MHE1

A client diagnosed with chronic alcohol addiction is being discharged from an inpatient treatment facility after detoxification. Which client outcome, related to Alcoholics Anonymous (AA), would be most appropriate for a nurse to discuss with the client during discharge teaching? 1. To immediately attend AA meetings at least weekly. 2. To rely on an AA sponsor to help control alcohol cravings. 3. To incorporate family in AA attendance. 4. To seek appropriate deterrent medications through AA.

1 The most appropriate client outcome for the nurse to discuss during discharge teaching is attending AA meetings at least weekly. AA is a major self-help organization for the treatment of alcohol addiction. It accepts alcohol addiction as an illness and promotes total abstinence as the only cure.

The client with panic disorder says, "When an attack happens, I feel like I am going to die." Which response should the nurse make? 1. "I know it's frightening, but try to remind yourself that this will only last a short time." 2. "Death from a panic attack happens so infrequently that there is no need to worry." 3. "Most people who experience panic attacks have feelings of impending doom." 4. "Tell me why you think you are going to die every time you have a panic attack."

1 The most appropriate nursing response to the client's concerns is to empathize with the client and provide encouragement that panic attacks only last a short period. Panic attacks usually last minutes but can, rarely, last hours.

The clinic nurse is triaging clients. The nurse should require which client with nonsuicidal self-injuring behavior to be seen immediately? 1. Is self-cutting in response to command hallucinations 2. Has a history of borderline personality disorder 3. Is on leave from the military 4. Has thoughts of being detached from the body

1 A client who exhibits nonsuicidal self-injuring behavior (self-cutting) in response to command hallucinations should be considered in need of immediate medical attention.

The nurse is working with a client diagnosed with somatic symptom disorder (SSD). Which distinguishing criterion is present in SSD but absent in illness anxiety disorder (IAD)? 1. Experiences significant physical symptoms 2. Has a change in the quality of self-awareness 3. Has a perceived disturbance in body image or appearance 4. Experiences anxiety about acquiring an illness

1 Individuals experiencing somatic symptoms without corroborating pathology are considered to have SSD, and those with minimal or no somatic symptoms would be diagnosed with IAD, a diagnosis new to the DSM-5.

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

1 The best nursing approach when working with a client diagnosed with borderline personality disorder is to be firm, consistent, and empathetic while addressing specific client behaviors. Individuals with borderline personality disorder always seem to be in a state of crisis and can often have negative patterns of interaction, such as manipulation and splitting.

The client diagnosed with chronic low back pain is considering acupuncture. Which response would the nurse make when the client asks about how this type of treatment works? 1. "Western medicine believes that acupuncture stimulates the body's release of pain-fighting chemicals called endorphins." 2. "I'm not sure if that would be a good idea. There are a lot of risks, including HIV." 3. "Acupuncture works by encouraging the body to increase its development of serotonin and norepinephrine." 4. "Your acupuncturist is your best resource for answering your specific questions."

1 The most appropriate response by the nurse is to educate the client on the medical philosophy that acupuncture stimulates the body's release of endorphins. The Western medical philosophy regarding acupressure and acupuncture is that they stimulate the body's own painkilling chemicals—the morphine-like substances known as endorphins.

The nursing student, having no knowledge of alternative treatments, states, "Aren't these therapies like a fad? Won't they eventually fade away?" Which response would the nurse make? 1. "Like nursing, complementary therapies take a holistic approach to healing." 2. "The American Nurses Association researches the effectiveness of these therapies." 3. "It is important to remain nonjudgmental about these therapies." 4. "Alternative therapy concepts are rooted in psychoanalysis."

1 The nurse is accurate when comparing complementary therapies to the holistic approach of nursing. Complementary medicine is viewed as holistic health-care, which deals not only with the physical perspective but also the emotional and spiritual components of the individual. The complementary therapies, as well as nursing process, view the person as consisting of multiple, integrated elements. Diagnostic measures are not based on one aspect, but include a holistic assessment of the person.

Neurological tests have ruled out pathology in a client's sudden lower-extremity paralysis. Which action would the nurse take? 1. Deal with physical symptoms in a detached manner. 2. Challenge the validity of physical symptoms. 3. Meet dependency needs until the physical limitations subside. 4. Encourage a discussion of feelings about the lower-extremity problem.

1 The nurse should assist the client in dealing with physical symptoms in a detached manner. The nurse should minimize time given in response to physical complaints. Lack of reinforcement may help to extinguish the maladaptive response.

At 11:30 p.m. the client diagnosed with antisocial personality disorder demands to phone a lawyer to file for a divorce. Unit rules state that no phone calls are permitted after 10 p.m. Which nursing response is most appropriate? 1. "Go ahead and use the phone. I know this pending divorce is stressful." 2. "You know better than to break the rules. I'm surprised at you." 3. "It is after the 10 p.m. phone curfew. You will be able to call tomorrow." 4. "A divorce shouldn't be considered until you have had a good night's sleep."

3 The most appropriate response by the staff is to restate the unit rules in a calm, assertive manner. The nurse can encourage the client to verbalize frustration while maintaining an accepting attitude. The nurse may also help the client to identify the true source of frustration.

The aging client takes an antipsychotic for schizophrenia spectrum disorder and a beta-adrenergic blocking agent for hypertension. Based on an understanding of the combined side effects of these drugs, which statement by a nurse is most appropriate? 1. "Make sure you concentrate on taking slow, deep, cleansing breaths." 2. "Watch your diet and try to engage in some regular physical activity." 3. "Rise slowly when you change position from lying to sitting or sitting to standing." 4. "Wear sunscreen and try to avoid midday sun exposure."

3 The most appropriate statement by the nurse is to instruct the client to rise slowly when changing positions. Antipsychotic medications and beta blockers cause a decrease in blood pressure. When given in combination, the additive effect of these drugs places the client at risk for developing orthostatic hypotension.

The client is experiencing a severe panic attack. Which nursing intervention would meet this client's physiological need? 1. Teach deep breathing relaxation exercises. 2. Place the client in a brightly lit room. 3. Have the client breathe into a paper bag. 4. Administer the ordered prn buspirone (BuSpar).

3 The nurse can meet this client's physiological need by having the client breathe into a paper bag. Hyperventilation may occur during periods of extreme anxiety. Hyperventilation causes the amount of carbon dioxide (CO2) in the blood to decrease, possibly resulting in lightheadedness, rapid heart rate, shortness of breath, numbness or tingling in the hands or feet, and syncope. If hyperventilation occurs, assist the client to breathe into a small paper bag held over the mouth and nose. Six to 12 natural breaths should be taken, alternating with short periods of diaphragmatic breathing.

The client diagnosed with dissociative identity disorder (DID) switches personalities when confronted by the nurse about inappropriate actions. The nurse recognizes that this dissociation serves which function? 1. It is a means to attain secondary gain. 2. It is a means to explore feelings of excessive and inappropriate guilt. 3. It serves to isolate painful events so the person's awareness and anxiety are decreased. 4. It serves to establish personality boundaries and limit inappropriate impulses.

3 The nurse should anticipate that a client who switches personalities when confronted about inappropriate actions is dissociating in order to isolate painful events to reduce a client's awareness and anxiety associated with events that are perceived as extremely stressful. The transition between personalities is usually sudden, dramatic, and precipitated by stress.

The client presents with symptoms of alcohol withdrawal and states, "I haven't eaten in three days." The nurse's assessment reveals BP 170/100 mm Hg, P 110, R 28, and T 97°F (36°C) with dry mucous membranes and poor skin turgor. What should be the priority nursing diagnosis? 1. Denial 2. Fluid volume excess 3. Imbalanced nutrition: less than body requirements 4. Ineffective individual coping

3 The nurse should assess that the priority nursing diagnosis is imbalanced nutrition: less than body requirements based upon the client's statement regarding lack of nutritional intake for three days. The client is exhibiting signs and symptoms of malnutrition, as well as alcohol withdrawal. The nurse should consult a dietitian, restrict sodium intake to minimize fluid retention, and provide small, frequent feedings of nonirritating foods.

Which treatment would a nurse determine is appropriate for a client experiencing frequent migraine headaches? 1. St. John's wort combined with an antidepressant 2. Ginger tea combined with a beta-blocker 3. Feverfew, used according to directions 4. Kava-kava added to a regular diet

3 The nurse should determine that the appropriate treatment for a client experiencing frequent migraine headaches is the herb feverfew. Feverfew is effective in either fresh leaf or freeze-dried form. It is considered to be safe in reasonable doses.

The client diagnosed with schizophrenia spectrum disorder tells the nurse, "I'm sad that the voice is telling me to stop seeing my psychiatrist." Which symptom is the client exhibiting? 1. Magical thinking 2. Persecutory delusions 3. Command hallucinations 4. Altered thought processes

3 The nurse should determine that the client is exhibiting command hallucinations. Clients with command hallucinations could potentially be physically, emotionally, and/or sexually harmful to others or to self.

The college student has severe test anxiety. Instead of studying for finals, the student relieves stress by attending a movie. Which priority nursing diagnosis should the campus nurse assign for this student? 1. Non-adherence R/T test taking 2. Ineffective role performance R/T helplessness 3. Ineffective coping R/T anxiety 4. Powerlessness R/T fear

3 The priority nursing diagnosis for this student is ineffective coping R/T anxiety. The nurse should assist in implementing interventions that will improve the student's healthy coping skills and reduce anxiety.

On the first day of a client's alcohol detoxification, which nursing intervention should take priority? 1. Strongly encourage the client to attend 90 Alcoholics Anonymous (AA) meetings in 90 days. 2. Educate the client about the biopsychosocial consequences of alcohol abuse. 3. Administer ordered chlordiazepoxide (Librium) in a dosage according to protocol. 4. Provide thiamin supplements to prevent Wernicke-Korsakoff syndrome.

3 The priority nursing intervention for this client should be to administer ordered chlordiazepoxide in a dosage according to protocol. Chlordiazepoxide is a benzodiazepine and is often used for medication-assisted therapy in alcohol withdrawal to reduce life-threatening complications.

Which data in the history would the nurse expect to find in a client diagnosed with substance-induced psychotic disorder? 1. Had delirium 2. Had less severe withdrawal symptoms 3. Has an opioid use disorder 4. Has a fluid and electrolyte imbalance

3 The prominent hallucinations and delusions associated with substance-induced or medication-induced disorder are found to be directly attributable to substance intoxication or withdrawal, like opioid use disorder.

The nurse is assessing a client diagnosed with somatic symptom disorder (SSD). Which findings would the nurse expect to observe? 1. Presence of multiple personalities, depersonalization, derealization, and "gaps" in memory 2. Aphonia, la belle indifference, paralysis with no physical reason, and possible hallucinations 3. Anxious, seeing several health-care providers simultaneously, overmedicates, and vague symptoms 4. Pretends to be ill, aggravates existing symptoms, inflicts self-injury and has many hospitalizations

3 These findings indicate somatic symptom disorder. Clients often receive medical care from several health-care providers, sometimes concurrently, leading to the possibility of dangerous combinations of treatments. They tend to seek relief through overmedicating with prescribed analgesics or antianxiety agents. Symptoms may be vague, dramatized, or exaggerated in their presentation.

Which statement by the client indicates successful teaching about taking lithium carbonate (Lithobid) for the treatment of bipolar disorder? 1. "I should decrease my intake of sodium." 2. "Drinking ten large glasses of water a day is good for me." 3. "Weight gain is a common, but troubling, side effect." 4. "Diarrhea should be expected while using this drug."

3 This statement indicates successful teaching. Weight gain is a common side effect of lithium carbonate.

A high school student has learned that she cannot graduate. Her boyfriend will be attending a college out of state that she planned to attend. She is admitted to a psychiatric unit after overdosing on Tylenol. Which is the priority nursing diagnosis for this client? 1. Ineffective coping R/T situational crisis AEB powerlessness 2. Anxiety R/T fear of failure 3. Risk for self-directed violence R/T hopelessness 4. Risk for low self-esteem R/T loss events AEB suicidal ideations

3 The priority nursing diagnosis for this client is risk for self-directed violence R/T hopelessness. Nurses would prioritize diagnoses and outcomes based on potential safety risk to the client or others.

Place the following stages of the codependency recovery process according to Cermak beginning with the first stage (1-4). (Enter the number of each stage in the proper sequence, using comma and space format, such as: 1, 2, 3, 4) 1. The Core Issues Stage 2. The Reintegration Stage 3. The Survival Stage 4. The Reidentification Stage

3, 4, 1, 2

A home care nurse notices the client who startles easily is exhibiting signs of posttraumatic stress disorder. The nurse asks, "Have you ever made a suicide attempt?" to which the client responds, "Yes, I have." Which response should the nurse make next? 1. Notify the primary care provider 2. Gently touch the client's arm 3. Say, "Why would you do that? I am here to help you." 4. Ask, "Are you having thoughts of suicide right now?"

4 A "yes" response to either question ("In the past month, have you had thoughts about suicide?" and "Have you ever made a suicide attempt?") should prompt the nurse to ask a third question, "Are you having thoughts of suicide right now?"

Which client statement demonstrates positive progress toward recovery from a substance use disorder? 1. "I have completed detox and therefore am in control of my drug use." 2. "When I can't control my cravings, I will faithfully attend Narcotic Anonymous." 3. "As a church deacon, my focus will now be on spiritual renewal." 4. "Taking those pills got out of control. It cost me my job, marriage, and children."

4 A client who takes responsibility for the consequences of substance use disorder or substance addiction is making positive progress toward recovery. This would indicate completion of the first step of a 12-step program (AA).

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

4 An appropriate nursing diagnosis when working with a client diagnosed with schizoid personality disorder is social isolation R/T inability to relate to others. These clients avoid close or romantic relationships, interpersonal attachments, and intimate sexual relationships.

A highly agitated client paces the unit and states, "I could buy and sell this place." The client's mood fluctuates from fits of laughter to outbursts of anger. Which chart entry would the nurse document for this client's behavior? 1. "Rates mood 8/10. Exhibiting looseness of association. Euphoric." 2. "Mood irritability. Exhibiting magical thinking. Nervousness." 3. "Blunted affect. Exhibiting delusions of reference. Hyperactive." 4. "Agitated and pacing. Exhibiting grandiosity. Mood labile."

4 Based upon the client's behaviors and statements, the nurse would chart "Agitated and pacing. Exhibiting grandiosity. Mood labile." The client is exhibiting mood labile from fits of laughter to outbursts of anger. Grandiosity refers to the attitude that one's abilities are better than everyone else's (I could buy and sell this place).

When a practitioner corrects subluxation by manipulating the vertebrae of the spinal column, which therapy is the practitioner employing? 1. Allopathic 2. Therapeutic touch 3. Massage 4. Chiropractic

4 Chiropractic therapy involves the correction of subluxations by manipulating the vertebrae of the spinal column. The theory behind chiropractic medicine is that energy flows from the brain to all parts of the body through the spinal cord and spinal nerves.

The nurse presents a staff development session about the various challenges in the treatment of clients diagnosed with bipolar disorder. Which factor should the nurse include that is an essential component of relapse prevention? 1. Methods to treat insomnia 2. Inability to control irritability 3. Lack of insight 4. Medication adherence

4 Medication adherence must be emphasized as an essential component of relapse prevention. Discontinuation can result in return of bipolar symptoms.

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

1 The nurse should educate the family that clients diagnosed with avoidant personality disorder desire intimacy but fear it, while clients diagnosed with schizoid personality disorder prefer to be alone.

An adolescent diagnosed with schizophrenia spectrum disorder experiences command hallucinations to harm others. The client's parents ask a nurse, "Where do the voices come from?" Which response should the nurse make? 1. "Your child has a chemical imbalance of the brain, which leads to altered perceptions." 2. "Your child's hallucinations are caused by medication interactions." 3. "Your child has too little serotonin in the brain, causing delusions and hallucinations." 4. "Your child's abnormal hormonal changes have precipitated auditory hallucinations."

1 The nurse should explain that a chemical imbalance of the brain leads to altered perceptions. The current position on the dopamine hypothesis is that positive symptoms (like command hallucinations) may be related to increased numbers of dopamine receptors in the brain causing an imbalance.

The client diagnosed with schizophrenia spectrum disorder is prescribed an antipsychotic. Which client symptoms, related to the side effects of this medication, should prompt a nurse to intervene immediately? 1. Sore throat and malaise 2. Light-colored urine and bradycardia 3. Anosognosia and avolition 4. Dry mouth and urinary retention

1 The nurse should intervene immediately if the client experiences signs of an infectious process—such as a sore throat, fever, and malaise—when taking antipsychotic drugs.

The client diagnosed with bipolar disorder: manic episode has a goal of gaining 2 lbs. (0.91 kg.) by the end of the week. Which action would the nurse take to achieve this outcome? 1. Provide client with high-calorie finger foods throughout the day. 2. Accompany client to cafeteria to encourage adequate dietary consumption. 3. Initiate total parenteral nutrition to meet dietary needs. 4. Teach the importance of a varied diet to meet nutritional needs.

1 The nurse should provide the client with high-calorie finger foods throughout the day to help the client achieve the outcome of gaining 2 lbs. (0.91 kg.) by the end of the week. Because of the hyperactive state, the client will have difficulty sitting still to consume large meals. Foods and drinks that can be carried around and eaten with little effort will be more effective.

The client is prescribed alprazolam (Xanax) for acute anxiety. Which client finding should cause a nurse to question this order? 1. History of alcohol use disorder 2. History of personality disorder 3. History of schizophrenia 4. History of hypertension

1 The nurse should question a prescription of alprazolam for acute anxiety if the client has a history of alcohol use disorder. Alprazolam is a benzodiazepine used in the treatment of anxiety and has an increased risk for physiological dependence and tolerance. A client with a history of substance use disorder may be more likely to abuse other addictive substances.

A client diagnosed with major depression and substance use disorder has an altered sleep pattern and demands a psychiatrist prescribe a sedative. Which rationale explains why the nurse should encourage the client to first try nonpharmacological interventions? 1. Sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance. 2. Sedative-hypnotics decrease the production of needed liver enzymes. 3. Sedative-hypnotics lengthen necessary REM (rapid eye movement, dream) sleep. 4. Sedative-hypnotics are known not to be as effective in promoting sleep as antidepressant medications.

1 The nurse should recommend nonpharmacological interventions to this client because sedative-hypnotics are potentially addictive, and their effectiveness will be compromised owing to tolerance and cross-tolerance. The effects of central nervous system depressants are additive with one another, capable of producing physiological and psychological addiction.

The client with a myocardial infarction tells the intensive care nurse, "You won't have to care for me pretty soon. I will not be a burden to you or others." Which initial action should the nurse take? 1. Screen the client for suicide 2. Transfer the client to the medical unit 3. Allow the client some private, quiet time 4. Teach the client that he or she will be able to care for himself or herself

1 The nurse should screen the client for suicide as the initial action. Even though the client has a myocardial infarction and not a mental health disorder, the client's statement indicates possible depression and suicide. The nurse must remember that clients in all medical settings may not be forthcoming with thoughts of suicide unless specifically asked.

A lonely, depressed divorcée has been self-medicating with small amounts of cocaine for the past year to feel better. Which term should the nurse use in report to best describe this individual's situation? 1. Psychological addiction 2. Codependence 3. Substance induced disorder 4. Intoxication

1 The nurse should use the term psychological addiction to best describe the client's situation. A client is considered to be psychologically addicted to a substance when there is an overwhelming desire to use a drug in order to produce pleasure (feel better) or avoid discomfort.

The nurse is assessing a client diagnosed with hoarding disorder. Which statement would the nurse expect to hear from the client? 1. "I am a perfectionist." 2. "I get obsessive about cleaning my counter tops." 3. "I donate my clothing to charities." 4. "I prefer to have wide walkways in my home."

1 The nurse would expect the client to say this. Associated symptoms of hoarding disorder include perfectionism, indecisiveness, anxiety, depression, distractibility, and difficulty planning and organizing tasks.

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

1 The priority nursing diagnosis for a client diagnosed with paranoid personality disorder should be risk for violence: directed toward others R/T suspicious thinking. Clients diagnosed with paranoid personality disorder are often tense and irritable, which increases the likelihood of violent behavior. The desire for reprisal and vindication is so intense that a possible loss of control can result in aggression and violence.

Which nursing diagnosis is the priority for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

1 The priority nursing diagnosis for a client experiencing alcohol withdrawal should be risk for injury R/T central nervous system stimulation. Alcohol withdrawal may include the following symptoms: coarse tremors of hands, tongue, or eyelids; nausea or vomiting; malaise or weakness; tachycardia; sweating; elevated blood pressure; anxiety; depressed mood; hallucinations; headache; and insomnia.

The client diagnosed with bipolar disorder intentionally overdoses on antidepressants. Family members report that the client has experienced a relationship break-up, anorexia, and a recent job loss. Which nursing diagnosis is the priority based upon the client's signs and symptoms? 1. Risk for self-directed violence R/T multiple losses 2. Anxiety: severe R/T hyperactivity 3. Imbalanced nutrition: less than body requirements R/T refusal to eat 4. Dysfunctional grieving R/T hopelessness

1 The priority nursing diagnosis for this client should be risk for self-directed violence R/T multiple losses. The nurse should always prioritize client safety. This client is at risk for suicide because of the recent suicide attempt and losses of a relationship and job.

The nursing instructor is teaching about medications used to treat clients diagnosed with panic disorder. Which student statement indicates teaching has been effective? 1. "Clonazepam (Klonopin) is particularly effective in the treatment of panic disorder." 2. "Clonidine (Catapres) is used off-label in long-term treatment of panic disorder." 3. "Atenolol (Tenormin) can be used in low doses to relieve symptoms of panic attacks." 4. "Buspirone (BuSpar) is used for its immediate effect to lower anxiety during panic attacks."

1 The student indicates learning has occurred when he or she states that clonazepam is a particularly effective treatment for panic disorder. Clonazepam is a type of benzodiazepine in which the major risk is physical dependence and tolerance, which may encourage abuse. It can be used on an as-needed basis to reduce anxiety and its related symptoms.

A nurse is assessing a pathological gambler. What would differentiate this client's behaviors from the behaviors of a non-pathological gambler? 1. Pathological gamblers have abnormal levels of neurotransmitters, whereas non-pathological gamblers do not. 2. Pathological gambling occurs more commonly among women, whereas non-pathological gambling occurs more commonly among men. 3. Pathological gambling generally runs an acute course, whereas non-pathological gambling runs a chronic course. 4. Pathological gambling is not related to stress relief, whereas non-pathological gambling is related to stress relief.

1 There is a correlation between pathological gambling and abnormalities in the neurotransmitter, dopamine. This is not the case with non-pathological gambling.

Which statement by the nurse indicates a correct understanding of psychopharmacology for somatic disorders? 1. "Somatization disorders with depression can be treated with selective serotonin reuptake inhibitors." 2. "Anxiety associated with these disorders can be treated long-term with benzodiazepines." 3. "Conversion disorder can be treated with intravenous administration of antidepressants." 4. "First-line treatment for depersonalization-derealization disorder is antianxiety agents."

1 This statement indicates a correct understanding. Psychopharmacology is not effective unless it is being used to treat underlying depression or anxiety. When antidepressant therapy is warranted, selective serotonin reuptake inhibitors are generally preferred.

The nurse is providing discharge teaching to a client about benzodiazepines. Which client statement would indicate a need for further follow-up instructions? 1. "I will need scheduled blood work in order to monitor for toxic levels of this drug." 2. "I won't stop taking this medication abruptly because there could be serious complications." 3. "I will not drink alcohol while taking this medication." 4. "I won't take extra doses of this drug because I can become addicted."

1 This statement indicates a need for additional information about taking benzodiazepines when stating the need for blood work to monitor for toxic levels. Benzodiazepines do not require blood work.

A client is brought to an emergency department by police after threatening to jump off a bridge several hours ago. To assess for suicide potential, which question would a nurse ask first? 1. "Are you currently thinking about harming yourself?" 2. "Why do you want to harm yourself?" 3. "Have you thought about the consequences of your actions?" 4. "Who is your emergency contact person?"

1 The nurse would first assess the client for current harmful or suicidal thoughts to minimize risk of harm to the client and provide appropriate interventions. A suicidal client is experiencing a psychiatric emergency. The crisis team's priority is to assess client safety.

Which nursing statements or questions represent appropriate communication to assess an individual in crisis? (Select all that apply.) 1. "Tell me what happened." 2. "Which coping methods have you used, and did they work?" 3. "Describe to me what your life was like before this happened." 4. "Let's focus on the current problem." 5. "I'll assist you in selecting functional coping strategies."

1, 2, 3 This is an appropriate statement to encourage the client to communicate. This statement enables the client to evaluate current coping strategies for effectiveness. This is an appropriate statement to encourage the client to communicate.

Which of the following interventions would a nurse use when caring for an inpatient client who expresses anger inappropriately? (Select all that apply.) 1. Maintain a calm demeanor. 2. Clearly delineate the consequences of the behavior. 3. Use therapeutic touch to convey empathy. 4. Set limits on the behavior. 5. Teach the client to avoid "I" statements related to expression of feelings.

1, 2, 4

Which of the following are behavior assessment categories in the Broset Violence Checklist? (Select all that apply.) 1. Confusion 2. Paranoia 3. Boisterousness 4. Panic 5. Irritability

1, 3, 5

Place the spectrum of schizophrenic and other psychotic disorders as described by the DSM-5 on a gradient of psychopathology from least to most severe (1-4). (Enter the number of each disorder in the proper sequence, using comma and space format, such as: 1, 2, 3, 4) 1. Delusional disorder 2. Schizophrenia 3. Schizophreniform disorder 4. Substance-induced psychotic disorder

1, 4, 3, 2

The client diagnosed with obsessive-compulsive disorder has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? 1. The client will refrain from ritualistic behaviors during daylight hours. 2. The client will wake early enough to complete rituals prior to breakfast. 3. The client will participate in three unit activities by day three. 4. The client will substitute a productive activity for rituals by day one.

2 An appropriate initial client outcome is for the client to wake early enough to complete rituals prior to breakfast.

The nurse discovers the client purposefully inserted a contaminated catheter into the urethra, leading to a urinary tract infection. The nurse recognizes this behavior as characteristic of which mental disorder? 1. Illness anxiety disorder 2. Factitious disorder 3. Functional neurological symptom disorder 4. Depersonalization-derealization disorder

2 Factitious disorders involve conscious, intentional feigning of physical or psychological symptoms. Individuals with factitious disorder pretend to be ill in order to receive emotional care and support commonly associated with the role of client. Individuals become very inventive in their quest to produce symptoms.

Which finding would alert the nurse that a client is exhibiting selective amnesia? 1. Cannot relate any lifetime memories. 2. Can describe driving to Iowa but cannot remember the car accident that occurred. 3. Can explain abstract concepts. 4. Cannot provide personal demographic information during admission assessment.

2 In selective amnesia, the individual can recall only certain incidents associated with a stressful event for a specific period after the event, like driving to Iowa but not remembering the car accident.

Which premise is basic to the recovery model used to treat clients diagnosed with bipolar disorder? 1. Medication compliance 2. Independent management 3. Total absence of symptoms 4. Improved psychosocial relationships

2 Independent management is a basic premise for the recovery model. The recovery model has been used primarily in caring for individuals with serious mental illness, such as schizophrenia and bipolar disorder. However, concepts of the model are amenable to use with all individuals experiencing emotional conditions with which they require assistance and who have a desire to take control and manage their lives more independently.

Which nursing intervention is appropriate when caring for a client diagnosed with borderline personality disorder? 1. Seclude the client when inappropriate behaviors are exhibited. 2. Rotate staff members who work with the client. 3. Teach about antianxiety medications to improve medication compliance. 4. Offer sympathy when client engages in self-mutilation.

2 Rotate staff members who work with the client in order to avoid client's developing dependence on particular individuals. These interventions are intended to help the individual understand that staff splitting will not be tolerated, and to work toward diminishing clinging and distancing behaviors.

The client diagnosed with antisocial personality disorder spits, curses, and refuses to answer questions during the assessment interview. Which response would the nurse make? 1. "You are very disrespectful. You need to learn to control yourself." 2. "I understand that you are angry, but this behavior will not be tolerated." 3. "What behaviors could you modify to improve this situation?" 4. "Which antipersonality disorder medications have helped you in the past?"

2 The appropriate nursing response is to reflect the client's feeling while setting firm limits on behavior. Clients diagnosed with antisocial personality disorder have a low tolerance for frustration, see themselves as victims, and use projection as a primary ego defense mechanism.

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

2 The behaviors presented in the question represent symptoms of dependent personality disorder. Nurturance provided from one source and discouragement of independent behaviors can contribute to the development of this personality disorder. Dependent behaviors may be rewarded by a parent who is overprotective and discourages autonomy.

A nurse questions the charge nurse about an order for fluvoxamine (Luvox) 300 mg daily in two divided doses for a client diagnosed with obsessive-compulsive disorder (OCD). Which charge nurse response is most accurate? 1. "High doses of tricyclic medications will be required for effective treatment of OCD." 2. "High doses of selective serotonin reuptake inhibitor (SSRI), above what is effective for depression, may be required for OCD." 3. "The dose of Luvox is low because of the side effect of daytime drowsiness." 4. "The dose of this SSRI is outside the therapeutic range and needs to be brought to the psychiatrist's attention."

2 The most accurate charge nurse response is that SSRI doses in excess of what is effective for treating depression may be required in the treatment of OCD. SSRIs have been approved by the Food and Drug Administration for the treatment of OCD. Fluvoxamine is an SSRI.

A son is seeking advice about his mother who seems to worry unnecessarily about everything. The son states, "Should I seek psychiatric help for my mother?" Which is an appropriate nursing response? 1. "My mother also worries unnecessarily. I think it is part of the aging process." 2. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." 3. "From what you have told me, you should get her to a psychiatrist as soon as possible." 4. "Worry and anxiety are complex phenomena and are effectively treated only with psychotropic medications."

2 The most appropriate response by the nurse is to explain to the son that anxiety is considered abnormal when it is out of proportion and impairs functioning. Anxiety is a normal reaction to a realistic danger or threat to biological integrity or self-concept.

Which action would the nurse take to establish a trusting relationship with a client diagnosed with schizophrenia spectrum disorder? 1. Establish personal contact with family members 2. Be reliable, honest, and consistent during interactions 3. Share limited personal information 4. Sit close to the client to establish rapport

2 The nurse can enhance the establishment of a trusting relationship with a client diagnosed with schizophrenia spectrum disorder by being reliable, honest, and consistent during interactions. The nurse should also convey acceptance of the client's needs and maintain a calm attitude.

The client reports taking an herbal remedy to lose weight. The client states, "I'm taking the recommended dose, but it seems like if two capsules are good, four would be better!" Which response would the nurse make? 1. "Herbal medicines are more likely to cause adverse reactions than prescription medications." 2. "Increasing the amount of herbal medicines can lead to overdose and toxicity." 3. "There are no regulations in place for herbal medicines, so ingredients are often unknown." 4. "Certain companies are better than others. Always buy a reputable brand of herbal medicine."

2 The nurse should advise the client that increasing the amount of herbal preparations can lead to overdose and toxicity. The notion that something designated as being "natural" means that it is completely safe is a myth.

The nurse is working in a long-term care facility. Which action by the nurse demonstrates attention to a priority issue for screening for all clients in the facility? 1. Performing crisis intervention 2. Assessing a client for trauma 3. Determining presence of hallucinations 4. Monitoring for anxiety disorders

2 The nurse should assess for trauma. Three of the most important issue to screen for are trauma, suicide risk, and substance use disorders.

Which nursing diagnosis is the priority for a client experiencing alcohol withdrawal? 1. Risk for injury R/T central nervous system stimulation 2. Disturbed thought processes R/T tactile hallucinations 3. Ineffective coping R/T powerlessness over alcohol use 4. Ineffective denial R/T continued alcohol use despite negative consequences

2 The nurse should assess the client for substance addiction, because clients who are addicted to alcohol or benzodiazepines may have developed cross-tolerance to analgesics and require increased doses to achieve effective pain control. Cross-tolerance is exhibited when one drug results in a lessened response to another drug.

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

2 The nurse should associate schizotypal personality disorder with this behavior. Magical thinking, ideas of reference, illusions, and depersonalization are part of their everyday world. Examples include superstitiousness; belief in clairvoyance, telepathy, or "sixth sense"; and beliefs that "others can feel my feelings."

Which outcome would the nurse add to the plan of care for an inpatient client diagnosed with somatic symptom disorder (SSD)? 1. The client will admit to fabricating physical symptoms to gain benefits by day three. 2. The client will list three potential adaptive coping strategies to deal with stress by day two. 3. The client will identify the connection between function loss and severe stress by day three. 4. The client will maintain a sense of reality during stressful situations by day four.

2 The nurse should determine that an appropriate outcome for a client diagnosed with SSD would be for the client to list three potential adaptive coping strategies to deal with stress by day two.

The nurse is teaching staff about clients diagnosed with histrionic personality disorder and the quality of their relationships. Which statement made by a staff member indicates learning has occurred? 1. "Their dramatic style tends to make their interpersonal relationships interesting and fulfilling." 2. "Their interpersonal relationships tend to be shallow and fleeting, serving their dependency needs." 3. "They tend to develop few relationships because they are strongly independent but generally maintain deep affection." 4. "They pay particular attention to details, which can interfere with the development of relationships."

2 The nurse should evaluate that learning has occurred when the staff member describes clients diagnosed with histrionic personality disorder as having relationships that are shallow and fleeting. These types of relationships tend to serve their dependency needs.

A nurse is reviewing the stat laboratory data of a client in the emergency department. At what minimum blood alcohol level should a nurse expect intoxication to occur? 1. 50 mg/dL 2. 100 mg/dL 3. 250 mg/dL 4. 300 mg/dL

2 The nurse should expect that 100 mg/dL is the minimum blood alcohol level at which intoxication occurs. Intoxication usually occurs between 100 and 200 mg/dL.

When planning care for a client diagnosed with borderline personality disorder, which self-harm behavior should a nurse expect the client to exhibit? 1. Highly lethal methods to commit suicide 2. Suicidal gestures to elicit a rescue response from others 3. Isolation and starvation as suicidal methods 4. Self-mutilation from decreased endorphins in the body

2 The nurse should expect that a client diagnosed with borderline personality disorder may use suicidal gestures to elicit a rescue response from others. Repetitive, self-mutilating behaviors are common in borderline personality disorders that result from feelings of abandonment following separation from significant others.

Which client is most likely to be admitted to an inpatient facility for self-destructive behaviors? 1. One with antisocial personality disorder 2. One with borderline personality disorder 3. One with schizoid personality disorder 4. One with paranoid personality disorder

2 The nurse should expect that a client diagnosed with borderline personality disorder would most likely be admitted to an inpatient facility for self-destructive behaviors. The behavior of clients with borderline personality disorder is unstable, and hospitalization is often required as a result of attempts at self-injury, persistent suicide risk, substance abuse and dependence, or a combination of these behaviors.

The client questions the nurse about therapeutic touch. Which nursing response best explains the goal of this therapy? 1. "This enhances circulation to the body by deep, circular massage." 2. "This re-patterns the body's energy field by the use of rhythmic hand motions." 3. "This improves breathing by increasing oxygen to the brain and body tissues." 4. "This decreases blood pressure by releasing body toxins."

2 The nurse should explain that the goal of the practice of therapeutic touch is to re-pattern the body's energy field by the use of rhythmic hand motions. Therapeutic touch is based on the philosophy that the human body projects fields of energy that become blocked when pain or illness occurs. These energy fields extend beyond the surface of the body, meaning the practitioner need not actually touch the client's skin. Instead, the therapist's hands are passed over the client's body, remaining 2 to 4 inches from the skin.

The client diagnosed with bipolar disorder is distraught over insomnia experienced over the last 2 nights and a 13-lb. (5.9 kg.) weight loss over the past 2 weeks. Which nursing diagnosis is priority? 1. Knowledge deficit R/T bipolar disorder 2. Imbalanced nutrition: less than body requirements R/T hyperactivity 3. Risk for suicide R/T powerlessness 4. Altered sleep patterns R/T mania

2 The nurse should identify that the priority nursing diagnosis for this client is altered nutrition: less than body requirements R/T hyperactivity. Because of the client's rapid weight loss, the nurse should prioritize interventions to ensure proper nutrition and physical health.

A client with schizophrenia spectrum disorder presents with bizarre behaviors and delusions. Which nursing action should be prioritized to maintain this client's safety? 1. Monitor for medication nonadherence. 2. Note escalating behaviors immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors.

2 The nurse should note escalating behaviors immediately, to maintain this client's safety. Early intervention may prevent an aggressive response and keep the client and others safe.

A client with a history of alcohol use disorder is brought to an emergency department (ED) by family members who state that the client has had nothing to drink in the last 48 hours. When the nurse reports to the ED physician, which client sign or symptom should be the nurse's first priority? 1. Hearing and visual impairment 2. Blood pressure of 180/100 mm Hg 3. Mood rating of 2/10 on numeric scale 4. Dehydration

2 The nurse should recognize that high blood pressure is a symptom of alcohol withdrawal syndrome and should promptly report this finding to the physician. Complications associated with alcohol withdrawal syndrome may progress to alcohol withdrawal delirium in about the second or third day following cessation of prolonged alcohol use.

The nurse is caring for a client with schizophrenia spectrum disorder who is experiencing a flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which statement correctly differentiates the client's positive and negative symptoms of schizophrenia? 1. Paranoid delusions, anhedonia, and anergia are positive symptoms of schizophrenia. 2. Paranoid delusions, neologisms, and echolalia are positive symptoms of schizophrenia. 3. Paranoid delusions, anergia, and echolalia are negative symptoms of schizophrenia. 4. Paranoid delusions, flat affect, and anhedonia are negative symptoms of schizophrenia.

2 The nurse should recognize that positive symptoms of schizophrenia include, but are not limited to, paranoid delusions, neologisms, and echolalia.

The nurse in the emergency department (ED) is assessing a client who with a long history of depression. The nurse finds that the client has gained weight, has dry skin, and has cold sensitivity. The nurse determines the client's depression is exacerbating, further examination and testing reveal the client has hypothyroidism. Which phenomenon occurred? 1. Depression screening 2. Social distancing 3. Trauma-informed caring 4. Diagnostic overshadowing

2 The nurse should refer the client to a psychiatrist. Psychiatrists provide diagnostic, medication management, and counseling services to clients.

Which information would the nurse include in a teaching session about alternative therapies? 1. These therapies view all humans as being biologically similar. 2. These therapies view a person as a combination of multiple, integrated elements. 3. These therapies focus primarily on the structure and functions of the body. 4. These therapies focus on disease from a purely scientific method perspective.

2 The nurse should understand that alternative therapies view a person as a combination of multiple, integrated elements.

A client has been diagnosed with major depressive episode. After treatment with an antidepressant, the client exhibits pressured speech and flight of ideas. Based on this symptom change, which information should the nurse share with the health-care provider? 1. Ask to increase the dosage of the antidepressant. 2. Ask that the client be reevaluated. 3. Ask to order benztropine (Cogentin) for the extrapyramidal symptoms. 4. Ask that another class of antidepressants be used.

2 The nurse would ask the health-care provider to reevaluate the client because the client switched from depression to mania. Antidepressants carry as high as a 40% risk of potentially triggering a switch from depression to mania in individuals with bipolar disorder. A full manic episode that emerges during antidepressant treatment (e.g., medication, electroconvulsive therapy) but persists beyond the physiological effect of that treatment is sufficient evidence for a manic episode and, therefore, a Bipolar I diagnosis.

An inpatient client with a known history of violence suddenly begins to pace. Which additional client behavior would alert a nurse to escalating anger and aggression? 1. The client requests prn medications. 2. The client has a tense facial expression. 3. The client refuses to eat lunch. 4. The client sits in group with back to peers.

2 The nurse would assess that tense facial expressions may indicate that a client's anger is escalating.

The client diagnosed with borderline personality disorder brings up a conflict with the staff in a community meeting and develops a following of clients who unreasonably demand modification of unit rules. How can the nursing staff best handle this situation? 1. Allow the clients to apply the autocratic process when developing unit rules. 2. Maintain consistency of care and open communication to avoid staff manipulation. 3. Allow the client spokesman to verbalize concerns during a unit staff meeting. 4. Maintain unit order by the application of punitive leadership.

2 The nursing staff can best handle this situation by maintaining consistency of care by open communication to avoid staff manipulation. Clients with borderline personality disorder can exhibit negative patterns of interaction, such as clinging and distancing, splitting, manipulation, and self-destructive behaviors.

Which client assessment finding would alert the nurse to question a diagnosis of brief psychotic disorder? 1. Has impaired reality testing for a 24-hour period. 2. Has auditory hallucinations for the past 3 hours. 3. Has bizarre behavior for 1 day. 4. Has confusion for 3 weeks.

2 This disorder is identified by the sudden onset of psychotic symptoms that may or may not be preceded by a severe psychosocial stressor. These symptoms last at least 1 day but less than 1 month and there is an eventual full return to the premorbid level of functioning.

The nurse is preparing a presentation about the onset of symptoms for agoraphobia. Which information should the nurse include in the teaching session? 1. Occurs in early adolescence and persists until midlife 2. Occurs in the 20s and 30s and persists for many years 3. Occurs in the 40s and 50s and persists until death 4. Occurs after the age of 60 and persists for at least 6 years

2 This information should be included in the teaching session. The onset of the symptoms of agoraphobia most commonly occurs in the 20s and 30s and persists for many years.

The nurse is teaching the staff about specific phobias. Which statement from a staff member indicates teaching has been effective? 1. "These clients recognize their fear as excessive and frequently seek treatment." 2. "These clients have a panic level of fear that is overwhelming and unreasonable." 3. "These clients experience symptoms that mirror a cerebrovascular accident." 4. "These clients exhibit symptoms of tachycardia, dysphagia, and diaphoresis."

2 This statement indicates successful teaching. Individuals with specific phobias have a panic level of fear that is overwhelming and unreasonable. Phobia is fear cued by a specific object or situation in which exposure to the stimuli produces an immediate anxiety response.

The client with bipolar disorder refuses to take lithium carbonate (Lithobid) because of excessive weight gain. In order to increase adherence, which anticonvulsant medication should the nurse be prepared to administer? 1. Sertraline (Zoloft) 2. Valproic acid (Depakote) 3. Verapamil (Calan) 4. Lurasidone (Latuda)

2 Valproic acid is an anticonvulsant that helps stabilize mood. Anticonvulsant drugs used either alone or in combination with lithium have produced satisfactory results in stabilizing moods in bipolar disorder.

A despondent client who has recently lost her husband of 30 years tearfully states, "I'll feel a lot better if I sell my house and move away." Which nursing response is most appropriate? 1. "I'm confident you know what's best for you." 2. "This may not be the best time for you to make such an important decision." 3. "Your children will be terribly disappointed." 4. "Tell me why you want to make this change."

2 During crisis intervention, the nurse would guide the client through a problem-solving process. The nurse would help the individual confront the source of the problem, encourage the individual to discuss changes he or she would like to make, and encourage exploration of feelings about aspects of the crisis that cannot be changed.

A wife brings her husband to an emergency department (ED) after an attempt to hang himself. He is a full-time student and works 8 hours at night to support his family. He states, "I can't function any longer under all this stress." Which type of crisis is the client experiencing? 1. Maturational/developmental crisis 2. Psychiatric emergency crisis 3. Anticipated life transition crisis 4. Traumatic stress crisis

2 The nurse would determine that the client is experiencing a psychiatric emergency crisis. Psychiatric emergencies occur when crisis situations result in severe impairment, incompetence, or an inability to assume personal responsibility.

Which client response would reflect the impulsive self-destructive behavior that is commonly associated with borderline personality disorder when the day-shift nurse leaves the unit? 1. The client suddenly leans on the nurse's arm and whispers, "The night nurse is evil. You have to stay." 2. The client suddenly hugs the nurse's arm and states, "I will be up all night if you don't stay with me." 3. The client suddenly grabs the nurse's arm, yelling, "Please don't go! I can't sleep without you being here." 4. The client suddenly shows the nurse a bloody arm and states, "I cut myself because you are leaving me."

4 The client who states, "I cut myself because you are leaving me," reflects impulsive self-destructive behavior that is commonly associated with borderline personality disorder. Repetitive, self-mutilating behaviors are common in clients diagnosed with borderline personality disorders that result from feelings of abandonment following separation from significant others.

Which nursing intervention would be most appropriate when caring for an agitated, suspicious client diagnosed with schizophrenia spectrum disorder? 1. Supply neon lights and soft music. 2. Maintain continual eye contact throughout the interview. 3. Use therapeutic touch to increase trust and rapport. 4. Provide personal space to respect the client's boundaries.

4 The most appropriate nursing intervention is to provide personal space to respect the client's boundaries. Providing personal space may serve to reduce anxiety and thus reduce the client's risk for violence. The nurse should observe the client while carrying out routine tasks.

The nurse asks the client with schizophrenia spectrum disorder, "Do you receive special messages from certain sources, such as the television or radio?" The nurse is assessing which potential symptom of this disorder? 1. Loose associations 2. Paranoid delusions 3. Magical thinking 4. Delusions of reference

4 The nurse is assessing for the potential symptom of delusions of reference. A client who believes he or she receives messages through the radio or TV is experiencing delusions of reference. These delusions involve the client interpreting events within the environment as being directed toward himself or herself. Clients with delusions of reference believe that others are trying to send them messages in various ways, or they must break a code to receive a message.

The nurse holds the hand of a client who is experiencing alcohol withdrawal. The nurse is assessing for which condition? 1. Emotional strength 2. Wernicke-Korsakoff syndrome 3. Tachycardia 4. Coarse tremors

4 The nurse is most likely assessing the client for coarse tremors secondary to alcohol withdrawal. Withdrawal from alcohol can also cause headache, insomnia, transient hallucinations, depression, irritability, anxiety, elevated blood pressure, sweating, tachycardia, malaise, and coarse tremors.

The nurse is caring for a client diagnosed with dissociative identity disorder (DID). What is the primary goal of therapy for this client? 1. To recover memories while improving thinking patterns 2. To prevent social isolation 3. To decrease anxiety and need for secondary gain 4. To collaborate among subpersonalities to improve functioning

4 The nurse should anticipate that the primary therapeutic goal for a client diagnosed with DID is to collaborate among subpersonalities to improve functioning. Some clients choose to pursue a lengthy therapeutic regimen to achieve integration, a blending of all the personalities into one. The goal is to optimize the client's functioning and potential.

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

4 The nurse should assess that a client who states that he or she is getting a message from beyond indicates a potential diagnosis of schizotypal personality disorder. The person experiences magical thinking, ideas of reference, illusions, and depersonalization as part of daily life. Examples include superstitiousness; belief in clairvoyance; telepathy, or "sixth sense"; and beliefs that "others can feel my feelings."

Which client statement indicates a knowledge deficit related to a substance use disorder? 1. "Although it's legal, alcohol is one of the most widely abused drugs in our society." 2. "Tolerance to heroin develops quickly." 3. "Flashbacks from lysergic acid diethylamide (LSD) use may reoccur spontaneously." 4. "Marijuana is like smoking cigarettes. Everyone does it. It's essentially harmless."

4 The nurse should determine that the client has a knowledge deficit related to substance use disorders when the client compares marijuana to smoking cigarettes and claims it to be harmless. The evidence of research indicates that smoked marijuana is harmful.

The client is newly diagnosed with obsessive-compulsive disorder and spends 50 minutes folding clothes and rearranging them in drawers. Which nursing action would best address this client's problem? 1. Distract the client with other activities whenever ritual behaviors begin. 2. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. 3. Lock the room to discourage ritualistic behavior. 4. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.

4 The nurse should discuss with the client the anxiety-provoking triggers that precipitate the ritualistic behavior. If the client is going to be able to control interrupting anxiety, he or she must first learn to recognize precipitating factors.

The client asks a nurse to explain the difference between alternative and complementary medicine. Which is an appropriate nursing response? 1. "Alternative medicine is a more acceptable practice than complementary medicine." 2. "Alternative and complementary medicine are terms that essentially mean the same thing." 3. "Complementary medicine disregards traditional medical approaches." 4. "Complementary therapies partner alternative approaches with traditional medical practice."

4 The nurse should explain to the client that complementary therapies partner alternative approaches with traditional medicine. About 34 percent of adults in the US use some form of complementary or alternative therapy.

The health-care provider prescribes lithium carbonate (Eskalith) and olanzapine (Zyprexa) for a client with severe manic episodes. The client's spouse asks the nurse how Zyprexa works. Which response would the nurse make? 1. "Zyprexa in combination with Eskalith cures bipolar disorder symptoms." 2. "Zyprexa prevents extrapyramidal side effects." 3. "Zyprexa increases the effectiveness of the immune system." 4. "Zyprexa calms the agitation associated with mania."

4 The nurse should explain to the client's spouse that olanzapine can calm agitation associated with mania.

Which are examples of primary and secondary gains that a client diagnosed with SSD: predominately pain, may experience? 1. Primary: chooses to seek a new health-care provider; Secondary: euphoric feeling from new medications 2. Primary: euphoric feeling from new medications; Secondary: chooses to seek a new health-care provider 3. Primary: receives get-well cards; Secondary: pain prevents attending stressful family reunion 4. Primary: pain prevents attending stressful family reunion; Secondary: receives get-well cards

4 The nurse should identify that primary gains are those that allow the client to avoid an unpleasant activity (stressful family reunion) and that secondary gains are those in which the client receives emotional support or attention (get-well cards).

The client taking lithium carbonate (Lithobid) presents to an emergency department with a temperature of 101°F (38°C), severe diarrhea, blurred vision, and tinnitus. Which interpretation should the nurse make regarding these symptoms? 1. Symptoms indicate spending too much time outdoors without sunblock. 2. Symptoms indicate antipsychotic withdrawal syndrome. 3. Symptoms indicate the development of neutropenia. 4. Symptoms indicate lithium carbonate toxicity.

4 The nurse should interpret that the client's symptoms indicate lithium carbonate toxicity. The signs and symptoms of toxicity include ataxia, blurred vision, severe diarrhea, persistent nausea and vomiting, and tinnitus. Lithium levels should be monitored monthly with maintenance therapy to ensure therapeutic blood levels.

Which guideline should the nurse use to help differentiate a client diagnosed with panic disorder from a client diagnosed with generalized anxiety disorder (GAD)? 1. GAD is acute in nature, and panic disorder is chronic. 2. Chest pain is a common GAD symptom, whereas this symptom is absent in panic disorders. 3. Depression is a common symptom in GAD and rare in panic disorder. 4. Depersonalization is absent in GAD but is commonly seen in panic disorder.

4 The nurse should recognize that a client diagnosed with panic disorder experiences depersonalization, whereas a client diagnosed with GAD would not. Depersonalization refers to being detached from oneself when experiencing extreme anxiety.

A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in an emergency department reveals no pathology. Which nursing diagnosis should be the nurse's first priority? 1. Fear 2. Powerlessness 3. Altered role performance 4. Anxiety

4 The nurse should suspect that the client has exhibited signs and symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden-onset panic attacks in which the person feels intense fear, apprehension, or terror.

The nurse is teaching about the etiology of illness anxiety disorder (IAD) from a psychodynamic perspective. Which statement by a staff member about clients diagnosed with this disorder indicates that learning has occurred? 1. "When there is a familial predisposition to this disorder, they may develop this disorder." 2. "When the sick role relieves them from stressful situations, their physical symptoms are reinforced." 3. "They misinterpret and cognitively distort their physical symptoms." 4. "They express personal worthlessness through physical symptoms, because physical problems are more acceptable than psychological problems."

4 The nurse should understand that from a psychodynamic perspective, IAD occurs because physical problems are more acceptable than psychological problems.

The nurse in the emergency department (ED) is assessing a client who with a long history of depression. The nurse finds that the client has gained weight, has dry skin, and has cold sensitivity. The nurse determines the client's depression is exacerbating, further examination and testing reveal the client has hypothyroidism. Which phenomenon occurred? 1. Depression screening 2. Social distancing 3. Trauma-informed caring 4. Diagnostic overshadowing

4 The nurse used diagnostic overshadowing, a phenomenon in which clients' physical symptoms are attributed to their mental illness. The nurse attributed the weight gain, dry skin, and cold sensitivity to the depression rather than to hypothyroidism.

Which medications would the nurse most likely administer to a client who has a history of opiate withdrawal? 1. Haloperidol (Haldol) and acamprosate (Campral) 2. Naloxone (Narcan) and naltrexone (ReVia) 3. Disulfiram (Antabuse) and lorazepam (Ativan) 4. Methadone (Dolophine) and clonidine (Catapres)

4 The nurse would administer methadone and clonidine for a client who has a history of opiate withdrawal. As the dose of methadone diminishes, renewed abstinence symptoms may be ameliorated by the addition of clonidine.

Which describes the rationale for holding a debriefing session with clients and staff after a take-down intervention has taken place in an inpatient unit? 1. Reinforce unit rules with the client population. 2. Create protocols for the future release of tensions associated with anger. 3. Process client feelings and alleviate fears of undeserved seclusion and restraint. 4. Discuss the situation that led to inappropriate expressions of anger.

4 The nurse would determine that the purpose for holding a debriefing session with clients and staff after a take-down intervention is to discuss the situation that led to inappropriate behavior. It is important to determine the factors leading to the inappropriate behavior in order to develop future intervention strategies. It is also important to help clients and staff process feelings about the situation.

A new mother is concerned about her ability to perform her parental role. She is quite anxious and ambivalent about leaving the postpartum unit. To offer effective client care, a nurse would note that this type of crisis is precipitated by 1. Unexpected external stressors. 2. Preexisting psychopathology. 3. An acute response to an external situational stressor. 4. Normal life-cycle transitions that overwhelm the client.

4 The nurse would understand that this type of crisis is precipitated by normal life-cycle transitions that overwhelm the client. Reassurance and guidance would be provided as needed, and the client should be referred to services that can provide assistance.

Which statements reflect current attitudes toward complementary and alternative therapies? (Select all that apply.) 1. Some health insurance companies are beginning to cover treatments such as acupuncture and massage therapy. 2. The majority of third-party payers do not cover chiropractic client treatments. 3. A large number of U.S. medical schools, among them Harvard and Yale, now offer coursework in holistic methods. 4. The American Medical Association supports the inclusion of complementary and alternative medicine in medical education. 5. Interest in dietary supplements is decreasing worldwide.

ANS: 1, 3, 4

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

ANS: 1, 3, 4, 5

The nurse is caring for a client diagnosed with generalized anxiety disorder. Which activities would the nurse encourage for this client? (Select all that apply.) 1. Recognize the signs of escalating anxiety. 2. Avoid any situation that causes stress. 3. Employ newly learned relaxation techniques. 4. Cognitively reframe thoughts about situations that generate anxiety. 5. Avoid caffeinated products.

ANS: 1, 3, 4, 5

A nurse is about to meet with a client suffering from codependency. Which data would the nurse expect to find during the assessment of this client? (Select all that apply.) 1. Has a long history of focusing thoughts and behaviors on other people 2. As a child, experienced overindulgent and overprotective parents 3. Is a people pleaser and does almost anything to gain approval 4. Exhibits helpless behaviors but actually feels very competent 5. Can achieve a sense of control through fulfilling the needs of others

ANS: 1, 3, 5

A nursing supervisor is offering an impaired staff member information regarding a peer assistance program. Which facts should the supervisor include? (Select all that apply.) 1. A hot-line number will be available in order to call for help. 2. A verbal contract detailing the method of treatment will be initiated prior to the program. 3. Peer support is provided through regular contact with the impaired nurse. 4. Contact to provide peer support will last for one year. 5. One of the program goals is to intervene early in order to reduce hazards to clients.

ANS: 1, 3, 5

The client is diagnosed with illness anxiety disorder (IAD). Which symptoms would the client most likely exhibit? (Select all that apply.) 1. Doctor shopping 2. Pseudocyesis 3. Anxiety 4. Flat affect 5. Avoids hospitals

ANS: 1, 3, 5

The client is exhibiting symptoms of generalized amnesia. Which questions should the nurse ask to help confirm this diagnosis? (Select all that apply.) 1. "Have you taken any new medications recently?" 2. "Have you recently traveled away from home?" 3. "Have you recently experienced any traumatic event?" 4. "Have you ever felt detached from your environment?" 5. "Have you had any history of memory problems?"

ANS: 1, 3, 5

The nurse is admitting a client with a diagnosis of schizotypal personality disorder. Which client findings would make the nurse question this diagnosis? (Select all that apply.) 1. Is the center of attention 2. Has unusual perceptual experiences 3. Has a bipolar disorder 4. Is odd and eccentric but not delusional 5. Has autism spectrum disorder

ANS: 1, 3, 5

Which practices should a nurse describe to a client as being incorporated during yoga therapy? (Select all that apply.) 1. Deep breathing 2. Meridian flow 3. Balanced body postures 4. Massage 5. Meditation

ANS: 1, 3, 5

An older adult client has a diagnosis of dysthymic disorder. Which signs and symptoms should the nurse expect the client to exhibit? (Select all that apply.) 1. Sad mood on most days 2. Mood rating of 2 out of 10 for the past 6 months 3. Labile mood 4. Sad mood for the past 3 years after spouse's death 5. Pressured speech when communicating

ANS: 1, 4

The client has been diagnosed with generalized anxiety disorder (GAD). Which symptoms would the nurse observe upon assessment? (Select all that apply.) 1. Muscle tension 2. Paresthesia 3. Hyperventilation 4. Restlessness 5. Procrastination

ANS: 1, 4, 5

Which guidelines from the U.S. Departments of Agriculture and Health and Human Services would the nurse use to promote health and prevent disease in clients? (Select all that apply.) 1. Consume less than 300 mg per day of dietary cholesterol. 2. Limit total calorie intake to 2,000 calories per day. 3. Reduce daily sodium intake to 3,000 mg per day. 4. Consume less than 10 percent of calories from saturated fatty acids. 5. Limit alcohol consumption to one drink per day for women and two drinks per day for men.

ANS: 1, 4, 5

After 5 months of taking nortriptyline (Aventyl) for depressive symptoms, a client reports that the medication doesn't seem as effective as before. Which question should the nurse ask to determine the cause of this problem? 1. "Are you consuming foods high in tyramine?" 2. "How many packs of cigarettes do you smoke daily?" 3. "Do you drink any alcohol?" 4. "When did you last eat yogurt?"

ANS: 2

The depressed client is receiving light therapy. Which instruction would the nurse share with the client? 1. "White LED lights will be used with protective glasses to block ultraviolet rays." 2. "You will sit in front of the light box with your eyes open." 3. "The light sessions will start out at 5 minutes and work up to 30 minute intervals." 4. "Vagal stimulation from the light waves will help release melatonin in the brain."

ANS: 2

The nurse is caring for a client with a postpartum emotional disorder. Which postpartum disorder is correctly matched with its presenting symptoms? 1. Baby blues (lack of concentration, agitation, guilt, and an abnormal attitude toward bodily functions) 2. Moderate postpartum depression (irritability, loss of libido, sleep disturbances, expresses concern about inability to care for baby) 3. Maternity blues (overprotection of infant, severe guilt, depressed mood, lack of concentration) 4. Postpartum depression with psychotic features (transient depressed mood, decisive, abnormal fear of child abduction, suicidal ideations)

ANS: 2

The nurse is caring for a client with major depressive disorder who is withdrawn, uncommunicative, and secludes self in room. Which nursing diagnosis should the nurse add to the plan of care? 1. Spiritual distress 2. Social isolation 3. Low self-esteem 4. Powerlessness

ANS: 2

The nurse is teaching the depressed client about bupropion (Wellbutrin). Which statement by the client indicates effective teaching? 1. "I will begin to wear short sleeves when outdoors." 2. "I will not take two pills if I miss a dose." 3. "I will discontinue the medication when my depression is gone." 4. "I will stand up smoothly and quickly to keep my balance."

ANS: 2

The nurse performs a full physical health assessment on an older adult client admitted with a diagnosis of major depressive disorder. What is the rationale for the nurse's assessment? 1. The attention during the assessment is beneficial in decreasing social isolation in the elderly. 2. Depression can generate somatic symptoms that can mask actual physical disorders. 3. Physical health complications are likely to arise from antidepressant therapy. 4. Depressed geriatric clients avoid addressing physical health and ignore medical problems.

ANS: 2

Which characteristic would help a nurse distinguish between dysthymia and major depressive disorder (MDD)? 1. Dysthymia is associated with the menstrual cycle. 2. Dysthymia is a chronically depressed mood. 3. MDD lasts for at least 2 years. 4. MDD does not have delusions or hallucinations.

ANS: 2

Which scale would a nurse practitioner use to assess a depressed client? 1. Zung Depression Scale 2. Hamilton Depression Rating Scale 3. Beck Depression Inventory 4. AIMS Depression Rating Scale

ANS: 2

The client who prefers to use St. John's wort and psychotherapy in lieu of medication therapy asks for tips on using St. John's wort. Which teaching points should the nurse provide? (Select all that apply.) 1. Select a reputable brand that provides 1200 mg/day. 2. Take with food to lessen the GI irritation. 3. Monitor for adverse reactions. 4. Do not take with an anticoagulant. 5. Stay in the sun for at least 30 minutes.

ANS: 2, 3

The nurse is discussing treatment options with a client who has arachnophobia. Which commonly used behavioral therapies for phobias should the nurse explain to the client? (Select all that apply.) 1. Benzodiazepine therapy 2. Systematic desensitization 3. Imploding (flooding) 4. Competing response training 5. Habit reversal training

ANS: 2, 3

A nursing supervisor is about to meet with a staff nurse suspected of diverting clients' pain medications. Which assessment data would lead the supervisor to suspect that the staff nurse is impaired? (Select all that apply.) 1. Is frequently absent from work 2. Experiences mood swings 3. Makes elaborate excuses for behavior 4. Frequently uses the restroom 5. Has a flushed face

ANS: 2, 3, 4, 5

The client experiences sadness and melancholia in September continuing through November. Which factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) 1. Gender differences in social opportunities 2. Increased production of melatonin 3. Hyposecretion of cortisol 4. Less exposure to natural sunlight 5. Blockade of histamine reuptake

ANS: 2, 4

A nursing instructor is teaching nursing students about cirrhosis of the liver. Which statements by nursing students about hepatic encephalopathy indicate successful teaching? (Select all that apply.) 1. "A diet rich in protein will promote hepatic healing." 2. "This condition results from a rise in serum ammonia, leading to impaired mental functioning." 3. "In this condition, an excessive amount of serous fluid accumulates in the abdominal cavity." 4. "Neomycin and lactulose are used in the treatment of this condition." 5. "This condition is caused by the inability of the liver to convert ammonia to urea."

ANS: 2, 4, 5

A client is prescribed transdermal selegiline (Emsam) for depressive symptoms. Which action would the nurse take to administer this medication? 1. Apply new patch to the lower abdomen. 2. Apply new patch to inner surface of upper arm. 3. Place new patch on dry, intact skin. 4. Place direct heat to new patch for a tight seal.

ANS: 3

The client with major depressive episode is experiencing command hallucination for self-harm. Which intervention should be the nurse's priority at this time? 1. Obtaining an order for locked seclusion until client is no longer suicidal 2. Conducting 15-minute checks to ensure safety 3. Placing the client on one-to-one observation while continuing to monitor suicidal ideations 4. Encouraging client to express feelings related to suicide

ANS: 3

The nurse assesses a client with major depressive disorder. Which assessment finding would the nurse observe? 1. Sadness subsides quickly 2. Promiscuous behaviors 3. Unable to feel any pleasure 4. Excessive spending sprees

ANS: 3

The nurse discovers a client has a history of divorce, job loss, family estrangement, and cocaine abuse. Which theory explains the etiology of this client's depressive symptoms? 1. Psychoanalytic theory 2. Object loss theory 3. Learning theory 4. Cognitive theory

ANS: 3

The nurse is assisting with electroconvulsive therapy (ECT). What is the rationale for administering 100% oxygen to a client during and after ECT? 1. To prevent brain damage from the electrical impulse of the procedure 2. To prevent decreased blood pressure, pulse, and respiration owing to electrical stimulation 3. To prevent anoxia resulting from medication-induced paralysis of respiratory muscles 4. To prevent blocked airway, resulting from seizure activity

ANS: 3

A client is taking phenelzine (Nardil). Which statement by the client should cause the nurse to intervene? 1. "I cannot use over-the-counter medications for my colds." 2. "I have to cut out eating my raisin bran every morning." 3. "I will have to avoid pepperoni pizza when eating with my friends." 4. "I am taking diet pills to lose weight for my friend's wedding."

ANS: 4

The nurse determines that a depressed client is using the cognitive distortion of "automatic thoughts." Which client statement is evidence of the "automatic thought" of discounting positives? 1. "It's all my fault for trusting him." 2. "I don't play games. I never win." 3. "She never visits, because she thinks I don't care." 4. "Growing plants is so easy. Any old fool can grow a rose."

ANS: 4

The nurse is preparing an antidepressant medication for a 13-year-old client who is experiencing major depressive disorder. Which FDA-approved medication should the nurse administer? 1. Paroxetine (Paxil) 2. Sertraline (Zoloft) 3. Citalopram (Celexa) 4. Escitalopram (Lexapro)

ANS: 4

Which highest priority outcome would the nurse add to the plan of care for a depressed client? 1. The client will promise to remain safe. 2. The client will discuss feelings with staff and family by day three. 3. The client will establish a trusting relationship with the nurse. 4. The client will not harm self during hospital stay.

ANS: 4 The nurse's highest priority should be that the client will not harm self during the hospital stay. Client safety should always be the nurse's highest priority.

The nurse is assessing a teenaged client diagnosed with cyclothymic disorder. Which DSM-5 diagnostic criteria would the nurse expect this client to meet? (Select all that apply.) 1. Symptoms lasting for a minimum of two years 2. Numerous periods with manic symptoms 3. Possible comorbid diagnosis of a delusional disorder 4. Symptoms cause clinically significant impairment in important areas of functioning 5. Depressive symptoms that do not meet the criteria for major depressive episode

ANS: 4, 5

Which information should the nurse include when teaching parents who have children or adolescents with symptoms of bipolar disorder? (Select all that apply.) 1. First-line treatment is a second-generation antipsychotic. 2. In children and adolescents with bipolar disorder there is a high risk of relapse. 3. There is a direct link between development of bipolar disorder and attention deficit/hyperactivity disorder. 4. The diagnosis of bipolar disorder cannot be assigned prior to the age of 18. 5. Genetic predisposition is not a reliable diagnostic determinant.

ANS: 1, 2

The nurse is teaching about the diagnosis disruptive mood dysregulation disorder (DMDD). Which information should the nurse include? (Select all that apply.) 1. Symptoms include verbal rages or physical aggression toward people or property. 2. Temper outbursts must be present in at least two settings (at home, at school, or with peers). 3. DMDD is characterized by severe recurrent temper outbursts. 4. The temper outbursts are manifested only behaviorally. 5. Symptoms of DMDD must be present for 18 or more months to meet diagnostic criteria.

ANS: 1, 2, 3

Which information would the nurse include in a teaching session about predisposing factors in the development of bipolar disorder, mania episode? (Select all that apply.) 1. There are excessive levels of glutamate. 2. Mania has greater right-side reduction in brain activity. 3. Steroids are the most common medication to trigger a manic response. 4. Expression of gene ANK3 is decreased in manic episodes. 5. Dopamine levels are decreased in mania.

ANS: 1, 2, 3

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

ANS: 1, 2, 3

The clinic nurse is caring for a client with ulcerative colitis who has signs of depression. Which additional conditions should the nurse assess for in this client? (Select all that apply.) 1. Mania 2. Cardiovascular disease 3. Metabolic syndrome 4. Diabetes 5. Emphysema

ANS: 1, 2, 3, 4

The diagnosis of catatonic disorder due to another medical condition is made when the client's medical history, physical examination, or laboratory findings provide evidence that symptoms are directly attributed to which conditions? (Select all that apply.) 1. Epilepsy 2. Hypothyroidism 3. Hyperadrenalism 4. Encephalitis 5. Hyperaphia

ANS: 1, 2, 3, 4

The nurse is preparing a staff development presentation to improve the screening, intervention, and referral process for clients in the geriatric community center. Which information should the nurse identify as barriers to this initiative? (Select all that apply.) 1. Patient concerns about privacy 2. Competing workload demands 3. New nurses 4. The staff's attitude 5. Changing screening requirements

ANS: 1, 2, 3, 4

The client asks the nurse about pet therapy. Which responses by the nurse provide the client with accurate information? (Select all that apply.) 1. "Pet therapy reduces depression." 2. "Pet therapy decreases blood pressure." 3. "Pet therapy enhances client mood." 4. "Pet therapy improves sensory functioning." 5. "Pet therapy mitigates the effects of loneliness."

ANS: 1, 2, 3, 5

The depressed client is prescribed a monoamine oxidase inhibitor (MAOI). Which statements by the client should indicate to a nurse that the discharge teaching about this medication has been successful? (Select all that apply.) 1. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." 2. "I guess I will have to give up my glass of red wine with dinner." 3. "I'll have to be very careful about reading food labels." 4. "I'm going to drink my caffeinated coffee in the morning." 5. "I'll be sure not to stop this medication abruptly."

ANS: 1, 2, 3, 5

A clinic nurse is about to meet with a client diagnosed with a gambling disorder. The nurse would assess which symptoms and behaviors? (Select all that apply.) 1. Stressful situations precipitate gambling behaviors. 2. Anticipation and restlessness can only be relieved by placing a bet. 3. Winning brings about feelings of sexual satisfaction. 4. Gambling is used as a coping strategy. 5. Compulsive gambling began in early adolescence.

ANS: 1, 2, 4

The nurse is a manager of a pediatric unit. Which actions should the nurse manager take to equip staff to address neuropsychiatric symptoms in pediatric clients? (Select all that apply.) 1. Encourage use of screening tools 2. Provide education of staff members 3. Keep referrals to a minimum 4. Increase social contact with individuals with mental illness 5. Promote defensive medicine

ANS: 1, 2, 4

The nurse is assessing a client for antisocial personality disorder. According to the DSM-5, which symptoms must the client meet in order to be assigned this diagnosis? (Select all that apply.) 1. Age of at least 18 years old 2. Deceitful for personal gain 3. Frequent feelings of being down, remorseful, or hopeless 4. Disregard for and failure to honor financial obligations 5. Avoidance of social events and interaction with others

ANS: 1, 2, 4

Which nursing statements exemplify the process that must be completed by a nurse in the pre-introductory phase prior to caring for clients diagnosed with a substance-related disorder? (Select all that apply.) 1. "I am easily manipulated and need to work on this prior to caring for these clients." 2. "Because of my father's alcoholism, I need to examine my attitude toward these clients." 3. "I need to review the side effects of the medications used in the withdrawal process." 4. "I'll need to set boundaries to maintain a therapeutic relationship." 5. "I need to take charge when dealing with clients diagnosed with substance disorders."

ANS: 1, 2, 4

Which modalities should a nurse recognize as integral parts of a treatment program when planning care for clients diagnosed with schizophrenia spectrum disorder? (Select all that apply.) 1. Group therapy 2. Medication management 3. Deterrent therapy 4. Supportive family therapy 5. Social skills training

ANS: 1, 2, 4, 5

An attractive female client with a diagnosis of body dysmorphic disorder (BDD) presents with high anxiety levels because of her belief that her facial features are large and grotesque. Which additional symptoms would support this diagnosis? (Select all that apply.) 1. Mirror checking 2. Excessive grooming 3. Stereotypic movement 4. History of delusional thinking 5. Skin picking

ANS: 1, 2, 5

The client is diagnosed with functional neurological symptom disorder. Which symptoms would the nurse most likely observe? (Select all that apply.) 1. Anosmia 2. Abreaction 3. Akinesia 4. Aphonia 5. Amnesia

ANS: 1, 3, 4

____________________ disorder is manifested by signs and symptoms of schizophrenia, along with a strong element of symptomatology associated with the mood disorders (depression or mania).

Schizoaffective

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

Schizoid

Antianxiety drugs are also called ____________________ and minor tranquilizers

anxiolytics

The concept of ____________________ arose out of a need to define the dysfunctional behaviors that are evident among members of the family of a chemically dependent person.

codependency

Interventions that are different from, but used in conjunction with, traditional or conventional medical treatment are termed ____________________ medicine

complementary

The DSM-5 diagnosis of functional neurological symptom disorder can also be identified as ___________________ disorder.

conversion

A sudden event in one's life that disturbs homeostasis, during which usual coping mechanisms cannot resolve the problem, can be defined as a ______.

crisis

Which factor differentiates a client diagnosed with schizotypal personality disorder from a client diagnosed with schizoid personality disorder? 1. Clients diagnosed with schizotypal personality disorder are treated with cognitive behavioral therapy, whereas clients diagnosed with schizoid personality disorder need medications. 2. Clients diagnosed with schizoid personality disorder experience anxiety only in social settings, whereas clients diagnosed with schizotypal personality disorder experience generalized anxiety. 3. Clients diagnosed with schizotypal personality disorder experience social anxiety from paranoid fears, whereas clients diagnosed with schizoid personality disorder would isolate themselves on a continual basis. 4. Clients diagnosed with schizoid personality disorder have magical thinking and depersonalization, whereas clients diagnosed with schizotypal personality disorder do not.

3 A client diagnosed with schizoid personality disorder prefers being alone to being with others. However, clients with schizotypal personality disorder have excessive social anxiety that does not diminish with familiarity and tends to be associated with paranoid fears rather than negative judgments about self.

The nurse is providing care to a depressed, introverted client who is receiving outpatient surgery for a fractured hip. Which action should the nurse take to provide patient-centered care? 1. Refer the client for involuntary hospitalization 2. Allow the client plenty of solitude time to prepare for surgery 3. Involve the client in choosing a blue or green gown to wear 4. Develop a partnership with the spouse who is not withdrawn

3 Allowing the client to make decisions about their care (choosing a blue or green gown) is an indication of patient-centered care. Just because a client has a mental illness does not necessarily mean that they are incapable of making decisions.

Which physically healthy adult client should a nurse identify as exhibiting the characteristics of a dependent personality disorder? 1. Meets social needs by contact with 15 cats 2. Has a history of depending on intense relationships to meet basic needs 3. Lives with parents and relies totally on public transportation 4. Is serious, inflexible, and lacks spontaneity

3 An adult client who lives with parents and totally relies upon public transportation exhibits signs of dependent personality disorder. Dependent personality disorder is characterized by a pervasive and excessive need to be taken care of that leads to submissive behaviors.

The psychiatrist prescribes haloperidol (Haldol) 50 mg bid, benztropine (Cogentin) 1 mg prn, and zolpidem (Ambien) 10 mg at bedtime for a client with schizophrenia spectrum disorder. Which client behavior would warrant the nurse to administer benztropine? 1. Tactile hallucinations 2. Tardive dyskinesia 3. Muscle rigidity 4. Reports of hearing disturbing voices

3 An anticholinergic medication such as benztropine would be used to treat the extrapyramidal symptom of muscle rigidity.

Which information would a nurse include in client teaching about social anxiety disorder? 1. Obsessions are the underlying reason for clients to avoid social situations. 2. These people avoid social interactions because of a perceived physical flaw. 3. Individuals with social anxiety disorder avoid performing in front of others. 4. People with this disorder avoid social gatherings because of fear of separation.

3 Clients diagnosed with social anxiety disorder have a marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

In which setting should the nurse be aware that the client with a substance use disorder would most likely seek initial treatment? 1. Psychiatric hospital 2. Addiction treatment center 3. Urgent care clinic 4. Inpatient psychiatric unit

3 Clients with substance use disorders commonly seek care first in general medical and community practice settings, like an urgent care clinic, before being treated in psychiatric or substance abuse treatment settings.

Which criteria according to the DSM-5 would need to be present for a client to be diagnosed with dissociative fugue? 1. An inability to recall important autobiographical information 2. Clinically significant distress in social and occupational functioning 3. Sudden unexpected travel or bewildered wandering 4. "Blackouts" related to alcohol toxicity

3 Dissociative fugue is characterized by a sudden, unexpected travel away from customary place of daily activities, or by bewildered wandering, with the inability to recall some or all of one's past.

Which nursing action would be identified with Stage IV of Roberts' Seven-stage Crisis Intervention Model? 1. Collaboratively implement an action plan. 2. Help the client identify the major problems or crisis precipitants. 3. Help the client deal with feelings and emotions. 4. Collaboratively generate and explore alternatives.

3 Helping a client deal with feelings and emotions aligns with Stage IV: Deal with Feelings and Emotions.

The nurse is caring for clients in a free community clinic. Which technique should the nurse use to conduct a trauma screening? 1. Quickly assessing the overall situation 2. Implementing a thorough head-to-toe assessment 3. Interviewing in a secluded area 4. Using empathy with the family members

3 Interviewing in a secluded area is the technique the nurse should use during a trauma screening. It is critical that nurses conduct trauma screenings in private and communicate with a compassionate, nonjudgmental attitude.

A client diagnosed with a gambling disorder asks the nurse about medications that may be ordered by the physician to treat this disorder. The nurse would give the client information on which medications? 1. Escitalopram (Lexapro) and clozapine (Clozaril) 2. Citalopram (Celexa) and olanzapine (Zyprexa) 3. Lithium carbonate (Lithobid) and naltrexone (ReVia) 4. Haloperidol (Haldol) and ziprasidone (Geodon)

3 Lithium carbonate (Lithobid) and naltrexone (ReVia) have demonstrated some effectiveness for gambling disorder.

The client with migraine headaches says, "My nurse practitioner told me that acupuncture may enhance the effects of my medications." Which type of therapy is the nurse practitioner recommending? 1. Alternative 2. Physiological 3. Complementary 4. Psychosocial

3 Since the acupuncture is being used in combination with medication, the nurse practitioner is recommending a type of complementary therapy. It is complementing the conventional methods (medication) with the addition of an alternative strategy (acupuncture).

A nurse is preparing a staff education session about the impaired nurse and the consequences of this impairment. Which statement by a staff member indicates successful teaching? 1. "The state board of nursing must be notified with subjective documentation of impairment." 2. "All state boards of nursing have passed laws that, under any circumstances, do not allow impaired nurses to practice." 3. "Some state boards of nursing administer the treatment programs themselves, while others refer the nurse to other resources." 4. "After a return to practice, a recovering nurse may be closely monitored for several days."

3 Some of these state boards administer the treatment programs themselves, and others refer the nurse to community resources or state nurses' association assistance programs. This may require successful completion of inpatient, outpatient, group, or individual counseling treatment program(s); evidence of regular attendance at nurse support groups or 12-step program; random negative drug screens; and employment or volunteer activities during the suspension period.

A client's wife has been making excuses for her alcoholic husband's work absences. In family therapy, she states, "His problems at work are my fault." Which response by the nurse is therapeutic? 1. "Why do you assume responsibility for his behaviors?" 2. "I think you should start to confront his behavior." 3. "Your husband needs to deal with the consequences of his drinking." 4. "Do you understand what the term enabler means?"

3 The appropriate nursing response is to use confrontation with caring. The nurse should understand that the client's wife may be in denial and enabling the husband's behavior. Codependency is a typical behavior of spouses of alcoholics. The nurse must help the wife through the stages of recovery beginning with Stage I: The Survival Stage in which the partner begins to let go of the denial that problems exist.

During her uncle's wake, a 5-year-old girl runs up to the casket before her mother can stop her. An appointment is made with a nurse practitioner when the child starts twisting and pulling out her hair, resulting in hair loss. Which nursing diagnosis should the nurse assign to this child? 1. Fear 2. Altered family processes 3. Ineffective impulse control 4. Disturbed body image

3 The child is suffering from trichotillomania, which leads to ineffective impulse control. This child is coping with the anxiety generated by viewing her deceased uncle by pulling out her hair.

The nurse is working in an emergency department. With which client should the nurse use the screening, brief intervention, and referral to treatment approach (SBIRT)? 1. Has suicidal thoughts 2. Has nonsuicidal self-injuring behavior 3. Has an opioid addiction 4. Has been raped

3 The client with an opioid addiction should be screened and cared for using the SBIRT approach. The SBIRT approach is an evidence-based approach that can be used in various settings for substance abuse and addiction.

What is the first step the nurse should take to reduce stigma of mental health clients? 1. Increase social contact with mental health clients 2. Attend on-the-job training about mental health clients 3. Have a willingness to interact with mental health clients 4. Understand the person as a mental health client

3 The first step is to have a willingness to interact with mental health clients. The nurse should be willing to engage in meaningful relationships with people who have mental illnesses and addictions.

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

3 The goal of treatment for clients diagnosed with personality disorders should be to reduce inflexibility of personality traits that interfere with functioning and relationships.

The nursing instructor is teaching about bipolar disorders. Which symptom should the instructor include that is present during a manic episode but is absent in hypomania? 1. Inflated self-esteem or grandiosity 2. Decreased need for sleep 3. Psychosis 4. Flight of ideas or racing thoughts

3 The instructor would include psychosis in the teaching session. In hypomania the episode is not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization. If there are psychotic features, the episode is, by definition, manic. Therefore, psychotic features occur with mania but not with hypomania.

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

3 The most appropriate nursing intervention is to use clear, calm statements with a confident physical stance. A calm attitude provides the client with a feeling of safety and security.

A client diagnosed with schizophrenia spectrum disorder states, "Can't you hear him? It's the devil. He's telling me I'm going to hell." Which is the most appropriate nursing response? 1. "Did you take your medicine this morning?" 2. "You are not going to hell. You are a good person." 3. "The voices must sound scary, but I do not hear any voices." 4. "The devil only talks to people who are receptive to his influence."

3 The most appropriate nursing response is to reassure the client while not reinforcing the hallucination. Reminding the client that "the voices" are not real will prevent validation of the hallucination. It is also important for the nurse to connect with the client's fears and inner feelings.

Parents ask a nurse how they should reply when their son, diagnosed with schizophrenia spectrum disorder, tells them that voices command him to harm others. Which nursing response is appropriate? 1. "Tell him to stop discussing the voices." 2. "Ignore what he is saying, while attempting to discover the underlying cause." 3. "Focus on the feelings generated by the hallucinations and present reality." 4. "Present objective evidence that the voices are not real."

3 The most appropriate response by the nurse is to instruct the parents to focus on the feelings generated by the hallucinations and present reality. The parents should accept that their child is experiencing the hallucination but should not reinforce this unreal sensory perception.

Which statement by a client who is beginning tricyclic antidepressant therapy indicates successful teaching? 1. "I will continue to take this medication even if the symptoms have not subsided." 2. "I will start to see results in about 2 weeks." 3. "I will continue to smoke." 4. "I will start to cut down on my alcohol intake and have only one glass of wine at supper."

ANS: 1

The client living in a riverfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. The psychiatric nurse practitioner decides to try systematic desensitization. Which best explanation of this treatment should the nurse provide? 1. "Using your imagination, we will attempt to achieve a state of relaxation." 2. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." 3. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety while in a relaxed state." 4. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."

3 The nurse should explain to the client that when participating in systematic desensitization, he or she will go through a series of increasingly anxiety-provoking steps that will gradually increase tolerance while in a relaxed state. Systematic desensitization was introduced by Joseph Wolpe in 1958 and is based on behavioral conditioning principles.

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

3 The nurse should identify that a client diagnosed with avoidant personality disorder would be grateful for the compliment but would fear later rejection and humiliation. Individuals diagnosed with avoidant personality disorder are extremely sensitive to rejection and are often awkward and uncomfortable in social situations.

Which medication treatment should the nurse administer to clients diagnosed with generalized anxiety disorder (GAD)? 1. Long-term treatment with diazepam (Valium) 2. Acute symptom control with propranolol (Inderal) 3. Long-term treatment with buspirone (BuSpar) 4. Acute symptom control with ziprasidone (Geodon)

3 The nurse should identify that an appropriate treatment for clients diagnosed with GAD is long-term treatment with buspirone. Buspirone is an anxiolytic medication that is effective in 60% to 80% of clients diagnosed with GAD. Buspirone takes 10 to 14 days for alleviation of symptoms but does not have the dependency concerns of other anxiolytics.

The chronically fatigued client is diagnosed with major depressive disorder. After taking antidepressant medication for 6 weeks, the client's symptoms have not resolved. Which nutritional deficiency should a nurse identify as potentially contributing to the client's symptoms? 1. Vitamin A 2. Vitamin C 3. Iron 4. Calcium

3 The nurse should identify that an iron deficiency could contribute to feelings of chronic fatigue because iron is needed to produce hemoglobin. Iron should be consumed by eating meat, fish, green leafy vegetables, nuts, eggs, and enriched bread and pasta.

Looking at a slightly bleeding paper cut, the client screams, "Somebody help me quick! I'm bleeding. Call 911!" The nurse should identify this behavior as characteristic of which personality disorder? 1. Schizoid 2. Obsessive-compulsive 3. Histrionic 4. Paranoid

3 The nurse should identify this behavior as characteristic of histrionic personality disorder. Individuals with this disorder tend to be self-dramatizing, attention seeking, over-gregarious, and seductive.

The nurse develops the following outcomes for a client diagnosed with bipolar disorder: manic episode: 1. Maintain nutritional status. 2. Interact appropriately with peers. 3. Remain free from injury. 4. Sleep 6 to 8 hours a night. In which order would the nurse prioritize the outcomes, starting with the highest and ending with the lowest priority outcome? 1. 2, 1, 3, 4 2. 4, 1, 2, 3 3. 3, 1, 4, 2 4. 1, 4, 2, 3

3 The nurse should order client outcomes based on priority in the following order: Remain free of injury, maintain nutritional status, sleep 6 to 8 hours a night, and interact appropriately with peers. The nurse should prioritize the client's safety (remain free of injury) first, followed by physical health (nutrition and then sleep), and ending with social needs, interacting with others.

A client with schizophrenia spectrum disorder presents with bizarre behaviors and delusions. Which nursing action should be prioritized to maintain this client's safety? 1. Monitor for medication nonadherence. 2. Note escalating behaviors immediately. 3. Interpret attempts at communication. 4. Assess triggers for bizarre, inappropriate behaviors.

3 The nurse should plan to teach the client how to make eye contact when communicating. Social skills, such as making eye contact, can assist clients to communicate needs and to establish relationships.

The client is newly diagnosed with dissociative identity disorder (DID) stemming from severe childhood sexual abuse. Which nursing intervention takes priority? 1. Encourage exploration of sexual abuse. 2. Suggest guided imagery. 3. Establish trust and rapport. 4. Administer antianxiety medications.

3 The nurse should prioritize establishing trust and rapport when beginning to work with a client diagnosed with DID. DID was formerly called multiple personality disorder. Trust is the basis of every therapeutic relationship. Each personality views itself as a separate entity and must be treated as such to establish rapport.

The client diagnosed with schizophrenia spectrum disorder tells a nurse about voices commanding him to kill his ex-spouse. Which nursing diagnosis is priority for this client? 1. Disturbed sensory perception 2. Altered thought processes 3. Risk for violence: directed toward others 4. Risk for injury

3 The nurse should prioritize the diagnosis risk for violence: directed toward others. A client who hears voices commanding him to kill someone is at risk for other-directed violence. Other risk factors for violence include aggressive body language, verbal aggression, catatonic excitement, and rage reactions.

Which symptom should the nurse observe in a client diagnosed with obsessive-compulsive personality disorder? 1. Intrusive and persistent thoughts 2. Unwanted, repetitive ritualistic behavior 3. Lack of spontaneity when dealing with others 4. Feelings of "sixth sense" that are externally imposed

3 The nurse should suspect a diagnosis of obsessive-compulsive personality disorder when a client experiences lack of spontaneity. Individuals with this disorder are very serious, formal, and have difficulty expressing emotions. They are perfectionistic and preoccupied with rules.

The nurse tells a client diagnosed with obsessive-compulsive personality disorder that the nursing staff will start alternating weekend shifts. Which response should the nurse expect from this client? 1. "You really don't have to go by that schedule. I'd just stay home sick." 2. "There has got to be a hidden agenda behind this schedule change." 3. "Who do you think you are? I expect to interact with the same nurse every Saturday." 4. "You can't make these kinds of changes! Isn't there a rule that governs this decision?"

4 The statement, "You can't make these kinds of changes! Isn't there a rule that governs this decision?" is typical of a client with obsessive-compulsive disorder. The nurse should identify that a client with obsessive-compulsive personality disorder would have a difficult time accepting changes. This disorder is characterized by inflexibility and lack of spontaneity. Individuals with this disorder are very serious, formal, over-disciplined, perfectionistic, and preoccupied with rules.

The nursing instructor is teaching about the DSM-5 diagnostic criteria for depersonalization-derealization disorder. Which student statement indicates a need for follow-up instruction? 1. "Clients with this disorder can experience emotional and/or physical numbing and a distorted sense of time." 2. "Clients with this disorder can experience unreality or detachment with respect to their surroundings." 3. "During the course of this disorder, individuals or objects are experienced as dreamlike, foggy, lifeless, or visually distorted." 4. "During the course of this disorder, the client is out of touch with reality and is impaired in social, occupational, or other areas of functioning."

4 This statement indicates a need for further follow-up instruction. The DSM-5 states that during the depersonalization and/or derealization experiences, reality testing remains intact, but the symptoms cause significant distress or impairment in social, occupation, or other important areas of functioning. Depersonalization (a disturbance in the perception of oneself) is differentiated from derealization, which describes an alteration in the perception of the external environment.

The nurse is teaching a client diagnosed with anxiety about treatment options. Which statement by the client indicates effective teaching? 1. "There is nothing that I can do to that will reduce anxiety." 2. "Medication is available, but only for those who have had anxiety for a year or more." 3. "If I ignore the symptoms of anxiety, it will go away." 4. "Practicing yoga or meditation may help reduce my anxiety."

4 This statement indicates effective teaching. Practicing yoga or meditation may help reduce the symptoms of anxiety. These are examples of stress management.

Which term should a nurse use to describe the administration of a central nervous system (CNS) depressant to a client with alcohol withdrawal? 1. Antagonist treatment 2. Deterrent therapy 3. Codependency therapy 4. Medication-assisted treatment

4 Various medications have been used to decrease the intensity of symptoms in an individual who is withdrawing from, or who is experiencing the effects of excessive use of, alcohol and other drugs. This is called medication-assisted treatment.

An involuntarily committed client purposely pushes a dinner tray off the bedside table onto the floor. Which nursing intervention would a nurse implement to address this behavior? 1. Initiate forced medication protocol. 2. Help the client to explore the source of anger. 3. Ignore the act to avoid reinforcing the behavior. 4. With staff support, set firm limits on the behavior.

4 The most appropriate nursing intervention is to set firm limits on the behavior.

A college student, who was nearly raped while out jogging, completes a series of appointments with a rape crisis nurse. At the final session, which client statement most clearly suggests that the goals of crisis intervention have been met? 1. "You've really been helpful. Can I count on you for continued support?" 2. "I work out in the college gym rather than jogging outdoors." 3. "I'm really glad I didn't go home. It would have been hard to come back." 4. "I carry mace when I jog. It makes me feel safe and secure."

4 The nurse would evaluate that the client who has developed adaptive coping strategies has achieved the goals of crisis intervention. The final phase of crisis intervention involves evaluating the outcome of the crisis intervention and anticipatory planning.

A client comes to a psychiatric clinic experiencing sudden extreme fatigue, decreased sleep, and decreased appetite. The client works 12 hours a day and rates anxiety as 8/10 on a numeric scale. Which long-term outcome is realistic in addressing this client's crisis? 1. The client will change his type-A personality traits to more adaptive ones within one week. 2. The client will list five positive self-attributes. 3. The client will examine how childhood events led to his overachieving orientation. 4. The client will return to previous adaptive levels of functioning by week six.

4 The nurse would identify that a realistic long-term outcome for this client is to return to previous adaptive levels of functioning. The nurse would work with the client to develop attainable outcomes that reflect immediacy of the situation.

Order the stages of Roberts' Seven-stage Crisis Intervention Model. (Enter the number of each step in the proper sequence, using comma and space format, such as: 1, 2, 3, 4.) 1. Deal with feelings and emotions. 2. Generate and explore alternatives. 3. Rapidly establish rapport. 4. Psychosocial and lethality assessment. 5. Identify the major problems or crisis precipitants. 6. Follow up. 7. Implement an action plan

4, 5, 2, 1, 3, 7, 6

Prioritize the depressive disorders and their predominant affective symptoms from least to most severe (1-4). (Enter the number of each disorder in the proper sequence, using comma and space format, such as 1, 2, 3, 4.) 1. Dysthymic disorder (helplessness, powerlessness, pessimistic outlook, low self-esteem) 2. Uncomplicated grieving (feelings of anger, anxiety, guilt, helplessness) 3. Major depressive episode (total despair, worthlessness, flat affect, apathy) 4. Transient depression (sadness, dejection, feeling downhearted, having "the blues")

ANS: 4, 2, 1, 3

The nurse is preparing a presentation about Beck's cognitive theory. Which cognitive distortion would the nurse include in the teaching session? 1. Negative expectation of the environment 2. Negative expectation of the present 3. Negative expectation of the career 4. Negative expectation of the family

ANS: 1

Which action should the nurse take when a depressed client refuses electroconvulsive therapy (ECT)? 1. Accept the client's decision 2. Inform the client that the procedure is mandatory 3. Tell the client that the signature verifies informed consent 4. Call the family to receive approval

ANS: 1

The nurse is preparing a staff education session about depression in adolescents. Which statement by a staff member indicates teaching has been effective? 1. "Adolescents are not likely to suffer from depression." 2. "Depressed adolescents normally seek immediate treatment." 3. "Many symptoms are attributed to normal adjustments of adolescents." 4. "Suicide is not common among depressed adolescents."

Correct Answer: 3 This statement would indicate effective teaching because many symptoms of depression may be attributed to normal adjustments of adolescents.

____________________ personality disorder is characterized by colorful, dramatic, and extroverted behavior in excitable, emotional people.

Histrionic

____________________ personality disorder is a pervasive mistrust and suspiciousness of others, such that their motives are interpreted as malevolent.

Paranoid

____________________ are intrusive thoughts that are recurrent and stressful, and even though these thoughts are recognized by the individual as irrational, they continue to be repetitive and cannot be ignored.

Obsessions

____________________ personality disorder is characterized by a lack of self-confidence and excessive need to be taken care of that leads to a passive and submissive role

Dependent

______ are false sensory perceptions not associated with real external stimuli and may involve any of the five senses

Hallucinations

____________________ is an alteration in mood that is expressed by feelings of elation, inflated self-esteem, grandiosity, hyperactivity, agitation, racing thoughts, and accelerated speech.

MANIA

____________________ is a pervasive and sustained emotion that may have a major influence on a person's perception of the world.

Mood

______ who choose to work in nonpsychiatric settings are the frontline responders in recognizing, intervening, and referring clients with neuropsychiatric illness for further treatment.

NURSES