MH: Chapter 21-24 prep u
The mental health nurse assesses for the most common mental health disorder found in children when asking
"Do you ever get scolded at school for not sitting still? One in five to ten children and adolescents surveyed exhibited symptomology of attention deficit/hyperactivity disorder, which can sometimes be evidenced by an inability to sit still in school.
A client is being assessed for complex somatic symptom disorder. Which client statement would the nurse interpret as most likely supporting this diagnosis?
"I am always in pain; there is nothing I can do to relieve it." Although the client may complain of various symptoms, pain is the most common complaint.
A 73-year-old man has been brought to the emergency department by his daughter and son-in-law due to abrupt and uncharacteristic changes in behavior, including impairments of memory and judgment. The subsequent history and diagnostic testing have resulted in a diagnosis of delirium. Which of the following teaching points about the client's diagnosis should the nurse provide to his family?
"If the underlying cause of delirium is identified and treated, most people return to their previous level of functioning." Delirium is characterized by reversibility, but this does not mean that treatment is not required or that spontaneous resolution occurs. Delirium is never considered a normal, age-related change.
The nurse is teaching the parents of a child with conduct disorder about methods to deal with their child's detention from school for breaking science equipment. What advice should the nurse give the parents to deal with the situation?
"You should be supportive of the school for taking this step regarding your child's inappropriate behavior." The nurse should explain to the parents that the child has received detention for behaving inappropriately in school and that they should support the school for this instead of blaming it. Using severe punishment is not a recommended treatment strategy for conduct disorder. The child with conduct disorder is unlikely to be depressed or guilty for receiving detention from school.
A nurse is planning to educate a client who is diagnosed with intermittent explosive disorder about self-management strategies for the condition. What topics should the nurse address while teaching this client? Select all that apply.
-Relaxation techniques - Strategies for anger management - Strategies to avoid alcohol and substance use The education imparted by the nurse should focus on helping the client manage the symptoms associated with intermittent explosive disorder. The nurse should teach the client relaxation techniques, anger management strategies, and strategies to prevent the use of alcohol and drugs. Clients with IED are unlikely to have pain or diet-related problems, therefore, these need not be taught to the client.
A client is being evaluated for decline in cognitive function. The client's wife asks the nurse to explain the term dementia to her. The nurse bases her response on the knowledge that dementia is which of the following? You selected:
A primary brain pathology Dementia results from primary brain pathology that usually is irreversible, chronic, and progressive. The prognosis depends on whether the cause can be identified and the condition reversed
The nurse is counseling a family with a child who has been abused by an adult family friend in the past. When explaining the child's needs to the family, which of the following would be most important for the nurse to stress?
A supportive relationship with an adult A major protective factor against psychopathology stemming from abuse and neglect is the establishment of a supportive relationship with at least one adult who can provide empathy, consistency, and possibly a corrective experience. Long-term psychotherapy and antidepressant medication may or may not be appropriate. Short-term parental separation would be unlikely because the abuser was a family friend, not a parent.
The nurse is counseling a family with a child who has been abused by an adult family friend in the past. When explaining the child's needs to the family, which of the following would be most important for the nurse to stress?
A supportive relationship with an adult A major protective factor against psychopathology stemming from abuse and neglect is the establishment of a supportive relationship with at least one adult who can provide empathy, consistency, and possibly a corrective experience. Long-term psychotherapy and antidepressant medication may or may not be appropriate. Short-term parental separation would be unlikely because the abuser was a family friend, not a parent.
The nurse is caring for a client with dementia. The client's brain images show atrophy of cerebral neurons and enlargement of the third and fourth ventricles. What is the cause of dementia in this client?
Alzheimer's disease The client's brain images show atrophy of cerebral neurons and enlargement of the third and fourth ventricles. These findings are indicative of Alzheimer's disease. In Picks's disease, there is degeneration of frontal and temporal lobes. In vascular dementia there are multiple vascular lesions of the cerebral cortex and subcortical structures. In Parkinson's disease, the primary pathology is the loss of neurons in the basal ganglia.
The mother of an 8-year-old girl was concerned that her daughter may have mental retardation. The mother states that her daughter has difficulty communicating. Which of the following would confirm a diagnosis of mental retardation?
An intelligence quotient (IQ) of 70 or below DSM-IV-TR diagnostic criteria for mental retardation include the following: an IQ of approximately 70 or below; concurrent deficits or impairments in present adaptive functioning in at least two of the following areas—communication, self-care, home living, and social/interpersonal skills; and onset before 18 years.
A 13-year-old child is constantly involved in breaking tables and chairs at school. On further assessment, the nurse finds that the child has conduct disorder. Which condition is the child most likely to develop in the future if not treated properly for this condition?
Antisocial personality disorder As many as 30% to 50% of children diagnosed with conduct disorder are later diagnosed with antisocial personality disorder as adults. Proper treatment could prevent the onset of antisocial personality disorder in this client. Depression, schizophrenia, and anxiety are not known to be consequences of conduct disorder
A client complains of severe low back pain that began shortly after the death of her mother two years ago. No physical cause has been found to account for the pain. She has been largely responsible for the care of four younger siblings because her father spends much of the week out of town on work-related business. Based on the client's symptoms, which of the following nursing diagnoses is most appropriate for her at this time?
Anxiety exhibited by unfounded somatic complaints The client is experiencing stress related to her current life situation and reacting by somatization to deal with her feelings. Therefore, "anxiety exhibited by unfounded somatic complaints" would be the correct nursing diagnosis. The other choices are not appropriate
The child psychiatric assessment differs from that of adults in which of the following ways?
Attention to developmental milestones Attention to feelings, signs and symptoms, and family history is common to both age groups. Attention to developmental milestones and stages is prioritized in the child psychiatric assessment
A child is diagnosed with autism spectrum disorder and is experiencing aggression and irritability. Which medication would the nurse expect to be prescribed to address these issues?
Atypical antipsychotics No medication has proved effective at changing the core social and language deficits of autism. However, there are numerous psychiatric medications such as atypical antipsychotics for aggression and irritability, and antidepressants to treat anxiety and compulsions. There is minimal evidence that anticonvulsants and traditional mood stabilizers are useful in managing mood liability and aggression. Examples of drugs used: haloperidol (Haldol) or risperidone for tantrums, aggressive behavior Other meds: naltrexone, clomipramine, clonidine, and stimulants.
The nurse is caring for a client in the neighborhood clinic. The client tells the nurse that ever since he was an adolescent, he has avoided social situations because he has "one ear that is obviously bigger than the other ear." The nurse observes that one of the client's ears does not appear to be larger than the other ear. The nurse suspects that the client may be experiencing which of the following?
Body dysmorphic disorder The client is most likely experiencing body dysmorphic disorder. These clients focus on real but slight defects in appearance and avoid social situations. Complex somatic symptom disorder involves somatic symptoms and cognitive distortions. Functional neurologic symptoms (conversion disorder) involve the expression of severe emotional distress or unconscious conflict through physical symptoms. Factitious disorder involves the intentional causing of an illness or injury to receive attention of health care providers.
When assessing children, the nurse needs to ask more of which type of question compared with assessment of adults?
Closed ended Children think in more concrete terms; thus, the nurse needs to ask more specific and fewer open-ended questions than would typically be asked of adults.
Which of the following characteristics differentiates conversion disorder from malingering disorder?
Conversion disorder is an unconscious process, while malingering disorder is a deliberate fabrication of symptoms. In conversion disorder, anxiety-provoking impulses are converted unconsciously into functional symptoms. Malingering disorder is characterized by the voluntary production of false or grossly exaggerated physical or psychological symptoms. Both produce rewards, and neither has any pathophysiological cause. Neither disorder is considered permanent or untreatable condition
A nurse is preparing a plan of care for a client diagnosed with body dysmorphic disorder. Which nursing diagnosis would the nurse most likely identify as the priority?
Disturbed Body Image The obvious nursing diagnosis is Disturbed Body Image. Nursing care should focus on building a therapeutic relationship and supporting the patient's positive physical aspects.
A nurse is preparing a care plan for a child with autistic disorder. Which of the following would be an appropriate nursing diagnosis for this client?
Disturbed Sensory Perception related to diminished awareness of stimuli An appropriate nursing diagnosis for a child with autistic disorder would include Disturbed Sensory Perception. Hopelessness may be related to conduct disorder. Disturbed Sleep Pattern would be appropriate for clients with ADHD. Risk for Other-Directed Violence correlates with conduct disorder.
An 80-year-old is brought to the clinic by his wife. He has a history of peripheral vascular disease and Type 2 diabetes. The wife states that he hasn't seemed himself for the preceding few days, noting that he has been lethargic and mildly confused at times and has been incontinent of urine. She reports that his blood glucose levels have been elevated. The nurse considers which of the following as the most likely explanation for the client's change in mental status?
Delirium related to underlying medical problem Any disturbance in any organ or system that affects the brain can disrupt metabolism and neurotransmission, leading to a decline in cognition and function. Infections, fluid and electrolyte imbalances, and drugs are the most frequent causes of delirium. Older adults are especially susceptible to delirium disorders because the aging neurologic system is particularly vulnerable to insults caused by underlying systemic conditions. Indeed, delirium often predicts or accompanies physical illness in older adults
When describing the term alexithymia as a personality trait associated with somatic symptom disorder, which of the following would the nurse include in the explanation?
Difficulty identifying and expressing emotion Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete externally oriented thinkers. The term does not refer to physical symptoms, or issues involving cognition or neuroactivity in brain areas.
A child is suspected of having obsessive-compulsive disorder. Which of the following would be the first step in assessing the child?
Distinguishing between normal childhood rituals and worries and those that are pathologic Although frequency, amount of interference and severity of the family's response would be important, the first step in the assessment of OCD in children is to distinguish between normal childhood rituals and worries, and pathologic rituals and obsessional thoughts
The wife caregiver of a client with dementia tells the nurse that her husband has been agitated lately. She states, "I don't know how to handle this. He was always such a gentle person!" Which of the following interventions should the nurse suggest?
Distract the client with family photos and discuss the events pictured. At times, there may seem to be no way to resolve the emotional frustration, agitation, or outbursts of the client who is angry with the environment and those in it. The caregiver might find it beneficial to redirect or distract the client. This can be done by asking to see a client's personal items, such as photographs, and then talking about the family members and life events illustrated by the photographs in the book
When developing the plan of care for the family of a child with a neurodevelopmental disorder, which of the following would be least appropriate to include?
Excluding the parents from being included in the plan of care
In which mental health disorder are physical or psychological symptoms (or both) fabricated to assume the sick role?
Factitious disorder In factitious disorder, physical or psychological symptoms (or both) are fabricated to assume the sick role. In factitious disorder by proxy, the intentional production of symptoms is in others, usually children. Hypochondriasis occurs when individuals are fearful of developing a serious illness based on their misinterpretation of body sensations. Conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms.
The nurse is assessing a child with autism spectrum disorder. After reading the medical history, the nurse finds that the child engages in stereotypical motor behavior. Which observation of the child made by the nurse might be indicative of stereotypical motor behavior?
Flapping hands repeatedly Stereotypical motor behavior refers to repetitive or ritualistic movement of a body part, such as repeated flapping of the hands. Using limited gestures while communicating, an inability to engage in play activities, and having unusual reactions to sounds, smells, and other sensory experiences are behaviors typically seen in children with autism spectrum disorder. These behaviors, however, cannot be referred to as stereotypical motor behaviors.
A nurse is studying the brain images of children with attention deficit hyperactivity disorder (ADHD). In these images, the nurse would find abnormalities related to which area of the brain?
Frontal lobe Studies have proven that ADHD is associated with malfunction of the frontal lobe. Decreased metabolism and decreased perfusion to the frontal lobe are the physiological alterations known to cause ADHD. Dysfunction of the parietal lobe would cause abnormalities in sensory perception. Dysfunction of the occipital lobe would cause abnormalities in vision. Dysfunction of the temporal lobe would cause dysfunction in communication
After teaching a group of nursing students about intellectual ability, the instructor determines that the teaching was successful when the students identify which of the following as the most common etiology?
Genetic syndromes Although exposure to toxins, perinatal complications, and environmental effects are associated with intellectual disability, the most common etiology is related to genetic syndromes.
Which of the following treatment modalities is especially helpful for adolescents?
Group therapy Group therapy is especially helpful for adolescents for whom the influence of peers is strong; adolescents are more likely to accept feedback and suggestions from their peers than from adults. Group therapy is less threatening than individual therapy and allows the adolescent to identify with others who have similar problems. (
Paul is an 84-year-old man suffering from delirium. He has been in a nursing home for the past 2 years, but recently is becoming combative and has become a threat to staff. Which of the following medication would Paul most likely receive for these symptoms?
Haloperidol (Haldol) Staff members must seriously consider this option when a client's behavior threatens the safety of self, family, or staff. Haloperidol (Haldol), a neuroleptic given either orally or by injection, is most commonly used for symptoms of delirium
A nurse is working with a child undergoing behavioral modification therapy for his attention deficit hyperactivity disorder (ADHD). The nurse finds that the child is thin. What could be the most likely reason for this observation?
He cannot sit through meals. Children with ADHD are not patient enough to sit through meals. This results in reduced dietary intake. This is the most likely reason for children with ADHD to be thin. Children with ADHD do not have impaired taste sensation. These children do not have loss of appetite unless they are on drugs like methylphenidate (Ritalin). It is not known whether children with ADHD are genetically predisposed to being thin
A 65-year-old man has been admitted to the ICU following surgical resection of the bowel. He has developed a fever. In addition to treating the fever, nurses also monitor the man for signs of delirium. Which of the following behaviors might indicate that he is becoming delirious?
He removes his surgical bandage and begins picking at his sheets. Features of delirium may include a reduced level of consciousness, a disrupted sleep-wake cycle, and an abnormality of psychomotor behavior. The hospitalized client with delirium will try to remove intravenous (IV) lines and other tubes, "pick" at the air or the bed sheet, and try to climb over side rails or the end of the bed.
Samuel is a 6-year-old boy who has been diagnosed with autism. Which of the following symptoms would you expect Samuel to display?
He spends time alone and shows little interest in making friends. Children with autism develop language slowly or not at all. They may use words without attaching meaning to them or communicate with only gestures or noises. They spend time alone and show little interest in making friends. Approximately 80% of people with autism also are classified as mentally retarded. Their most distinctive feature, however, is their seeming isolation from the world around them. This detachment and aloofness help distinguish people with autism from those who are solely mentally retarded
A client who has been having difficulty functioning in his daily life comes to the nurse and states, "I'm really afraid. I've had these funny feelings in my stomach. I'm scared that I might have cancer." The client has been seen by numerous health care professionals and no evidence of cancer has been demonstrated. The nurse suspects which of the following?
Hypochondriasis When individuals are fearful of developing a serious illness based on their misinterpretation of body sensations, the term hypochondriasis can be used to describe this preoccupation. The fear of having an illness continues despite medical reassurance, and this interferes with psychosocial functioning. The individual spends time and money on repeated examinations looking for feared illnesses. With factitious disorder, the illness or injury is intentionally caused to gain attention of health care workers. Functional neurologic symptom disorder or conversion disorder is a psychiatric condition in which severe emotional distress or unconscious conflict is expressed through physical symptoms. (le
A 15-year-old client with intermittent explosive disorder gives no history of childhood abuse, neglect, or maltreatment. What could be the cause of the disorder in this client?
Imbalance in the production of serotonin Childhood abuse, neglect, or maltreatment is often the cause of intermittent explosive disorder (IED). As the client does not have a history of any of these, the client likely has the disorder because of other factors. Other etiologic factors include imbalance in the production of serotonin and dysfunction of the frontal lobe. Parietal lobe dysfunction and depleted blood glucose levels are not associated with IED. Presence of coronary artery disease is not a known etiologic factor in IED but is strongly correlated with the disease.
Which of the following would be the most appropriate intervention for an adolescent who is manipulative and exhibiting aggressive behaviors?
Limit setting Limit setting involves three steps: informing the client of the rule or limit, explaining the consequences if the client exceeds the limit, and stating the expected behavior.
The nurse is planning an initial therapy session with a client age 20 years whose parents had alcoholism. The nurse anticipates that the client would most likely exhibit symptoms of which of the following?
Low self-concept For children who do not experience significant psychopathology, the experience of growing up in a family with substance abuse can lead to a poor self-concept, as children feel responsible for their parents' behavior, become isolated, and start to mistrust their own perceptions because the family denies the reality of the addiction.
Which of the following is the priority intervention for a client diagnosed with delirium?
Maintenance of safety Maintenance of safety is the priority intervention for the client diagnosed with delirium. Management of confusion, promotion of sleep, and proper nutrition are important but not the priority
Which medication is the most effective treatment for ADHD?
Methylphenidate (Ritalin)
The most severe form of factitious disorder includes which of the following?
Munchausen's syndrome In 1951, the term Munchausen's syndrome was used to describe the most severe form of factitious disorder, which was characterized by fabricating a physical illness, having recurrent hospitalizations, and going from one medical provider to another. Malingering occurs when an individual intentionally produces illness symptoms that are motivated by another specific self-serving goal, such as being classified as disabled or avoiding work. Alexithymia and hypochondriasis are not factitious disorders
Which of the following is the most common problem in people with complex somatic symptom disorder (CSSD)?
Pain Pain is the most common problem in people with CSSD. Because pain is usually related to symptoms of all the major body systems, it is unlikely that somatic intervention such as an analgesic will be effective on a long-term basis. Nausea, muscle weakness, and numbness and tingling in the extremities are not the most common problems associated with CSSD
A client with dementia becomes extremely agitated shortly after being admitted to the psychiatric unit. The nurse is reluctant to use physical restraints to control the client. What is a likely reason the nurse this reluctance?
Physical restraints may increase the client's agitation The use of physical restraints are usually a last resort for clients with dementia, as restraint use may increase any fears or thoughts of being threatened. The nurse may need to use physical restraints if the patient is pulling at intravenous lines or catheters. Physical restraints do not commonly cause injury to the client or lead to fatality.
A client diagnosed with factitious disorder tells the nurse an incredible story about how he overcame a tremendous disability. Based on the client's history, the nurse knows that the story is not all true. The client is exhibiting which of the following?
Pseudologia fantastica With factitious disorder, clients are extremely creative in simulating illnesses, and they tell fascinating but false stories of personal triumph. These tales are referred to as pseudologia fantastica and are a core symptom of the disorder. Pseudologia fantastica are stories that are not entirely improbable and often contain a matrix of truth and falsehood. Malingering involves an individual who intentionally produces illness symptoms but is motivated by as self-serving goal such as being classified as disabled or avoiding work. Individuals with alexithymia have difficulty identifying and expressing their emotions. They have a preoccupation with external events and are described as concrete externally oriented thinkers. Hypochondriasis is seen in individuals who are fearful of developing a serious illness based on their misinterpretation of body sensations.
When assessing a client with somatic symptom disorder, which of the following would the nurse most likely note?
Reports of physical symptoms do not have a demonstrable organic basis to fully account for them. A central feature of somatic symptom disorder is a report of physical symptoms without a demonstrable organic basis to fully account for the symptoms. Symptoms or magnified health concerns are not under the client's conscious control. Denial and repression are not chief defense mechanisms used. Clients do not willfully control the physical symptoms.
Which of the following nursing diagnoses would be the priority for the client experiencing acute delirium?
Risk for Injury related to confusion and cognitive deficits The plan of care must be deliberately designed to meet the client's unique needs, with safety always being the nurse's highest priority. Risk for injury is a NANDA diagnosis and the etiology of confusion and cognitive deficits are factors that can be modified through nursing care
A child diagnosed with Tourette's syndrome is to be started on pharmacologic therapy. Which of the following would the nurse most likely expect to be prescribed?
Risperdone Two classes of drugs are commonly used in the treatment of tics: antipsychotics and alpha-adrenergic receptor agonists. The use of atypical antipsychotics such as risperidone and aripiprazole is replacing the use of older antipsychotics, haloperidsol and pimozide.The alpha2-adrenergic receptor agonist clonidine (Catapres) has been used in treating Tourette's disorder for more than 30 years. Guanfacine (Tenex) is a newer alpha2-adrenergic receptor agonist that has only recently been studied in children with Tourette's disorder. However, the level of improvement in tic symptoms is generally less than that observed with the antipsychotics.
Which medication classification has been shown to be effective in some cases of somatoform disorders?
SSRIs SSRIs have been shown to be effective in some cases of somatoform disorders
A client with complex somatic symptom disorder also has anxiety. Which of the following would the nurse expect to be prescribed?
Selective serotonin reuptake inhibitor (SSRI) For the client with complex somatic symptom disorder and anxiety, SSRIs are used, in a higher dose than prescribed for depression to relieve and manage the symptoms. MAOIs, such as phenelzine, would be used to treat complex somatic symptom disorder and depression. TCAs and atypical antipsychotics would not be used
A 7-year-old boy being treated for depression will most likely be given which of the following first-line pharmacologic treatments?
Serotonin reuptake inhibitors The most commonly used antidepressant medications for children and adolescents are the SSRIs. Side effects, especially nausea, headache, and stomachache, are minimal, especially when the starting dose is low with a gradual increase to a therapeutic level.
Keisha is a 42-year-old married woman with two children, ages 16 and 18. She is also caring for her mother, who is in the late stages of Alzheimer's disease. The nurse would want to assess Keisha for which of the following?
Signs of stress Nurses must assess family members, especially caregivers, for signs of stress or burnout. Although this issue might not be pertinent during early stages of dementia, it becomes paramount as clients progressively degenerate and demands for physical care mount.
Over the past 5 years, a client has had two exploratory surgeries and numerous examinations for severe abdominal pain. All diagnostic and laboratory results have been negative for organic problems. The client has had vague descriptions of periods of anxiety and depression, and has continued to seek medical assistance for the abdominal pain and various other physical problems. The nurse would assess this client as using which of the following defense mechanisms?
Somatization This client is using somatization. The physical symptoms are a method of reducing anxiety. Dissociation is a disturbance in integrated personal functions. Thoughts and feelings are split into different mental compartments. Displacement is the transfer of emotional reactions from one person or object to another. Repression is the defense mechanism in which experiences are blocked from the conscious mind.
Which of the following is a disturbance of the normal fluency and time patterning of speech?
Stuttering Stuttering is a disturbance of the normal fluency and time patterning of speech. Phonologic disorder involves problems with articulation. Mixed receptive-expressive language disorder includes problems of expressive language disorder along with difficulty understanding and determining the meaning of words and sentences. Expressive language disorder involves an impaired ability to communicate through verbal and sign language.
The psychiatric nurse documents that the cognitively impaired client is exhibiting "confabulation" when observed ...
Telling other clients that he "was a dairy farmer" when he actually ran a small grocery store Confabulation is the filling in of memory gaps with false but sometimes plausible content to conceal the memory deficit, such as a client telling others that he "was a dairy farmer" when he actually ran a small grocery store. Evidence of perseveration is a client telling the staff repeatedly that "my name is George and I'm hungry." Sundown syndrome can be described as a client pacing nervously and resisting the staff's request to "get ready for bed." Concrete thinking is described when the client asks where the cats are when told it's "raining cats and dogs."
The nurse is assessing a child with tic disorder. The nurse documents in the assessment sheet that the child exhibits coprolalia. What might be be interpreted from this?
The child continuously repeats socially unacceptable words. Coprolalia is a complex vocal tic in which a child with tic disorder continuously repeats socially unacceptable, often obscene, words. Grunting and shrugging of the shoulders are common simple vocal and motor tics, respectively. Repeating the last heard phrase is a type of vocal tic known as echolalia.
The nurse expects the child with expressive language disorder is likely to present with which nursing assessment finding?
The child has difficulty forming complete sentences. The child with expressive language disorder may have difficulty communicating through verbal or sign language. The child does not have impaired ability to produce sound. The child may not stutter while speaking, but would not be able to organize words to make sentences while speaking. The child does not have receptive language disorder, thus would not have difficulty understanding the meaning of words and sentences
The nurse is assessing a client who reports severe chest pain. The client appears worried and frightened. Further assessment and laboratory testing does not reveal any abnormalities. The nurse observes that in the absence of any medical personnel, the client watches TV, is relaxed, and speaks to a friend on the phone in a normal tone of voice. What should the nurse suspect in this case?
The client may be malingering. Malingering refers to the intentional production of false or grossly exaggerated physical or psychological symptoms. These people do not have any real physical symptoms, or they grossly exaggerate relatively minor symptoms. This behavior is motivated by external motives and the patient's symptoms end when the desired outcome has been achieved Hypochondriasis is a condition in which a client is preoccupied with possibly having a disorder or contracting a serious illness. In silent angina, the client has no physical discomfort. In Munchausen's syndrome, a person intentionally produces physical or psychological symptoms solely to gain attention.
The nurse is assessing an adolescent with conduct disorder. The nurse finds that the adolescent is not interested in seeking summer employment. What is the most likely reason for the client's disinterest in getting a job?
The client prefers stealing money over working for it. The adolescent with conduct disorder is most likely to steal money for survival instead of earning it through employment. Feeling too disturbed to be able to work and feeling that he would be inefficient at work are not behaviors related to clients with conduct disorder. Depression and anxiety are not present in clients with conduct disorder.
An 82-year-old woman with a diagnosis of vascular dementia has been admitted to the geriatric psychiatry unit of the hospital. In planning the care of this client, which of the following outcomes should the nurse prioritize?
The client will be free of injury Control of agitation and promotion of self-worth are important outcomes, but safety is a priority concern. A client whose diagnosis necessitates hospitalization may or may not be capable of identifying or making changes in life routines
The nurse is carrying out the nursing process in the care of a client who has been diagnosed with body dysmorphic disorder (BDD). Which of the following goals should be prioritized in the planning of this client's care?
The client will verbalize acceptance of appearance. Central to BDD is a lack of acceptance of physical appearance. Consequently, acceptance of appearance is a priority in the care of a client with BDD. The thinking that characterizes the disorder is not classified as delusional. Promoting health maintenance is a relevant goal but is not specific to BDD. Reducing BMI does not address the etiology of BDD
A client with complex somatic symptom disorder is complaining of significant pain in the joints. When providing care to this client, which of the following would be most important for the nurse to keep in mind?
The client's experience of pain is real. Even though there is no medical explanation for the pain, the client's pain is real and has serious psychosocial implications. Aggressive pharmacologic treatment of the symptoms must be avoided. Nonpharmacologic strategies, including complementary and alternative treatments, should be used to assist in pain relief. Outcomes developed need to avoid focusing on the biologic aspects of the disorder and instead help the client overcome the pain through biopsychosocial approaches
A mother brings her teenaged son, who is complaining of having a severe headache, to the clinic. The teenager is groaning with pain. During assessment, the client asks the nurse for a note to excuse his absence from school. After further assessment, the nurse suspects that the client is malingering. What leads the nurse to come to this conclusion? Choose the best answer.
The client's symptoms disappeared after getting the medical note. A malingerer is a person who intentionally produces false or grossly exaggerated physical or psychological symptoms. This behavior is motivated by external motives and once the motives have been met, the client's symptoms will disappear. If the client had studied all night for an exam, he may have been suffering from a tension headache and the symptoms would have remained after he he received the medical note. If a client doesn't have any underlying cause of headache on assessment, it could be concluded that the client either is a malingerer or has a somatic symptom illness. However, clients do not have voluntary control over somatic symptoms. If the client reports having signs related to raised intracranial pressure, such as nausea, which are not consistent with the assessment findings, then the client may have Munchausen's syndrome. In this condition the client inflicts illness or injury on oneself in order to gain attention
A nurse is caring for a client with conduct disorder. The nurse tells the client, "It is not appropriate for you to break things in this center every time you get angry. You should inform me when you get angry. If you break anything else in the facility, you will not be allowed to play video games for a week." What is the statement indicative of?
The nurse is trying to teach limit setting. The nurse tells the client that his behavior is inappropriate and that there will be consequences if the same behavior is continued. The nurse is trying to teach the client limit setting. This sentence does not indicate that the nurse is teaching social skills, problem solving, or coping strategies.
A group of friends have arrived at the hospital to visit a client recently diagnosed with delirium. The nurse tells the friends they can visit with the client one at a time. What is the likely reason for the nurse to give this instruction?
The nurse wants to prevent increasing the client's confusion The nurse understands that too many visitors or more than one person speaking at once may increase the client's confusion. The nurse should also explain to the visitors, that they should speak quietly with the client, one at a time. This may help prevent the client from becoming overstimulated. Talking with many friends at a time doesn't pose a physical danger to the client. While it is ideal for the client to demonstrate proper orientation, it is not the reason the nurse monitors the client's response to visitors. Talking to one person at a time does not help the client maintain an adequate balance of activity and rest.
Which of the following is a significant obstacle in providing psychiatric care for clients who have somatoform disorders?
They are often unrecognized because clients receive treatment in different primary care offices, and care is often fragmented Patients focus on physical symptoms as the primary problem. When physicians are unable to diagnose the cause, patients are often referred to other physicians for further physical assessment.
The nurse uses the technique of timeout for a client with conduct disorder. Which problem demonstrated by the client would have led the nurse to use this technique?
Threatening the nurse Timeout is used to prevent aggression when the client's behavior starts to escalate, such as yelling or threatening someone. This technique helps the client with conduct disorder to gain control of emotions and outbursts. This technique may not be useful for helping the client interact with the nurse, to build better social relationships, or to perform daily chores.
A nurse is caring for a client with conduct disorder who injures people around him when he is angry. Which is the primary goal for intervention in this case?
To ensure safety of others. With a physically aggressive client, the nurse should first ensure the safety of others. Reducing the aggression of the client, helping the client express his feelings, and helping the client to develop good peer relationships are all goals of treatment. These outcomes are of a comparatively lesser priority than safety
Why would a nurse ask a female adolescent client with conduct disorder to maintain a diary?
To help identify her feelings. Clients with conduct disorder are tough on the exterior but have difficulty expressing their feelings and emotions. Keeping a diary can be very useful to help these clients to identify and express their emotions and feelings. Keeping a diary would not improve problem solving or teach socially acceptable behavior. It also does not reduce the chances of an angry outburst. The nurse should teach problem-solving skills, continually involve the client in age-appropriate discussions, and use techniques such as timeout to address these challenges.
A client was admitted to the ICU after a motor vehicle accident. She sustained a right parietal injury, resulting in an acute confusional state or delirium. She complains that there are "bugs crawling around" on her arms. The nurse understands what?
Transient tactile hallucinations are sometimes seen in delirium. With delirium, as is the case with the client, transient tactile hallucinations are seen in many cases. This type of tactile hallucination would not indicate schizophrenia or brain damage, nor would the client be any more prone to them at any time of the day.
The nurse is working with the family of a client who is newly diagnosed with Alzheimer's type dementia. Which of the following suggestions would be effective for assisting the family in daily orienting of their family member when the client returns home?
Use daily newspapers, calendars, and a set routine. Using daily newspapers, calendars, and a set, unchanging routine would be a more effective way to provide daily orientation for the family member. Changing daily activities would make it more difficult to maintain orientation. Reading to the client for long periods of time would not maintain client involvement and appropriate stimulation. Using daily quizzes would place stressful demands on the client and not provide functionally appropriate tasks
A woman in her fifties has contacted her care provider because of concerns for her husband, who has suddenly begun behaving uncharacteristically in recent days. Most recently, he became lost while driving to his home of 30 years and temporarily forgot his son's name. Diagnostic testing has ruled out delirium and he had been previously healthy. What is the most likely cause of the husband's cognitive changes?
Vascular dementia The onset of vascular dementia is usually earlier than that of DAT and DLB. Onset is generally abrupt, with fluctuating, rapid changes in memory and other cognitive impairment.
Tacrine (Cognex) is a drug that is used in clients with cognitive disorders. Tacrine works mainly by
elevating levels of acetylcholine (ACH) in the system by decreasing binding sites of acetylcholinesterase. Tacrine (Cognex) inhibits acetylcholinesterase, helping to elevate the level of ACh in the system by decreasing the binding sites of acetylcholinesterase. This lengthens the potential for cholinergic activity.
John has become bored with his PlayStation, which had been his positive reward for cleaning his room. The most effective intervention with John at this time would be to
let John choose another reward that would be more fun. Positive rewards need to be viewed as desirable to motivate desired behavior changes.
A 13-year-old boy who has been diagnosed with oppositional defiant disorder has taunted the nurse when she bent over to pick something up and mocked her weight. How should then nurse respond?
say, "That's not an acceptable thing to say." A direct, matter-of-fact approach to hostile or inappropriate behavior is beneficial when engaging with adolescents.
The hallmark of amnestic disorders is ...
short-term memory loss. Amnestic disorders include conditions in which short-term memory loss is a hallmark. The deterioration of memory is so great that it prevents clients from functioning at previous levels of social and occupational performance and seriously deters them from learning new information.
A school nurse is assessing a group of adolescent students. The nurse wants to find and counsel the students who have abnormal behavior. Based on the assessment, which students would need counseling? Select all that apply.
• A student who is extremely depressed • A student who frequently visits the hospital despite having no physical problems Abnormal behaviors in adolescence include excessive depression and frequent hypochondriacal complaints. Behaving critically toward oneself and others and exhibiting competitive behavior are normal behaviors in adolescence. More involvement in studies and decreased involvement in play indicate erratic work-leisure patterns. This behavior is also considered normal
A 12-year-old child is brought to the mental health clinic by his parents because of a court-ordered evaluation. When assessing the child, which of the following would lead the nurse to suspect that the child has a conduct disorder? Select all that apply.
• Destruction of neighbor's car on two separate occasions • Arrests for petty larceny several times • Evidence of overt lying Conduct disorder is characterized by more serious violations of social norms, including aggressive behavior, destruction of property, and cruelty to animals. Children and adolescents with conduct disorder often lie to achieve short-term ends, may be truant from school, may run away from home, and may engage in petty larceny or even mugging. Oppositional defiant disorder is characterized by a persistent pattern of disobedience; argumentativeness; angry outbursts; low tolerance for frustration; and a tendency to blame others for misfortunes, large and small
A group of nurses is reviewing information about the signs and symptoms of functional neurologic symptom disorder. The students demonstrate understanding of this disorder when they identify which of the following? Select all that apply.
• Difficulty swallowing • Impaired coordination • Loss of touch Clients with conversion disorder have neurologic symptoms that include impaired coordination or balance, paralysis, aphonia (inability to produce sound), difficulty swallowing or a sensation of a lump in the throat, and urinary retention. They also may have loss of touch, vision problems, blindness, deafness, and hallucinations. In some instances, they may have seizures.
A nurse is teaching a child with ADHD and his parents about the prescribed atomoxetine. The nurse determines that the education was successful when they identify which of the following as an adverse effect of the drug? Select all that apply.
• Headache • Vomiting • Somnolence Common adverse events related to atomoxetine include headache, abdominal pain, decreased appetite, vomiting, somnolence, and nausea.
A child with attention deficit hyperactivity disorder has been prescribed Dextroamphetamine (Dexedrine). For what effects should the nurse tell the parents to monitor the child? Select all that apply.
• Insomnia • Weight loss • Appetite suppression Dextroamphetamine (Dexedrine) is a commonly prescribed drug to treat symptoms of ADHD. Insomnia, weight loss and appetite suppression are the common side effects associated with this drug. The nurse should educate the parents on monitoring these effects. Hypotension and weight gain are not common side effects of this drug.
When assisting the parents of a child diagnosed with ADHD, which of the following would the nurse suggest? Select all that apply.
• Keep to regular routines • Maintain a calm environment • Set clear limits with consequences Explanation: Interventions that can help the parents of a child with ADHD include: setting clear limits with clear consequences, using few words and simplifying instructions; establishing and maintaining a predictable environment with clear rules and regular routines for eating, sleeping, and playing; promoting attention by maintaining a calm environment with few stimuli; establishing eye contact before giving directions and asking the child to repeat what was heard; encouraging the child to do homework in a quiet place outside of a traffic pattern; and assisting the child to work on one assignment at a time (reward with a break after each completion).
Which behaviors should the nurse anticipate in children with mild conduct disorder? Select all that apply.
• Repeated lying • Minor shoplifting Repeated lying and minor shoplifting are examples of the mild form of conduct disorder. Behaviors such as conning people and drinking alcohol are seen with moderate forms of conduct disorder. Cruelty to classmates is seen with the severe form of conduct disorder.
A nurse is assessing a 2-year-old child diagnosed with autism spectrum disorder. Which findings does the nurse expect to find on assessment? Select all that apply.
• The child does not relate to parents. • The child avoids eye contact. • The child becomes upset with minor changes in routine. Children with autism spectrum disorder tend to avoid eye contact with people. They do not identify or relate to their parents and remain detached. These children get upset with minor changes in routine. Children with autism spectrum disroder do not enjoy engaging in play or make-believe with toys. These children do not get frightened if left alone; in fact, they prefer being left alone
