NUR 123 Exam 2

Jasmine is a 19-year-old student who visits the university health center. She shares that, before an exam this semester, she experienced sweating, shortness of breath, abdominal pain, and the sensation of her heart being "in her throat." She found out later she got a grade of "D" on the exam, which alarmed her. She says, "I've always gotten Bs, and this is a subject I'm good at. "The symptoms scared her so much that over the next month, she began avoiding class for fear of feeling like that again. When she did attend class one day, she reports feeling tightness in her chest and her heart started pounding. As she began to breathe faster, she just said a silent prayer to not freak out, waiting for class to be over so she could get out of there. "Now I don't go to class. I just read and watch movies in my dorm—it's terrible. When I even think about classes and exams, I get stomach aches and nausea." She begins to cry and says, "Even when I don't think I'm anxious, I'm afraid of getting anxious. I want to go to school and get my degree. I just don't know what to do." 2. Choose the most likely options to complete the following statement. Jasmine is diagnosed with a moderate panic disorder. Based on her strong desire to continue attending school, the priority outcome is to ____1_____. The nurse will assist the student to accomplish this goal by focusing on ____2______, as well as ___3______.

1. Develop multiple coping strategies to offset or reduce panic episodes 2. Helping the student overcome maladaptive avoidant behaviors 3. Monitoring and controlling anxiety responses

Jasmine is a 19-year-old student who visits the university health center. She shares that, before an exam this semester, she experienced sweating, shortness of breath, abdominal pain, and the sensation of her heart being "in her throat." She found out later she got a grade of "D" on the exam, which alarmed her. She says, "I've always gotten Bs, and this is a subject I'm good at. "The symptoms scared her so much that over the next month, she began avoiding class for fear of feeling like that again. When she did attend class one day, she reports feeling tightness in her chest and her heart started pounding. As she began to breathe faster, she just said a silent prayer to not freak out, waiting for class to be over so she could get out of there. "Now I don't go to class. I just read and watch movies in my dorm—it's terrible. When I even think about classes and exams, I get stomach aches and nausea." She begins to cry and says, "Even when I don't think I'm anxious, I'm afraid of getting anxious. I want to go to school and get my degree. I just don't know what to do." 3. Choose the most likely options to complete the statement below. The nurse will teach this client that a great benefit of the benzodiazepine will be its ____1____. Two common side effects the client will need to monitor and report will be ____2____ and ____3____.

1. initial quick onset of action 2. sedation 3. ataxia

The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of which classification of medications? a. Anticholinergic medication. b. Standard antipsychotic medication. c. A short-acting benzodiazepine medication. d. Tricyclic antidepressant medication.

c A short-acting benzodiazepine medication.

What defense mechanisms can only be used in healthy ways? a. Idealization and splitting b. Suppression and humor c. Altruism and sublimation d. Reaction formation and denial

c Altruism and sublimation

Studies have shown a correlation between mental disorders and which medical condition? a. Chronic renal failure b. Psoriasis c. Asthma d. Cardiovascular disease

d Cardiovascular disease

What is a possible outcome criterion for a client diagnosed with anxiety disorder? a. Client reports reduced hallucinations. b. Client demonstrates persistent avoidance behaviors. c. Client reports feelings of tension and fatigue. d. Client demonstrates effective coping strategies.

d Client demonstrates effective coping strategies.

Living comfortable and materialistic lives in Western societies seems to have altered the original hierarchy proposed by Maslow in that: a. Once lower level needs are satisfied, no further growth feels necessary b. Self-actualization is easier to achieve with financial stability c. Esteem is more highly valued than safety d. Focusing on materialism reduces interests in love, belonging, and family

d Focusing on materialism reduces interests in love, belonging, and family

Which disorder is characterized by the client's misinterpretation of physical sensations or feelings? a. Somatic disorder b. Conversion disorder c. Factitious disorder d. Illness anxiety disorder

d Illness anxiety disorder

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

d Not allowing the client to wash hands after touching a "dirty" object

Terry is a young male in a chemical dependency program. Recently he has become increasingly distracted and disengaged. The nurse concludes that Terry is: a. Bored b. Depressed c. Bipolar d. Not ready to change

d Not ready to change

The treatment team meets to discuss a client's plan of care. Which of the following factors will be priorities when planning interventions? a. Availability of immediate family to come to meetings b. Financial ability c. Current college performance d. Readiness to change behaviors

d Readiness to change behaviors

Providing care to a client diagnosed with a somatization disorder can be frustrating owing to the client's lack of an organic illness. In order to best manage this barrier to care the staff should implement which personal intervention? a. Attend in-services that focus on the various aspects of somatic disorders. b. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself. c. Rotate care of the client among the entire nursing department staff to minimize the frustration. d. Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

d Regularly discuss their feelings about the client during the unit's interprofessional care meetings.

When discussing somatic disorders from a cultural perspective, which statement is true? a. Somatic disorders are rarely observed in males. b. Secondary gain is seldom a factor in somatic disorders. c. Underdeveloped countries rarely tolerate somatic disorders. d. Somatic symptoms vary widely from culture to culture.

d Somatic symptoms vary widely from culture to culture.

A 26-year-old patient who abuses heroin states, "I've been using more heroin lately because I've begun to need more to feel the effect I want." What effect does this statement describe? a. Intoxication b. Withdrawal c. Addiction d. Tolerance

d Tolerance

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

d severe

What precipitating emotional factor has been associated with an increased incidence of cancers?. Select all that apply a. Anxiety b. Job-related stress c. Acute grief d. Feelings of hopelessness and despair from depression e. Prolonged, intense stress

d, e d. Feelings of hopelessness and despair from depression e. Prolonged, intense stress

The nurse is providing care for a patient demonstrating behaviors associated with moderate levels of anxiety. What question should the nurse ask initially in attempting to help the patient de-escalate the anxiety? a. "Do you know what will help you manage your anxiety?" b. "Do you need help to manage your anxiety?" c. "Can you identify what was happening when your anxiety began to increase?" d. "Are you feeling anxious right now?"

C. "Can you identify what was happening when your anxiety began to increase?"

A woman suddenly finds she cannot see but seems unconcerned about her symptom and tells her husband, "Don't worry, dear. Things will all work out." Her attitude is an example of what process? a. La belle indifference b. Depersonalization c. Dissociative amnesia d. Regression

a La belle indifference

Inability to leave one's home because of avoidance of severe anxiety suggests the existence of which anxiety disorder? a. Panic attacks with agoraphobia b. Posttraumatic stress response c. Obsessive-compulsive disorder d. Generalized anxiety disorder

a Panic attacks with agoraphobia

A 72-year-old client diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When the healthcare provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? a. The client is at risk for falls. b. The client should be treated with cognitive therapies because of his advanced age. c. The client has a history of nonadherence with medications. d. The client may become addicted faster than younger clients.

a The client is at risk for falls.

In a parent-teacher conference, the school nurse meets with the parents of a profoundly shy 8-year-old girl. The parents hold hands, speak softly, respond briefly, and have poor eye contact. The nurse recognizes that the child is most likely exposed to parental modeling and a. The inherited shyness trait b. A lack of affection in the home c. Severe punishment by the parents d. Is afraid to say something foolish

a The inherited shyness trait

Which patient is at increased risk for the development of anxiety and will require frequent assessment by the nurse? Select all that apply a. Exacerbation of asthma signs and symptoms b. History of peanut and strawberry allergies c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of traumatic brain injury

a, c, d, e a. Exacerbation of asthma signs and symptoms c. History of chronic obstructive pulmonary disease d. Current treatment for unstable angina pectoris e. History of traumatic brain injury

Which assessment data confirm the suspicion that a patient is experiencing opioid withdrawal? Select all that apply a. Pupils are dilated b. Pulse rate is 62 beats per minute c. Slow movements d. Extreme anxiety e. Sleepy

a, d a. Pupils are dilated d. Extreme anxiety

The activity of gamma-aminobutyric acid (GABA) contributes to slowing of neural activity. Which of the following drugs facilitate the action of GABA? a. Benzodiazepines b. Antihistamines c. Anticonvulsants d. Noradrenergics

a. Benzodiazepines

Which statement made by a client would support the diagnosis of Illness anxiety disorder? a. "I know I have cancer, but the doctors just cannot find it." b. "I feel as though I'm outside my body watching what is happening." c. "I woke up one morning, and my left leg was paralyzed from the knee down." d. "I feel confused and disoriented."

a "I know I have cancer, but the doctors just cannot find it."

Jasmine is a 19-year-old student who visits the university health center. She shares that, before an exam this semester, she experienced sweating, shortness of breath, abdominal pain, and the sensation of her heart being "in her throat." She found out later she got a grade of "D" on the exam, which alarmed her. She says, "I've always gotten Bs, and this is a subject I'm good at. "The symptoms scared her so much that over the next month, she began avoiding class for fear of feeling like that again. When she did attend class one day, she reports feeling tightness in her chest and her heart started pounding. As she began to breathe faster, she just said a silent prayer to not freak out, waiting for class to be over so she could get out of there. "Now I don't go to class. I just read and watch movies in my dorm—it's terrible. When I even think about classes and exams, I get stomach aches and nausea." She begins to cry and says, "Even when I don't think I'm anxious, I'm afraid of getting anxious. I want to go to school and get my degree. I just don't know what to do." 4. Check those follow-up findings that indicate effectiveness of the actions taken. Check all that apply a. Reports one panic attack in two weeks. b. Returned to class with one absence in the past 4 weeks. c. Earned a grade of B on the last exam. d. Reports eating three meals a day in the cafeteria e. Has taken up running as a stress reliever when "feeling uneasy" f. Reports socializing with friends on the weekends.

a, b, c, e a. Reports one panic attack in two weeks. b. Returned to class with one absence in the past 4 weeks. c. Earned a grade of B on the last exam. e. Has taken up running as a stress reliever when "feeling uneasy"

Natalya, a patient with a history of alcohol use disorder, has been prescribed disulfiram (Antabuse). Which physical effects support the suspicion that the patient has relapsed? Select all that apply. a. Intense nausea b. Diaphoresis c. Acute paranoia d. Confusion e. Dyspnea

a, b, d, e a. Intense nausea b. Diaphoresis d. Confusion e. Dyspnea

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

a, c, d, e a. An eating disorder c. A history of sexual abuse d. A history of childhood trauma e. A sibling with the disorder

A patient diagnosed with opioid use disorder has expressed a desire to enter into a rehabilitation program. What initial nursing intervention during the early days after admission help ensure the patient's success? a. Restrict visitors to family members only b. Manage the patient's withdrawal symptoms well c. Provide the patient a low-stimulus environment d. Advocate for at least 3 months of treatment

b Manage the patient's withdrawal symptoms well

Delusionary thinking is a characteristic of which form of anxiety? a. Chronic anxiety b. Panic level anxiety c. Severe anxiety d. Acute anxiety

b Panic level anxiety

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating which ego defense mechanism? a. Projection b. Reaction formation c. Rationalization d. Undoing

b Reaction formation

benzodiazepines

binds to benzodiazepine receptors, facilitates action of GABA, slowing neural transmission thus lowering anxiety (Xanax) (Valium)

A symptom commonly associated with panic attacks? a. Apathy b. Obsessions c. Fear of impending doom d. Fever

c Fear of impending doom

Ever since participating in a village raid where explosives were used, a military veteran has been unable to walk. After all diagnostic testing were negative for any physical abnormalities, the client was diagnosed with conversion disorder. What is the nurse's best response when asked by the client, "Why can't I walk?" a. "Your legs don't work because your brain is screwed up." b. "You are overly anxious about having a severe illness." c. "Your emotional distress is being expressed as a physical symptom." d. "You are making up your symptoms as a cry for help."

c "Your emotional distress is being expressed as a physical symptom."

You are caring for Yolanda, a 67-year-old patient who has been receiving hemodialysis for 3 months. Yolanda reports that she feels angry whenever it is time for her dialysis treatment. You attribute this to: a. Organic changes in Yolanda's brain b. A flaw in Yolanda's personality c. A normal response to grief and loss d. Denial of a reality of a poor prognosis

c A normal response to grief and loss

What statement by a client would indicate that goals for treatment for a somatization disorder are being achieved? a. "I take my medications just as the physician prescribed." b. "I feel less anxiety than before." c. "My memory is better than it was a month ago." d. "I don't think about my symptoms all the time as I used to be."

d "I don't think about my symptoms all the time as I used to be."

A client being prepared for discharge tells the nurse, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone? a. "It helps your mood so that you don't feel the need to do drugs." b. "It is a sedative that will help you sleep at night, so you are more alert and able to make good decisions." c. "It will keep you from experiencing flashbacks." d. "It helps prevent relapse by reducing drug cravings."

d "It helps prevent relapse by reducing drug cravings."

A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." Which response should the nurse make initially? a. "Try not to think about the feelings and sensations you're experiencing." b. "Let's try to focus on that adorable little granddaughter of yours." c. "Why don't you sit down over there and work on that jigsaw puzzle?" d. "What things have you done in the past that helped you feel more comfortable?"

d "What things have you done in the past that helped you feel more comfortable?"

Which client is most likely to initially demonstrate behaviors suggesting a somatic disorder? a. 43-year-old female b. 33-year-old male c. 13-year-old male d. 23-year-old female

d 23-year-old female

An obsession is defined as what? a. Thinking of an action and immediately taking the action b. An intense irrational fear of an object or situation c. A recurrent behavior performed in the same manner d. A recurrent, persistent thought or impulse

d A recurrent, persistent thought or impulse

What action should you take when a female staff member is demonstrating behaviors associated with a substance use disorder? a. Accompany the staff member when she is giving patient care. b. Offer to attend rehabilitation counseling with her. c. Refer her to a peer assistance program. d. Confront her about your concerns and/or report your concerns to a supervisor immediately.

d Confront her about your concerns and/or report your concerns to a supervisor immediately.

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

d Determine the use of chemical substances for anxiety relief.

Panic attacks in Latin American individuals often involve demonstration of which behavior? a. Blushing b. Repetitive involuntary actions c. Offensive verbalizations d. Fear of dying

d Fear of dying

Selective inattention is first noted when experiencing which level of anxiety? a. Mild b. Panic c. Severe d. Moderate

d Moderate

Valium

may be used short term to treat anxiety symptoms (benzodiazepine)

Xanax

may be used short term to treat panic disorder and agoraphobia (benzodiazepine)

The primary difference between a factitious disorder and other somatic disorders is described in which statement? a. Factitious disorders have a symptomatology that is actually controlled by the client. b. Factitious disorders are always self-directed. c. Factitious disorders have their origins in depression and anxiety. d. Factitious disorders respond well to confrontation as a primary therapeutic technique.

a Factitious disorders have a symptomatology that is actually controlled by the client.

Donald, a 49-year-old male, is admitted for inpatient alcohol detoxification. The rationale for admission into the program is due to: a. Heavy use of a substance known to cause withdrawal b. A need for rehabilitation c. The potential for relapse d. CNS hypoactivity following cessation of alcohol consumption

a Heavy use of a substance known to cause withdrawal

A 23 years old is admitted with reports of abdominal pain, dizziness, and headache. When told that all the results of a physical workup have been negative, the client shares, "Now I am having back pain." Which notation in the client's medical record may alert the nurse to the possibility of malingering? a. A court date this week for drunk driving b. Was adopted at the age of 5 years c. A history of oppositional-defiant disorder d. A history of physical abuse by his stepfather

a A court date this week for drunk driving

A 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for this client's treatment plan while in the hospital? a. Client will be medically stabilized while in the hospital. b. Client will take a leave of absence from college to alleviate stress. c. Client will return to a pre-drug level of functioning within 1 week. d. Client will state within 3 days that they will totally abstain from drugs and alcohol.

a Client will be medically stabilized while in the hospital.

Melanie is a 38-year-old female admitted to the hospital to rule out a neurological disorder. The testing was negative, yet she is reluctant to be discharged. Today she has added lower back pain and a stabbing sensation in her abdomen. The nurse suspects a factitious disorder in which Melanie may: a. Consciously be trying to maintain her role of a sick patient b. Not recognize her unmet needs to be cared for c. Protect her child from illness d. Recognize physical symptoms as a coping mechanism

a Consciously be trying to maintain her role of a sick patient

It is most important for the nurse to employ which holistic strategy when managing clients diagnosed with a somatization disorder? a. Considering all dimensions of the patient, including biological, psychological, and sociocultural b. Incorporating spirituality and religion into treatment c. Involving every member of the family as well as the patient in treatment d. Utilizing many different therapeutic strategies or modalities for enhanced coping

a Considering all dimensions of the patient, including biological, psychological, and sociocultural

Which mental health disorder is an example of a somatoform disorder? a. Conversion disorder b. Depersonalization c. Dissociative identity disorder d. Dissociative fugue

a Conversion disorder

What therapeutic intervention should be prescribed for a client diagnosed with a somatoform disorder? a. Conveying an interest in the client rather than in the symptoms b. Encouraging the client to use benzodiazepines liberally c. Encouraging the client to rely on the nurse to meet the client's needs d. Steering conversation away from the client's feelings

a Conveying an interest in the client rather than in the symptoms

A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of which ego defense mechanism? a. Denial b. Undoing c. Suppression d. Altruism

a Denial

Benzodiazepines are useful for treating alcohol withdrawal because they are associated with which action? a. Exerting a calming effect b. Decreasing serotonin availability c. Increasing dopamine release d. Blocking cortisol secretion

a Exerting a calming effect

A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports which information? a. Repeated verbalizing prayers results in a relaxed feeling. b. Being unable to work for the last 12 months. c. Eating in public makes the client extremely uncomfortable. d. Symptoms started right after being robbed at gunpoint.

b Being unable to work for the last 12 months.

Which statement about somatoform disorders is true? a. No relation exists between these disorders and early childhood loss or trauma. b. Clients lack awareness of the relations among symptoms, anxiety, and conflicts. c. Nurses perceive clients with these disorders as easy to care for. d. An organic basis exists for each group of disorders.

b Clients lack awareness of the relations among symptoms, anxiety, and conflicts.

Which statement is true regarding substance addiction and medical comorbidity? a. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier. b. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. c. Most substance abusers do not have medical comorbidities. d. There has been little research done regarding substance addiction disorders and medical comorbidity.

b Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.

Max is a 30-year-old male who arrives at the emergency department stating "I feel like I am having a stroke". During the intake assessment, the nurse discovers that Max has been working for 36 hours straight without eating and has consumed 8 double espresso drinks and 12 caffeinated sodas. The nurse suspects: a. Fluid overload b. Dehydration and caffeine overdose c. Benzodiazepine overdose d. Sleep deprivation syndrome

b Dehydration and caffeine overdose

A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. Which ego defense mechanism is in use? a. Projection b. Repression c. Displacement d. Reaction formation

b Repression

A client asks the nurse what kind of therapy will help. Based on current knowledge, what form of therapy is most appropriate for a client diagnosed with a conversion disorder? a. "Modeling will be used; as you see desired behaviors modeled by the therapist you will be able to also achieve the expected outcome." b. "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders." c. "A combination of antianxiety and antidepressant therapy is the most effective therapy." d. "Aversion therapy is often used because in effect you are punishing yourself by not being able to walk."

b "Cognitive-behavioral therapy (CBT) has been shown to consistently provide the best outcome for these types of disorders."

Lester and Alene have always enjoyed gambling. Lately, Alene has discovered that their savings account is down by $50,000. Alene insists that Lester undergo therapy for his gambling behavior. The nurse recognizes that Lester is making progress when he states: a. "I understand that I am a bad person for depleting our savings." b. "Gambling activates the reward pathways in my brain." c. "Gambling is the only thing that makes me feel alive." d. "We have always enjoyed gaming. I do not know why Alene is so upset."

b "Gambling activates the reward pathways in my brain."

Conversion disorder is described as an absence of a neurological diagnosis that manifest in neurological symptoms. Channeling of emotions, conflicts, and stressors into physical symptoms is thought to be the cause of conversion disorder. Which statement is true? a. People with conversion disorder are extremely upset about often dramatic symptoms b. Abnormal patterns of cerebral activation have been found in individuals with conversion disorder c. An organic cause is usually found in most cases of conversion disorder d. Symptoms can be turned off and on depending on the patients' choice

b Abnormal patterns of cerebral activation have been found in individuals with conversion disorder

Working to help the client view an occurrence in a more positive light is referred to by which term? a. Flooding b. Cognitive restructuring c. Desensitization d. Response prevention

b Cognitive restructuring

Which item of data should be routinely gathered during assessment of a client with a somatoform disorder? a. Potential for violence b. Dependence on medication c. Level of confusion d. Personal identity disturbance

b Dependence on medication

The nurse is providing teaching to a preoperative client just before surgery. The client is becoming more and more anxious and begins to report dizziness and heart pounding. The client also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? a. To reinforce the preoperative teaching by restating it slowly. b. Do not attempt any further teaching at this time. c. Have a family member read the preoperative materials to the client. d. Have the client read the teaching materials instead of providing verbal instruction.

b Do not attempt any further teaching at this time.

A client experiencing a panic attack keeps repeating, "I'm dying, I can't breathe.". What action by the nurse should be most therapeutic initially? a. Asking the client what he means when he says, "I am dying." b. Encouraging the client to take slow, deep breaths c. Offering an explanation about why the symptoms are occurring d. Verbalizing mild disapproval of the anxious behavior

b Encouraging the client to take slow, deep breaths

A primary health provider describes a client as "malingering." The nurse knows this means that the client is demonstrating which behavior? a. Experiencing symptoms that cannot be explained medically. b. Falsely claiming to have symptoms. c. Experiencing symptoms that have a physiological basis. d. Seeking medication to ease pain of psychological origin.

b Falsely claiming to have symptoms.

Which medication should the nurse be prepared to educate patients on when they are prescribed a selective serotonin reuptake inhibitor (SSRI) for panic attacks? a. Alprazolam (Xanax) b. Fluoxetine (Prozac) c. Clonazepam (Klonopin) d. Venalafaxine (Effexor)

b Fluoxetine (Prozac)

Which signs and symptoms are associated with opioid withdrawal? a. Synesthesia, depersonalization, and hallucinations. b. Lacrimation, rhinorrhea, dilated pupils, and muscle aches. c. Illusions, disorientation, tachycardia, and tremors. d. Fatigue, lethargy, sleepiness, and convulsions.

b Lacrimation, rhinorrhea, dilated pupils, and muscle aches.

Samantha is a new patient to the mental health clinic and is seeking assistance for what she describes as "severe anxiety." In addition to daily self-medicating with alcohol, Samantha describes long-term use of herbal kava. The nurse knows that kava is associated with inhibiting P450 and orders which of the following tests? a. Electrocardiogram b. Liver enzymes c. Glomerular filtration rate d. Complete blood count

b Liver enzymes

The term tolerance, as it relates to substance abuse, refers to which situation? a. The use of a substance beyond acceptable societal norms b. The need to take larger amounts of a substance to achieve the same effects c. The signs and symptoms that occur when an addictive substance is withheld d. The additive effects achieved by taking two drugs with similar actions

b The need to take larger amounts of a substance to achieve the same effects

Generally, which statement regarding ego defense mechanisms is true? a. They seldom make the person more comfortable. b. They often involve some degree of self-deception. c. They are usually effective in resolving conflicts. d. They are rarely used by mentally healthy people.

b They often involve some degree of self-deception.

Lucas is a nurse on a medical floor caring for Kelly, a 48-year-old patient with newly diagnosed type 2 diabetes. He realizes that depression is a complicating factor in the patient's adjustment to her new diagnosis. What problem has the most potential to arise? a. Development of agoraphobia b. Treatment nonadherence c. Frequent hypoglycemic reactions d. Sleeping rather than checking blood sugar

b Treatment nonadherence

What class of medications is commonly prescribed for somatic disorders? a. mood stabilizers. b. anxiolytics. c. antidepressants. d. antipsychotics.

b anxiolytics.

What term is used to identify a syndrome that occurs after stopping the long-term use of a drug? a. tolerance. b. withdrawal. c. amnesia. d. enabling.

b withdrawal.

Which statement or statements made by the nurse demonstrates an understanding of the effective use of relaxation therapy for anxiety management? Select all that apply a. "Relaxation therapy's main goal is to prevent exhaustion by removing muscle tension." b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "you've said that going to group makes you nervous, so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

b, c, d, e b. "Muscle relaxation promotes the relaxation response." c. "Show me how you learned to deep breathe in yesterday's therapy session." d. "you've said that going to group makes you nervous, so let's start relaxing now." e. "I've given you written descriptions of the various relaxation exercises for you to review."

The nursing diagnosis denial is especially useful when working with substance use disorders and gambling. Which statements describe this diagnosis? Select all that apply a. Reports inability to cope b. Does not perceive the danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit the impact of disease on life pattern

b, c, d, e b. Does not perceive the danger of substance use or gambling c. Minimizes symptoms d. Refuses healthcare attention e. Unable to admit the impact of disease on life pattern

A homebound patient diagnosed with agoraphobia has been receiving therapy at home. The nurse recognizes effective teaching when the patient states the following: a. "I may never leave the house again." b. "Having groceries delivered is very convenient." c. "My risk for agoraphobia is increased by my family history." d. "I will go out again someday, just not today."

c. "My risk for agoraphobia is increased by my family history."

Jasmine is a 19-year-old student who visits the university health center. She shares that, before an exam this semester, she experienced sweating, shortness of breath, abdominal pain, and the sensation of her heart being "in her throat." She found out later she got a grade of "D" on the exam, which alarmed her. She says, "I've always gotten Bs, and this is a subject I'm good at. "The symptoms scared her so much that over the next month, she began avoiding class for fear of feeling like that again. When she did attend class one day, she reports feeling tightness in her chest and her heart started pounding. As she began to breathe faster, she just said a silent prayer to not freak out, waiting for class to be over so she could get out of there. "Now I don't go to class. I just read and watch movies in my dorm—it's terrible. When I even think about classes and exams, I get stomach aches and nausea." She begins to cry and says, "Even when I don't think I'm anxious, I'm afraid of getting anxious. I want to go to school and get my degree. I just don't know what to do." 1. Identify the assessment findings that will require follow-up by the nurse. (Select all that apply.) a. Lives in the dorm b. Pounding heart c. Praying to calm herself d. Abdominal pain e. Feeling of doom f. Crying g. Shortness of breath h. Chest discomfort i. Intellectual deficit for field of study j. Grade of D on an important exam

b, d, e, g, h Pounding heart Abdominal pain Feeling of doom Shortness of breath Chest discomfort

The care plan of a patient diagnosed with a somatic disorder includes the nursing diagnosis ineffective coping. Which patient behavior demonstrates a successful outcome for that nursing diagnosis? a. Showers and dresses in clean clothes daily b. Calls a friend to talk when feeling lonely c. Spends more time talking about pain in her abdomen d. Maintains focus and concentration

b. Calls a friend to talk when feeling lonely

The nurse is caring for a client on day 1 post-surgical procedure. The client becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the client's actions? a. Reassure the client that what they are feeling is normal anxiety and do deep breathing exercises with her. b. Reassure the client that you will stay until the anxiety subsides. c. Call for staff help and assess the client's vital signs. d. Use the call light to inquire whether the client has been prescribed prn anxiety medication.

c Call for staff help and assess the client's vital signs.

What would be an appropriate expected outcome of the treatment plan for a client diagnosed with a conversion disorder that interferes with the ability to walk effective? a. Client will walk unassisted within 1 week. b. Client will return to a pre-illness level of functioning within 2 weeks. c. Client will be able to state two new effective coping skills within 2 weeks. d. Client will assume full self-care within 3 weeks.

c Client will be able to state two new effective coping skills within 2 weeks.

A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating which defense mechanism? a. Projection b. Rationalization c. Denial d. Reaction formation

c Denial

What can be said about the comorbidity of anxiety disorders? a. Substance abuse disorders rarely coexist with anxiety disorders. b. Anxiety disorders virtually never coexist with mood disorders. c. Depression may occur prior to onset of anxiety. d. Anxiety disorders generally exist alone.

c Depression may occur prior to onset of anxiety.

Diane, a 63-year-old mother of three, was brought to the community psychiatric clinic. Diane and her son had a bitter fight over finances. Ever since Diane has been complaining of "a severe pain in my neck." She has seen several doctors who cannot find a physical basis for the pain. The nurse knows that: a. Showing concern for Diane's pain will increase her obsessional thinking. b. Diane's symptoms are manipulative and under conscious control. c. Diane believes there is a physical cause for the pain and will resist a psychological explanation. d. Diane is trying to make her son feel bad about the argument.

c Diane believes there is a physical cause for the pain and will resist a psychological explanation.

Which medication is FDA approved for treatment of anxiety in children? a. Sertraline b. Clomipramine c. Duloxetine d. Fluoxetine

c Duloxetine

What is the major distinction between fear and anxiety? a. Fear enables constructive action; anxiety is dysfunctional. b. Fear is a universal experience; anxiety is neurotic. c. Fear is a response to a specific danger; anxiety is a response to an unknown danger. d. Fear is a psychological experience; anxiety is a physiological experience.

c Fear is a response to a specific danger; anxiety is a response to an unknown danger.

Which nursing diagnosis should be investigated for clients with somatoform disorders? a. Self-care deficit b. Deficient fluid volume c. Ineffective coping d. Delayed growth and development

c Ineffective coping

The record mentions states that the client habitually relies on rationalization. The nurse might expect the client to present with what behavior? a. Behaves in ways that are the opposite of his or her feelings. b. Misses appointments. c. Justifies illogical ideas and feelings. d. Makes jokes to relieve tension.

c Justifies illogical ideas and feelings.

A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress would include what behavior? a. Report both nausea and vomiting b. Exhibit stoic behavior c. Suddenly tremble severely d. Laugh inappropriately

c Suddenly tremble severely

Opioid use disorder is characterized by: a. Lack of withdrawal symptoms b. Intoxication symptoms of pupillary dilation, agitation, and insomnia c. Tolerance d. Requiring smaller amounts of the drugs to achieve a high over time

c Tolerance

When a client is prescribed lorazepam 1 mg po four times a day (qid) for 1 week for generalized anxiety disorder, the nurse should which intervention as the priority? a. question the physician's order because the dose is excessive. b. explain the long-term nature of benzodiazepine therapy. c. teach the client to limit caffeine intake. d. tell the client to expect mild insomnia.

c teach the client to limit caffeine intake.

A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested what substance? (Select all that apply.) Select all that apply. a. ReVia b. Ayahuasca c. Flunitrazepam d. Gamma-hydroxybutyrate (GHB) e. Clonidine

c, d c. Flunitrazepam d. Gamma-hydroxybutyrate (GHB)

Isabel is a straight-A student, yet she suffers from severe test anxiety and seeks medical attention. The nurse interviews Isabel and develops a plan of care. The nurse recognizes the effective teaching about mild anxiety when Isabel states the following: a. "I would like to try a benzodiazepine for my anxiety." b. "If I study harder, my anxiety level will go down." c. "Mild anxiety is okay because it helps me to focus." d. " I have fear that I will fail at college."

c. "Mild anxiety is okay because it helps me to focus."

Which patient is at greatest risk for developing a stress-induced myocardial infarction? a. A patient who lost a child in an accidental shooting 24 hours ago b. A woman who has begun experiencing early signs of menopause c. A patient who as spent years trying to sustain a successful business d. A patient who was diagnosed with chronic major depressive disorder 10 years ago

d A patient who was diagnosed with chronic major depressive disorder 10 years ago

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? a. Social anxiety disorder b. Agoraphobia c. Panic disorder d. Adult separation anxiety disorder

d Adult separation anxiety disorder

You are caring for Aaron, a 38-year-old patient diagnosed with somatic symptom disorder. When interacting with you, Aaron continues to focus on his severe headaches. In planning care for Aaron, which of the following options would be appropriate? a. Call for a family meeting with Aaron in attendance to confront Aaron regarding diagnosis b. Educate Aaron on alternative therapies to deal with pain c. Improve reality testing by telling Aaron you do not believe that the headaches are real d. After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

d After a limited discussion of physical concerns, shift focus to feelings and effective coping skills

To maximize the therapeutic effect, which lifestyle practice should the nurse discourage for a patient who has recently been prescribed an antianxiety medication? a. Eating high-protein foods b. Using acetaminophen without first discussing it with a healthcare provider c. Taking medications after eating dinner or while having a bedtime snack d. Buying a large coffee with sugar and extra cream each morning on the way to work

d Buying a large coffee with sugar and extra cream each morning on the way to work