Mental Health Review

The client diagnosed with mania tells the nurse, "I think you are nice looking. Maybe we could go to my room." Which response by the nurse is the most therapeutic?" A. "Let's walk down to the seclusion room." B. "That's not appropriate, and I feel offended." C. "I don't have that kind of relationship with my clients." D. "Let's focus on recovery; it's time for group therapy."

A. "Let's walk down to the seclusion room." - seclusion is unnecessary B. "That's not appropriate, and I feel offended." - Rather than confronting the client, it is more effective to redirect the client as clients with mania are easily distracted. C. "I don't have that kind of relationship with my clients." - Rather than acknowledge the provocative comment, it is more effective to redirect the client. D. "Let's focus on recovery; it's time for group therapy." This is the most therapeutic response by the nurse and is redirecting to the client. Hypersexual behavior and impulsivity are symptoms of mania. (D)

The nurse is reviewing the discharge plan with the father of the adolescent recently diagnosed with paranoid schizophrenia. Which statement made by the father indicates understanding of the client's diagnosis? A. "My wife and I will need to watch for signs of depression" B. "He won't get worse if he continues to take his medication" C. "He has a good chance that this will be his only hospitalization" D. "We will keep him at home so we can monitor his illness closely"

A. "My wife and I will need to watch for signs of depression" - Stating the need to watch for signs of depression indicates the father understands that the client's diagnosis of paranoid schizophrenia is associated with a high risk of depression. Clients diagnosed with schizophrenia are at high risk for suicide when suffering from depression.

Which of the following client assessments on the use of a benzodiazepine would be a priority concern to the nurse? A. A history of alcohol or substance abuse B. A lack of adequate coping skills C. A history of closed head injury D. A diet high in tyramine-rich foods

A. A history of alcohol or substance abuse - Because benzos have a serious abuse potential, they are generally contraindicated for clients with a history of alcohol or substance abuse. The other choices are not factors with benzos

The nurse is preparing to care for the newly hospitalized client diagnosed with Korsakoff's psychosis from alcohol abuse. Which intervention should the nurse plan to implement? A. Administer thiamine intravenously B. Give Octreotide acetate intravenously C. Apply soft wrist restraints for safety D. Start oxygen at 2L/NC

A. Administer thiamine intravenously - Confusion, loss of recent memory, and the use of confabulation occurs in Korsakoff's psychosis in alcoholics due to a deficiency in thiamine. Thiamine (B1) deficiency occurs from insufficient intake and malabsorption of nutrients from the toxic effects of alcohol. Thiamine administration may reduce confusion and prevent further impairment. B. Give Octreotide acetate intravenously - Octreotide acetate (Sandostatin) is a vasoconstrictor given to lower portal blood pressure and can prevent rebleeding from esophageal varices that can occur as a complication of alcohol abuse. C. Apply soft wrist restraints for safety - Least restrictive measures, such as a 1:1 sitter or family presence, should be used before applying restrains. D. Start oxygen at 2L/NC - Confusion due to Korsakoff's psychosis is treated with thiamine, not oxygen. (A)

The nurse is reviewing diet restrictions with the client taking an MAOI. The nurse should inform the client of which symptom that can occur when the client is nonadherent to diet restrictions? A. Akathisia B. Agranulocytosis C. Severe Hypotension D. Explosive occipital headache

A. Akathisia - unpleasant sensations of "inner" restlessness that results in an inability to sit still - not a symptom associated with MAOIs and food restrictions B. Agranulocytosis - not a symptoms associated with MAOIs and food restrictions C. Severe Hypotension - Hypertension is a symptom associated with MAOIs and food restrictions - not hypotension D. Explosive occipital headache - symptom of hypertensive crisis, which is a major concern with the combination of MAOI and certain foods (aged cheeses, overripe fruit, and sausage) (D)

The client reports becoming physically ill with frequent crying episodes, intense feelings of worthlessness, and loss of appetite on the anniversary of the death of the client's spouse. The client reports that this has occurred for the last five (5) years. What should be the nurse's focus when counseling the client? A. Anticipatory grief B. Uncomplicated grief C. Delayed grief reaction D. Distorted grief reaction

A. Anticipatory grief - grief over a loss before it occurs B. Uncomplicated grief - the client's self-esteem remains intact with symptom resolution C. Delayed grief reaction - the absence of the expression of grief during situations when a grief reaction is expected D. Correct - Distorted grief reaction - The symptoms are exaggerated and prolonged (D)

The nurse identifies that an individual with antisocial personality disorder exhibits poor judgment, emotional distance, aggression, and impulsivity. Which phase of the nursing process is being completed by the nurse? A. Assessment B. Diagnosis C. Outcome identification D. Planning E. Implementation F. Evaluation

A. Assessment -- she is collecting information about the client's behavior

The priority nursing action for the nurse administering an antidepressant drug to a client is which of the following? A. Check the client's mouth for possible hoarding of the drug B. Instruct the client that the therapeutic effects of the drug may take two weeks. C. Administer the drug with food D. Monitor the blood pressure

A. Check the client's mouth for possible hoarding of the drug - Clients who are suicidal may attempt to hoard their drugs by "cheeking" them to be used later for a suicide attempt.

An adolescent hospitalized with conduct disorder has been seen taking items from the nurse's station. The most therapeutic response by the nurse would be to: A. Confront the client with his behavior and maintain limit setting. B. Request stimulant medication to control his behavior. C. Recognize that the client is not responsible for his actions. D. Tell the client he will be punished for stealing.

A. Confront the client with his behavior and maintain limit setting. Management of the client with conduct disorder includes explaining the rules of the unit and maintaining limits on behavior. There is a loss of privileges if the client continues to violate unit rules. Stimulants do not control antisocial behavior.

The nurse caring for a client with mania understands that the client's behavior is a way of avoiding feelings of despair. The expression of behaviors opposite to those being experienced is an example of which defense mechanism? A. Conversion B. Splitting C. Sublimation D. Reaction formation

A. Conversion-The development of physical symptoms in response to inner conflict B. Splitting-The defense mechanism used by those with borderline personality disorder, the inability to hold opposing thoughts, feelings, or beliefs - everything is either black or white - no in-between C. Sublimation-The channeling of unacceptable thoughts and behaviors into socially acceptable behaviors. D. Reaction formation-Reaction formation is the outward expression of feelings that are opposite to those experienced.(D)

The experienced nurse is orienting a new nurse on a mental health unit. Which intervention should the nurse suggest when attempting to establish a therapeutic relationship with the newly admitted client diagnosed with major depressive disorder? A. Sit with the client in silence B. Invite the client to attend an exercise class C. Ask the client to join others to watch a 2-hour movie D. Ask the client how his or her day should be scheduled

A. Correct - Sit with the client in silence - an effective therapeutic intervention for the client diagnosed with major depressive disorder is to sit with the client in silence. - Nonverbal communication conveys respect, understanding, and interest.

The nurse observes that the client with a history of violent command hallucinations mumbles erratically while making threatening gestures directed toward a particular staff member. Which nursing intervention is the most appropriate? A. Ask the client to explain the cause of the anger B. Observe the client for signs of escalating agitation C. Place the client in seclusion to help de-escalate anger D. Inform the client of pending restraint if behavior does not subside

A. Correct Ask the client to explain the cause of the anger - when dealing with the client who is hallucinating, the most appropriate intervention is for the nurse to empathize with the client's experience while engaging in therapeutic communication to discuss the root of the client's concerns. Asking the client to explain the cause of the anger is client-0centered and focuses on the behavior

Which of the following should the nurse include in the plan of care for a client taking an antidepressant drug? A. Encourage the client to drink low-calorie beverages. B. Instruct the client to take the drug on an empty stomach. C. Inform the client that urinary frequency is an adverse reaction. D. Monitor the client for bradycardia prior to administration

A. Encourage the client to drink low-calorie beverages. - - Antidepressants have adverse reactions including weight gain, gi upset, urinary retention, and tachycardia. Clients should avoid high-caloric drinks to avoid weight gain.

The parent expresses concern that her son, newly admitted to the mental health unit, may be using methamphetamine. Which nursing assessment findings are consistent with methamphetamine abuse? A. Hypotension and bradycardia B. Constricted pupils and fatigue C. Anorexia and recent weight loss D. Bruises and scrapes on the extremities

A. Hypotension and bradycardia - Usually increased BP and HR B. Constricted pupils and fatigue - Dilated - not constricted pupils (Constricted indicates opiate abuse) - fatigue with any drug abuse C. Anorexia and recent weight loss - Weight loss is associated with methamphetamine and other stimulant abuse due to their ability to cause a rise in metabolic rate and varying degrees of anorexia. D. Bruises and scrapes on the extremities (C)

The nurse observes that the client diagnosed with OCPD is exhibiting reaction formation. The nurse should plan to assess for which other defense mechanisms commonly associated with this disorder? A. Isolation and Undoing B. Projection and Undoing C. Introjection and Rationalization D. Intellectualization and Introjection

A. Isolation and Undoing - Isolation is a defense mechanism to separate a thought or memory from the feelings or emotions associated with it. Undoing is a defense mechanism to symbolically negate or cancel out a previous action of experience that is found to be intolerable. B. Projection and Undoing - Projection is attributing to another persons feelings or impulses unacceptable to oneself. Undoing is commonly associated with this disorder. C. Introjection and Rationalization - Introjection is internalization of the beliefs and vales of another person, and these symbolically become a part of the self to the extent that the feeling of separateness or distinctness is lost. Rationalization is appropriate to this disorder. D. Intellectualization and Introjection - Intellectualization is appropriate to this disorder as it is an attempt to avoid expressing actual emotions associated with a stressful situation by suing the intellectual processes of logic, reasoning, and analysis. Introjection is not associated with this disorder. (A)

Which of the following is a priority to include in the plan of care for a client taking fluoxetine (Prozac)? A. Monitor the client for hypertension B. Avoid giving on an empty stomach C. Wait 14 days after discontinuing a monoamine oxidase inhibitor before starting Prozac D. Administer simultaneously with thioridazine (Mellaril)

A. Monitor the client for hypertension - Prozac is a SSRI. The client should be monitored for otho hypo (not hypertension) and instructed to change positions cautiously. B. Avoid giving on an empty stomach - Prozac may be administered with food to decrease gi upset. C. Wait 14 days after discontinuing a monoamine oxidase inhibitor before starting Prozac - It is priority to wait 14 days after discontinuing a MAOI before starting Prozac D. Administer simultaneously with thioridazine (Mellaril) - Prozac may not be given with Mellaril - Mellaril - This medication is used to treat certain mental/mood disorders (e.g., schizophrenia) (C)

The nurse is observing the movements of a client receiving Thorazine. The client continually paces and rocks back and forth when sitting. The nurse recognizes that the client is experiencing: A. Oculogyric crisis B. Akathisia C. Dystonia D. Bradykinesia

A. Oculogyric crisis is the name of a dystonic reaction to certain drugs or medical conditions characterized by a prolonged involuntary upward deviation of the eyes. B. Akathisia - movement disorder characterized by a feeling of inner restlessness and inability to stay still. C. Dystonia (tone) a movement disorder in which a person's muscles contract uncontrollably D. Bradykinesia - slowness of movement and is one of the cardinal manifestations of Parkinson's disease. Weakness, tremor and rigidity may contribute to but do not fully explain bradykinesia. (B)

The nurse is assessing the client who reports that setting and watching fires helps relieve anxiety The client states, "After I watch something burn, I feel so much better." Which mental health disorder should the nurse associate with the client's behavior? A. Pyromania B. Kleptomania C. Conduct disorder D. Antisocial personality disorder

A. Pyromania - impulse-control disorder in which a person sets fires to relieve tension B. Kleptomania - impulse control disorder characterized by stealing to relieve tension or to satisfy an uncontrollable urge. C. Conduct disorder - not mainly explained through fire-setting behavior; however, some clients having this disorder have a history of setting fires D. Antisocial personality disorder - not mainly explained through fire-setting behavior; however, some clients having this disorder have a history of setting fires (A)

Which of the following foods would the nurse suggest as an item from the lunch menu for a client taking a MAOI? A. Smoked fish B. Bologna sandwich C. Cottage cheese D. Salad with bleu cheese dressing

A. Smoked fish, B. Bologna sandwich, D. Salad with bleu cheese dressing are reflective of food that is high in tyramine. Aged cheeses are not allowed on the diet. A client taking MAOIs have to avoid foods that are high in tyramine because it can lead to significant complications resulting in hypertensive crisis. C. Cottage cheese -- cottage cheese is unfermented therefore allowed

A client who has been taking haloperidol (Haldol) for 15 years tells the nurse of some involuntary muscle movement of the mouth, arms, and legs. The nurse documents this as: A. Tardive dyskinesia B. Hypertonia C. Hypotonia D. Anhedonia

A. Tardive dyskinesia - a long-term adverse reaction to typical antipsychotics. Characterized by involuntary muscle movements, particularly of the mouth and extremities. B. Hyper tonia - - too much muscle tone so that arms or legs, for example, are stiff and difficult to move C. Hypo tonia - floppy baby syndrome, is a state of low muscle tone (the amount of tension or resistance to stretch in a muscle), often involving reduced muscle strength. D. Anhedonia - Anhedonia is the inability to feel pleasure. It's a common symptom of depression as well as other mental health disorders (A)

The nurse is caring for four clients in the ED. Which client has the greatest potential for demonstrating violent behavior toward the staff? A. The young adult in severe pain after a motorcycle accident B. The inebriated client who has frostbite after falling asleep in the park C. The teenager being treated for injuries received in a gang-related fight D. The client who has schizophrenia and requires stitches to a forearm cut

A. The young adult in severe pain after a motorcycle accident - while pain is a stressor, it alone is not an indication that the client will become violent B. Correct - The inebriated client who has frostbite after falling asleep in the park - Alcohol or drug intoxication is a predictor of violent behavior due to the individual's altered cognitive function. C. The teenager being treated for injuries received in a gang-related fight - gang affiliation, while suggestive of a violent environment, is not by itself an indicator of violent behavior in the ED setting D. The client who has schizophrenia and requires stitches to a forearm cut - schizophrenia can result in paranoid delusions that can precipitate aggression, a diagnosis of schizophrenia alone is not a factor in violent behavior (B)

A client recently been admitted for depression and suicidal ideations with a plan to hang himself. The nurse assesses the client most carefully for risk for attempting suicide at which time? A. When the client is silent and unlikely to tell anyone B. When the client is ready to go home and afraid of leaving the hospital C. When the client's family goes on vacation D. When the client begins to demonstrate clinical improvement

A. When the client is silent and unlikely to tell anyone - A silent client who is not willing to share with others is at risk but may be place on constant observation. B. When the client is ready to go home and afraid of leaving the hospital - Being afraid to go home ma be a positive sign that the client is aware of the danger he or she may pose to him or herself. C. When the client's family goes on vacation - Vacation is a stressful time, and being left alone would place the client at risk D. Correct - When the client begins to demonstrate clinical improvement - Suicidal clients are at most risk when they begin to demonstrate improvement and have the energy to carry out suicide. (D)

The nurse is assessing a client suspected of having a dissociative disorder. Which of the following describes a dissociative disorder? Dissociative disorders: A. are produced by extreme anxiety B. appear only in schizophrenia C. are fixed and chronic D. are voluntary

A. are produced by extreme anxiety - Dissociative disorders are produced by extreme anxiety, when circumstances become overwhelming and the traditional coping mechanism cannot contain the anxiety.

The client is instructed to take mirtazapine (Remeron) for depression. Which of the following would best indicate that the client is complying with the prescribed regimen? A. places the tablet on the tongue and waits 30 seconds for it to dissolve. B. waits two hours after administration before driving or operating dangerous equipment. C. avoids caffeine and irritating foods in the diet. D. reports adverse reactions of bloody diarrhea.

A. places the tablet on the tongue and waits 30 seconds for it to dissolve. - Remeron is a tetracyclic antidepressant used in the treatment of depression. The tablets come as oral disintegrating tabs and should be admin initially in the evening, before sleep, until the drug effects are known. 30 seconds until dissolved on the tongue.

The nurse is conducting an admission history on the client being hospitalized with symptoms characteristic of schizophrenia. Which interview question demonstrates that the nurse can identify the most prevalent comorbid substance abuse issue for the client with schizophrenia? A. "When did you last smoke or use marijuana?" B. "Did you bring any street drugs to the hospital?" C. "How much alcohol do you drink in a 24-hour period?" D. "Did you give the nursing assistant all your cigarettes and lighters?"

A., B., C., - Marijuana, street drug use nor alcohol abuse is not the most commonly used in this population D. "Did you give the nursing assistant all your cigarettes and lighters?" - This interview question demonstrates that the nurse is aware that nicotine use is prevalent in this population. Nicotine dependence in persons with schizophrenia ranges from 70-90%.

A client addicted to morphine is being treated for withdrawal symptoms. The drug commonly administered for opiate withdrawal is: A. Tranxene B. Methadone C. Narcan D. Antabuse

B- Methadone tranxene is for alcohol withdrawal Narcan is opiate and narcotic overdose Antabuse is for treatment of alcoholism

The recently discharged veteran who served in active combat reports symptoms of recurring intrusive thoughts, insomnia, and hypervigilance. Which question would be most helpful in establishing a diagnosis? A. "Do you find yourself falling asleep while working?" B. "Are you also having nightmares when you do sleep?" C. "Your hair seems thin. Are you also pulling at your hair?" D. "Have you ever been diagnosed with obsessive-compulsive disorder?"

B. "Are you also having nightmares when you do sleep?" - all the reported symptoms are consistent with PTSD and are often present with veterans who have been exposed to combat trauma. Asking about nightmares will help establish a diagnosis.

The nurse is assessing the client diagnosed with pseudocyesis. Which statement from the client is consistent with pseudocyesis? A. "These bruises are from falling when I black out and faint." B. "Everyone tells me that I just 'glow' now that I am pregnant." C. "I can't even smell the lilacs even though their scent is strong." D. "The doctor says I'm not having a seizure with these staring spells."

B. "Everyone tells me that I just 'glow' now that I am pregnant." - pseudocyesis is a conversion symptom due to a strong desire to be pregnant, even though pregnancy has not occurred.

The nurse is caring for a client who is seeing UFOs and asks if the nurse is also afraid of the UFOs. Which of the following would be an appropriate response from the nurse? A. "I don't know what you are talking bout; I don't see any UFOs." B. "I can tell that what you're seeing frightens you; how can I help to make you more comfortable?" C. "I see the UFOs too, and they scare me; what are we going to do?" D. "I don't see the UFOs; are you ready to come to group?"

B. "I can tell that what you're seeing frightens you; how can I help to make you more comfortable?" - This choice validates the client's feelings without agreeing with or challenging the client's irrational beliefs.

Which of the following would be the most appropriate statement for the nurse to make to a client found pacing in the hall? A. "The ballgame is on in the dayroom. Perhaps you'd like to watch it." B. "I noticed you've been pacing. Can you tell me how you are feeling?" C. "I think you'd be much more comfortable in your room." D. "I can tell something is wrong. What is it?"

B. "I noticed you've been pacing. Can you tell me how you are feeling?" - What the nurse needs to do is assess what is happening with the client.

The client is reporting vague dread; she is pacing and hyperventilating. Her jaw is clenched, and she is wringing her hands. What type of medication should the nurse anticipate in the physicians orders? A. A barbiturate B. An anxiolytic C. An antipsychotic D. A CNS stimulant

B. Correct - An anxiolytic - a drug used to reduce anxiety

The nurse is caring for a client with a major depressive disorder. Which nursing problem should be priority? A. Powerlessness B. Attempted suicide C. Anticipatory grieving D. Disturbed sleep pattern

B. Attempted suicide - correct - the potential for suicidal behavior is priority for the client with a major depressive disorder who previously attempted suicide.

The nurse is preparing to discharge a client who is receiving Nardil. The nurse should tell the client to: A. Wear protective clothing and sunglasses outside. B. Avoid medications containing pseudoephedrine. C. Drink six to eight glasses of water a day. D. Avoid foods that are high in purine.

B. Avoid medications containing pseudoephedrine - it can result in a hypertensive crisis.

The nurse is working with a client with OCPD. Which approach should the nurse use? A. Inflexible and autocratic B. Calm and nonconfrontational C. Direct, hurried, and organized D. Uninterrupted and confrontational

B. Calm and nonconfrontational - yes - persons with OCPD (Obsessive-Compulsive personality disorder) tend to maintain control by carefully and thoroughly following procedures. It is important to use a calm and nonconfrontational approach, as any request is likely to increase the client's anxiety level.

Which of the following is at the greatest risk for suicide? A. A 65-year-old African-American male B. A 70-year-old European-American male C. A 30-year-old Hispanic-American female D. A 16-year-old African-American female

B. Correct - A 70-year-old European-American male - The group at highest risk for successfully completing suicide attempts are European-American males over the age of 50 (white, male, older adult)

The mental health assistant is assigned to work with the client who has delusions. Which action by the assistant requires the most immediate attention by the nurse? A. Reassuring the client by saying, "I'll eat the food if you do." B. Attempting to convince the client that the "food here isn't poisoned" C. Asking the nurse what to do because the client says, "I'm being poisoned" D. Asking another assistant to change assignments to avoid working with this client

B. Correct - Attempting to convince the client that the "food here isn't poisoned" - attempting to convince a delusional client and prove the client wrong is likely to increase the client's anxiety and result in acting out behavior that can be a risk to both the client and the milieu. The assistant needs to be instructed immediately that such attempts to logically address the client's delusions are nontherapeutic and pose a concern for safety.

The client admitted to a behavioral medicine unit with a diagnosis of catatonic schizophrenia is constantly rearranging furniture and appears to be responding to internal stimuli. In addition to being free of physical injury during phases of hyperactivity, which short-term goal is appropriate for this client? A. The client will sleep at least 6 hours per night B. The client will consume adequate food and fluid per day C. The client will engage in at least one client-to-client interaction per day D. The client will show decreased activity within 24 hours of onset of hyperactivity

B. Correct - The client will consume adequate food and fluid per day - The excited phase of catatonic schizophrenia is marked by periods of extreme activity and potential violent behavior. The primary nursing focus for the client during this phase is to prevent both physical exhaustion and injury by providing adequate food and fluids and by maintaining a safe, low-stimulus environment

After a staff member has been involved in a particularly violent episode with a client, when should the nurse plan for debriefing to occur? A. After the staff has had an opportunity to become calm B. Immediately to facilitate processing of feelings C. Not until the staff requests such an intervention D. After a 3-day time-off period

B. Immediately to facilitate processing of feelings - Debriefing allows the staff an opportunity to ventilate feelings and to calm down. It should always occur, and should be done as soon as possible after the client and all others are safe. All staff should be encouraged to participate.

The nurse is assessing the client, attempting to differentiate the client's symptoms between delirium and depression. Which symptoms of the client are unique to depression? A. Labile affect and lack of motivation B. Sadness and lack of motivation C. Presence of hallucinations and disturbance in sleep patterns D. Disturbance in sleep patterns and labile affect

B. Sadness and lack of motivation are associated with depression and not delirium

The nurse is caring for a preschool-aged child admitted with a diagnosis of suspected child abuse. During painful procedures, the child remains quiet and watchful. When planning the care of a victim of child abuse, the nurse should give priority to: A. Arranging playtime with same-age children. B. Scheduling the same caregiver each day. C. Asking how the injury occurred. D. Praising the child for grown-up behavior.

B. Scheduling the same caregiver each day - assigning a consistent caregiver will best meet the child's need for safety and security.

The client taking Zoloft tells the nurse that she has also been taking St. John's wort. The nurse should report this information to the doctor because: A. The two substances have opposing effects. B. The amount of medication my be reduced. C. Herbals only provide a placebo effect. D. It will be necessary to increase the dosage

B. The amount of medication my be reduced. St. John's wort has an antidepressant effect so it might be necessary to reduce the current medication dosage.

The nurse is caring for a client with schizoid personality disorder. In determining what the plan of care should consist of, which of the following should the nurse consider? A. The client quickly becomes attached to the group leader B. The client displays behavior lacking social tact or grace in a group C. The client becomes overly emotional in the group setting D. The client attempts to build intimate relationships with other group members.

B. The client displays behavior lacking social tact or grace in a group - . Individuals with schizoid personality disorder have difficulty showing and sharing their emotions. They lack the desire to be part of a group or have intimacy in their relationships. This leads to inappropriate behaviors and a lack of social tact and grace in a group or social setting.

The nurse is caring for the client diagnosed with psychogenic fugue. Which information in the client's medical record should indicate to the nurse that the diagnosis is correct? A. The client demonstrates having more than one distinct personality. B. The client recently forgot all personal information following an accident. C. The client claims to have superhero qualities following a recent suicide attempt. D. The client resides in a homeless shelter after being physically abused by his/her spouse.

B. The client recently forgot all personal information following an accident. - yes, also the nurse should identify that the diagnosis of psychogenic fugue is based upon the client's symptoms of assuming a new identity.

The nurse is planning care for the client diagnosed with acute mania. What situation must occur prior to initiating treatment with lithium carbonate? A. The client must have been fasting for the past 12 hours B. The client's kidney function should be within normal parameters C. The client's behavior has not been controlled with room seclusion D. Benzodiazepine use has been discontinued in the client's treatment

B. The client's kidney function should be within normal parameters - yes The most common lithium-induced kidney problem is impaired ability to concentrate urine, which may affect up to 60% of patients in the beginning of treatment, with the problem persisting in about 20% to 25%.

The nurse informs another nurse that stress is an essential component of somatoform disorders because stress: A. is the only feature of this disorder B. exacerbates the illness C. is a positive force in overcoming the illness D. is not a precursor to the development of this disorder

B. exacerbates the illness

The nursing assistant comments to the nurse about the recently admitted client with bipolar disorder. "I think the new admit is faking being ill. Yesterday the client didn't say a word, and today it's nonstop talking!" Which response by the nurse is the most helpful? A. "Thanks for letting me know. I think the client may be looking for attention." B. "It is more appropriate to refer to the client by name and not as the new admit." C. "The client has rapid-cycle bipolar disorder; it includes quickly changing moods." D. "Some people are quiet; the client has the right to decide when and when not to talk."

C. "The client has rapid-cycle bipolar disorder; it includes quickly changing moods." - about 1:6 clients w bipolar d/o experience this rapid-cycling pattern of quickly changing moods.

The nurse assesses the client who reports feeling full of energy in spite of having been awake for the past 48 hours. Which diagnosis is the nurse likely to find documented in the client's medical record? A. Korsakoff's psychosis B. Bipolar disorder/ mixed type C. Bipolar disorder/ manic type D. Obsessive-compulsive disorder

C. Bipolar disorder/ manic type - increased psychomotor activity with diminished need for sleep are associated with bipolar disorder of the manic type

The nurse is assessing the client with dysthymia who reports symptoms of depressed mood. Which assessment finding should the nurse most associate with the essential feature of dysthymia? A. For the past 2 weeks has had feelings of sadness and emptiness B. Decreased ability to think or concentrate daily for the past 2 weeks C. Chronically depressed mood for most of the day for at least 2 years D. In the past week attempted suicide and had recurrent thoughts of death.

C. Chronically depressed mood for most of the day for at least 2 years - Individuals diagnosed with dysthymia (Chronic depressive disorder) describe their mood as sad or "down in the dumps: more days than not for at least 2 years. The depressive symptoms are chronic but less severe and may not be easily distinguished from the person's usual functioning.

The nurse assesses which of the following for a client with conversion disorder? A. Intentionally produced clinical manifestations B. Minimal distress or impairment C. Clinical manifestations are not limited to pain or sexual dysfunction D. Absence of causative psychologic factors.

C. Clinical manifestations are not limited to pain or sexual dysfunction

During an initial home visit with the client, the nurse discovers cluttered possessions taking up 75% of the living space and obstructing access into the home and all rooms except the bathroom. What should be the nurse's interpretation of the client's behavior? A. Inability to focus related to possible passive-aggressive personality disorder. B. An attention-seeking behavior related to possible histrionic personality disorder. C. Hoarding behavior related to possible obsessive-compulsive personality disorder. D. Inattentiveness to surroundings related to possible borderline personality disorder.

C. Correct - Hoarding behavior related to possible obsessive-compulsive personality disorder. - hoarding behavior is associated with OCD and OCPD. It is due to fear and anxiety concerning loss of control over situations, objects, or people

A client is taking chlorpromazine (Thorazine). Based on metabolism of this prescribed medication, the nurse supports the concomitant use of which herb? A. Valerian root B. Ginger C. Milk thistle D. Hawthorn

C. Correct - Milk thistle - Thorazine a phenothiazine, is metabolized in the liver. Milk thistle, the liver herb, is known to reduce the risk of hepatotoxicity caused by phenothiazines.

The nurse is working with the client with histrionic personality disorder. Which behaviors should the nurse expect? A. Shows apathy in conversations until trust is established B. Lacks close friends or companions other than first-degree relatives C. Discomfort in situations in which the client is not the center of attention D. Harbors recurrent suspicions about the fidelity of his or her partner

C. Discomfort in situations in which the client is not the center of attention - diagnostic criteria for histrionic personality disorder include discomfort in situations in which the client is not the center of attention. The client requires constant affirmation of approval and acceptance from others.

The registered nurse is delegating the clinical assignments on a psychiatric unit. Which of the following assignments should the nurse delegate to the licensed practical nurse? A. Notify the physician of a child being admitted who has a mother suspected of Munchausen's syndrome by proxy B. Assess a client for the diagnostic criteria of a somatization disorders C. Empathize with a client who has a somatoform disorder by understanding the client's pain D. Establish the nursing diagnoses for a client with a somatization disorder

C. Empathize with a client who has a somatoform disorder by understanding the client's pain - Empathizing can be done by any nurse working with a client with somatization disorder.

The client with no psychiatric history is admitted to an ED after physically assaulting his wife. The client is frightened by his loss of control, which he states was precipitated by his wife's complaining and lack of support. The client tells the nurse he is self-employed, recently expanded his company nationally, and has many well-known friends. The client's wife states, "The business is losing money, yet he continues his lavish lifestyle; what's important to him is who he knows and how it looks!" The nurse determines that the client's behavior is typical of which disorder? A. Schizoid personality disorder B. Borderline personality disorder C. Narcissistic personality disorder D. Dependent personality disorder

C. Narcissistic personality disorder - YES - characterized by constant seeking or praise and attention, an egocentric attitude, envy, rage, and violence when others are not supportive.

Which of the following should be the priority consideration for the nurse caring for a client performing overt rituals? A. The ritual should be interrupted every time it is observed. B. The client should be asked what the rationale is for performing the ritual C. Performing the ritual serves to decrease the client's anxiety D. A less disruptive ritual should be substituted

C. Performing the ritual serves to decrease the client's anxiety - yes

A client who has been regularly taking lorazepam (Ativan) for the past three months reports a recent onset of tremors, irritability, and insomnia. The client states, "I quit taking my Ativan because a friend had said it was just a crutch." The nurse documents this client's clinical manifestations as an indication of: A. A cry for more help B. An anxiety attack since she is off her Ativan C. Signs of withdrawal from Benzodiazepines D. Just her nerves getting the best of her

C. Signs of withdrawal from Benzodiazepines - Tremors, irritability and insomnia are all signs of withdrawal from Benzos

When a client has panic-level anxiety, plans for nursing intervention should include: A. Darkening the room and offering warm blankets. B. Having the client describe how he or she usually copes with anxiety. C. Staying with the client. D. Alerting security to the situation.

C. Staying with the client. - Staying with the client reduces the anxiety and helps assure safety.

Which of the following behaviors is a client suspected of obsessive-compulsive personality disorder validates the diagnosis and should be reported? A. Fantasies about unlimited success B. Looks for hidden meanings from others C. Task completion hampered by perfectionism D. Task completion hampered by lack of confidence

C. Task completion hampered by perfectionism - A Client with OCD likes to hoard money and finds it hard to discard worn-out possessions. Such a client is preoccupied with details, aspires to perfection, is excessively devoted to work, is over conscientious, is rigid, and is reluctant to delegate tasks.

The nurse reads in the medical record that the client with borderline personality disorder (BPD) has "splitting." What is the nurse's interpretation of "splitting?" A. The client is having an intense psychotic episode and has become catatonic. B. The client has an identity disturbance with an unstable self-image or sense of self. C. The client is using a defense mechanism in which all objects are seen as good or bad. D. The client's behavior shows a pattern of unstable and intense interpersonal relationships.

C. The client is using a defense mechanism in which all objects are seen as good or bad. - "Splitting" is a primitive defense mechanism in which all objects, individuals, or situations are seen as good or bad. Individuals with BPD have an inability to accept and integrate positive and negative feelings.

The morning staff of an inpatient psychiatric unit has just completed the change of shift report. The nurse should give priority to assessing the client: A. With schizophrenia having auditory hallucinations B. Scheduled for electroconvulsive therapy C. With a lithium level of 1.8 meq/L D. Receiving chlorpromazine with a WBC of 7,500

C. With a lithium level of 1.8 meq/L - This is a toxic lithium level. Normal Lithium level is 0.6 - 1.2

The nurse is preparing to lead a group therapy session with clients recovering from alcohol and other substances. Which seating arrangement would be most effective to facilitate group participation and discussion?

Clients and the nurse seated in chairs arranged in a circle is most effective for promoting communication. The room is arranged so that there are no barriers between members

The nurse is administering medication to various clients on the mental health unit. The nurse should most definitely complete a variance report if which medication is found unsecured? A. Risperidone B. Clonazepam C. Venlafaxine D. Lithium

Clonazepam--> controlled substance -- symbol on package

The nurse evaluates which of the following lab results as within the normal range for a client who is receiving lithium carbonate (Eskalith)? A. 2.0 mEq/L B. 0.5 mEq/L C. 1.8 mEq/L D. 1.2 mEq/L

D. 1.2 mEq/L Lithium is an antimanic drug used in the treatment of manic phase in bipolar disorders and in the prevention of bipolar manic-depressive psychosis. Blood level is most accurate if the blood is drawn 12 hours after the last dose. The client should avoid eating prior to having a lithium level drawn to avoid a food-lithium interaction and an inaccurate result. 0.6-1.2 mEq/L is within normal range

The nurse is assessing the client with paranoid personality disorder. Which behavior should the nurse expect? A. Able to trust only those who are fair and threat the client well. B. Sees the goodwill of another when that behavior does not exist. C. Acts the opposite of what the client may be thinking or feeling D. Analyzes the behavior of others to find hidden and threatening meanings.

D. Analyzes the behavior of others to find hidden and threatening meanings. - yes, usually exhibits mistrust and suspicion of others such that the behavior of others is analyzed to find hidden and threatening meanings.

The client with an anxiety disorder tells the nurse that being in crowds creates thoughts of losing control and the need to hurriedly leave. What should the nurse recommend as an effective, nonpharmacological therapy for managing the client's symptoms of anxiety? A. Family systems therapy B. Psychoanalytical therapy C. Electroconvulsive therapy (ECT) D. Cognitive behavioral therapy (CBT)

D. Cognitive behavioral therapy (CBT) - is a treatment that focuses on patterns of thinking that are maladaptive and would be an effective choice for the described symptoms.

If an overdose of benzodiazepines is suspected, the nurse should anticipate what medication order to reverse that drug's effects? A. Diazepam (Valium) B. Triazolam (Halcion) C. Fluvoxamine (Luvox) D. Flumazenil (Ramazicon)

D. Correct - Flumazenil (Ramazicon) - benzodiazepine antagonist

The nurse in the ED is assessing the client who was injured in a car accident. The nurse considers that the client may have psychogenic amnesia when the client is unable to recall any personal information. Which statement that reflect the nurse's critical thinking about psychogenic amnesia is correct? A. Psychogenic amnesia is a long-lasting condition B. Psychogenic amnesia is seen more often in men than women C. Psychogenic amnesia is categorized with memory loss and dementia D. Psychogenic amnesia symptoms include wandering and disorientation

D. Correct - Psychogenic amnesia symptoms include wandering and disorientation - it is a neurocognitive disorder caused by an impact to the head or other mechanism that displaces the brain. Symptoms can include wandering, confusion, and disorientation.

The nurse observes the client, who has a history of aggressive behavior toward others, swearing and kicking the furniture in the dayroom. Based on the client's behavior, what should be the nurse's priority? A. De-escalate the client's agitation B. Eliminate the source of agitation C. Assess the client's agitation level D. Provide for a safe, therapeutic milieu

D. Correct -Provide for a safe, therapeutic milieu - the safety of the client, staff, and others is a nursing priority when the client begins to show aggression (Maslow's Hierarchy of Needs theory to prioritize the options)

The nurse is caring for the client who is two (2) days post-admission to a medical unit and has a long history of heavy alcohol abuse. The nurse should monitor for all of the following acute complications related to alcohol abuse except: A. Seizures B. Pancreatitis C. GI Bleeding D. Exophthalmos E. Delirium tremens

D. Exophthalmos - is a bulging of the eye anteriorly out of the orbit. Exophthalmos can be either bilateral (as is often seen in Graves' disease) or unilateral (as is often seen in an orbital tumor).

The client diagnosed with schizophrenia is refusing to take a prescribed psychotropic medication. The nurse attempts to persuade the client to comply with the HCP's orders. Under which circumstance could the client be forced to take this medication? A. If the client claims to be God and here to save the world B. If the client threatens to leave the hospital immediately C. If the client talks about a suicide attempt that occurred last week D. If the client claims to be a vampire and threatens to kill the nurse

D. If the client claims to be a vampire and threatens to kill the nurse - The client can be forced to take medication if dangerous behavior is exhibited to self or others. The client must also be judged incompetent, and the medication must have a reasonable chance of helping the client.

The nurse receives an order to administer phenelzine 15 mg tid to the client diagnosed with borderline personality disorder. Based on the findings of the client's medication record, which should be the nurse's reasoning for questioning the medication order? A. The combination of phenelzine and fluoxetine will drastically lower the blood pressure B. Tension headaches may result when carbamazepine and alprazolam are combined C. MAOIs are not used to treat borderline personality disorder due to the risk of suicide D. Phenelzine and fluoxetine should not be taken together due to excessive serotonin release

D. Phenelzine and fluoxetine should not be taken together due to excessive serotonin release - Fluoxetine (Prozac) is an SSRI and Phenelzine (Nardil) is an MAOI. SSRIs and MAOIs should not be taken together because excessive release of serotonin (Serotonin syndrome) may result with associated mental, cardiovascular, GI and neuromuscular alterations

Which nursing diagnosis is least likely to apply to the client admitted with a diagnosis of borderline personality disorder? A. Risk for self-injury B. Identity disturbance C. Self-esteem disturbance D. Sensory-perceptual alteration

D. Sensory-perceptual alteration

A client with paranoid personality disorder monopolizes group activities with complaints that the staff is out to get him. The nurse should: A. Point out that his suspicions are unfounded B. Ask the client to return to his room for a while. C. Tell the client that his is upsetting others. D. Talk with the client in a nonchallenging manner.

D. Talk with the client in a nonchallenging manner.-one of the most therapeutic actions the nurse can take with the paranoid client is to spend time with him but not challenge his delusions.

The nurse understands which of the following to be a manifestation of dissociative identity disorder? A. The personalities are all aware of one another B. The disorder is never chronic C. The recall of traumatic events is intact D. The client was confronted with an intolerable terror event.

D. The client was confronted with an intolerable terror event. - The initial event of a dissociative disorder was an event the client confronted and found so intolerable that the client's memory split off into another personality.