Mental Test #3

A potentially pregnant 16 year old client says that she has been "hooking up" with a boy she considers to be her boyfriend. Which of the following responses should the nurse make first?

"Describe what you mean by hooking?"

A client diagnosed with OCD arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which of the following statements made by the nurse best deals with the clients feelings of "going crazy?"

-What do you mean when you say you think you're going crazy?

The nurse understand that with the right help at the right time, a client can successfully resolve a crisis and function better than before the crisis, based primarily on which of the following factors?

Acquisition of new coping skills

A client is diagnosed with agoraphobia without panic disorder. Which type of therapy is most effective for this illness?

Behavior therapy

A client loses control and throws two chairs toward another client. What should the nurse do next?

Call for assistance for restrain the client and administer an intramuscular tranquilizer

A client demonstrates moderate anxiety regarding a pending medical procedure. The nurse should do which of the following to minimize the client's anxiety about the procedure?

Providing a brief explanation and then doing the procedure quickly.

The nurse incorporates the underlying premise of crisis intervention, about providing "the right kind of help at the right time," to achieve which of the following goals initially?"

Regaining emotional security and equilibrium.

A client reports becoming involved with legislation that promotes gun safety after the death of a child by accidental shooting. Which defense mechanism is the client exhibiting?

Sublimation

Which nursing diagnosis should a nurse give highest priority when caring for a client with major depressive disorder?

potential for injury

Which of the following client statements indicates the need for additional teaching about benzodiazepines?

• "I can't stop taking the drug anytime I want."

A mother asks a nurse why the anticonvulsant valproic acid (Depakene) is being prescribed for her son who is beginning therapy for control of his aggressive behaviors. The nurse's response is based on the fact that anticonvulsants are helpful in reducing manic and impulsive behavior by

• Increasing the levels of gamma-aminobutyric acid (GABA), thereby inhibiting neurotransmission in the CNS

While teaching a group of volunteers for a crisis hotline, a volunteer asks, "What if I'm not sure why someone is calling?" Which of the following statements by the nurse is most helpful?"

"Ask the caller to tell you why he or she is calling you today."

A 40 year old client who is quite anxious says that she would "rather die than be pregnant." Which of the following responses by the nurse is most helpful"?

"I see you're upset. Take some deep breaths to relax a little."

A distraught father is waiting for his son to come out of surgery. He accidentally backed the car into his son, causing multiple fractures and a serious head injury. Which of the following statements by the father should alert the nurse to the need for a psychiatric consultation?

"If he dies, there will be nothing for me to but join him."

During the interview at a crisis center, a newly widowed client reveals the wish, to join my husband in Heaven." After the nurse asks the client to sign a no harm contract, which of the following statements is appropriate to say next?

"Tell me what feelings you have been experiencing."

A client is being discharged after hospitalization for a suicide attempt. Which question asked by the nurse assesses the learned prevention and future coping strategies of the client?

"What skills can you utilize if you experience problems again?"

A client has been taking increased amounts of Xanax for about 6 months for anxiety. She asks the nurse how she can "get off the Xanax." The most accurate answer by the nurse is which of the following?

-"Instead of Xanax, you will take lorazepam (Ativan) in decreasing doses and frequency over a period of 3 to 4 days.

A newly admitted 20-year old client, diagnosed with PTSD, reluctantly reveals that she escaped from a satanic cult 2 years ago. The mother has been in the cult since the client was 3 years old and refused to leave with the client. The client says, "Nobody will ever believe the horrible things the men did to me, and my mother never stopped them." Which of the following responses is appropriate for the nurse to make?

-"It must be difficult to talk about what happened. I'm willing to listen."

A client with acute stress disorder states to the nurse, "I am having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her to the store." Which of the following responses by the nurse is most therapeutic?

-"The accident just happened and could not have been predicted"

The client, a veteran of the Vietnam War who has PTSD, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which of the following responses by the nurse is appropriate?

-"You did what you had to do at that time."

A client with PTSD needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. The nurse interprets this action as which of the following?

-A necessary break in the treatment

A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which of the following is the most therapeutic response?

-Are you feeling anxious?

A client is being admitted to the addictions unit for a confirmed and long-term addiction to Xanax (alprazolam). She continues to strongly deny her addiction, stating she was prescribed the Xanax to control her "panic attacks." Which of the following procedures would be the most important during the admission process? Select all that apply.

-Assess the client for suicide, escape, and aggression risks. -With the client present, search the client's clothes and belongings for contraband and restricted items. -Initiate withdrawn precautions -Obtain a urine specimen for a urine drug screen

A client is scheduled for discharge and will be taking Luminal for an extended period. The nurse would place the highest priority on teaching the client which point that directly relates to client safety.

-Avoid drinking alcohol while taking this medication

A client diagnosed with OCD has been talking Zoloft but would like to have more energy every day. At his monthly checkup, he reports that his massage therapist recommended he take St. John's wort to help his depression. The nurse should tell the client:

-Combining St. John's wort with the Zoloft can cause a serious reaction called serotonin syndrome

A client with a long history of experiencing dissociative identity disorder is admitted to the unit after the cuts on her legs were sutured in the ER. During the admission interview, the client tearfully states that the she does not know what happened to her legs. Then a stronger, alter personality states the client is useless, weak, and needs to be eliminated completely. The nurse should do which of the following first?

-Contact with the alter personality to tell the nurse when he has the urge to harm the client and the body they both share

The nurse notices that a client diagnosed with major depression and social phobia must get up and move to another area when someone sits next to her. Which of the following actions by the nurse is appropriate?

-Convey awareness of the client's anxiety about being around others

When developing the plan of care for a client with acute stress disorder who lost her sister in a boating accident, which of the following should the nurse initiate?

-Facilitating progressive review of the accident and its consequences

A client gives the home health nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication?

-Frequent hand washing with hot soapy water

A client with panic disorder is taking alprazolam (Xanax) 1 mg PO 3x daily, The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which of the following neurotransmitters?

-Gamma-aminobutyrate

The nurse is administering risperidone (Risperdal) to a client who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to the client?

-Get up slowly when changing positions

When planning discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal?

-Identifying anxiety-producing situations

The nursing is describing the medication side and adverse effects to a client who is taking oxazepam (serax). What information should the nurse incorporate in the discussion?

-Increase fluids and bulk in the diet

The UAP tells the nurse that the client with a somatoform disorder is sick and is not coming to the dining room for lunch. The nurse should direct the UAP to do which of the following?

-Invite the client to lunch and accompany him to the dining room

The client diagnosed with a fear of eating in public places or in front of other people has finished eating lunch in the dining room area in the nurse's presence. Which of the following statements by the nurse should reinforce the client's positive action?

-It is progress for you to eat in the dining room with me

A 16-year old boy who is academically gifted is about to graduate from HS early since he has completed all courses needed to earn a diploma. Within the last 3 months he has begun to experience panic attacks that have forced him to leave classes early and occasionally miss a ay of school. He is concerned these attacks may hinder his ability to pursue a college degree. What would be the best response by the school nurse who has been helping him deal with his panic attacks.

-It sounds like you have a real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment.

A client brought to the emergency department is perspiring profusely, breathing rapidly, and having dizziness and palpations. Problems of a cardiovascular nature are ruled out, and the clients diagnosis is tentatively listed as a panic attack. After the symptoms pass, the client states, "I thought I was going to die." Which of the following responses by the nurse is best.

-It was very frightening for you

A new client on the psychiatric unit has been diagnosed with depression and OCPD. During visiting hours, her husband states to the nurses that he doesn't understand this OCPD and what can be done about it. What information should the nurse share with the client and her husband? Select all that apply.

-Perfectionism and overemphasis on tasks usually interfere with friendships and leisure time -There are medicines, such as clomipramine (Anafranil) or fluoxetine (Prozac) that may help -Remind your wife that it is "OK" to be human and make mistakes -This disorder typically involves inflexibility and a need to be in control

A client who has been taking buspirone (Buspar) for 1 month returns to the clinic for a follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred?

-Rapid heartbeat or anxiety

A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she's going crazy. Which of the following actions should the nurse use first?

-Reassure the client that her feelings are typical reactions to serious trauma

Which of the following points should the nurse include when teaching a client about panic disorder.

-Symptoms of a panic attack are time limited and will abate

A client is returning to the primary care physician's office for follow-up on his diagnosis of CAD. After all the appropriate exams and assessments are completed, the nurse asks the client about how well he is sleeping. The client states, "Oh that's not a problem anymore. I take a couple of my wife's Valiums (diazepam) and sleep like a baby. Which of the following information should the nurse obtain? Select all that apply.

-The dose of the Valium he is taking and how long he has been taking it -Exactly how many Valiums he takes at night and during the day -What was interfering with his sleep prior to starting the Valium

A 17-year old female client who has been treated for an anxiety disorder since middle school with behavioral treatment and as-needed (PRN) anxiety medication is preparing to go to college. The parents are concerned that she will experience an exacerbation of symptoms if she attends college out of town and want the daughter to attend the local community college and live at home. The girl believes she can handle the challenge of leaving home for college. How should the nurse in the outpatient clinic respond to the family's concerns?

-There are many pros and cons here that we all need to discuss together

Which of the following statements by a client who has been taking buspirone (Buspar) as prescribed for 2 days indicates the need for further teaching?

-This medication will help my tight, aching muscles

After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient client for follow-up. Which of the following is most important for the client to use for continued alleviation of anxiety?

-Using adaptive and palliative methods to reduce anxiety

A client admitted with OCD who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. Because of his behavior, the client missed having breakfast yesterday with the other clients. Which of the following actions should the nurse institute to help the client be on time for breakfast?

-Wake the client up an hour earlier to perform his ritual

A client with acute stress disorder has avoided feelings of anger toward her rapist and cannot verbally express them. The nurse suggests which of the following activities to assist the client with expressing her feelings?

-Writing in a journal

A client is being discharged after three days of hospitalization for a suicide attempt that followed the receipt of a divorce notice. Which of the following, if verbalized by the client, indicates to the nurse that the client is ready for discharge?

A list of support persons and community resources.

While a client is taking Xanax which of the following should the nurse instruct the client to avoid.

Alcohol

While a client is taking alprazolam (Xanax, which of the following should the nurse instruct the client to avoid?

Alcohol

A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which of the following responses by the nurse is most therapeutic?

Are you feeling anxious?

A young man makes an appointment to see the psychiatric nurse at the Employee Assistance Program of a large corporation because his female boss is sending him provocative e-mails and making seductive remarks on his voicemail at home. The nurse informs him about corporate workplace violence guidelines, and he agrees to work with corporate security on the issue. What should the nurse do next?

Ask the client about his reactions to this situation

A client with a long history of experiencing dissociative identity disorder is admitted to the unit after the cuts on her legs were sutured in the Emergency Department. During the admission interview, the client tearfully states that she does not know what happened to her legs. Then a stronger, alter personality states that the client is useless, weak, and needs to be eliminated completely. The nurse should do which of the following first?

Assist the client to engage in the work associated with the normal grieving process

A client's medication sheet contains a prescription for sertraline (Zoloft). To ensure safe administration of the medication, how should the nurse administer dose?

At same time each evening

A client is scheduled for discharge and will be taking phenobarbital sodium (Luminal) for an extended period. The nurse would place highest priority on teaching the client which point that directly relates to client safety?

Avoid drinking alcohol while taking this medication

A client diagnosed with OCD has been taking sertraline (Zoloft) but would like to have more energy every day. At his monthly check up, he reports that his massage therapist recommended he take St. John's wort to help his depression. The nurse should tell the client:

Combining St. John's wort with the Zoloft can cause a serious reaction called serotonin syndrome."

A client with a history of self-mutilation and substance abuse begins talking about memories of torture and ritual abuse that ended 15 years ago. To her knowledge, no others were or are being abused by her parents. To assist the client to recover from such torture and abuse, the nurse should suggest which of the following options? Select all that apply

Dealing with ambivalent feelings toward her parents · Determining alternatives to self-destructive behaviors · Developing safe ways to deal with her rage and guilt

A major role in crisis intervention is getting a client's significant others involved in helping with the immediate crisis as soon as possible. The nurse should determine that the support persons are prepared to help when they verbalize which of the following?

Emergency resources and when to used them.

The nurse is performing a follow-up teaching session with a client discharged 1 month ago. The client is taking fluoxetine (Prozac). What information would be important for the nurse to obtain during this client visit regarding the side/adverse effects of the medication?

GI dysfunction

The nurse cares for a middle aged client with a below the knee amputation. Which statement indicates the need for further assessment of the client's body image?

I hope i can handle having a prosthesis, but i'm really wondering what my wife will think.

The nurse is teaching a client who is being started on imipramine (Tofranil) about the medication. The nurse should inform the client to expect maximum desired effects at what time period following initiation of the medication?

In 2-3 weeks

The nurse is describing the medication side and adverse effects to a client who is taking oxazepam (Serax). What information should the nurse incorporate in the discussion?

Increase fluids and bulk in diet

· A woman who was raped in her home was brought to the emergency department by her husband. After being interviewed by the police, the husband talks to the nurse. "I don't know why she didn't keep the doors locked like I told her. I can't believe she has had sex with another man now." The nurse should respond by saying:

Let's talk about how you feel. Maybe it would help to talk to other men who have been through this

The nurse is assessing a client who has just experienced a crisis. The nurse should first assess this client for which of the following behaviors?

Level of anxiety

A 75 year old client is newly diagnosed with diabetes. The nurse is instructing him about blood glucose testing. After the session, the client states, i can't be expected to remember all this stuff. The nurse should recognize their response as most likely related to which of the following?

Moderate to severe anxiety.

A nurse should anticipate that a client diagnosed with antisocial personality disorder may use the primary ego defense mechanism of:

Projection

A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurses that she feels like she's going crazy. Which of the following actions should the nurse use FIRST?

Reassure the client that her feelings are typical reactions to serious trauma.

The client is fidgeting and has trouble sitting still. He has difficulty concentrating and is tangential. Which of the following interventions should help decrease this client's level of anxiety? Select all that apply.

Refocusing attention -Allowing visitation -Assisting with problem solving

A client with OCD reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I cant stop until I do it right." The nurse interprets the client's behavior as most likely representing an effort to obtain which of the following?

Relief from anxiety

A client is unwilling to go out of the house for fear of "making a fool of myself in public." Because of this fear, the client remains homebound. Based on these data, which mental health disorder is the client experiencing?

Social Phobia

A client is unwilling to go out of the house for fear of "making a fool of myself in public." Because of this fear, the client remains homebound. Based on these data, which mental health disorder is the client experiencing?

Social phobia

Which of the following points should the nurse include when teaching a client about panic disorder?

Symptoms of a panic attack are time limited and will abate.

An adult client diagnosed with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do?

Teach the woman to use cognitive behavioral approaches to manage her anxiety.

Which of the following statements by a client who has been taking buspirone (BuSpar) as prescribed for 2 days indicates the need for further teaching?

This medication will help me tight, aching muscles.

A client is taking diazepam (Valium) for generalized anxiety disorder. WHich instruction should the nurse give to this client? Select all that apply.

To consult with his health care provider before he stopped taking the drug Not to sue alcohol while taking the drug. To Stop taking the drug if he experiences swelling of the lips and face and difficulty breathing

A client taking lithium carbonate reports vomiting, abdominal pain, diarrhea, blurred vision, tinnitus, and tremors. The lithium level is 2.5 mEq/L. This level is indicative of which finding?

Toxic

A client is diagnosed with GAD and given a prescription for venlafaxine (Effexor). Which of the following information should the nurse include in a teaching plan for this client? Select all that apply.

Various strategies for reducing anxiety. The benefits and mechanisms of action of effexor in treating GAD. The management of the common side effects of EFfexor. Substituting adaptive coping strategies for maladaptive ones.

Based on a client's history of violence toward others and her inability to cope with anger, which of the following should the nurse use as the most important indicator of goal achievement before discharge?

Verbalization of her feelings in an appropriate manner

A client with schizophrenia has been started on medication therapy with clozapine. The nurse should assess the results of which lab study to monitor adverse effects from this medication?

WBC count

Nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client?

Writing

A nurse is caring for a client who was violently raped 3 months ago and has a diagnosis of rape-trauma syndrome. Which assessment findings associated with rape-trauma syndrome should a nurse anticipate? SELECT ALL THAT APPLY.

o Phobias o Anorexia o Flashbacks o Migraine headaches

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on intervention for managing hallucinations and anxiety. Which statement in response to these instructions suggests to nurse that client understands instructions?

· "when I begin to hallucinate, I'll call my therapist and talk about what I should do."

Nurse is caring for a client who is experiencing disturbed thought processes as a result of paranoia. In formulating nursing interventions with the members of the health care team, what best instruction should the nurse provide to staff?

· Avoid laughing or whispering in front of client

A client receiving tricyclic antidepressants arrives at the mental health clinic. Which observation would indicate that the client is following the medication plan correctly?

· Client arrives at the clinic neat and appropriate in appearance

Which nursing interventions are appropriate for hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply.

· Communicate expected behaviors to client · Assist client in identifying ways offsetting limits on personal behaviors · Follow through about consequences of behaviors in nonpunitive manner · Have client state consequences for behaving in ways that are viewed unacceptable

A client is admitted to medical nursing unit with diagnosis of acute blindness after being involved in hit-and-run accident. When diagnostic testing cannot identify any organic reason why the client cannot see, a mental health consult is prescribed. Which condition will be the focus of this consult?

· Conversion disorder

A hospitalized client is started on phenelzine (Nardil) for the treatment of depression. The nurse should instruct the client that which foods are acceptable to consume while taking this medication? Select all that apply

· Crackers · Tossed salad

A client says to the nurse, "The federal guards were sent to kill me." What is the best nursing response to the client's concern?

· Do you feel afraid that people are trying to hurt you?

A manic client begins to make sexual advance towards visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to nurse. Based on the analysis of this situation, which intervention should the nurse implement?

· Escort the client to their room, with assistance of other staff

A client gives the home health nurse a bottle of clomipramine (Anafranil). The nurse notes that the medication has not been taken by the client in 2 months. Which behavior observed in the client would validate noncompliance with this medication?

· Frequent hand-washing with hot soapy water

The nurse is administering risperidone (Risperdal) to client who is scheduled to be discharged. Before discharge, which instruction should the nurse provide to client?

· Get up slowly when changing positions

When planning the discharge of a client with chronic anxiety, the nurse directs the goals at promoting a safe environment at home. Which is the most appropriate maintenance goal?

· Identifying anxiety producing situations

· A Native American client is being assessed for emotional distress following a family crisis. In anticipating pharmacological treatment, the nurse understands that a Native American client most likely would:

· Prefer to use herbal remedies and other plant therapies with healing properties.

Nurse observes that client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, what is nurse's immediate priority?

· Provide safety for the client and other clients on unit

A client who has been taking buspirone (Buspar) for 1 month returns to clinic for follow-up assessment. The nurse determines that the medication is effective if the absence of which manifestation has occurred?

· Rapid heartbeat or anxiety

A hospitalized client has begun taking bupropion (Wellbutrin) as an antidepressant agent. The nurse understands that which is an adverse effect, indicating that the client is taking an excessive amount of medication?

· Seizure activity

The nurse is conducting group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement?

· Setting limits on the client's behavior

Nurse is caring for a client diagnosed with catatonic stupor who is lying on the bed in a fetal position. What is most appropriate nursing intervention?

· Sit beside the client to silence with occasional open-ended questions

A client is admitted to mental health unit with diagnosis of depression. Nurse should develop a plan of care for client that includes which of the following?

· Structured program of activities in which the client can participate

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches TV. The nurse determines that client is experiencing which medication complication?

· Tardive dyskinesia

A client diagnosed with delirium becomes disoriented and confused at night. Which intervention should the nurse implement initially?

· Use an indirect light source and turn off the television

A client reports becoming physically ill with frequent crying spells, intense feelings of worthlessness, and loss of appetite on the anniversary of the death of the client's spouse. The client reports this has occurs for the last 5 years. Based on the reported symptoms, what should a nurse conclude that the client is experiencing?

· distorted grief reaction

A client tells a nurse about an intense fear of dogs that causes the client to avoid visiting others unless it is confirmed that there are no dogs on the premises. The client further explains that these fears seem unreasonable, but the fear continues in spite of this acknowledgement. Based on the client's report, which conclusion by the nurse is accurate?

• A fear that is recognized as excessive and unreasonable is a DSM-IV criterion for phobias

A nurse is providing instructions to a client. Which substances should a client who is taking alprazolam (Xanax) be cautioned to avoid? SELECT ALL

• Alcohol • Antihistamines • Narcotics • Antidepressants

A client who is receiving amitriptyline (Elavil) 150 mg daily is scheduled for surgery. Which statement reflects accurate understanding of safety concerns in this situation?

• Amitriptyline can cause hypertensive episodes during surgery

A nurse is developing a teaching plan for a client prescribed nortriptyline (Pamelor). Which self-care aspects should be included to minimize medication side effects and prevent injury? SELECT ALL

• Avoid driving until vision is completely clear to prevent injury • Suck on candy or ice chips to keep your mouth moist • Try running water in the bathroom to stimulate urination • Increase fluid and fiber in the diet to prevent constipation

A nurse assesses a client who reports feeling full of energy in spite of being awake for the past 48 hours. Which diagnosis is the nurse likely to find documented in the client's medical record?

• Bipolar disorder/maniac type

A hospitalized client is exhibiting occasional anxiety. A nurse notifies a health-care provider to request that a prn anxiolytic medication be prescribed. Which medication, if prescribed, should the nurse question regarding its effectiveness for prn use?

• Buspirone (Buspar)

Which approach should a nurse use when working with an individual diagnosed with obsessive-compulsive disorder?

• Calm and nonconfrontational

A client diagnosed with an anxiety disorder tells a nurse that being in crowds creates thoughts of losing control and the need to hurriedly leave. What should the nurse recommend as an effective, non-pharmacological therapy for managing the client's symptoms of anxiety?

• Cognitive behavioral therapy (CBT)

An adult client diagnosed with obsessive-compulsive personality disorder is being admitted into a psychiatric department after rubbing lesions into both hands and face from excessive washing. The client is refusing to accept any treatment for the wounds or the mental health diagnosis. What actions should be taken by the nurse? SELECT ALL

• Do not treat the client; the client is competent • Notify the physician of the refusal; the client is competent

A nurse is reviewing diet restrictions with a client taking a MAOI. Which symptom could occur with nonadherence to diet restrictions while take a MAOI?

• Explosive occipital headache

A physician writes in a client's progress notes, "Will switch to medications from the older medications to a newer GABA-ergic anticonvulsant to treat client's instability of mood, transient mood crashes, and inappropriate and intense outburst of anger." Which medication should a nurse consider when reviewing the physician's new orders?

• Gabapentin (Neurontin)

A public health nurse visits a client's home and discovers a multitude of cluttered possessions taking up 75% of the living space, obscuring entrance into the home and access to all rooms except the bathroom. The chairs and table are covered with various objects. The nurse interprets the client's behavior as:

• Hoarding related to an OCD or obsessive-compulsive personality disorder

A nurse is teaching an education class to clients with mild to moderate anxiety. Which teaching strategies should the nurse practice when educating the clients? SELECT ALL

• Maintain a calm, nonthreatening manner • Create an atmosphere of low stimuli • Encourage the client to verbalize thoughts and feelings that could contribute to symptoms of anxiety • Limit the length of class time and the amount of provided information

A nurse is caring for a client who was violently raped 3 months ago and has a diagnosis of rape-trauma syndrome. Which assessment findings associated with rape-trauma syndrome should a nurse anticipate? SELECT ALL

• Phobias • Anorexia • Flashbacks • Migraine headaches

A recently discharge veteran reports symptoms of recurring intrusive thoughts, insomnia, and hypervigilance. Which mental health diagnosis would a nurse suspect for this client?

• Posttraumatic stress disorder

A nurse is assessing a client who reports that setting and watching fires helps to relieve anxiety. The client reports relieving tension by setting fires stating, "After I watch something burn, I feel so much better." The nurse is aware that setting fires can be dangerous and believes that the client is suffering from a mental health disorder. Which mental health diagnosis should the nurse expect?

• Pyromania

A nurse is admitting a client diagnosed with generalized anxiety disorder. During the client's assessment, the nurse determines that which findings would be consistent with general anxiety disorder? SELECT ALL

• Restlessness or feeling keyed up or on edge • Difficulty controlling the anxiety • Irritability • Muscle tension

A client, who switched to paroxetine (Paxil) several days ago after taking imipramine (Tofranil) for several years, presents with tachycardia, hypertension, fever, sweating, and confusion. A nurse notifies the health care provider, suspecting the client is experiencing:

• Serotonin syndrome

The parent of an adolescent client who is taking chlordiazepoxide (Librium) for the past 2 months calls a nurse requesting to have the dose increased because of the child's anxiety. The parent states the medication is being administered as directed. Which should be the nurse's best interpretation of the situation?

• The client may be developing a tolerance to chlordiazepoxide and needs the medication dose reevaluated.

After teaching a group of students who are volunteering for a local crisis hotline, the nurse judges that further education about crisis and intervention is needed when a student states which of the following?

"Most people in crisis will be calling the line once every day for at least a year."

A client is experiencing withdrawal symptoms leading to sleep deprivation. A nurse should recognize that the client is at greatest risk for violent behavior due to:

Anxiety over lack of access to the substance of choice.

A client with panic disorder is taking alprazolam (Xanax) 1 mg PO three times daily. The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which of the following neurotransmitters?

Gamma-aminobutyrate.

The client diagnosed with agoraphobia refuses to walk down the hall to the group room. Which of the following responses by the nurse is appropriate?

I'll walk with you

A client with PTSD needs to find a new housing and wants to wait for a month before setting another appointment to see the nurse. The nurse interprets this action as which of the following?

• A necessary break in treatment.

A client is to be started on citalopram (Celexa) for treatment of depression, which information should be most important for a nurse to include when planning teaching for the client?

• If sexual side effects become unbearable, consult your health care provider

The nurse is planning care for a client being admitted to the nursing unit who attempted suicide. Which priority nursing intervention should the nurse include in the plan of care?

• One to one suicide precautions

A 16-year-old client who is being seen by the crisis nurse after making several superficial cuts on her wrist states that all her friends are siding with her ex-boyfriend and won't talk to her anymore. She says she knows that the relationship is over, but "if I can't have him, no one else will." Which of the following client problems takes the highest priority?

A-Risk for other-directed violence

A client who comes to the crisis center in a very distressed state tells the nurse, "I just can't get over being fired last week. I've asked for help; I've talked to friends. I've tried everything to get through this, but nothing is working. Help me!" Which of the following should the nurse use as the initial crisis intervention strategy?

Emotion management

A client is diagnosed with generalized anxiety disorder (GAD) and given a prescription for venlafaxine (effexor). Which of the following information should the nurse include in a teaching plan for this client? Select all that apply

• Various strategies for reducing anxiety • The benefits and mechanisms of action of effexor in treating GAD • The management of the common side effects of effexor • Substituting adaptive coping strategies for maladaptive ones

The nurse working at the site of a severe flood sees a woman, standing in knee-deep water, sharing at an empty lot. The woman states. "I keep thinking that this is a nightmare and that I'll wake up and see that my house is still there." Which of the following crisis intervention strategies are most needed at this time? Select all that apply.

Ask the client about any physical injuries she may have · Determine if any of her family are injured or missing. · Allow the client to talk about her fears, anger, and other feelings. · Assess her for risk of suicide and other signs of decompensation.

A true crisis state, involving a period of severe disorganization, is difficult to endure emotionally and physically. The nurse recognizes that a client will only be able to tolerate being in crisis for which of the following lengths of time?

Four to six weeks

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is ver. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan?

Increasing the level of suicide precautions

A client has been diagnosed with PTSD because he experienced childhood sexual abuse by his babysitter and her boyfriend from ages 4 to 10. He is admitted for the second time after physically assaulting a woman he said was a prostitute. "She is no better than my babysitter and deserves to be dead. I'd like to kill the sitter too." With the knowledge of PTSD and CSA, which of the following nursing interventions should be implemented at admission? Select all that apply.

Institute precautions for suicide, assault and escape. Ask him to sign a no harm contract Provide safe outlets for his anger and rage In one to one staff talks, encourage him to safely verbalize his hanger toward his babysitter and her boyfriend.

A 16 year old boy who is academically gifted is about to graduate from high school early since he has completed all courses needed to earn a diploma. Within the last 3 months he has begun to experience panic attacks that have forced him to leave classes early and occasionally miss a day of school. He is concerned that these attacks may hinder his ability to pursue a college degree. What would be the BEST response by the school nurse who has been helping him deal with his panic attacks?

It sounds like you have real concern about transitioning to college. I can refer you to a health care provider for assessment and treatment.

A client brought to the emergency department is perspiring profusely, breathing rapidly, and having dizziness and palpitation. Problems of a cardiovascular nature are ruled out, and the client's diagnosis is tentatively listed as a panic attack. After the symptoms pass, the client states, "I thought I was going to die." Which of the following response by the nurse is BEST?

It was very frightening for you.

A client diagnosed with OCD arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which of the following statements by the nurse best deals with the client's feelings of "going crazy?"

What do you mean when you say you think you're going crazy?"

At discharge, a nurse documents that a client taking lithium has an accurate understanding of self care. On which client statement should the nurse base this judgement?

· "I need to eat enough foods containing sodium and drink at least 2 to 3 liters of fluid daily"

A 75 year old woman was brought to crisis center by her husband. The husband reports that his wife has been in shock and anxious since her purse was stolen outside of their home. The woman blames herself for being robbed, is worried about her stole wallet and credit cards, and is afraid to go home. The nurse should do which of the following? Select all that apply.

· Encourage her to talk about the robbery and her feelings · Discuss what changes at home would help her feel safe · Investigate if she has physical injuries from her robbery

A client is diagnosed with agoraphobia without panic disorder. Which type of therapy is most effective for this illness.

• Behavior Therapy

Which aspect is most appropriate for a nurse to include in a teaching plan for a client taking amitriptyline (Elavil)?

• Establish a calorie controlled diet plan suitable to the client's preferences

Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal?

• The adolescent gives away a DVD and a cherished autographed picture of a performer

The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and is making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client.

• You seem restless; tell me what is happening

A depressed client on an inpatient unit says to the nurse, "my family would be better off without me." What is the nurse's best response?

• You sound very upset. Are you thinking of hurting yourself

A 13 year old girl, whose family is living in a cult, ran away from the group's compound to her aunt's house. The aunt brought the girl to the emergency department after finding multiple knife cuts in various stages of healing on the girl's body. She is admitted to the unit because of many trauma related symptoms. The nurse should take which of the following actions? Select all that apply.

Teach her emotion management skills to help her deal with her "normal reactions to an abnormal situation." · Assess her for other possible injuries, pregnancy, and sexually transmitted diseases. · Teach her ways to control self-destructive behaviors such as suicide attempts, self -mutilation, and rage outbursts. · Obtain a sample for a urine drug screen and routine urinalysis. · Help her process her emotions and memories as she is willing to share these.

A 17 year old female client who has been treated for an anxiety disorder since middle school with behavioral treatments and PRN anxiety medication is preparing to go to college. The parents are concerned that she will experience an exacerbation of symptoms if she attends college out of town and want the daugher to attend the local community college and live at home. The girl believes she can handle the challenges of leaving home for college. How should the nurse in the outpatient clinic respond to the family's concerns?

There are many pros and cons here that we all need to discuss together.

A client with acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Which of the following responses by the nurse is most therapeutic?

• "The accident just happened and could not have been predicted."

A nurse is providing instructions to a client. Which substances should a client who is taking alprazolam (Xanax) be cautioned to avoid? SELECT ALL THAT APPLY

• Alcohol • Antihistamines • Narcotics • antidepressants

A nurse of the crisis access center of a psychiatric facility in a major city notices a sudden increase in the number of incoming calls one afternoon. After quickly surveying the call sheets, the nurse find that most callers are very anxious after military aircrafts flew very low over the city. Which of the following strategies would be MOST appropriate in this situation? SELECT ALL THAT APPLY.

• Instruct the crisis workers to additionally screen callers about where they were on 9/11/01 and their memories of that event. • Give the crisis workers a list of symptoms of PTSD and techniques for dealing with these symptoms. • Ask for an emergency meeting with the managers of the inpatient and outpatient services to formulate a contingency plan for increased services if needed. • Ask the major media outlet s in the city to make scripted public service announcement about the possible recurrence of symptoms experienced after the event of 9/11. -Prepare for a scripted interview with the local medial about PTSD symptoms and techniques for dealing with these symptoms.

The nurse is developing a long-term care plan for an outpatient client diagnosed with dissociative identity disorder. Which of the following should be included in this plan? Select all that apply.

• Learning how to manage feelings, especially anger and rage. • Identifying resources to call when there is a risk of suicide or self-mutilation. • Selecting a method for alter personalities to communicate with each other, such as journaling. • Helping each alter accept the goal of sharing and integrating all their memories.

· A client, being discharged from treatment for alcoholism, is receiving teaching on taking daily doses of disulfiram (Antabuse). Which client statement indicated to a nurse that the client correctly understands the safe use of disulfiram?

· o "I should avoid products such as vanilla extract or certain cough preparations containing alcohol while taking disulfiram."

· A client who completed inpatient treatment for addiction to heroin is prescribed to take daily doses of methadone during outpatient treatment. The nurse concludes that the primary rationale for the client's outpatient treatment with methadone is to:

· o Reduce heroin craving by binding to the brain receptor sites usually occupied by heroin.

he client diagnosed with a fear of eating in public places or in front of other people has finished eating lunch in the dining area in the nurse's presence. Which of the following statements by the nurse should reinforce the client's positive action?

• "It is progress for you to eat in the dining room with me."

A newly admitted 20 year old client, diagnosed with PTSD, reluctantly reveals that she escaped from a satanic cult 2 years ago. The mother has been in the cult since the client was three years old and reused to leave with the client. The client says, "Nobody will ever believe the horrible things the men did to me, and my mother never stopped them." Which of the following responses is appropriate for the nurse to make?

• "It must be difficult to talk about what happened. I'm willing to listen."

Since taking the antidepressant doxepin (Sinequan) a female client has been reporting a decrease in sexual desire. She says she "just isn't that interested" because she "just doesn't enjoy sex anymore." She and her partner agree that they miss the excitement they used to share. Which is the most helpful response by a nurse?

• "This may be due to your medication. How would you feel about talking to your doctor about changing to a different type of antidepressant?"

The nurse is developing a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor?

• A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

A nurse developing a teaching plan for a client prescribed nortriptyline (Pamelor). Which self care aspects should be included to minimize medication side effects and prevent injury?

• Avoid driving until vision is completely clear to prevent injury • Suck on candy or ice chips to keep your mouth moist • Try running water in the bathroom to stimulate urination • Increase fluid and fiber in the diet to prevent constipation

The nurse notices that a client diagnosed with major depression and social phobia must got up and move to another area when someone sits next to her. Which of the following actions by the nurse is appropriate?

• Convey awareness of the client's anxiety about being around others.

A comanager of a convenience store was taking the daily receipts to the bank when she was robbed at gunpoint. She did not report the robbery and could not be found for two days. In a city 100 miles away, a hotel manager called the police because the woman gave a false name and address. After learning that the robbery was confirmed by the bank cameras, she was admitted to the hospital with a diagnosis of dissociative fugue. The nurse should include which of the following in the client's care plan? Select all that apply.

• Develop trust and rapport to provide safety and support. • Rule out possible physical and neurological causes for the fugue. • Seclude the client from the other clients because of her lack of memory. • Encourage the client to talk about her feelings about what has been happening.

The police arrive at the emergency department with a client who has lacerated both wrists. What is the initial nursing action?

• Examine and treat the wound site

A client is being treated with clozapine (clozaril). Which findings during a nurse's assessment indicate that the client's experiencing adverse effects of clozapine? SELECT ALL THAT APPLY

• Extreme salivation • Agranulocytosis • Blood glucose 192 mg/dL • Seizure activity

The emergency department nurse is caring for an adult client who is a victim of family violence. Which priority instruction should be included in the discharge instructions?

• Information regarding shelters

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse determines that this type of crisis could be caused by which event?

• The death of a loved one

A client taking sertraline (Zoloft) for treatment of depression for the past 11 months reports feeling much better and wishes to discontinue the medication. Which is the most appropriate response by a nurse?

• The medication will have to be reduced gradually to prevent undesirable symptoms"

A client brought to the ED is perspiring profusely, breathing rapidly and having dizziness and palpitations. Problems of a cardiac nature are ruled out and the client's diagnosis is tentatively listed as a panic attack. After the symptoms pass, the client states"i thought i was going to die." Which of the following responses by the nurse is best?

• It was very frightening for you

A client is diagnosed with borderline personality disorder (BPD) is taking olanzapine (Zyprexa). A nurse notes that the medication is effective when observing a reduction SELECT ALL THAT APPLY

• Levels of anxiety • Thoughts of paranoia • Expression of hostility

A client with OCD, who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. BEcause of his behavior, the client missed having breakfast yesterday with the other clients. Which of the following actions should the nurse institute to help the client be on time for breakfast?

• Wake the client an hour earlier to perform his ritual.

The nurse is conducting an initial assessment on a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, what is the most appropriate question?

• What leads you to seek help now

A client with acute stress disorder has avoided feelings of anger toward her rapist and cannot verbally express them. The nurse suggests which of the following activities to assist the client with expressing her feelings?

• Writing in a journal

A nurse is assessing a client for adverse effects of trazodone (Desyrel). Which assessment finding should the nurse determine is an adverse effect unique to the use of trazodone?

Priapism

A client is admitted to the psychiatric hospital for evaluation after numerous incidents of threatening others, angry outbursts, and two episodes of hitting a coworker at the grocery store where he works. The client is very anxious and tells the nurse who admits him, "I didn't mean to hit him. He made me so mad that I just couldn't help it. I hope I don't hit anyone here." To ensure a safe environment, the nurse should first:

Tell him that hitting others is unacceptable behavior and ask him to tell a staff member when he begins feeling angry

A grandson who calls the crisis center expression concern about his grandmother, who lost her husband a month ago, states, "She has been in bed for a week and is not eating or showering. She told me that she did not want to kill herself, but it's not like her to do nothing for herself. She won't even talk to me when I visit her." The nurse encourages the grandson to bring his grandmother to the center for evaluation based on which of the following reasons?

The behaviors may reflect passive suicidal thoughts

On a crisis shelter hotline, the nurse talks to two 11 year old boys who think a friend sniffs glue. They say his breath sometimes smells like glue and he acts drunk. They say they are afraid to tell their parents about the friend. When formulating a reply, the nurse should consider which of the following?

The boys probably fear punishment.

A 35 year old has been killed as a result of a terrorist attack. What should the nurse advise the friends and relatives of the victim to do during the early stages of recovery process? Select all that apply.

· Keep in contact with other family and friends · · Attend memorial or religious services · Use relaxation techniques and physical activities · · Attend community meetings with others who have lost loved ones

An anxious young adult is brought to the interviewing room of a crisis shelter, sobbing, and saying that she thinks she is pregnant but does not know what to do. Which of the following nursing interventions is most appropriate at this time?

· Recommend a pregnancy test after acknowledging the client's distress.

The nurse should warn a client who is taking a benzodiazepine about using which of the following medications in combination with his current medication?

• Antacids.

A client taking tranylcypromine (Parnate) develops a list of possible meal plans. Which meal plans should a nurse determine compromise safe food and beverage selections? SELECT ALL THAT APPLY

• Baked chicken, mashed potatoes, and gravy, 8 oz 2% milk • Grilled salmon, steamed broccoli, 12 oz lemon lime soda • Grilled pork loin, rice, green beans, 12 oz diet clear soda

A hospitalized client is exhibiting occasional anxiety. A nurse notifies a health care provider to request that a prn anxiolytic medication be prescribed. Which medication, if prescribed, should the nurse question regarding its effectiveness for prn use?

• Buspirone (Buspar)

When developing the plan of care for a client with acute stress disorder who lost her sister in a boating accident, which of the following should the nurse initiated?

• Facilitating progressive review of the accident and its consequences.

A client is admitted with a recent history of severe anxiety following a home invasion and robbery. During the initial assessment interview, which statement by the client would indicate to the nurse the possible diagnosis of posttraumatic stress disorder?

• I keep reliving the robbery • I see his face everywhere i go • I might have died over a few dollars in my pocket

The parent of an adolescent client who is taking chlordiazepoxide (Librium) for the past 2 months calls a nurse requesting to have the dose increased because of the child's increasing anxiety. The parent states the medication is being administered as directed. Which should be the nurse's best interpretation of this situation?

• The client may be developing tolerance to chlordiazepoxide and needs the medication dose reevaluated

After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient clinic for follow-up. Which of the following is most important for the client to use for continued alleviation of anxiety?

• Using adaptive and palliative methods to reduce anxiety.

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action?

• Assigning a staff member to the client who will remain with the client at all times

After a recreational game of basketball with peers, a client taking lithium from bipolar disorder complains of feeling nauseous and shaky, having blurred vision, and finding it hard to stand. Considering this information, which action should be taken by a nurse?

• Call the health care provider (HCP) ro request that a stat lithium level be prescribed

A new nurse describes the action of tricyclic antidepressants as relieving symptoms of depression by inhibiting neuronal uptake of the neurotransmitters serotonin and norepinephrine. Based on the illustration, at which labeled site should the new nurse state that inhibition takes place?

• Receptor site

A client with OCD reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I can't stop until I do it just right." The nurse interprets the client's behavior as most likely representing an effort to obtain which of the following?

• Relief from anxiety.

A female victim of sexual assault is being seen in the crisis center. The client states that she still feels "as though the rape just happened yesterday," even though it has been a few months since the incident. What is the most appropriate nursing response?

• Tell me more about the incident that causes you to feel like the rape just occurred

A client diagnosed with PTSD is readmitted for suicidal thoughts and continued trouble sleeping. She states that when she closes her eyes, she has vivid memories about being awakened at night. "My dad would be on top of me trying to have sex with me. I couldn't breathe." Which of the following suggestions would be appropriate for the nurse to make for the insomnia? Select all that apply.

• Trying relaxation techniques to help decrease her anxiety before bedtime. • Taking the quetiapine 25 mg as needed as prescribed by the primary health care provider. • Listening to calming music as she tries to fall asleep. • Leaving her door slightly open to decrease noise during the nightly checks.

The client, a veteran of the Vietnam war who has posttraumatic stress disorder, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which of the following responses by the nurse is appropriate?

• "You did what you had to do at that time."

The nurse has been observing a client closely who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing interventions is LEAST helpful to this client at this moment.

• Initiate confinement measures

A nurse is teaching an education class to clients with mild to moderate anxiety. Which teaching strategies should the nurse practice when education the clients. Select all that apply

• Maintain a non threatening environment • Create an atmosphere of low stimuli • Encourage the client to verbalize thoughts and feelings that could contribute to the symptoms of anxiety • Limit the length of class time and the amount of information provided

The nurse in the emergency department is caring for a young female victim of sexual assault. The client's physical assessment is complete, and the physical evidence has been collected. The nurse notes that the client is withdrawn, confused, and at times physically immobile. How should the nurse interpret these behaviors?

• Normal reactions to a devastating event