.

With which client should the nurse make the assessment that not using touch would probably be in the client's best interests? a. a recent immigrant from russia b. a deeply depressed client c. a chinese american client d. a tearful client reporting pain

c. a chinese american client Chinese americans may not like to be touched by strangers since it is a cultural characteristic

According to Freud, a client experiencing dysfunction of the conscious as part of the mind will have problems with which aspect of memory? a. recent memory b. long term memory c. all memories d. painful memories

c. all memories Freud describes the conscious part of the mind as containing all of the material that the person is aware of at any one time and so as dysfunction of the conscious mind involves all memories.

What tem is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices? a. acculturation b. ethnocentrism c. enculturaiton d. Cultural encounters

c. enculturation 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, wihch sometimes takes several generations. Cultural encounters occur when members of varying cultures meet and interact

A 72-year-old patient is hospitalized diagnosed with pneumonia and experiencing delirium. When the client points to the IV pole and screams, "Get him out of here! He's going to hurt me!", the nurse recognizes the response as a(n) a. hallucination b.delusion c. illusion d.confabulation

c. illusion Illusions are erros in perception of sensory stimuli. The stimulus is a real object in the enviro; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or over their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that gov't agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self esteem

Meditation is successful in promoting stress reduction because it brings about which outcome? a. prevents endorphin release b. changes the clients energy field c. quiets the sympathetic nervous system d. activates the parasympathetic nervous system

c. quiets the sympathetic NS sympathetic ns stimulation prepares the body for flight or fight in response to stress. Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic NS.

Which right of the client has been violated if he is medicated without being asked for his permission? a. right of dignity and respect b. right to treatment c. right to informed consent d. right to refuse treatment

c. right to informed consent Before being given medication, the client should be fully informed about the reason for, the expected outcome of, and any side effects of the med. If, in a nonemergency situation, he is given medication after refusing it, his right to informed consent has been violated

A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as a. mild b. moderate c.severe d. panic

c. severe Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic sx such as He or pounding heart. Mild and moderate levels of anxiety do not demonstrate these feelings while panic is even more intense than the scenario implies

What is the primary difference between a social and a therapeutic relationship? a. type of information exchanged b. amount of satisfaction felt c.type of responsibilty involved d.amount of emotion invested

c. type of responsibility involved In a therapeutic relationship the nurse assumes responsibility for focusing the relationship on the client's needs, facilitating communication, assisting the client with problem solving, and helping the client identify and test alternative coping strategies

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? a. a client and family member attend counseling sessions together at a neighborhood clinic b. implementation of a more flexible work schedule for staff c. Improved reimbursement for services provided in the community d. A client diagnosed with schizophrenia has avoided being rehospitalized for 16 mo

d. A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization. The other options are not goals of ACT

Emily asks you what kind of therapy will help her. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? a. A combination of antianxiety and antidepressant therapy b. aversion therapy c. modeling d. CBT

d. CBT is the most consistently supported tx for the full spectrum of somatic dx. All the other options are incorrect and do not describe the most used and effective therapy for this dx

Which nursing diagnosis for a psychiatric client is correctly structured and worded? a. Hopelessness related to severe chronic depression b. Spiritual distress as evidenced by client stating "God has abandoned me because I'm a bad person" c. Defensive coping related to lack of insight associated w illicit drug use d. Imbalanced nutrition: less than body requirements related to poor self concept as evidenced by reporting "I'm not worthy of eating"

d. This diagnosis contains all the required components: problem statement, related factors, and defining characteristics

A client has reached the stable plateau phase of schizophrenia. What is the appropriate clinical planning focus for this client? a. safety and crisis intervention b. acute symptom stabilization c. stress and vulnerability assessment d. social, vocational, and self care skills

d. during the stable plateau phase, planning is geared toward client and family edu and skills training that will help maintain optimal functioning of schizophrenic individuals in the community. All of the other options should have been handled PREVIOUSLY

Which of the following persons has the highest risk factors for physical abuse? a. a 7 mo old baby who has colic and doesn't sleep through the night b. A 53 yr old man w CVD living w his son c.a 28 yr old wife whose husband has a diagnosis of anxiety dx d. a 77 yr old living w her daughter and son in law

d. older women dependent on family members for care are at higher risk for abuse. The other options do not describe specific characteristics that put them at higher risk for abuse

Schizophrenia is best characterized as presenting which personality trait? a. split b. multiple c. ambivalent d. deteriorating

d. the course of schizo is marked by recurrent acute exacerbations. W each relapse of psychosis, an increase in residual dysfunction and deterioration occurs

A client who has recently received a terminal cancer diagnosis has expressed the desire to, "stay out of the hospital and die at home." Which nursing intervention will best help the client achieve this end-of-life goal? a. involving the client and his or her family in treatment decisions b. encouraging adherance to medical treatment plan c. discussing available pain control measures d.assistance w advance care planning

d. This has helped pts and their families achieve end of life goals, avoid hospitalization, and increase hospice and palliative care use. While the other options are appropriate interventions, none are as focused on assuring the client's end of life goals that are documented supporting their achievement

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be: a. "you are safe here. This is a locked unit, and no one can get in" b. "I do not believe I understand the word volmers. Tell me more about them" c. "Why do you think someone is going to harm you?" d. "It must be frightening to think someone is going to harm you"

d. This response focuses on the clients feelings and neither directly supports the delusion nor denies the clients experience. Option A gives global reassurance. Option b encourages elaboration about the delusion. Option c asks for info that the client will likely be unable to answer

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? a. meditation b. breathing exercises c. journal keeping d. biofeedback

d. biofeedback biofeedback is usually thought to be most effective in people with low to moderate hypnotic ability. For people w hypnotic ability, meditation, progressive muscle relaxation, and other CBT techniques produce the most rapid reduction in clinical symptoms

During a therapeutic encounter, the nurse makes an effort to ensure the use of two congruent levels of communication. What is the rationale for this? a. the mental image of a word may not be the same for both nurse and client b. one statement may simultaneously convey conflicting messages c. many of the clients remarks are no more than social phrases d.content of messages may be contradicted by process

d. content of messages may be contradicted by process Verbal messages may be contradicted by the nonverbal message that is conveyed. The nonverbal message is usually more consistent with the client's feelings than the verbal message. None of the remaining options are so directly associated w assuring congruency

Which medication is FDA approved for treatment of anxiety in children? a. sertraline b. fluoxetine c. clomipramine d. duloxetine

d. duloxetine A few drugs are approved specifically for anxiety and OCD in children and adolescents. The FDA approved the selective SNRI duloxetine (Cymbalta) in 2014 for children aged 7 to 17 years for GAD. The FDA has approved four medications for use in children with OCD. they are clomipramine, fluoxetine, fluvoxamine, and sertraline.

A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing which unconscious emotion? a. congruence b.empathetic feelings c.countertransference d. positive transference

d. positive transference transference involves the client experiencing feelings toward a nurse that belong to a significant person in the client's past. If the client is motivated to work with you, completes assignments between sessions, and shares feelings openly, it is likely the patient is experiencing positive transferernce. The behavior is not associated w any other option

A client reports to the nurse that once he is released he will make sure his wife will never again be able to have him committed to a psychiatric hospital. What action should the nurse take? a. none because no explicit threat has been made b. ask the client if he is threatening his wife c. call the client's wife and report the threat d. report the incident to the client's therapist

d. report the incident to the client's therapist The Tarasoff ruling makes it necessary for nurses to report client statements that imply the client may harm another person or persons. The nurse resports to the treatment team, and the mandated reporter is responsible for notifying the person against whom the treat was made

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? a. preorientation phase b. orientation phase c. working phase d.termination phase

d. termination phase Termination, a stage in which the client must face the loss or ending of the therapeutic relationship, often reawakens the pain of earlier losses. This is not generally associated with other phases

Which statement is true regarding antisocial personality disorder (APD)? a. it is the least studied of the personality dx b. it is characterized by rigidity and inflexible standards of self and others c. persons w 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 w APD usually present for treatment because of awareness of how their behaviors are affecting others g.frontal lobe dysfunction is a brain change identified in APD

d., e., g., APD is the most studied and researched PD. Rigidity and inflexible standards describe OC-PD. Magical thinking describes STPD. People w APD usually present w depression because of the consequences of their behaviors, not because they care about the effects of their actions on others