Psych: Exam 2

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

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

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

Conversion disorder

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

Conveying an interest in the client rather than in the symptoms

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic? Knowledge of both national and local political activism The ability to cross service systems An awareness of own cultural and personal values Creative problem-solving and intervention skills

Creative problem-solving and intervention skills

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? Altruism Denial Undoing Suppression

Denial

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

Dependence on medication *Pts with somatoform disorder have become dependent on prescription meds for anxiety or pain relief. Assess how much and how long each med was used for*

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

Depression may occur prior to onset of anxiety.

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

Determine the use of chemical substances for anxiety relief. *Substance abuse often coexists with PTSD. Often the client's way of self-medicating to gain relief of symptoms*

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

23-year-old female

Which of the following patients would be appropriate to refer to a partial hospitalization program (PHP)? A depressed patient with a suicidal plan A patient being discharged from an inpatient alcohol rehabilitation unit A client who has stopped taking his or her antipsychotic medication and is neglecting his or her basic needs Jeff, who has mild depression symptoms and is starting outpatient therapy

A patient being discharged from an inpatient alcohol rehabilitation unit *PHP is for pts who need a step-down from inpatient and for those being diverted from hospitalization with intensive, short-term care from which they return home each day.*

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

A recurrent, persistent thought or impulse

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

A short-acting benzodiazepine medication.

A term is a synonym for the characteristic of genuineness? Respect Empathy Authentic Positive regard

Authentic

Which approach to reducing client stress is most effective in people with low to moderate hypnotic ability? Meditation Breathing exercises Journal keeping Biofeedback

Biofeedback

Which assessment monitors the effect of stress attributed to the stimulation of the hypothalamus-pituitary-adrenal cortex? Heart rate Triglycerides Blood glucose levels Brain norepinephrine

Blood glucose levels *Increased glucose levels heighten and maintain energy levels to meet the demands of a crisis or stressor*

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide? Break-away closet bars to prevent hanging Bedroom and dining areas with locked windows to prevent jumping Double-locked doors to prevent escaping from the unit Platform beds to prevent crush injuries

Break-away closet bars to prevent hanging *Hangings are the most common method of inpatient suicide*

What is response prevention?

a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval

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

Do not attempt any further teaching at this time.

Which medication is FDA approved for treatment of anxiety in children? Sertraline Fluoxetine Clomipramine Duloxetine

Duloxetine

An effective stress-reduction technique a nurse might teach an individual with performance anxiety is assertiveness. journal keeping. deep breathing. restructuring and setting priorities.

deep breathing.

what is severe anxiety characterized by?

feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart

Meditation is successful in promoting stress reduction because it brings about which outcome? Prevents endorphin release changes the client's energy field quiets the sympathetic nervous system activates the parasympathetic nervous system

quiets the sympathetic nervous system *Meditation reduces this state of alert by eliciting a relaxation response by creating a hypometabolic state of quieting the sympathetic nervous system*

What is altruism?

resolving emotional conflicts by meeting the needs of others

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's level of anxiety as mild. moderate. severe. panic.

severe *Severe anxiety is characterized by feelings of falling apart and impending doom, impaired cognition, and severe somatic symptoms such as headache and pounding heart.*

What is sublimation?

socially acceptable activity for unacceptable impulses

When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should... question the physician's order because the dose is excessive. explain the long-term nature of benzodiazepine therapy. teach the client to limit caffeine intake. tell the client to expect mild insomnia.

teach the client to limit caffeine intake.

What is the physiologic basis for the success of guided imagery? β-Endorphin release raises the pain threshold. Imagery raises the body level of cortisol and epinephrine. The sympathetic nervous system is stimulated to produce a quiet state. Brain catecholamines are less available to transmit pain impulses.

β-Endorphin release raises the pain threshold.

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

Encouraging the client to take slow, deep breaths

What is the primary advantage of using a case manager when considering the planning and implementation of client care? Increases collaborative practice. Enhances resource management. Increases client satisfaction with care. Promotes evidence-based psychiatric nursing.

Enhances resource management.

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

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

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

Falsely claiming to have symptoms. *Malingering is a consciously motivated act to deceive based on the desire for material gain.*

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

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

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

Fear of dying

A symptom commonly associated with panic attacks? Obsessions Apathy Fever Fear of impending doom

Fear of impending doom

The first stage of the general adaptation syndrome (GAS) can be characterized by which response? Eustress Fight or flight Resistance Exhaustion

Fight or flight *Stages of GAS* 1. Alarm: fight or flight 2. Resistance: attempts are made to cope w/ stressor 3. Exhaustion: physiological breakdown

The nurse would address which of the following goals in attempting to establish a therapeutic nurse-client relationship? (Select all that apply.) Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Providing the client with opportunities to socialize Assisting patients with problem solving to help facilitate activities of daily living Facilitating communication of distressing thoughts and feelings

Helping patients examine self-defeating behaviors and test alternatives Promoting self-care and independence Assisting patients with problem solving to help facilitate activities of daily living Facilitating communication of distressing thoughts and feelings

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

Illness anxiety disorder *Illness anxiety can be quite obsessive, because thoughts about illness may be intrusive and difficult to dismiss, even when the patient recognizes that his or her fears are unrealistic. IAD results in the misinterpretation of physical sensations as evidence of a serious illness.*

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

Ineffective coping

What would a client experience during a progressive relaxation session? Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed Being attached to a machine that monitors a physical parameter and receiving audible feedback about the state of that parameter Having a nurse enter the client's energy field to rebalance it and bring harmony Being led into a positive imaginary sensory experience

Instruction in sequential tensing and relaxing of various muscle groups until the entire body is relaxed

Stress can be attributed to stimulation of the hypothalamus-pituitary-adrenal cortex. Which assessment finding would confirm the long-term effects of such stress? (Select all that apply.) Insulin resistance A high resting heart rate Digestive problems Chronic muscle tension Obesity

Insulin Resistance Obesity

A therapeutic inpatient milieu will include which characteristic? It provides for the client's safety and comfort. Voluntarily admitted clients are generally allowed additional privileges. Rules and behavioral limits are flexibly enforced. Staff provide frequent and ongoing negative feedback to clients.

It provides for the client's safety and comfort.

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

Justifies illogical ideas and feelings.

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? Regression Depersonalization La belle indifference Dissociative amnesia

La belle indifference *La belle indifference is an attitude of unconcern about a symptom that is unconsciously used to lower anxiety.*

What tool should the nurse use in assessing the amount of stress a client has experienced in the past year? NANDA Handbook DSM-IV-TR Quick Mental Status Assessment Life-Changing Event Questionnaire

Life-Changing Event Questionnaire

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority? Fostering research Maintaining a therapeutic milieu Providing sympathetic listening Providing constructive negative feedback

Maintaining a therapeutic milieu *milieu environment serves as a real-life training ground for learning about self, and practicing communication/coping skills in preparation for a return to the community*

What function is shared by advanced practice and general practice psychiatric nurses? Prescriptive authority Admitting privileges Offers consultation services Membership on a multidisciplinary team

Membership on a multidisciplinary team

Selective inattention is first noted when experiencing which level of anxiety? Mild Moderate Severe Panic

Moderate *the individual's perceptual field is reduced and the client is not able to see the entire picture of events*

Which situation demonstrates the nurse functioning in the role of advocate? Providing one-to-one supervision for a client on suicide precautions Co-leading a medication education group for clients and families Attending an in-service education program to obtain recertification in cardiopulmonary resuscitation Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

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? Having the client repeatedly touch "dirty" objects Not allowing the client to seek reassurance from staff Not allowing the client to wash hands after touching a "dirty" object Telling the client that he or she must relax whenever tension mounts

Not allowing the client to wash hands after touching a "dirty" object *Response prevention is a technique by which the client is prevented from engaging in the compulsive ritual. A form of behavior therapy, response prevention is never undertaken without physician approval*

A client, whose friend recently committed suicide, asks the nurse about some ways to help cope with the stress regarding the event. Which option should the nurse discuss with the client? Isolation for a short time so that the pain isn't reinforced by explaining her feelings over and over Antianxiety medication to help her relax Starting a hobby to keep her mind off the troubling event Talking with friends and attending a loss support group

Talking with friends and attending a loss support group

Which phase of the nurse-client relationship may cause client anxieties to reappear and past losses to be reviewed? Preorientation phase Orientation phase Working phase Termination phase

Termination phase

Which criterion must be met to refer a client to a partial hospitalization program? The client is hospitalized at night in an inpatient setting. The client must be able to provide his or her own transportation daily. The client is able to return home each day. The clients are all recovering from an addiction.

The client is able to return home each day. *Returning home each day is a criterion because doing so allows the person to test out new skills and gradually re-enter the family and society.*

A 72-year-old patient 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 his provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? The client may become addicted faster than younger patients. The client is at risk for falls. The client has a history of nonadherence with medications. The client should be treated with cognitive therapies because of his advanced age.

The client is at risk for falls.

What factor exerts the greatest influence on the degree to which various life events upset a specific individual? The individual's perception of the event The individual's degree of spirituality The effect of the individual's health-sustaining behaviors The amount of social support available to the individual

The individual's perception of the event

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? "What things have you done in the past that helped you feel more comfortable?" "Let's try to focus on that adorable little granddaughter of yours." "Why don't you sit down over there and work on that jigsaw puzzle?" "Try not to think about the feelings and sensations you're experiencing."

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

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

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

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement? "We will help you make decisions that will keep you safe." "I am going to help you shower, so you will not smell so bad." "Your pocket knife and nail clippers will be kept in the nurses' station." "You will be having a number of tests to help us learn about your condition."

"I am going to help you shower, so you will not smell so bad."

Which statement by a patient who has been taught cognitive reframing indicates that the teaching was successful? "I do not have the ability to handle that job." "I can be successful if I do all the things required to learn the job." "I may be fired from the job but eventually I will find something else to do with my life." "I can never learn all there is to know for the job."

"I can be successful if I do all the things required to learn the job."

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

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

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

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

A patient admitted with anxiety asks, "What exactly are stressors?" What is the nurse's best response to the patient's question? "Stressors are events that happen that threaten your current functioning and require you to adapt." "Stressors are complicated neuro stimuli that cause mental illness." "It's best if you ask questions like that of your provider for a complete answer." "Instead of focusing on what stressors are, let's explore your coping skills."

"Stressors are events that happen that threaten your current functioning and require you to adapt."

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?" "Your legs don't work because your brain is screwed up." "Your emotional distress is being expressed as a physical symptom." "You are making up your symptoms as a cry for help." "You are overly anxious about having a severe illness."

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

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.) A history of childhood trauma A sibling with the disorder A history of sexual abuse A previous suicide attempt An eating disorder

A history of childhood trauma A sibling with the disorder A history of sexual abuse An eating disorder

Which of the following patients meets the criteria for an involuntary admission to a psychiatric mental health unit? A 23-year-old college student who has developed symptoms of anxiety and is missing classes and work A 30-year-old accountant who has developed symptoms of depression A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road A 76-year-old retired librarian who is experiencing memory loss and some confusion at times

A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road

Which client behavior illustrates eustress? A college student fails an exam. A bride is planning for her wedding. A man is laid off from his job. An adolescent gets into a fight at school.

A bride is planning for her wedding. *Eustress = good stress*

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation? A client and family members attend counseling sessions together at a neighborhood clinic Implementation of a more flexible work schedule for staff Improved reimbursement for services provided in the community A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months.

A client diagnosed with schizophrenia has avoided being rehospitalization for 16 months. *A primary goal of ACT is working intensely with the patient in the community to prevent rehospitalization.*

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 court date this week for drunk driving Was adopted at the age of 5 years A history of physical abuse by his stepfather A history of oppositional-defiant disorder Raised primarily in a single parent household

A court date this week for drunk driving

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? Panic disorder Adult separation anxiety disorder Agoraphobia Social anxiety disorder

Adult separation anxiety disorder *People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood*

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true? All rights remain intact. Only rights that do not involve decision making remain intact. The right to refuse treatment is no longer guaranteed. All rights are temporarily suspended.

All rights remain intact.

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

Altruism and sublimation

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention? Arranging for the client to have a screening for prostate cancer Notifying the family that the client will require a wheelchair when discharged Providing the client with organizations that help defray the cost of prescribed drug Arranging for respite care when the client's family needs to attend an out-of-state affair

Arranging for the client to have a screening for prostate cancer *The goal of managed care is to provide coordination of all health services with an emphasis on preventive care*

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

Being unable to work for the last 12 months.

The nurse is caring for a patient on day 1 post surgical procedure. The patient 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 patient's actions? Reassure the patient that what they are feeling is normal anxiety and do deep breathing exercises with her. Use the call light to inquire whether the patient has been prescribed prn anxiety medication. Call for staff help and assess the client's vital signs. Reassure the patient that you will stay until the anxiety subsides.

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

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

Cardiovascular disease

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided? The patients who are convicted criminals sentenced to home confinement. Care is provided to clients in unconventional settings. Care is provided by a preferred provider for a large HMO. The patients are provided for by a clinical specialist with the visiting nurse service.

Care is provided to clients in unconventional settings.

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

Client demonstrates effective coping strategies.

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? Client will walk unassisted within 1 week. Client will return to a pre-illness level of functioning within 2 weeks. Clients will be able to state two new effective coping skills within 2 weeks. Client will assume full self-care within 3 weeks.

Client will be able to state two new effective coping skills within 2 weeks. *An appropriate outcome for somatization disorders is to be aware of negative coping strategies and learn new, effective skills for coping within a realistic timeframe.*

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

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

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

Cognitive restructuring

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care? Nurses Social workers Clinical psychologists Chemical dependency counselors

Nurses

During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established? Pre-orientation Orientation Working Termination

Orientation *Contracting is part of the orientation phase of the relationship. Establishing the operational "rules" provides a foundation for the relationship*

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

Panic attacks with agoraphobia

Delusionary thinking is a characteristic of which form of anxiety? Chronic anxiety Acute anxiety Severe anxiety Panic level anxiety

Panic level anxiety

The relaxation response calls upon the initiation of what process? Sympathetic activation Parasympathetic activation Brainstem deactivation Increased cortisol production by the adrenals

Parasympathetic activation

Jacob is a college student whose friend recently committed suicide. Jacob rates his stress as low. Melissa was also friend with the person who committed suicide, but she rates her stress as high. The difference in how Jacob and Melissa rate their stress may be explained by which coping mechanism? Projection Denial Perception Repression

Perception

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method? Private insurance Medicare Medicaid Private pay

Private insurance

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need? Opportunity to act out fears and frustrations Providing a safe place to practice coping skills Meeting their physical as well as emotional needs Encouraging group communication about existing problems

Providing a safe place to practice coping skills

The psychiatric community health nurse engages in secondary prevention when implementing which intervention? Visiting a homeless shelter to provide mental health screenings for its clients Discussing the need for proper nutrition with a depressed new mother Providing stress reduction seminars at the local senior center Visiting the home of a client currently displaying manic behavior

Providing stress reduction seminars at the local senior center *Secondary prevention is aimed at reducing the prevalence of psychiatric disorders. Identification of problems, screening, and treatment are part of this level. While it does not stop the actual disorder from beginning, it is intended to delay or avert progression*

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? Projection Rationalization Reaction formation Undoing

Reaction formation *Reaction formation keeps unacceptable feelings or behaviors out of awareness by developing the opposite behavior or emotion.*

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? Regularly discuss their feelings about the client during the unit's interprofessional care meetings. Attend in-services that focus on the various aspects of somatic disorders. Rotate care of the client among the entire nursing department staff to minimize the frustration. Provide a unified approach to the client's behavior so as to manage and lessen the barrier itself.

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

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? Projection Repression Displacement Reaction formation

Repression

Self-help groups are useful for reducing stress because they provide the individual with the stress mediator that take what form? Social support Cultural support Life satisfaction Cognitive reframing

Social support

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

Somatic symptoms vary widely from culture to culture.

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

Suddenly tremble severely *Ataque de nervios (attack of the nerves) is a culture-bound syndrome that is seen in undereducated, disadvantaged females of Hispanic ethnicity*

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

They often involve some degree of self-deception.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege? Refusal of treatment. To send and receive mail. To seek legal counsel. To access all personal possessions.

To access all personal possessions.

When considering mental illness, recovery is best described to a client by which statement? Working, living, and participating in the community Never having to visit a mental health provider again Being able to understand the nature of the diagnosed illness A period of time when signs and symptoms are being managed

Working, living, and participating in the community

A class of medications commonly prescribed for somatic disorders is mood stabilizers. antidepressants. anxiolytics. antipsychotics.

anxiolytics

A client with hypertension uses an automatic cycling blood pressure cuff with audible changing tones. The client uses relaxation techniques to lower her blood pressure and is informed of her ongoing success by the tone. This process describes biofeedback. guided imagery. therapeutic touch. assertiveness training.

biofeedback

A nurse teaches a client a technique for examining negative thoughts and restating them in positive ways. What term is used to identify this technique? Guided imagery cognitive reframing wishful thinking confrontational assertion

cognitive reframing