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A client who has just begun attending Alcoholics Anonymous (AA) meetings asks a nurse how important it is to attend meetings regularly. What is the best response by the nurse?

"Do you think that attending these meetings won't be helpful?"

When a nurse sits next to a depressed client and begins to talk, the client responds, "I'm stupid and useless. Talk with the other people who are more important." Which response is most therapeutic?

"I want to talk with you because you are important to me."

A nurse approaches a depressed client who is sitting alone in the dayroom. What is best for the nurse to say to the client?

"I'll be sitting with you for a while today."

A client with schizophrenia is admitted to a psychiatric unit. The client is talking while walking in the hall, is unkempt, and obviously has not washed in several days. What should the nurse say when trying to help this client shower?

"I'll help you take your shower now."

A client with a diagnosis of schizophrenia, undifferentiated type, was admitted to the mental health hospital 3 days ago. The client stays in the bedroom except to eat and has no verbal interaction with other clients. When the nurse approaches, the client walks away and says, "Just leave me alone." What is the best response by the nurse?

"I'll talk to you later."

A school-aged child is brought to the clinic by the mother, who states, "Something is very wrong. My child never seems happy, and he refuses to play." When assessing this child for depressed behavior, the nurse initially begins with the statement:

"Let's talk about what you do after school."

A client who uses a ritual of counting paper in the printer tells the nurse, "I'm spending 30 minutes counting each time I make copies, and my boss is getting very upset. What should I do?" What is the best response by the nurse?

"Limit photocopying by clustering it to two or three times a day."

The nurse is interviewing a female adolescent with anorexia nervosa who is malnourished and severely underweight. The nurse concludes that the client is experiencing secondary gains from her behavior when she says:

"My mother keeps trying to get me to eat."

What is most appropriate for a nurse to say when interviewing a newly admitted depressed client whose thoughts are focused on feelings of worthlessness and failure?

"Tell me how you feel about yourself."

A client with schizophrenia reports having ongoing auditory hallucinations that he describes as "voices telling me that I'm a bad person" to the nurse. What is the best response by the nurse?

"Try to ignore the voices."

After detoxification a client with a long history of alcohol abuse decides to attend Alcoholics Anonymous (AA) meetings at the hospital. On the day of the second meeting the client says, "I can't go to the AA meeting today because I'm expecting an important phone call." The most therapeutic response by the nurse is:

"You are expected to go to the meeting."

A depressed client tells a nurse, "I want to die." What is the most therapeutic response by the nurse?

"You would rather not live."

Impulsivity Examples for ADHD

*Blurts out answers before question is completed *Difficulty waiting for turn *Interrupts or intrudes on others

Inattentive Examples for ADHD

*Fails to give close attention to details *Difficulty sustaining attention in tasks or play *Avoids, dislikes tasks that require sustained mental effort *Often does not seem to listen *Poor follow through to activities *Difficulty with organization *Loses things necessary for tasks *Easily distracted *Forgetful

Hyperactivity Examples for ADHD

*Fidgets *Trouble staying in seat *Runs about or climbs excessively and inappropriately *Difficulty playing quietly *Always on the "go" *Talks excessively

What are the goals of medications for ADHD?

*Improve impulse control *ability to concentrate *decrease distractibility *About 80 percent of children who need medication for ADHD still need it as teenagers. Over 50 percent need medication as adults.

Treatment for ADHD

*Management is a collaborative effort *Multimodal Therapy including; *Pharmacotherapy *Behavioral Interventions, such as: *Behavior Modification techniques *Cognitive behavior therapy *Patient, Parent, Caregiver education *Coaching and skills-training programs *School/community resources and accommodations

Cornerstone medication for ADHD/ADD

*Methylphenidate (Ritalin) *Daily dosage above 60 mg not recommended. Estimated dose range .3-.6 mg/kg/dose SIDE EFFECTS: Insomnia, decreased appetite, weight loss, headache, irritability, stomachache, and rebound agitation or exaggeration of pre-medication symptoms as it is wearing off. *Works quickly (within 30-60 minutes). *Use cautiously in patients with marked anxiety, motor tics or with family history of Tourette syndrome, or history of substance abuse. *Don't use if glaucoma or on MAOI *Effective in 70-80% of children *Approved for 6yo+

Behavior Management Plan for ADHD/ADD

*Minimize environmental distractions *Four Hallmarks of effective psychosocial interventions within behavioral plans 1) Consistency *All caregivers/teachers must adhere and administer the behavior plan consistently 2) Immediacy *Feedback and consequences must be administered immediately 3) Specificity *Caregivers/teachers must be explicit about behaviors being targeted 4) Saliency *Consequences should be meaningful and noticeable to child

Pharmacological Therapies for ADHD

*STIMULANT Medications (SIDE EFFECTS: Insomnia, nervousness, agitation, palpitations, anorexia, weight loss, changes in BP/pulse, impaired growth rates) *Ritalin *Concerta *Metadate CD *Focalin *Dexedrine *Adderall *Daytrana *Vyvanse *NONSTIMULANT Medication (SIDE EFFECTS: Suicide, hepatic damage) *atomoxetine (Strattera) *selective norepinephrine reuptake inhibitor

amphetamine (Adderall)

*Stimulant: Schedule II Medication *Used for ADHA and Narcolepsy *Can be abused as a performance enhancer (both physical and cognitive) and effect of euphoria. *Side Effects and Assessment *Monitor LFTs *Hyper or Hypotension from vagal stimulation, Raynauds phenomen, tachycardia *Erectile dysfunction/priapism *Insomnia and increased alertness *appetite suppression *may take 2 weeks for full effect *Approved for 3yo +

Why is ADHD sometimes not detected until the child enters school (younger than 4) ?

*Typical behaviors of ADHD is attributed to normal early childhood characteristics* so clinicians hesitate to make a diagnosis of ADHD before 6 yo and Psychiatrist suggests to be slow to make the diagnosis and in addition, consider parent training and specialized day care before resorting to stimulant drugs.

Screening and Diagnosis for ADHD

*Usually brought for evaluation when behaviors interfere with school when it Interferes with the daily functioning of teachers or parents" (Maternal Child...) *Complete history evaluation done *Testing on child *Questionnaires administered to parents, caregivers, teachers: *Child Behavior checklist *Conners-Wells Self-Report scales *Conners' Rating Scales *ADHD Rating Scale-IV

Nurse teaching on Ritalin administration

-give after meals, as needed, to minimize decrease in appetite effect -Administer in the morning and last dose 6 hours before bed time to avoid insomnia -the child should decrease caffeine consumption -adaptive treatment plans: teach about titrating of dose to meet individual needs/measuring treatment success/modifying of regime to keep pace with developmental and activity needs

Cont. Nurse teachings

-often taken during school hours/school year (may be off for a time to help growth/drug holidays when school not in session) 3 to 4 weeks needed to check effectiveness -decreased RBCs/WBCs/platelets & increased prothrombin time (PT) possible: monitor labs/get baseline levels -constipation possible so increase fluids & fiber -Don't stop abruptly -Evaluate growth -encourage the child to get needed rest (may feel more tired at end of day)

Four Hallmarks of effective psychosocial interventions within behavioral plans

1) Consistency *All caregivers/teachers must adhere and administer the behavior plan consistently 2) Immediacy *Feedback and consequences must be administered immediately 3) Specificity *Caregivers/teachers must be explicit about behaviors being targeted 4) Saliency *Consequences should be meaningful and noticeable to child

The nurse finds a client with schizophrenia lying under a bench in the hall. The client states, "God told me to lie here." What is the best response by the nurse? 1. "I didn't hear anyone talking. Come with me to your room." 2."What you heard was in your head; it was your imagination." 3."Come to the dayroom and watch television. It will help take your mind off of this." 4."God would not tell you to do that, he wants you to behave reasonably."

1. "I didn't hear anyone talking. Come with me to your room." The nurse is focusing on reality and trying to distract and refocus the client's attention.

The nurse manager is evaluating a primary nurse who is working with a hospitalized adolescent client with the diagnosis of conduct disorder. Which intervention by the primary nurse should the nurse manger question? 1. Discussing rules of the unit 2. Allows opportunities for choices 3. Explaining the consequences for not following unit regulations 4. Encouraging the verbalization of negative feelings toward others

1. Discussing rules of the unit (The environment must be consistent and predictable to limit manipulative behavior.)

Frontal lobe deficits in schizophrenia are thought to be responsible for: 1. Disorganized thinking 2. Hallucinations 3. Depression 4. Parkinsonism

1. Disorganized thinking Good. The frontal lobe is responsible for organized thinking. If there are deficits or alterations in this region, disorganized thinking will result.

When caring for a withdrawn, reclusive, psychotic client, the priority goal is for the client to develop: 1. Trust 2. Self-worth 3. A sense of identity 4. Improved social skills

1. Trust Trust is basic to all therapies; without trust a therapeutic relationship cannot be established.

A client who is a polysubstance abuser has been ordered by the court to seek drug and alcohol counseling. When working with the client, the nurse identifies several treatment goals. List in priority order the outcome criteria for this client.

1. Verbalizes that a substance abuse problem exists 2. Discusses effect of drug use on self and others 3. Expresses negative feelings about the current life situation 4. Explores the use of substances and problematic behaviors

Which nursing intervention is a priority when planning nursing care for a client experiencing delirium tremens (DTs) related to alcohol withdrawal? 1. Administer benzodiazepine medication as ordered. 2. Monitor labs for ammonia levels and coagulation times. 3. Take vital signs frequently to monitor for hypovolemic shock. 4. Provide a well-balanced meal and encourage fluids

1.Administer benzodiazepine medication as ordered. Administering benzodiazepines takes priority for this client to prevent hypertensive crisis and seizures associated with DT symptoms during alcohol withdrawal. Monitoring ammonia levels and coagulation times is appropriate for a client with cirrhosis. Monitoring hypovolemic shock is appropriate for a client with esophageal varices. Nutritional and fluid intake is an appropriate intervention for the client with alcoholism, but is not priority for treatment of DT symptoms.

When assessing the mental status of a 7- or 8-year-old child, it is most important for the nurse to: 1. Listen to the parent's description of the child's behvior 2. Compare the child's functioning from one day to another 3. Engage parents in a discussion about the child's feelings 4. Determine the child's mental status by using direct questions

2. Compare the child's functioning from one day to another Comparison over time is the only way for the nurse to accurately assess the mental status of a child.

The nurse notes that a client with schizophrenia and receiving an antipsychotic medication is moving her mouth, protruding her tongue, and grimacing as she watches television. The nurse determines that the client is experiencing which medication complication? 1. Parkinsonism 2. Tardive Dyskinesia 3. Hypertensive crisis 4. Neuroleptic

2. Tardive Dyskinesia Good. Tardive dyskinesia is a reaction that can occur from antipsychotic medication. It is characterized by uncontrollable involuntary movements of the body and extremities, particularly the tongue. Parkinsonism is characterized by tremors, masklike facies, rigidity, and a shuffling gait. Hypertensive crisis can occur from the use of monoamine oxidase inhibitors and is characterized by hypertension, occipital headache radiating frontally, neck stiffness and soreness, nausea, and vomiting. Neuroleptic malignant syndrome is a potentially fatal syndrome that may occur at any time during therapy with neuroleptic (antipsychotic) medications. It is characterized by dyspnea or tachypnea, tachycardia or irregular pulse rate, fever, blood pressure changes, increased sweating, loss of bladder control, and skeletal muscle rigidity.

A client says to the nurse, "The federal guards were sent to kill me." What is the best nursing response to the client's concern? 1. "I don't believe this is true." 2. "The guards are not out to kill you" 3. "Do you feel afraid that people are trying to hurt you?" 4. "What makes you think the guards were sent out to hurt you?"

3. "Do you feel afraid that people are trying to hurt you?" It is most therapeutic for the nurse to empathize with the client's experience. The remaining options lack this connection with the client. Disagreeing with delusions may make the client more defensive, and the client may cling to the delusions even more. Encouraging discussion regarding the delusion is inappropriate.

A nurse teaches a client about the side effects and precautions associated with the typical antipsychotic haloperidol (Haldol). The nurse evaluates that the teaching is understood when the client states: 1. "I will immediately report any diarrhea or vomiting to my doctor." 2. "I will not eat any tyramine-containing foods while I'm taking this drug." 3. "I'll avoid direct sunlight and use a sunscreen product when I go outdoors." 4. "I'll maintain an adequate fluid intake because I may urinate more than usual."

3. "I'll avoid direct sunlight and use a sunscreen product when I go outdoors." Photosensitivity is a side effect of many antipsychotic medications. 1. These adaptations are side effects of lithium, not Haldol. 2. Avoiding tyramine-containing foods is a precaution associated with MAO inhibitors, not Haldol. 4. This is a precaution associated with lithium, not Haldol.

A child with ADHD had this nursing diagnosis: impaired social interaction, related to excessive neuronal activity, as evidenced by aggressiveness and dysfunctional play with others. Which finding indicates the plan of care was effective? 1. Improved ability to identify anxiety and use self-control strategies 2. Increased expressiveness in communication with others 3. Engages in cooperative play with other children 4. Increased responsiveness to authority figures

3. Engages in cooperative play with other children

A nurse is assessing an adolescent client with the diagnosis of schizophrenia, undifferentiated type. Which signs and symptoms should the nurse expect the client to experience? 1. Paranoid delusions and hypervigilance 2. Depression and psychomotor retardation 3. Loosened associations and hallucinations 4. Ritualistic behaviors and obsessive thinking

3. Loosened associations and hallucinations Loosened associations and hallucinations are the primary behaviors associated with a thought disorder such as schizophrenia. Paranoid delusions and hypervigilance are more common in paranoid-type schizophrenia than in the undifferentiated type. Depression and psychomotor retardation are not characteristic of schizophrenia. Ritualistic behavior and obsessive thinking generally are associated with obsessive-compulsive disorders, not schizophrenia.

A hyperactive self-destructive child is to be discharged from an inpatient setting in a few days. In preparation for the child's discharge, it is most important for the nurse to plan to: 1. Establish, maintain, and enforce limits on behavior 2. Meet with child's teacher to review child's needs 3. Schedule a team conference with child and parents 4. Help child to begin terminating relationship with nursing staff

3. Schedule a team conference with child & parents This provides an opportunity for the team, the child, and the parents to interact in a therapeutic environment.

Which intervention should the nurse include in the plan of care for a client experiencing opiate withdrawal? 1. Administer diazepam (Valium) 2. Administer naloxone (Narcan) 3. Administer clonidine (Catapres) 4. Administer bromocriptine (Parlodel)

3.Administer clonidine (Catapres) Clonidine (Catapres) blocks opioid receptor sites in the treatment of opioid withdrawal. Diazepam (Valium) is a benzodiazepine used as treatment for alcohol withdrawal and hallucinogen (LSD, PCP) overdose. Naloxone (Narcan) is a narcotic antagonist which quickly reverses CNS depression associated with opioid overdose, not opioid withdrawal. Bromocriptine (Parlodel) is used as treatment for stimulant (amphetamines, cocaine) withdrawal

The nurse is preparing a client with a history of command hallucinations for discharge by providing instructions on interventions for managing hallucinations and anxiety. Which statement in response to these instructions suggests to the nurse that the client understands the instructions? 1. "My medications aren't likely to make me anxious." 2. "I'll go to support group and talk so that I don't hurt anyone." 3. "It's not likely that I'll get anxious or hear things if I get enough sleep and eat well." 4. "When I begin to hallucinate, I'll call my therapist and talk about what I should do."

4. "When I begin to hallucinate, I'll call my therapist and talk about what I should do." Good. The risk for impulsive and aggressive behavior may increase if a client is receiving command hallucinations to harm self or others. If the client is experiencing a hallucination, the nurse should ask the client whether he or she has intentions to hurt him- or herself or others. Talking about auditory hallucinations can interfere with subvocal muscular activity associated with a hallucination. The client statements in the remaining options will aid in wellness, but are not specific interventions for hallucinations, if they occur.

The nurse is caring for a client who is experiencing disturbed thought processes as a result of paranoia. In formulating nursing interventions with the members of the health care team, what best instruction should the nurse provide to the staff? 1. Have the client sign a release of information to appropriate parties for assessment purposes. 2. Begin to educate the client about social supports in the community. 3. Increase socialization of the client with peers. 4. Avoid laughing or whispering in front of the client.

4. Avoid laughing or whispering in front of the client Good. Disturbed thought process related to paranoia is the client's problem, and the plan of care must address this problem. The client is experiencing paranoia and is distrustful and suspicious of others. The members of the health care team need to establish a rapport and trust with the client. Laughing or whispering in front of the client would be counterproductive. The remaining options ask the client to trust on a multitude of levels. These options are actions that are too intrusive for a client who is paranoid.

To help a disturbed, acting-out child develop a trusting relationship, the nurse should: 1. Inquire as to the child's feelings about the parents 2. Implement a half hour one-to-one interaction daily 3. Initiate limit setting and explain the rules to be followed 4. Offer periodic support and emphasize safety in play activities

4. Offer periodic support and emphasize safety in play activities This action sets a foundation for trust because it allows the child to see that the nurse cares.

A client with schizophrenia has been started on medication therapy with clozapine (Clozaril). The nurse should assess the results of which laboratory study to monitor for adverse effects from this medication? 1. Platelet Count 2. Blood Glucose 3. Liver Function Tests 4. White Blood Cell Count

4. White Blood Cell Count A client taking clozapine (Clozaril) may experience agranulocytosis, which is monitored by reviewing the results of the white blood cell count. Treatment is interrupted if the white blood cell count decreases to less than 3000 cells/mm3. Agranulocytosis could be fatal if undetected and untreated. The other laboratory studies are not related specifically to the use of this medication.

A male client is diagnoses with schizotypal personality disorder. Which signs would this client exhibit during social situation? A. Paranoid thoughts B. Emotional affect C. Independence need D. Aggressive behavior

A neuromuscular blocking agent is administered to a client before ECT therapy. The Nurse should carefully observe the client for? A. Respiratory difficulties B. Nausea and vomiting C. Dizziness D. Seizures

A nursing care plan for a male client with bipolar 1 disorder should include: A. Providing a structured environment B. Designing activities that will require the client to maintain contact with reality C. Engaging the client in conversing about current affairs D. Touching the client provide assuranve

Joey, a client with antisocial personality disorder, belches loudly. A staff member asks Joey, "Do you know why people find you repulsive?" This statement most likely would elicit which of the following client reactions? A. Defensiveness B. Embarassment C. Shame D. Remorsefulness

Nurse Hazel is caring for a male client who experiences false sensory perceptions with no basis in reality. This perception is known as: A. Hallucinations B. Delusions C. Loose Associations D. Neologisms

Nurse Joey is aware that the signs and symptoms that would be most specific for diagnosis anorexia are? A. Excessive weight loss, amenorrhea & abdominal distension B. Slow pulse, 10% weight loss and alopecia C. Compulsive behavior, excessive fears and nausea D. Excessive activity, memory lapses and an increased pulse

Nurse Jonel is providing information to a community group about violence in the family. Which statement by a group member would indicate a need to provide additional information? A. "Abuse occurs more in low-income families" B. "Abuser are often jealous or self-centered." C. "Abuser use fear and intimidation." D. "Abuser usually have poor self-esteem."

Nurse Monette recognizes that the focus of environmental (MILIEU) therapy is to: A. Manipulate the environment to bring about positive changes in behavior B. Allow the client's freedom to determine whether or not they will be involved in activities C. Role play life events to meet individual needs D. Use natural remedies rather than drugs to control behavior

Nurse Patricia is aware that the major health complication associated with intractable anorexia nervosa would be? A. Cardiac dysrhythmias resulting to cardiac arrest B. Glucose intolerance resulting in protracted hypoglycemia C. Endocrine imbalance causing cold amenorrhea D. Decreased metabolism causing cold intolerance

Nurse Tony was caring for a 41 year old female client. Which behavior by the client indicates adult cognitive development? A. Generates new levels of awareness B. Assumes responsibility for her actions C. Has maximum ability to solve problems and learn new skills D. Her perceptions are based on reality

When teaching parents about childhood depression Nurse Trina should say? A. It may appear acting out behavior B. Does not respond to conventional treatment C. Is short in duration and resolves easily D. Looks almost identical to adult depression

When working with a male client suffering phobia about black cats, Nurse Trish should anticipate that a problem for this client would be? A. Anxiety when discussing phobia B. Anger toward the feared object C. Denying that the phobia exist D. Distortion of reality when completing daily routines

Genevieve only attends social events when a family member is also present. She exhibits behavior typical of which anxiety disorder? A. Agoraphobia B. Generalized anxiety disorder C. Obsessive-compulsive disorder D. Post-traumatic stress disorder

A Agoraphobia is a disorder characterized by avoidance of situations in which escape may not be possible or help may be unavailable.

Mr. Johnson is newly admitted to a psychiatric unit because of severe obsessive compulsive behavior. Which initial response by the nurse would be most therapeutic for him? A. Accepting the client's ritualistic behaviors B. Challenging the client's need for rituals C. Expressing concern about the harmfulness of the client's rituals D. Limiting the client's rituals that are excessive

A It is important to accept the client's need to perform ritualistic behaviors in this situation; admission to a psychiatric unit is stressful, and this client will tend to increase rituals when anxious. Other options are not appropriate for a newly admitted client.

A newly admitted client is diagnosed with dissociative identity disorder. Which nursing intervention is a priority? A. Establish an atmosphere of safety and security. B. Teach new coping skills to replace dissociative behaviors. C. Process events associated with the origins of the disorder. D. Identify relationships among subpersonalities and work with each equally.

A A growing body of evidence points to the etiology of dissociative identity disorder as a set of traumatic experiences that overwhelms the individual's capacity to cope by any means other than dissociation. It is a priority for the nurse to establish an atmosphere of safety and security in which trust can be established. Trust must be established before a client would feel comfortable to discuss highly charged, past traumatic events.

When considering comorbid conditions, which nursing intervention is most appropriate for a client diagnosed with a dissociative disorder? A. Assessing client for suicidal ideations frequently during the day B. Administering medication to manage constipation as prescribed C. Inspecting skin for signs of damage resulting from repetitive hand washing D. Preparing for diagnostic testing to evaluate client's report that, "my heart skips beats"

A A suicide assessment should be performed with any psychiatric patient. Patients with somatic symptom disorders and related disorders, as well as dissociative disorder patients, may be especially prone to self-harm behaviors. While clients may experience constipation, cardiac arrhythmia, and compulsive behaviors, these conditions are not typically associated with dissociative disorders.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? A Actively listen to the parents' concern before planning interventions. B Encourage the parents to discuss these issues with the mental health team. C Provide literature regarding the disorder and its management. D Tell the parents they are overacting to the problem.

A Actively listen to the parents' concern before planning interventions. The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions. In option B, the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted. Providing literature regarding the disorder and its management may be useful intervention; however, the initial action needs to involve a more thorough exploration of the parents' concerns. Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents' legitimate concerns and belittles their feelings.

An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit: A. negativism and acting out. B. sadness and crying. C. suicidal thoughts. D. weight gain.

A Adolescents sometimes demonstrate behavior that is uncharacteristic of an adult with a psychiatric disorder. In a depressive disorder, an adolescent's negativism and acting out could be signs of depression. Sadness, crying, and suicidal thoughts are behaviors of both adolescents and adults. An adult may experience either weight loss or weight gain while depressed, whereas an adolescent may experience weight loss.

Nurse Tiffany reinforces the behavioral contract for a child having difficulty controlling aggressive behaviors on the psychiatric unit. Which of the following is the best rationale for this method of treatment? A. It will assist the child to develop more adaptive coping methods. B. It will avoid having the nurse be responsible for setting the rules. C. It will maintain the nurse's role in controlling the child's behavior. D. It will prevent the child from manipulating the nurse.

A Behavioral therapy is employed for the purpose of developing adaptive behavior that will improve coping. The nurse does not avoid setting rules; it is the responsibility of the nurse to establish and maintain appropriate limits. The nurse works to enhance the child's self-functioning and responsibility for his own behavior using appropriate means to develop better coping. Although reinforcing behavioral contracts will help prevent manipulative behavior by the child, this is not the best rationale for using behavioral treatment, which aims to improve client behavior.

Which outcome is most appropriate for Francis who has a dissociative disorder? A. Francis will deal with uncomfortable emotions on a conscious level. B. Francis will modify stress with the use of relaxation techniques. C. Francis will identify his anxiety responses. D. Francis will use problem-solving strategies when feeling stressed.

A Dissociative disorders occur when traumatic events are beyond an individual's recall because this memories have been "blocked" from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation.

The nurse is planning care for a client who has a phobic disorder manifested by a fear of elevators. Which goal would need to be accomplished first? The client A. demonstrates the relaxation response when asked. B. verbalizes the underlying cause of the disorder. C. rides the elevator in the company of the nurse. D. role plays the use of an elevator.

A The ability to use relaxation is basic to treatment of phobia. Clients with phobias are resistant to insight therapy. Riding the elevator accompanied by the nurse is an appropriate long-term goal. Role playing may be appropriate after the client has learned relaxation.

A 15-year-old boy was hospitalized in a psychiatric unit because he initiates frequent fights with peers. Which implementation is most appropriate? A. Anticipate and neutralize potentially explosive situations. B. Ignore minor infractions of rules against fighting. C. Isolate the adolescent from contact with peers. D. Talk to the adolescent each time fighting occurs.

A The nurse is responsible for maintaining a safe environment; therefore, it would be appropriate to observe for signs that an explosive situation is developing and to intervene to neutralize the situation, thereby preventing a fight. Ignoring minor infractions of rules against fighting on a psychiatric unit would not be a minor infraction and should not be ignored. This could lead to unsafe situations that could escalate out of control. Isolation and seclusion are methods of intervention that can be used as a last resort after less restrictive means are employed. Talking to the adolescent each time a fight occurs does not indicate that the nurse is setting and enforcing clear, consistent rules. The nurse needs to maintain safety and would not allow fighting to occur if it could be avoided.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? A. Actively listen to the parents' concern before planning interventions. B. Encourage the parents to discuss these issues with the mental health team. C. Provide literature regarding the disorder and its management. D. Tell the parents they are overacting to the problem.

A The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions. In option B, the nurse has not explored the problem and is deciding before adequately assessing the situation that the mental team should be consulted. Providing literature regarding the disorder and its management may be useful intervention; however, the initial action needs to involve a more thorough exploration of the parents' concerns. Telling the parents they are overreacting to the problem is inappropriate because it dismisses the parents' legitimate concerns and belittles their feelings.

Alexi who has separation anxiety disorder has not attended school for 3 weeks, and she cries and exhibits clinging behaviors when her mother encourages attendance. The priority nursing action by the home-care psychiatric nurse would be to: A. Assist the child in returning to school immediately with family support. B. Arrange for a home-school teacher to visit for 2 weeks. C. Encourage family discussion of various problem areas. D. Use play therapy to help the child express her feelings.

A When a child refuses to attend school as part of separation anxiety disorder, it is important to avoid reinforcing this behavior. The nurse's priority would be to assist the child to return to school immediately with support from the family. Arranging for a home-school teacher would reinforce the behavior of not attending school. Although encouraging family discussion of problem areas and the use of play therapy are appropriate treatment interventions, the priority is returning the child to school.

A. Anticipate and neutralize potentially explosive situations.

ADHD

A disorder that involves inattention and or hyperactivity and impulsivity. These children are highly distractible and unable to contain their responses to stimuli.

When establishing a plan of care, the nurse should understand that a male client's delusion that he is an important government adviser is most likely related to:

A need to feel a sense of importance within his environment

Which interventions are most appropriate for caring for a patient in alcohol withdrawal? SATA a. Monitor vital signs b. Provide a safe environment c. Address hallucinations therapeutically d. Provide stimulation in the environment e. Provide reality orientation as appropriate f. Maintain NPO status

A, B, C E

During an initial assessment of a client admitted to a substance abuse unit for detoxification and treatment, the nurse asks questions to determine patterns of use of substances. Which of the following questions are most appropriate at this time? Select all that apply. A. How long have you used substances? B. How often do you use substances? C. How do you get substances into your body? D. Do you feel bad or guilty about your use of substances? E. How much of each substance do you use? F. Have you ever felt you should cut down substance use? G. What substances do you use?

A, B, C, E, G These questions will elicit information about the client's pattern of use of substances. Options D and F are questions related to CAGE, a tool for screening suspected substance abusers.

Nurse Vicky is assessing a newly admitted client for symptoms of post-traumatic stress disorder (PTSD). Which symptoms are typically seen with this diagnosis? Select all that apply. A. Anger with numbing of other emotions B. Exaggerated startle response C. Feeling that one is having a heart attack D. Frequent thoughts about contamination E. Frequent nightmares F. Survivor's guilt

A, B, E, F These are common symptoms of PTSD. Option C is common in panic disorder, and option D is characteristic of obsessive-compulsive disorder.

The school nurse asseses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. A. Constant fidgeting and squirming B. Excessive fatigue and somatic complaints C. Difficulty paying attention to details D. Easily distracted E. Running away F. Talking constantly, even when inappropriate

A, C, D, F These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive. Options B and E are signs of emotional distress in a child and could be associated with a number of different psychiatric diagnoses.

The school nurse assesses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. A. Constant fidgeting and squirming B. Excessive fatigue and somatic complaints C. Difficulty paying attention to details D. Easily distracted E. Running away F. Talking constantly, even when inappropriate

A, C, D, and F These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive.

The psychiatric nurse is alert to warning signs of suicide in the adolescent population. From the following list, select those behaviors that are indicative of adolescent suicidal thinking. Select all that apply. A. Giving away prized possessions B. Associating with friends who are substance abusers C. Sudden withdrawal from friends and family D. Having difficulty concentrating on one thing at a time E. Being easily distracted by environmental events F. Verbal hints or threats about suicide

A, C, F These are all warning signs that an adolescent is having suicidal thoughts. The nurse should directly question any adolescent about suicide intent when these indicators are noted. Option B may indicate that the adolescent has a problem with substance use, but not necessarily suicide. Options D and E are signs of attention deficit hyperactivity disorder, not suicide.

A client with panic disorder experiences an acute attack while the nurse is completing an admission assessment. List the following interventions according to their level of priority. A. Remain with the client. B. Encourage physical activity. C. Encourage low, deep breathing. D. Reduce external stimuli. E. Teach coping measures.

A, D, C, B, then E. The nurse should remain with the client to provide support and promote safety. Reducing external stimuli, including dimming lights and avoiding crowded areas, will help decrease anxiety. Encouraging the client to use slow, deep breathing will help promote the body's relaxation response, thereby interrupting stimulation from the autonomic nervous system. Encouraging physical activity will help him to release energy resulting from the heightened anxiety state; this should be done only after the client has brought his breathing under control. Teaching coping measures will help the client learn to handle anxiety; however, this can only be accomplished when the client's panic has dissipated and he is better able to focus.

A,B,E,F These are common symptoms of PTSD. Option C is common in panic disorder, and option D is characteristic of obsessive-compulsive disorder.

DSM-V criteria for ADHD

A. A persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development, as characterized by either B. Six or more symptoms of inattentive or hyperactive-impulsive symptoms for children up to age 16, or five or more for age 17 and older. Symptoms have been present for at least 6 months and are inappropriate for developmental level. Several hyperactive-impulsive symptoms were present prior to age 12. C. Several inattentive or hyperactive-impulsive symptoms are present in two or more settings (e.g., at home, school, or work; with friends or relatives; in other activities). D. There is clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning. E. The symptoms do not occur exclusively during the course of schizophrenia or another psychotic disorder and are not better explained by another mental disorder.

Alfred was newly diagnosed with anxiety disorder. The physician prescribed buspirone (BuSpar). The nurse is aware that the teaching instructions for newly prescribed buspirone should include which of the following? A. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days. B. A warning about the incidence of neuroleptic malignant syndrome (NMS). C. A reminder of the need to schedule blood work in 1 week to check blood levels of the drug. D. A warning that immediate sedation can occur with a resultant drop in pulse.

A. A warning about the drugs delayed therapeutic effect, which is from 14 to 30 days. The client should be informed that the drug's therapeutic effect might not be reached for 14 to 30 days. The client must be instructed to continue taking the drug as directed. Option B: NMS hasn't been reported with this drug, but tachycardia is frequently reported. Option C: Blood level checks aren't necessary.

The nurse is working with a client who abuses alcohol. Which of the following facts should the nurse communicate to the client? A. Abstinence is the basis for successful treatment. B. Attendance at Alcoholics Anonymous meetings every day will cure alcoholism. C. For treatment to be successful, family members must participate. D. An occasional social drink is an acceptable behavior for the alcoholic

A. Abstinence is the basis for successful treatment. The foundation of any treatment for alcoholism is abstinence. Option B: Attendance at Alcoholics Anonymous is helpful to some individuals to maintain strict abstinence. Option C: Participation in treatment by the family is beneficial to both the client and the family but isn't essential. Option D: Abstinence requires refraining from social drinking.

The nurse is aware that the outcome criteria would be appropriate for a child diagnosed with oppositional defiant disorder? A. Accept responsibility for own behaviors B. Be able to verbalize own needs and assert rights. C. Set firm and consistent limits with the client D. Allow the child to establish his own limits and boundaries

A. Accept responsibility for own behaviors Children with oppositional defiant disorder frequently violate the rights of others. They are defiant, disobedient, and blame others for their actions. Accountability for their actions would demonstrate progress for the oppositional child. Option B is incorrect as the oppositional child usually, focuses on his own needs. Options C and D aren't outcome criteria but interventions.

A client with obsessive-compulsive disorder is hospitalized on an inpatient unit. Which nursing response is most therapeutic? A. Accepting the client's obsessive-compulsive behaviors B. Challenging the client's obsessive-compulsive behaviors C. Preventing the client's obsessive-compulsive behaviors D. Rejecting the client's obsessive-compulsive behaviors

A. Accepting the client's obsessive-compulsive behaviors A client with obsessive-compulsive behavior uses this behavior to decrease anxiety. Accepting this behavior as the client's attempt to feel secure is therapeutic. When a specific treatment plan is developed, other nursing responses may also be acceptable. Options B, C, and D: The remaining answer choices will increase the client's anxiety and therefore are inappropriate.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? A. Actively listen to the parents' concern before planning interventions. B. Encourage the parents to discuss these issues with the mental health team. C. Provide literature regarding the disorder and its management. D. Tell the parents they are overacting to the problem.

A. Actively listens to the parents' concern before planning interventions. The nurse would encourage parents to fully discuss and describe their perception of the problem in order to assess the family system before determining appropriate interventions.

The community nurse practicing primary prevention of alcohol abuse would target which groups for educational efforts? A. Adolescents in their late teens and young adults in their early twenties B. Elderly men who live in retirement communities C. Women working in careers outside the home D. Women working in the home

A. Adolescents in their late teens and young adults in their early twenties High-risk groups for alcohol abuse include individuals between ages 18 and 25 and the unemployed.

A. Agoraphobia Agoraphobia is a disorder characterized by avoidance of situations in which escape may not be possible or help may be unavailable.

A male client is being treated for alcoholism. After a family meeting, the client's spouse asks the nurse about ways to help the family deal with the effects of alcoholism. Nurse Lily should suggest that the family join which organization? A. Al-Anon B. Make Today Count C. Emotions Anonymous D. Alcoholics Anonymous

A. Al-Anon Al-Anon is an organization that assists family members to share common experiences and increase their understanding of alcoholism. Option B: Make Today Count is a support group for people with life-threatening or chronic illnesses. Option C: Emotions Anonymous is a support group for people experiencing depression, anxiety, or similar conditions. Option D: Alcoholics Anonymous is an organization that helps alcoholics recover by using a twelve-step program.

A. Anticipate and neutralize potentially explosive situations. The nurse is responsible for maintaining a safe environment; therefore, it would be appropriate to observe for signs that an explosive situation is developing and intervening to neutralize the situation, thereby preventing a fight.

Which medications have been found to help reduce or eliminate panic attacks? A. Antidepressants B. Anticholinergics C. Antipsychotics D. Mood stabilizers

A. Antidepressants

The newly hired nurse is assessing a client who abuses barbiturates and benzodiazepine. The nurse would observe for evidence of which withdrawal symptoms? A. Anxiety, tremors, and tachycardia B. Respiratory depression, stupor, and bradycardia C. Muscle aches, cramps, and lacrimation D. Paranoia, depression, and agitation

A. Anxiety, tremors, and tachycardia Barbiturates and benzodiazepine are CNS depressants; therefore, withdrawal symptoms are related to CNS stimulation caused by the rebounding of neurotransmitters (norepinephrine). Symptoms include increased anxiety, tremors, and vital sign changes (such as tachycardia and hypertension).

48. A client with major depression has not verbalized problem areas to staff or peers since admission to a psychiatric unit. Which activity should the nurse recommend to help this client express himself? A. Art therapy in a small group B. Basketball game with peers on the unit C. Reading a self-help book on depression D. Watching movie with the peer group

A. Art therapy provides a nonthreatening vehicle for the expression of feelings, and use of a small group will help the client become comfortable with peers in a group setting. Basketball is a competitive game that requires energy; the client with major depression is not likely to participate in this activity. Recommending that the client read a self-help book may increase, not decrease his isolation. Watching movie with a peer group does not guarantee that interaction will occur; therefore, the client may remain isolated.

Alexi who has separation anxiety disorder has not attended school for three (3) weeks, and she cries and exhibits clinging behaviors when her mother encourages attendance. The priority nursing action by the home-care psychiatric nurse would be to: A. Assist the child in returning to school immediately with family support. B. Arrange for a home-school teacher to visit for two (2) weeks C. Encourage family discussion of various problem areas. D. Use play therapy to help the child express her feelings.

A. Assist the child to return to school immediately with family support. When a child refuses to attend school as part of separation anxiety disorder, it is important to avoid reinforcing this behavior. The nurse's priority would be to assist the child in returning to school immediately with support from the family.

An assessment of a child reveals deficits in communication and social interaction. The child tends to engage in repetitive behaviors such as arranging and rearranging toys. Based on this assessment, the healthcare provider suspects which of these disorders? A. Autism spectrum disorder (ASD) B. Attention deficit hyperactivity disorder (ADHD) C. Intellectual development disorder (IDD) D. Tourette disorder (TD)

A. Autism spectrum disorder (ASD)

Nurse Lynnette notices that a female client with obsessive-compulsive disorder washes her hands for long periods each day. How should the nurse respond to this compulsive behavior? A. By designating times during which the client can focus on the behavior. B. By urging the client to reduce the frequency of the behavior as rapidly as possible. C. By calling attention to or attempting to prevent the behavior. D. By discouraging the client from verbalizing anxieties.

A. By designating times during which the client can focus on the behavior. The nurse should designate times during which the client can focus on the compulsive behavior or obsessive thoughts. Option B: The nurse should urge the client to reduce the frequency of the compulsive behavior gradually, not rapidly. Option C: She shouldn't call attention to or try to prevent the behavior. Trying to prevent the behavior may cause pain and terror to the client. Option D: The nurse should encourage the client to verbalize anxieties to help distract attention from the compulsive behavior.

2. Nurse John is aware that a serious effect of inhaling cocaine is? A. Deterioration of nasal septum B. Acute fluid and electrolyte imbalances C. Extra pyramidal tract symptoms D. Esophageal varices

A. Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.

The client admitted for alcohol detoxification develops increased tremors, irritability, hypertension, and fever. The nurse should be alert for impending: A. Delirium tremens B. Korsakoff's syndrome C. Esophageal varices D. Wernicke's syndrome

A. Delirium tremens Delirium Tremens is the most extreme central nervous system irritability due to withdrawal from alcohol. Option B: This refers to an amnestic syndrome associated with chronic alcoholism due to a deficiency in Vit. B. Option C: This is a complication of liver cirrhosis which may be secondary to alcoholism. Option D: This is a complication of alcoholism characterized by irregularities of eye movements and lack of coordination.

Nurse John is aware that a serious effect of inhaling cocaine is? A. Deterioration of nasal septum B. Acute fluid and electrolyte imbalances C. Extrapyramidal tract symptoms D. Esophageal varices

A. Deterioration of nasal septum Cocaine is a chemical that when inhaled, causes destruction of the mucous membranes of the nose.

35. The nurse understands that the therapeutic effects of typical antipsychotic medications are associated with which neurotransmitter change? A. Decreased dopamine level B. Increased acetylcholine level C. Stabilization of serotonin D. Stimulation of GABA

A. Excess dopamine is thought to be the chemical cause for psychotic thinking. The typical antipsychotics act to block dopamine receptors and therefore decrease the amount of neurotransmitter at the synapses. The typical antipsychotics do not increase acetylcholine, stabilize serotonin, stimulate GABA.

When developing a plan of care for a female client with acute stress disorder who lost her sister in a car accident. Which of the following would the nurse expect to initiate? A. Facilitating progressive review of the accident and its consequences B. Postponing discussion of the accident until the client brings it up C. Telling the client to avoid details of the accident D. Helping the client to evaluate her sister's behavior

A. Facilitating progressive review of the accident and its consequences The nurse would facilitate progressive review of the accident and its consequence to help the client integrate feelings & memories and to begin the grieving process.

A. Francis will deal with uncomfortable emotions on a conscious level. Dissociative disorders occur when traumatic events are beyond an individual's recall because these memories have been "blocked" from conscious awareness. Bringing the feelings associated with these events into conscious awareness and coping with these feelings will decrease the need for dissociation.

Nurse Bella is aware that assessment finding is most consistent with early alcohol withdrawal? A. Heart rate of 120 to 140 beats/minute B. Heart rate of 50 to 60 beats/minute C. Blood pressure of 100/70 mmHg D. Blood pressure of 140/80 mmHg

A. Heart rate of 120 to 140 beats/minute Tachycardia, a heart rate of 120 to 140 beats/minute, is a common sign of alcohol withdrawal. Blood pressure may be labile throughout withdrawal, fluctuating at different stages. Hypertension typically occurs in early withdrawal. Hypotension, although rare during the early withdrawal stages, may occur in later stages. Hypotension is associated with cardiovascular collapse and most commonly occurs in clients who don't receive treatment. The nurse should monitor the client's vital signs carefully throughout the entire alcohol withdrawal process.

A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following? A. Help the client execute actions that are feared B. Help the client develop insight into irrational fears C. Help the client substitutes one fear for another D. Help the client decrease anxiety

A. Help the client execute actions that are feared Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. Options B and C: There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another. Option D: Although the client's anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response

A client is admitted to the psychiatric unit with a diagnosis of alcohol intoxication and suspected alcohol dependence. Other assessment findings include an enlarged liver, jaundice, lethargy, and rambling, incoherent speech. No other information about the client is available. After the nurse completes the initial assessment, what is the first priority? A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output B. Checking the client's medical records for health history information C. Attempting to contact the client's family to obtain more information about the client D. Restricting fluids and leaving the client alone to "sleep off" the episode

A. Instituting seizure precautions, obtaining frequent vital signs, and recording fluid intake and output A nurse who lacks adequate information to determine which level of care a client requires must take all possible precautions to ensure the client's physical safety and prevent complications. To do otherwise could place the client at risk for potential complications. Options B and C: After taking all possible precautions, the nurse can begin seeking health history information and, as needed, modify the plan of care. Option D: Fluids are typically increased unless contraindicated by a preexisting medical condition.

A. It will assist the child to develop more adaptive coping methods. Behavioral therapy is employed for the purpose of developing adaptive behavior that will improve coping. The nurse works to enhance the child's self-functioning and responsibility for his own behavior using appropriate means to develop better coping

The care for the client experiencing alcohol withdrawal places priority on which of the following: A. Monitoring his vital signs every hour B. Providing a quiet, dim room C. Encouraging adequate fluids and nutritious foods D. Administering Librium as ordered

A. Monitoring his vital signs every hour Pulse and blood pressure are usually elevated during withdrawal; Elevation may indicate impending delirium tremens. Option B: Client needs quiet, well lighted, consistent and secure environment. Excessive stimulation can aggravate anxiety and cause illusions and hallucinations. Option C: Adequate nutrition with supplements of Vit. B should be ensured. Option D: Sedatives are used to relieve anxiety.

When interacting with a child diagnosed with Tourette syndrome (TS), the child states, "I am from Zychostan. I can speak Zycho." The child is demonstrating which type of communication? A. Neologism B. Clanging C. Palilalia D. Echolalia

A. Neologism

When caring for a patient during an acute panic attack, which of the following actions by the healthcare provider is most appropriate? A. Offer the patient reassurance of safety and security B. Ask open-ended questions to encourage communication C. Explore common phobias associated with panic attacks D. Use distraction techniques to change the patient's focus

A. Offer the patient reassurance of safety and security

46. A nurse is evaluating therapy with the family of a client with anorexia nervosa. Which of the following would indicate that the therapy was successful? A. The parents reinforced increased decision making by the client B. The parents clearly verbalize their expectations for the client C. The client verbalizes that family meals are now enjoyable D. The client tells her parents about feelings of low-self esteem

A. One of the core issues concerning the family of a client with anorexia is control. The family's acceptance of the client's ability to make independent decisions is key to successful family intervention. Although the remaining options may occur during the process of therapy, they would not necessarily indicate a successful outcome; the central family issues of dependence and independence are not addresses on these responses.

When nurse Hazel considers a client's placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client's: A. Perceptual field B. Delusional system C. Memory state D. Creativity level

A. Perceptual field Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.

12. When nurse Hazel considers a client's placement on the continuum of anxiety, a key in determining the degree of anxiety being experienced is the client's: A. Perceptual field B. Delusional system C. Memory state D. Creativity level

A. Perceptual field is a key indicator of anxiety level because the perceptual fields narrow as anxiety increases.

8. The most critical factor for nurse Linda to determine during crisis intervention would be the client's: A. Available situational supports B. Willingness to restructure the personality C. Developmental theory D. Underlying unconscious conflict

A. Personal internal strength and supportive individuals are critical factors that can be employed to assist the individual to cope with a crisis.

24. Tony with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobia include: A. Severe anxiety and fear B. Withdrawal and failure to distinguish reality from fantasy C. Depression and weight loss D. Insomnia and inability to concentrate

A. Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.

30. Barbara with bipolar disorder is being treated with lithium for the first time. Nurse Clint should observe the client for which common adverse effect of lithium? A. Polyuria B. Seizures C. Constipation D. Sexual dysfunction

A. Polyuria commonly occurs early in the treatment with lithium and could result in fluid volume deficit.

Nurse John recognizes that paranoid delusions usually are related to the defense mechanism of: A. Projection B. Identification C. Repression D. Regression

A. Projection Projection is a mechanism in which inner thoughts and feelings are projected onto the environment, seeming to come from outside the self rather than from within.

16. PROPRANOLOL (Inderal) is used in the mental health setting to manage which of the following conditions? A. Antipsychotic - induced akathisia and anxiety B. Obsessive - compulsive disorder (OCD) to reduce ritualistic behavior C. Delusions for clients suffering from schizophrenia D. The manic phase of bipolar illness as a mood stabilizer

A. Propranolol is a potent beta adrenergic blocker and producing a sedating effect, therefore it is used to treat antipsychotic induced akathisia and anxiety.

5. Before helping a male client who has been sexually assaulted, nurse Maureen should recognize that the rapist is motivated by feelings of: A. Hostility B. Inadequacy C. Incompetence D. Passion

A. Rapists are believed to harbor and act out hostile feelings toward all women through the act of rape.

An attorney who throws books and furniture around the office after losing a case is referred to the psychiatric nurse in the law firm's employee assistance program. The nurse knows that the client's behavior most likely represents the use of which defense mechanism? A. Regression B. Projection C. Reaction-formation D. Intellectualization

A. Regression An adult who throws temper tantrums, such as this one, is displaying regressive behavior, or behavior that is appropriate at a younger age. Option B: In projection, the client blames someone or something other than the source. Option C: In reaction formation, the client acts in opposition to his feelings. Option D: In intellectualization, the client overuses rational explanations or abstract thinking to decrease the significance of a feeling or event.

A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient's behavior is an attempt to accomplish which of the following? A. Relieve anxiety B. Promote oral health C. Avoid interacting with others D. Experience pleasure

A. Relieve anxiety

After administering naloxone (Narcan), an opioid antagonist, Nurse Ronald should monitor the female client carefully for which of the following? A. Respiratory depression B. Epilepsy C. Kidney failure D. Cerebral edema

A. Respiratory depression After administering naloxone (Narcan) the nurse should monitor the client's respiratory status carefully, because the drug is short acting & respiratory depression may recur after its effects wear off.

Tony with agoraphobia has been symptom-free for 4 months. Classic signs and symptoms of phobia include: A. Severe anxiety and fear B. Withdrawal and failure to distinguish reality from fantasy C. Depression and weight loss D. Insomnia and inability to concentrate

A. Severe anxiety and fear Phobias cause severe anxiety (such as panic attack) that is out of proportion to the threat of the feared object or situation. Physical signs and symptoms of phobias include profuse sweating, poor motor control, tachycardia and elevated B.P.

41. A client with a phobic disorder is treated by systematic desensitization. The nurse understands that this approach will do which of the following? A. Help the client execute actions that are feared B. Help the client develop insight into irrational fears C. Help the client substitutes one fear for another D. Help the client decrease anxiety

A. Systematic desensitization is a behavioral therapy technique that helps clients with irrational fears and avoidance behavior to face the thing they fear, without experiencing anxiety. There is no attempt to promote insight with this procedure, and the client will not be taught to substitute one fear for another. Although the client's anxiety may decrease with successful confrontation of irrational fears, the purpose of the procedure is specifically related to performing activities that typically are avoided as part of the phobic response.

50. Which activity would be most appropriate for a severely withdrawn client? A. Art activity with a staff member B. Board game with a small group of clients C. Team sport in the gym D. Watching TV in the dayroom

A. The best approach with a withdrawn client is to initiate brief, nondemanding activities on a one-to-one basis. This approach gives the nurse an opportunity to establish a trusting relationship with the client. A board game with a group clients or playing a team sport in the gym may overwhelm a severely withdrawn client. Watching TV is a solitary activity that will reinforce the client's withdrawal from others.

20. Initial interventions for Marco with acute anxiety include all except which of the following? A. Touching the client in an attempt to comfort him B. Approaching the client in calm, confident manner C. Encouraging the client to verbalize feelings and concerns D. Providing the client with a safe, quiet and private place

A. The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.

27. Nursing preparation for a client undergoing electroconvulsive therapy (ECT) resemble those used for: A. General anesthesia B. Cardiac stress testing C. Neurologic examination D. Physical therapy

A. The nurse should prepare a client for ECT in a manner similar to that for general anesthesia.

Initial interventions for Marco with acute anxiety include all except which of the following? A. Touching the client in an attempt to comfort him B. Approaching the client in calm, confident manner C. Encouraging the client to verbalize feelings and concerns D. Providing the client with a safe, quiet and private place

A. Touching the client in an attempt to comfort him The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety.

Ritalin is the drug of choice for children with ADHD. The side effects of the following may be noted: A. increased attention span and concentration B increase in appetite C.sleepiness and lethargy D. bradycardia and diarrhea

A. increased attention span and concentration The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.

Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital. When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. provide as much structure as possible for the child B. ignore the child's overactivity. C. encourage the child to engage in any play activity to dissipate energy D. remove the child from the classroom when disruptive behavior occurs

A. provide as much structure as possible for the child Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non -confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure.

Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital. When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to: A. Provide as much structure as possible for the child B. Ignore the child's overactivity. C. Encourage the child to engage in any play activity to dissipate energy D. Remove the child from the classroom when disruptive behavior occurs

A. provide as much structure as possible for the child Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non-confrontational approach and setting limit to time allotted for activities. Option B: The child will not benefit from a lenient approach. Option C: Dissipate energy through safe activities. Option D: This indicates that the classroom environment lacks structure.

A client is admitted for an overdose of amphetamines. When assessing this client, the nurse should expect to see: A. tension and irritability. B. slow pulse. C. hypotension. D. constipation.

A. tension and irritability. An amphetamine is a nervous system stimulant that is subject to abuse because of its ability to produce wakefulness and euphoria. An overdose increases tension and irritability. Options B and C: These are incorrect because amphetamines stimulate norepinephrine, which increases the heart rate and blood flow. Option D: Diarrhea is a common adverse effect, so option D is incorrect.

A 16-year-old boy is admitted to the facility after acting out his aggressions inappropriately at school. Predisposing factors to the expression of aggression include: A. violence on television. B. passive parents. C. an internal locus of control. D. a single-parent family

A. violence on television. Violence on television has been correlated with an increase in aggressive behavior. Option B: Passive parents contribute to acting-out behaviors but not specifically to violence. Option C: An internal locus of control leads to a positive sense of self-esteem and isn't related to violence or aggression. Option D: There is no direct correlation between single-parent families and violence.

A: Discussion of the feared object triggers an emotional response to the object.

Clients with eating disorders often exhibit similar symptoms. What should the nurse expect an adolescent with anorexia nervosa to exhibit?

Affective instability

When caring for a newly admitted depressed client, a nurse arranges for a staff member to remain with the client continuously. What information supports the nurse's decision to institute this precaution? Select all that apply.

Agitated pacing in the hall History of suicide attempts Statements that life is not worth living

A nurse is assessing a client with dementia. Which clinical manifestations are expected? Select all that apply.

Agitation Short attention span Disordered reasoning Impaired motor activities

A. Assist the child to return to school immediately with family support.

Which factors influence choice of medication for children with ADHD? a.Identifying the most effective agent b.Duration of action of specific medications c.Time course effects of medication associated with specific delivery systems, i.e. oral, patch... d.Probability of adherence to a given medication regime

All of these factors are important! considerations when choosing a pharmacologic agent for children with ADHD. Keys to effective pharmacotherapy include: best drug, at the best dose, with the best duration of action, and best delivery system for individual children. Goal: Normalize a child's functioning in all settings where functional impairment occurs.

A. Negativism and acting out.

An adolescent with a depressive disorder is more likely than an adult with the same disorder to exhibit: A. Negativism and acting out. B. Sadness and crying. C. Suicidal thoughts. D. Weight gain.

A client with bipolar disorder, manic episode, has a superior, authoritative manner and constantly instructs other clients in how to dress, what to eat, and where to sit. The nurse should intervene because these behaviors eventually will cause the other clients to feel:

Angry

A nurse recalls that in a conversion disorder, pseudoneurological symptoms such as paralysis or blindness:

Are generally necessary for the client to cope with a stressful situation

A male adolescent with the diagnosis of antisocial personality disorder spends a great deal of time with a female adolescent client on the unit. One day the nursing assistant enters the female client's room and finds them in bed together. The nursing assistant reports the incident to the nurse. The nurse should:

Arrange a discussion with both adolescents and follow mandatory reporting guidelines related to child abuse.

How would the nurse began to question/assess a child with ADHD?

Ask them what a typical day is like from start to finish.

A hyperactive client with bipolar I disorder becomes loud and insulting and says to a staff member, "Get lost, you old buzzard!" The nurse can best handle this situation by:

Asking the client to come with her for a walk

An admission assessment is conducted for a young adult client being admitted for suicidal ideation. In light of this information, the nurse recognizes that the priority intervention is:

Assessing the client for confusion and hyperreflexia

A psychiatric nurse has been working with a client who is experiencing a relapse of psychotic symptoms. Command hallucinations are ruled out, and the content of the auditory messages has been determined. What should the nurse's next planned intervention be?

Assisting the client in recognizing hallucinations when they occur

A nurse is caring for a client with the diagnosis of alcohol withdrawal delirium. Which action is most appropriate for the nurse to implement?

Assuring the client that the symptoms are part of the withdrawal syndrome

All of the following are appropriate crisis interventions. Place the interventions in the order the nurse would implement them for a client experiencing escalating levels of anxiety.

Attempt to identify the source of the anxiety. Encourage deep breathing and relaxation techniques. Provide firm but kind directions. Place the client in restraints if deemed dangerous.

A nurse is interviewing a client newly admitted to an outpatient program after withdrawal from alcohol. What behavior best indicates that the client has accepted that drinking is a problem?

Attends Alcoholics Anonymous meetings daily

Ritalin availability

Available as: Ritalin b.i.d.- orally before breakfast & lunch, unless experiencing anorexia, then after meals Ritalin LA- extended release taken once a day Ritalin SR- sustained released, also taken b.i.d. Ritalin transdermal patch- keep on 9 hours (12 hour duration) *Generally prescribed beginning at 6 yrs. old & over

A female client is admitted with a diagnosis of delusions GRANDEUR. This diagnosis reflects a belief that one is: A. Being killed B. Highly famous and important C. Responsible for evil world D. Connected to client unrelated to oneself

A male client who is experiencing disordered thinking about food being poisoned is admitted to the mental health unit. The nurse uses which communication technique to encourage the client to eat dinner? A. Focusing on self-disclosure of own food preference B. Using open ended questions and silence C. Offering opinion about the need to eat D. Verbalizing reasons that the client may not choose to eat

Conney with borderline personality disorder who is to be discharged soon threatens to "do something" to herself if discharged. Which of the following actions by the nurse would be most important? A. Ask a family member to stay with the client at home temporarily. B. Discuss the meaning of the client's statement with her C. Request an immediate extension for the client D. Ignore the clients statement because it's a sign of manipulation.

Linda is pacing the floor and appears extremely anxious. The duty nurse approaches in an attempt to alleviate Linda's anxiety. The most therapeutic question by the nurse would be? A. Would you like to watch TV? B. Would you like me to talk to you? C. Are you feeling upset now? D. Ignores the client.

Mario is admitted to the emergency room with drug-included anxiety related to over ingestion of prescribed antipsychotic medication . The most important piece of information the nurse in charge should obtain initially is the: A. Length of time on the med B. Name of the ingested medication and the amount ingested C. Reason for the suicide attempt D. Name of the nearest relative and their phone number

Nurse Anna can minimize agitation in a disturbed client by? A. Increasing stimulation B. Limiting unnecessary interaction C. Increasing appropriate sensory perception D. Ensuring constant client and staff contact

Nurse Claire is caring for a client diagnosed with bulimia. The most appropriate initial goal for a client diagnosed with bulimia is? A. Encourage to avoid foods B. Identify anxiety causing situations C. Eat only three meals a day D. Avoid shopping plenty of groceries.

Nurse Maureen is developing a plan of care for a female client with anorexia nervosa. Which actions should the nurse include in the plan? A. Provide privacy during meals B. Set-up a strict eating plan for the client C. Encourage client to exercise to reduce anxiety D. Restrict visits with the family

Nurse Monette is aware that extremely depressed cleints seem to do best in settings where they have: A. Multiple stimuli B. Routine Activities C. Minimum decision making D. Varied Activities

Nurse Trish is working in a mental health facility; the nurse priority nursing intervention for a newly admitted client with bulimia nervosa would be to? A. Teach clients to measure I&O B. Involve client in planning daily meal C. Observe client during meals D. Monitor client continuously

When planning care for a female client using ritualistic behavior, Nurse Gina must recognize that the ritual: A. Helps the client focus on the inability to deal with reality B. Helps the client control the anxiety C. Is under the client's conscious control D. Is used by the client primarily for secondary gains

Which of the following approaches would be most appropriate to use with a client suffering from narcissistic personality disorder when discrepancies exist between what the client states and what actually exist? A. Rationalization B. Supportive confrontation C. Limit setting D. Consistency

The community nurse visits the home of George, a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be cause of autism." D. "Although autism is genetically inherited, if you didn't have testing you could not have known this would happen."

B This statement is factual and does not cast blame on anything the parents did or did not do. The parents are not questioning whether other children will be affected; their concern is directed to the current situation and their feelings about it. The statement in option 3 is not true: Lack of prenatal care may be a risk factor in pervasive developmental disorders, but it is not the cause of autism. Although it is thought that there is a genetic component in autism, research has not identified specific genes and there is no diagnostic test for this. The statement in option D is misleading and would not alleviate guilt.

Nurse Sophia is teaching the parents of a child with pervasive developmental disorder about how to deal with the child when his behavior escalates and he begins throwing things and screaming. Which guideline would be most helpful for the parents to deal with the situation? A. Accept the child's limitations, and ignore this behavior. B. Decrease stimulation in the environment, and provide a time-out. C. Seek help when feeling overwhelmed by the child's behavior. D. Tell the child to calm down, and encourage quiet activity.

B A child with a pervasive developmental disorder can have bizarre responses to environmental stimuli. By decreasing that stimulating effect and providing a time-out, the child can more readily de-escalate the behaviors. Escalating behaviors, such as those described, require intervention to promote safety. It is inappropriate to ignore this. The situation requires immediate intervention. The parents should seek help when overwhelmed, but they must intervene when safety is an issue. The response in option D is inadequate; the child will not be able to calm down without assistance.

Which of the following clinical manifestations should the nurse assess in a client with depersonalization disorder? A. Anger B. Mechanical dreamy or detached feelings C. Ambivalence D. A loss of reality testing ability

B A client with depersonalization disorder has a mechanical dreamy or detached feeling. Client anger is not a cardinal sign. The client does not lose the ability to perform reality tests. Ambivalence is not a criterion for the diagnosis of depersonalization disorder.

Nurse Bennet is a community nurse practicing primary prevention for psychiatric disorders in children. On which of the following risk factors would he focus? A. Being raised in a single-parent home B. Family history of mental illness C. Lack of peer friendship D. Family culture

B Abnormal genes and family history of mental illness have been implicated in many psychiatric disorders occurring in children and adolescents. There is no evidence that being raised in a single-parent home will increase a child's risk of developing a psychiatric disorder. Children who have problems with peers and withdraw from social interaction may have a psychiatric disorder; however, the nurse noting this problem would be practicing secondary, not primary, prevention. Family culture is not a risk factor unless parental behavior is dramatically atypical from surrounding culture.

Chuck is a 20-year-old student diagnosed of having obsessive-compulsive behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his condition. Nurse Nicolette understands the rationale for this treatment is that the clomipramine: A. increases dopamine levels. B. increases serotonin levels. C. decreases norepinephrine levels. D. decreases GABA levels.

B According to the psychobiologic theory, dysregulation of the neurotransmitter serotonin is thought to contribute to obsessive-compulsive behavior. Clomipramine (Anafranil) is used to increase serotonin levels, thereby decreasing the need for obsessive-compulsive behaviors.

Nurse Gloria questions the parents of a child with oppositional defiant disorder about the roles of each parent in setting rules of behavior. The purpose for this type of questioning is to assess which element of the family system? A. Anxiety levels B. Generational boundaries C. Knowledge of growth and development D. Quality of communication

B An important element in assessing the family system is determining if the parents establish and maintain appropriate generational boundaries, establishing clear rules and expectations as part of the parental role. Although the parents may have anxiety regarding the role of parental rule setting, the nurse's question is not adequate to assess the anxiety levels. The question concerns the roles of the parents and the child in rule setting. It does not provide data regarding knowledge of growth and development or communication quality.

Nurse Martha is teaching her students about anxiety medications, she explains that benzodiazepines affect which brain chemical? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Norepinephrine D. Serotonin

B GABA is inhibitory Antianxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines.

Martin Sanchez is a 9-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality, which action would the nurse take? A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed. B. Interview Martin with his parents together, observing their interaction. C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone. D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.

B It is important for the nurse to be seen as a neutral person who is interested in the family as an adaptive functioning unit. By conducting the admission interview with the parents and child together, the nurse establishes this neutral role from the beginning. The responses on options A and C separate the parents and the child, and thus the nurse does not have an opportunity to establish a position of neutrality. Although the nurse would review the clinical record, this does not demonstrate to the family that she is an advocate for both parents and the child.

Which nursing assessment question is focused on determining the client's motivation for binge eating? A. "Does binging help you get the attention you need?" B. "Would you say that you are less depressed after binging?" C. "Are you less likely to hear voices while you are binging?" D. "Do you sleep better at least temporarily after binging?

B Overeating is frequently noted as a symptom of a depression. Binge eaters report that binge eating is soothing and helps to regulate their moods. The dysfunctional eating pattern is not associated with a need for attention, auditory hallucinations, or a sleep disorder.

A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder? A. An 8 year-old boy with asthma who has recently failed a grade in school B. A 20 year-old college student with DM who experienced date rape C. A 40 year-old widower who has recently lost his wife to cancer D. A wife of an individual with a severe substance abuse problem

B Post-traumatic stress disorder is caused by the the experience of severe, specific trauma. Rape is a severely traumatic event. Although the situations in options A, C, and D are certainly stressful, they are not at the level of severe trauma.

Jordanne is a client with a fear of air travel. She is being treated in a mental institution for phobic disorder. The treatment method involves systematic desensitization. The nurse would consider the treatment successful if: A. Jordanne plans a trip requiring air travel. B. Jordanne takes a short trip in an airplane. C. Jordanne recognizes the unrealistic nature of the fear of riding on airplanes. D. Jordanne verbalizes a decreased fear about air travel.

B Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchical fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane. The responses in options A and D may occur earlier in treatment, but not indicative of success. Generally, a phobic individual recognizes that his fear is disproportionate to the things he fears.

Mandy, a nurse is assessing a client for recent stressful life events. She recognizes that stressful life events are both: A. desirable and growth-promoting. B. positive and negative. C. undesirable and harmful. D. predictable and controllable.

B The concept of stressful life event is based on the research of Holmes and Rahe, who found that both positive and negative changes result on stress. Stressful life events are not always desirable and growth promoting, nor are they always undesirable and harmful. Some stressful life events can be predictable and controllable; however, many life events are entirely unpredictable.

A 5 year old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. argumentativeness, disobedience, angry outburst B. intolerance to change, disturbed relatedness, stereotypes C. distractibility, impulsiveness and overactivity D. aggression, truancy, stealing, lying

B These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder

The nurse concludes that the treatment plan for a client diagnosed with a dissociative disorder best demonstrates success when which observation is made? A. The client agrees to adhere to interventions identified in the treatment plan B. Client engages in productive discussions related to childhood trauma C. Reports of physical pain have lessened substantially D. Client regularly attends assertiveness training group

B Treatment is considered successful when outcomes are met. An appropriate goal would be that stress is handled adaptively, without the use of dissociation. Being able to engage productively in discussions about a stressful event would demonstrate successful achievement of the goal. While agreement to adhere to the treatment plan is a positive indicator, it doesn't necessarily demonstrate achievement of a foundational goal. The remaining options are associated with a diagnosis of somatic disorder rather than dissociative ones.

During a community visit, volunteer nurses teach stress management to the participants. The nurses will most likely advocate which belief as a method of coping with stressful life events? A. Avoidance of stress is an important goal for living. B. Control over one's response to stress is possible. C. Most people have no control over their level of stress. D. Significant others are important to provide care and concern.

B When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience. Stress can be positive and growth enhancing as well as harmful. The belief that one has some control is the significant factor in minimizing stress response.

The community nurse visits the home of George, a child recently diagnosed with autism. The parents expres feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be cause of autism." D. "Although autism is genetically inherited, if you didn't have testing you could not have known this would happen."

B his statement is factual and does not cast blame on anything the parents did or did not do. The parents are not questioning whether other children will be affected; their concern is directed to the current situation and their feelings about it. The statement in option 3 is not true: Lack of prenatal care may be a risk factor in pervasive developmental disorders, but it is not the cause of autism. Although it is thought that there is a genetic component in autism, research has not identified specific genes and there is no diagnostic test for this. The statement in option D is misleading and would not alleviate guilt.

A child is diagnosed with autistic spectrum disorder (ASD). Which of the following, if present in the patient's health history, will the healthcare provider identify as a factor associated with this disorder? Choose all answers that apply. A. Southeast Asian or Middle Eastern descent B. Sibling diagnosed with Asperger syndrome C. Concurrent diagnosis of fetal alcohol syndrome D. Advanced age of the mother or father E. Exposure to vaccines containing thimerosal

B, C, D

Which statement by a nurse providing care for clients diagnosed with personality disorders demonstrates therapeutic management of manipulative client behavior? Select all that apply. A. "Tell me what triggered your angry response to what I said." B. "The staff is responsible for determining unit rules that are fair to all clients." C. "Remember that all clients must follow the rules regarding the use of the telephone." D. "Missing group today means that you will not be able to attend the pizza party later." E. "Tell me what you are trying to accomplish by being so rude to the staff and other clients."

B, C, D Manipulation is the using or controlling of others or of situations for only one's personal benefit. Setting limits/rules, reinforcing the limits/rules, and enforcing consequences for disregarding the limits/rules demonstrates therapeutic management of manipulative behaviors. The remaining options are associated with the management of impulsivity.

The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? Select all that apply. A. Administering anti-anxiety medication as prescribed B. Encouraging the client to restructure thoughts C. Helping the client to use controlled relaxation breathing D. Helping the client examine evidence of stressors E. Questioning the client about early childhood relationships F. Teaching the client about anxiety and panic

B, C, D, F These are all appropriate techniques based on the framework of cognitive-behavioral therapy.

The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework? (Select all that apply.) A. Administering anti-anxiety medication as prescribed B. Encouraging the client to restructure thoughts C. Helping the client to use controlled relaxation breathing D. Helping the client examine evidence of stressors E. Questioning the client about early childhood relationships F. Teaching the client about anxiety and panic

B, C, D, F These are all appropriate techniques based on the framework of cognitive-behavioral therapy.

The parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) inquire about the types of therapeutic interventions that may benefit their child. Which of the following interventions will the healthcare provider suggest? Choose all answers that apply. A. Develop several long-term goals for improvement B. Assist the child to develop routines C. Provide detailed instructions for expected tasks D. Recognize and build on personal strengths E. Plan activities that provide opportunities for success F. Provide immediate feedback about behaviors

B, D, E, F

A student is assisting the healthcare provider to care for a baby diagnosed with Down syndrome (DS). Which the following statements made by the student indicates the student requires additional instruction about the disorder? A. "The baby's red and white blood cells and platelets will need to be monitored closely." B. "Both male and female patients diagnosed with Down syndrome are infertile." C. "The baby will be scheduled for an ultrasound of the heart to check for problems." D. "We will be checking the baby's thyroid hormone levels now and periodically."

B. "Both male and female patients diagnosed with Down syndrome are infertile."

The community nurse visits the home of George, a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be cause of autism." D. "Although autism is genetically inherited if you didn't have testing you could not have known this would happen."

B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." This statement is factual and does not cast blame on anything the parents did or did not do.

A client admitted to the psychiatric unit for treatment of substance abuse says to the nurse, "It felt so wonderful to get high." Which of the following is the most appropriate response? A. "If you continue to talk like that, I'm going to stop speaking to you." B. "You told me you got fired from your last job for missing too many days after taking drugs all night." C. "Tell me more about how it felt to get high." D. "Don't you know it's illegal to use drugs?"

B. "You told me you got fired from your last job for missing too many days after taking drugs all night." Confronting the client with the consequences of substance abuse helps to break through denial. Option A: Making threats isn't an effective way to promote self-disclosure or establish a rapport with the client. Option C: Although the nurse should encourage the client to discuss feelings, the discussion should focus on how the client felt before, not during, an episode of substance abuse. Encouraging elaboration about his experience while getting high may reinforce the abusive behavior. Option D: The client undoubtedly is aware that drug use is illegal; a reminder to this effect is unlikely to alter behavior.

A group of community nurses sees and plans care for various clients with different types of problems. Which of the following clients would they consider the most vulnerable to post-traumatic stress disorder? A. An eight (8)-year-old boy with asthma who has recently failed a grade in school B. A 20-year-old college student with DM who experienced date rape C. A 40-year-old widower who has recently lost his wife to cancer D. A wife of an individual with a severe substance abuse problem

B. A 20-year-old college student with DM who experienced date rape Post-traumatic stress disorder is caused by the experience of severe, specific trauma. Rape is a severely traumatic event. Although the situations in options A, C, and D are certainly stressful, they are not at the level of severe trauma.

42. Which client outcome would best indicate successful treatment for a client with an antisocial personality disorder? A. The client exhibits charming behavior when around authority figures B. The client has decreased episodes of impulsive behaviors C. The client makes statements of self-satisfaction D. The client's statements indicate no remorse for behaviors

B. A client with antisocial personality disorder typically has frequent episodes of acting impulsively with poor ability to delay self-gratification. Therefore, decreased frequency of impulsive behaviors would be evidence of improvement. Charming behavior when around authority figures and statements indicating no remorse are examples of symptoms typical of someone with this disorder and would not indicate successful treatment. Self-satisfaction would be viewed as a positive change if the client expresses low self-esteem; however this is not a characteristic of a client with antisocial personality disorder.

The nurse is caring for a client being treated for alcoholism. Before initiating therapy with disulfiram (Antabuse), the nurse teaches the client that he must read labels carefully on which of the following products? A. Carbonated beverages B. Aftershave lotion C. Toothpaste D. Cheese

B. Aftershave lotion Disulfiram may be given to clients with chronic alcohol abuse who wish to curb impulse drinking. Disulfiram works by blocking the oxidation of alcohol, inhibiting the conversion of acetaldehyde to acetate. As acetaldehyde builds up in the blood, the client experiences noxious and uncomfortable symptoms. Even alcohol rubbed onto the skin can produce a reaction. The client receiving disulfiram must be taught to read ingredient labels carefully to avoid products containing alcohol such as aftershave lotions. Options A, C, and D: Carbonated beverages, toothpaste, and cheese don't contain alcohol and don't need to be avoided by the client.

17. Which medication can control the extra pyramidal effects associated with antipsychotic agents? A. Clorazepate (Tranxene) B. Amantadine (Symmetrel) C. Doxepin (Sinequan) D. Perphenazine (Trilafon)

B. Amantadine is an anticholinergic drug used to relive drug-induced extra pyramidal adverse effects such as muscle weakness, involuntary muscle movements, pseudoparkinsonism and tar dive dyskinesia.

A patient diagnosed with agoraphobia is scheduled for a functional magnetic resonance imaging (fMRI) study of the brain. The healthcare provider anticipates that the scan will show increased activity in which of the following areas of this patient's brain? A Parietal lobe B Amygdala C Medulla D Cerebellum

B. Amygdala

When planning care for a client who has ingested phencyclidine (PCP), nurse Wayne is aware that the following is the highest priority? A. Client's physical needs B. Client's safety needs C. Client's psychosocial needs D. Client's medical needs

B. Client's safety needs The highest priority for a client who has ingested PCP is meeting safety needs of the client as well as the staff. Drug effects are unpredictable and prolonged, and the client may lose control easily. Options A, C, and D: After safety needs have been met, the client's physical, psychosocial, and medical needs can be met

Another client is brought to the emergency room by friends who state that he took something an hour ago. He is actively hallucinating, agitated, with an irritated nasal septum. A. Heroin B. Cocaine C. LSD D. Marijuana

B. Cocaine The manifestations indicate intoxication with cocaine, a CNS stimulant. Option A: Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. Option C: Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs. Option D: Intoxication with Marijuana, a cannabinoid is manifested by Option A: Intoxication with heroine is manifested by euphoria then impairment in judgment, attention and the presence of papillary constriction. Option C: Intoxication with hallucinogen like LSD is manifested by grandiosity, hallucinations, synesthesia and increase in vital signs. Option D: Intoxication with Marijuana, a cannabinoid is manifested by the sensation of slowed time, conjunctival redness, social withdrawal, impaired judgment, and hallucinations.

37. A client with depressive symptoms is given prescribed medications and talks with his therapist about his belief that he is worthless and unable to cope with life. Psychiatric care in this treatment plan is based on which framework? A. Behavioral framework B. Cognitive framework C. Interpersonal framework D. Psychodynamic framework

B. Cognitive thinking therapy focuses on the client's misperceptions about self, others and the world that impact functioning and contribute to symptoms. Using medications to alter neurotransmitter activity is a psychobiologic approachto treatment. The other answer choices are frameworks for care, but hey are not applicable to this situation.

B. Control over one's response to stress is possible. When learning to manage stress, clients find it helpful to believe that they have the ability to control their response to it. It is impossible to avoid stress, which is a normal life experience.

Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience: A. Heightened concentration B. Decreased perceptual field C. Decreased cardiac rate D. Decreased respiratory rate

B. Decreased perceptual field Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention and in ability to concentrate.

Nurse Gerry is aware that the defense mechanism commonly used by clients who are alcoholics is: A. Displacement B. Denial C. Projection D. Compensation

B. Denial Denial is a method of resolving conflict or escaping unpleasant realities by ignoring their existence.

Elsa is being treated in a chemical dependency unit. She tells the nurse that she only uses drugs when under stress and therefore does not have a substance problem. Which defense mechanism is the client using? A. Compensation B. Denial C. Suppression D. Undoing

B. Denial Individuals who have substance problems often use denial. Options A, C, and D: Compensation, suppression, and undoing are incorrect and do not fit the situation described.

Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe: A. Hyperactivity B. Depression C. Suspicion D. Delirium

B. Depression There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.

Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the "rotten nursing care". When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of: A. Projection B. Displacement C. Denial D. Reaction formation

B. Displacement The client's anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.

32. Discharge instructions for a male client receiving tricyclic antidepressants include which of the following information? A. Restrict fluids and sodium intake B. Don't consume alcohol C. Discontinue if dry mouth and blurred vision occur D. Restrict fluid and sodium intake

B. Drinking alcohol can potentiate the sedating action of tricyclic antidepressants. Dry mouth and blurred vision are normal adverse effects of tricyclic antidepressants.

A 39-year-old woman is undergoing prenatal screening for Down syndrome. Which of the following diagnostic tests gives the most accurate information about the probability of Down syndrome? A. Serum alpha fetoprotein (AFP) B. Fetal karyotype C. Amniotic fluid index D. Ultrasound

B. Fetal karyotype

Nurse Martha is teaching her students about anxiety medications; she explains that benzodiazepines affect which brain chemical? A. Acetylcholine B. Gamma-aminobutyric acid (GABA) C. Norepinephrine D. Serotonin

B. Gamma-aminobutyric acid (GABA) Antianxiety medications stimulate the neurotransmitter GABA, which is a chemical associated with relaxation. The other options are not affected by benzodiazepines.

B. Generational boundaries An important element in assessing the family system is determining if the parents establish and maintain appropriate generational boundaries, establishing clear rules and expectations as part of the parental role.

The nurse provides a referral to Alcoholics Anonymous to a client who describes a 20-year history of alcohol abuse. The primary function of this group is to: A. Encourage the use of a 12-step program. B. Help members maintain sobriety. C. Provide fellowship among members. D. Teach positive coping mechanisms.

B. Help members maintain sobriety. The primary purpose of Alcoholics Anonymous is to help members achieve and maintain sobriety. Options A, C, and D: Although each of the remaining answer choices may be an outcome of attendance at Alcoholics Anonymous, the primary purpose is directed toward sobriety of members.

B. Helps the client control the anxiety Option B: The rituals used by a client with obsessive-compulsive disorder help control the anxiety level by maintaining a set pattern of action.

When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system? A. Muscle tension B. Hyperactive bowel sounds C. Decreased urine output D. Constipation

B. Hyperactive bowel sounds The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.

B. Jordanne takes a short trip in an airplane. Systematic desensitization is a behavioral technique in which the client with a specific phobia is gradually able to work through hierarchal fears until the most fearful situation is encountered. In this case, the most fearful is riding an airplane.

Mario is admitted to the emergency room with drug-included anxiety related to over ingestion of prescribed antipsychotic medication. The most important piece of information the nurse in charge should obtain initially is the: A. Length of time on the med. B. Name of the ingested medication & the amount ingested C. Reason for the suicide attempt D. Name of the nearest relative & their phone number

B. Name of the ingested medication & the amount ingested Option B: In an emergency, lives saving facts are obtained first. The name and the amount of medication ingested are of utmost important in treating this potentially life threatening situation.

A client is admitted with needle tracks on his arm, stuporous and with pin point pupil will likely be managed with: A. Naltrexone (Revia) B. Narcan (Naloxone) C. Disulfiram (Antabuse) D. Methadone (Dolophine)

B. Narcan (Naloxone) Narcan is a narcotic antagonist used to manage the CNS depression due to overdose with heroin. Option A: This is an opiate receptor blocker used to relieve the craving for heroin. Option C: Disulfiram is used as a deterrent in the use of alcohol. Option D: Methadone is used as a substitute in the withdrawal from heroin

19. Kris periodically has acute panic attacks. These attacks are unpredictable and have no apparent association with a specific object or situation. During an acute panic attack, Kris may experience: A. Heightened concentration B. Decreased perceptual field C. Decreased cardiac rate D. Decreased respiratory rate

B. Panic is the most severe level of anxiety. During panic attack, the client experiences a decrease in the perceptual field, becoming more focused on self, less aware of surroundings and unable to process information from the environment. The decreased perceptual field contributes to impaired attention andinability to concentrate.

An 11-year-old child diagnosed with conduct disorder is admitted to the psychiatric unit for treatment. Which of the following behaviors would the nurse assess? A. Restlessness, short attention span, hyperactivity B. Physical aggressiveness, low-stress tolerance disregard for the rights of others C. Deterioration in social functioning, excessive anxiety, and worry, bizarre behavior D. Sadness, poor appetite and sleeplessness, loss of interest in activities

B. Physical aggressiveness, low-stress tolerance disregard for the rights of others Physical aggressiveness, low-stress tolerance, and a disregard for the rights of others are common behaviors in clients with conduct disorders.

Mandy, a nurse who works at Nurseslabs Rehabilitation Center is assessing a client for recent stressful life events. She recognizes that stressful life events are both: A. Desirable and growth-promoting. B. Positive and negative. C. Undesirable and harmful. D. Predictable and controllable.

B. Positive and negative. The concept of stressful life event is based on the research of Holmes and Rahe, who found that both positive and negative changes result in stress. Options A and C: Stressful life events are not always desirable and growth promoting, nor are they always undesirable and harmful. Option D: Some stressful life events can be predictable and controllable; however, many life events are entirely unpredictable.

The healthcare provider is developing a plan of care for a patient diagnosed with attention deficit hyperactivity disorder (ADHD) who is at immediate risk of self-harm. Which of the following is the priority nursing intervention? A. Provide additional emotional support to increase self-esteem B. Provide one-on-one observation until the risk has been resolved C. Encourage the patient to explore triggers for self-harm D. Work with the patient to develop a "no self-harm" contract

B. Provide one-on-one observation until the risk has been resolved

During a panic attack, a patient states, "I feel like I'm going to die!" The patient is hyperventilating, tachycardic, and reports feeling upper extremity numbness and tingling. Based on this patient's presentation, the healthcare provider would anticipate which additional clinical manifestation of the panic attack? A. Hypercapnia B. Respiratory alkalosis C. Respiratory acidosis D. Kussmaul respirations

B. Respiratory alkalosis

14. Malou with schizophrenia tells Nurse Melinda, "My intestines are rotted from worms chewing on them." This statement indicates a: A. Jealous delusion B. Somatic delusion C. Delusion of grandeur D. Delusion of persecution

B. Somatic delusions focus on bodily functions or systems and commonly include delusion about foul odor emissions, insect manifestations, internal parasites and misshapen parts.

A patient diagnosed with general anxiety disorder (GAD) reports ongoing nausea and abdominal bloating. A physical examination fails to confirm a medical illness to explain these symptoms. The healthcare provider suspects these findings are a result of which of the following? A. Dissociation B. Somatization C. Derealization D. Dysthymia

B. Somatization

A patient diagnosed with Tourette Syndrome (TS) receives RimabotulinumtoxinB (Myobloc) to treat a facial spasm. Which of the following assessments by the healthcare provider is a priority? A. Heart rate and rhythm B. Swallowing ability C. Injection site formation D. Level of consciousness

B. Swallowing ability

36. Which of the following best explains why tricyclic antidepressants are used with caution in elderly patients? A. Central Nervous System effects B. Cardiovascular system effects C. Gastrointestinal system effects D. Serotonin syndrome effects

B. The TCAs affect norepinephrine as well as other neurotransmitters, and thus have significant cardiovascular side effects. Therefore, they are used with caution in elderly clients who may have increased risk factors for cardiac problems because of their age and other medical conditions. The remaining side effects would apply to any client taking a TCA and are not particular to an elderly person.

A 25 -year old client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority? A. The client will commit to a drug-free lifestyle B. The client will work with the nurse to remain safe C. The client will drink plenty of fluids daily D. The client will make a personal inventory of strength

B. The client will work with the nurse to remain safe The priority goal in alcohol withdrawal is maintaining the client's safety. Options A, C, and D: Committing to a drug-free lifestyle, drinking plenty of fluids, and identifying personal strengths are important goals, but ensuring the client's safety is the nurse's top priority

A client experiencing alcohol withdrawal is upset about going through detoxification. Which of the following goals is a priority? A. The client will commit to a drug-free lifestyle. B. The client will work with the nurse to remain safe. C. The client will drink plenty of fluids daily. D. The client will make a personal inventory of strengths

B. The client will work with the nurse to remain safe. The priority goal in alcohol withdrawal is maintaining the client's safety. Options A, C, and D: Committing to a drug-free lifestyle, drinking plenty of fluids, and identifying personal strengths are important goals, but ensuring the client's safety is the nurse's top priority.

7. Joy who has just experienced her second spontaneous abortion expresses anger towards her physician, the hospital and the "rotten nursing care". When assessing the situation, the nurse recognizes that the client may be using the coping mechanism of: A. Projection B. Displacement C. Denial D. Reaction formation

B. The client's anger over the abortion is shifted to the staff and the hospital because she is unable to deal with the abortion at this time.

22. When performing a physical examination on a female anxious client, nurse Nelli would expect to find which of the following effects produced by the parasympathetic system? A. Muscle tension B. Hyperactive bowel sounds C. Decreased urine output D. Constipation

B. The parasympathetic nervous system would produce incomplete G.I. motility resulting in hyperactive bowel sounds, possibly leading to diarrhea.

1. Francis who is addicted to cocaine withdraws from the drug. Nurse Ron should expect to observe: A. Hyperactivity B. Depression C. Suspicion D. Delirium

B. There is no set of symptoms associated with cocaine withdrawal, only the depression that follows the high caused by the drug.

Situation: The nurse assigned to the detoxification unit attends to various patients with substance-related disorders. A 45 years old male revealed that he experienced a marked increase in his intake of alcohol to achieve the desired effect This indicates: A. Withdrawal B. Tolerance C. Intoxication D. Psychological dependence

B. Tolerance Tolerance refers to the increase in the amount of the substance to achieve the same effects. Option A: Withdrawal refers to the physical signs and symptoms that occur when the addictive substance is reduced or withheld. Option B: Intoxication refers to the behavioral changes that occur upon recent ingestion of substance. Option D: Psychological dependence refers to the intake of the substance to prevent the onset of withdrawal symptoms.

A male client has approached the nurse asking for advice on how to deal with his alcohol addiction. Nurse Sally should tell the client that the only effective treatment for alcoholism is: A. Psychotherapy B. Total abstinence C. Alcoholics Anonymous (AA) D. Aversion therapy

B. Total abstinence Total abstinence is the only effective treatment for alcoholism. Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain. Options A, C, and D: Psychotherapy, attendance at AA meetings, and aversion therapy are all adjunctive therapies that can support the client in his efforts to abstain.

47. A client with dysthymic disorder reports to a nurse that his life is hopeless and will never improve in the future. How can the nurse best respond using a cognitive approach? A. Agree with the client's painful feelings B. Challenge the accuracy of the client's belief C. Deny that the situation is hopeless D. Present a cheerful attitude

B. Use of cognitive techniques allows the nurse to help the client recognize that this negative beliefs may be distortions and that, by changing his thinking, he can adopt more positive beliefs that are realistic and hopeful. Agreeing with the client's feelings and presenting a cheerful attitude are not consistent with a cognitive approach and would not be helpful in this situation. Denying the client's feelings is belittling and may convey that the nurse does not understand the depth of the client's distress.

26. Rosana is in the second stage of Alzheimer's disease who appears to be in pain. Which question by Nurse Jenny would best elicit information about the pain? A. "Where is your pain located?" B. "Do you hurt? (pause) "Do you hurt?" C. "Can you describe your pain?" D. "Where do you hurt?"

B. When speaking to a client with Alzheimer's disease, the nurse should use close-ended questions.Those that the client can answer with "yes" or "no" whenever possible and avoid questions that require the client to make choices. Repeating the question aids comprehension.

4. A 48 year old male client is brought to the psychiatric emergency room after attempting to jump off a bridge. The client's wife states that he lost his job several months ago and has been unable to find another job. The primary nursing intervention at this time would be to assess for: A. A past history of depression B. Current plans to commit suicide C. The presence of marital difficulties D. Feelings of excessive failure

B. Whether there is a suicide plan is a criterion when assessing the client's determination to make another attempt.

31. Linda is pacing the floor and appears extremely anxious. The duty nurse approaches in an attempt to alleviate Linda's anxiety. The most therapeutic question by the nurse would be? A. Would you like to watch TV? B. Would you like me to talk with you? C. Are you feeling upset now? D. Ignore the client

B. Would you like me to talk with you? Option B: The nurse presence may provide the client with support & feeling of control.

A 5-year-old boy is diagnosed to have autistic disorder. Which of the following manifestations may be noted in a client with autistic disorder? A. Argumentativeness, disobedience, angry outburst B. Intolerance to change, disturbed relatedness, stereotypes C. Distractibility, impulsiveness, and overactivity D. Aggression, truancy, stealing, lying

B. intolerance to change, disturbed relatedness, stereotypes These are manifestations of autistic disorder. Option A: These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. Option C: These are manifestations of Attention Deficit Disorder. Option D: These are the manifestations of Conduct Disorder

B. intolerance to change, disturbed relatedness, stereotypes These are manifestations of autistic disorder. A. These manifestations are noted in Oppositional Defiant Disorder, a disruptive disorder among children. C. These are manifestations of Attention Deficit Disorder D. These are the manifestations of Conduct Disorder

The nurse is assessing a client on admission to the chemical dependency unit for alcohol detoxification. When the nurse asks about alcohol use, this client is most likely to: A. accurately describe the amount consumed. B. underestimate the amount consumed. C. overestimate the amount consumed. D. deny any consumption of alcohol.

B. underestimate the amount consumed. Most people who abuse substances underestimate their consumption in an attempt to conform to social norms or protect themselves. Options A, C, and D: Few accurately describe or overestimate consumption; some may deny it. Therefore, on admission, quantitative and qualitative toxicology screens are done to validate information obtained from the client.

A client is admitted to the emergency department after being found unconscious. Her blood pressure is 82/50 mm Hg. She is 5′ 4″ (1.6 m) tall, weighs 79 lb (35.8 kg), and appears dehydrated and emaciated. After regaining consciousness, she reports that she has had trouble eating lately and can't remember what she ate in the last 24 hours. She also states that she has had amenorrhea for the past year. She is convinced she is fat and refuses food. The nurse suspects that she has: A. bulimia nervosa. B. anorexia nervosa. C. depression.

B: Anorexia nervosa is an eating disorder characterized by self-imposed starvation with subsequent emaciation, nutritional deficiencies, and atrophic and metabolic changes. Typically, the client is hypotensive and dehydrated. Depending on the severity of the disorder, anorexic clients are at risk for circulatory collapse (indicated by hypotension), dehydration, and death. Option A: Bulimia nervosa is an eating disorder characterized by binge eating followed by self-induced vomiting. Option C: Although depression may be accompanied by weight loss, it isn't characterized by a body image disturbance or the intense fear of obesity seen in anorexia nervosa.

A client whose husband just left her has a recurrence of anorexia nervosa. The nurse caring for her realizes that this exacerbation of anorexia nervosa results from the client's effort to: A. manipulate her husband. B. gain control of one part of her life. C. commit suicide. D. live up to her mother's expectations.

B: By refusing to eat, a client with anorexia nervosa is unconsciously attempting to gain control over the only part of her life she feels she can control. Options A and D: This eating disorder doesn't represent an attempt to manipulate others or live up to their expectations (although anorexia nervosa has a high incidence in families that emphasize achievement). Option C: The client isn't attempting to commit suicide through starvation; rather, by refusing to eat, she is expressing feelings of despair, worthlessness, and hopelessness.

Linda is pacing the floor and appears extremely anxious. The duty nurse approaches in an attempt to alleviate Linda's anxiety. The most therapeutic question by the nurse would be? A. Would you like to watch TV? B. Would you like me to talk with you? C. Are you feeling upset now? D. Ignore the client

B: The nurse presence may provide the client with support & feeling of control.

An adolescent with a major depressive disorder is prescribed venlafaxine (Effexor). What signs or symptoms related to the medication should the nurse communicate immediately to the prescribing provider? Select all that apply.

Blurred vision Suicidal ideation Difficult urination

A client with schizophrenia is started on a regimen of chlorpromazine (Thorazine). After 10 days a shuffling gait, tremors, and some rigidity are apparent. Benztropine mesylate (Cogentin) 2 mg by mouth daily is prescribed. What should the nurse remember when administering these medications together?

Both medications have a cholinergic blocking action.

A nurse is caring for several clients with major thought disorders such as schizophrenia. They are all being treated with neuroleptic drugs. How do these drugs act in the body to promote mental health?

By blocking access to dopamine receptors at the postsynaptic receptor site

A 32 year old male graduate student, who has become increasingly withdrawn and neglectful of his work and personal hygiene, is brought to the psychiatric hospital by his parents. After detailed assessment, a diagnosis of schizophrenia is made. It is unlikely that the client will demonstrate: A. Low self esteem B. Concrete thinking C. Effective self boundaries D. Weak ego

A 39 year old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the basis of O.C. disorder is often: A. Problems with being too conscientious B. Problems with anger and remorse C. Feelings of guilt and inadequacy D. Feeling of unworthiness and hopelessness

A 75 year old client is admitted to the hospital with the diagnosis of dementia of the Alzheimer's type and depression. The symptom that is unrelated to depression would be? A. Apathetic response to the environment B. "I don't know" answer to questions C. Shallow of labile effect D. Neglect of personal hygiene

A characteristic that would suggest to Nurse Anne that an adolescent may have bulimia would be: A. Frequent regurgitation and re-swallowing food B. Previous history of gastritis C. Badly stained teeth D. Positive body image

A client is experiencing anxiety attack. The most appropriate nursing interventions should include? A. Turning on the television B. Leaving the client alone C. Staying with the client and speaking in short sentences D. Ask the client to play with other clients

A long term goal for a paranoid male client who has unjustifiably accused his wife of having many extramarital affairs would be to help the client develop: A. Insight into his behavior B. Better self control C. Feeling of self worth D. Faith in his wife

Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mmhg and pulse is 92 bpm. Which of the medications would the nurse expect to administer? A. Naloxone (Narcan) B. Benzlropine (Cogentin) C. Lorazepam (Ativan) D. Haloperidol (Haldol)

Marco approached Nurse Trisha asking for advice on how to deal with his alcohol addiction. Nurse Trisha should tell the client that the only effective treatment for alcoholism is: A. Psychotherapy B. Alcoholics Anonymous (A.A) C. Total Abstinence D. Aversion Therapy

Nurse Benjie is communicating with a male client with substance-induced persisting dementia; the client cannot remember facts and fills in the gaps with imaginary information. Nurse Benjie is aware that this is typical of? A. Flight of ideas B. Associative Looseness C. Confabulation D. Concretism

Nurse Nina is assigned to care for a client diagnosed with Catatonic Stupor. When nurse Nina enters the client's room, the client is found lying on the bed with a body pulled into a fetal position. Nurse Nina should? A. Ask the client direct questions to encourage talking B. Rake the client into the dayroom to be with other clients C. Sit beside the client in silence and occasionally ask open-ended questions. D. Leave the client alone and continue with providing care to the other clients

Nurse Trish would expect a child with a diagnosis of reactive attachment disorder to: A. Have more positive relation with the father than the mother B. Cling to mother and cry on separation C. Be able to develop only superficial relation with the others D. Have been physically abuse

Recognizing that somatic symptom disorders focus on physical symptoms, which client statement best demonstrates the unique characteristic of this type of disorder? A. "I wonder if my fear of cancer is real or imagined." B. "The pain I feel is nearly constant and very specific." C. "I've been to so many doctors but none can find out what's wrong with me." D. "For a while medication helped but now my stomach problems are back again."

When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? A. The client eliminates all anxiety from daily situations B. The client ignores feelings of anxiety C. The client identifies anxiety producing situations D. The client maintains contact with a crisis counselor

Which stress management behavior is most reflective of those associated with personality disorders? A. Binge drinking every weekend B. Demonstrating ritualistic behaviors C. Blaming spouse for the client's poor performance at work D. Having difficulty making a decision concerning which movie to view

The nurse admitting a client suspected of dissociative amnesia would report which of the following manifestations? A.The amnesia has its etiology in a medical condition B. The client exhibits common forgetfulness C. The client's inability to recall personal information D. The amnesia is the result of prolonged substance abuse

C A client with dissociative amnesia is unable to recall familiar personal information. The amnesia is not associated with a medical condition, such as brain injury, trauma, or toxicity of substances. The amnesia is beyond common forgetfulness.

Which nursing intervention will best address the intense need to control demonstrated by a client receiving treatment of bulimia nervosa? A. Monitoring the client for the presence of suicidal thoughts and behaviors B. Helping the client reframe irrational thinking that leads to dysfunctional eating C. Clearly stating expectations and admitting that they differ from those of the client D. Having the client keep a journal that identifies triggers that cause dysfunctional eating

C A straightforward statement that the nurse's perceptions are different will help avoid a power struggle. Arguments and power struggles intensify the patient's need to control. Suicide assessment relates to client safety. While reframing and journaling are appropriate, those interventions are not associated with the need for the client to control his or her life.

A client is admitted to the psychiatric clinic for treatment of anorexia nervosa. To promote the client's physical health, the nurse should plan to: A. severely restrict the client's physical activities. B. weigh the client daily, after the evening meal. C. monitor vital signs, serum electrolyte levels, and acid-base balance. D. instruct the client to keep an accurate record of food and fluid intake.

C An anorexic client who requires hospitalization is in poor physical condition from starvation and may die as a result of arrhythmias, hypothermia, malnutrition, infection, or cardiac abnormalities secondary to electrolyte imbalances. Therefore, monitoring the client's vital signs, serum electrolyte level, and acid base balance is crucial. Option A: This may worsen anxiety. Option B: This is incorrect because a weight obtained after breakfast is more accurate than one obtained after the evening meal. Option D: This would reward the client with attention for not eating and reinforce the control issues that are central to the underlying psychological problem; also, the client may record food and fluid intake inaccurately.

Which of the following medical conditions is commonly found in clients with bulimia nervosa? A. Allergies B. Cancer C. Diabetes mellitus D. Hepatitis A

C Bulimia nervosa can lead to many complications, including diabetes, heart disease, and hypertension. Options A, B, and D: The eating disorder isn't typically associated with allergies, cancer, or hepatitis A.

A nurse is developing a care plan for a female client with post-traumatic stress disorder. Which of the following would she do initially? A. Instruct the client to use distraction techniques to cope with flashbacks. B. Encourage the client to put the past in proper perspective. C. Encourage the client to verbalize thoughts and feelings about the trauma. D. Avoid discussing the traumatic event with client.

C Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Avoiding discussion and using distraction techniques would be inappropriate. Option B may be possible later, after the client is able to verbalize strong emotions.

Which assessment data confirms that the client diagnosed with anorexia nervosa has achieved a fundamental treatment outcome? A. Acknowledges that symptoms of depression exist B. Client has eaten 60% of three meals per day for 3 consecutive weeks C. Client has maintained weight at 87% of ideal body weight for 2 months D. Demonstrates an understanding of what constitutes healthy eating habits

C Some common outcome criteria for patients with anorexia nervosa include normalize eating patterns, as evidenced by eating 75% of three meals per day plus two snacks and achieving 85% to 90% of ideal body weight; demonstrating two new, healthy eating habits and improved self-acceptance; and participating in treatment of associated psychiatric symptoms (defects in mood, self-esteem), not just acknowledging the presence of symptoms.

A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification: A. Profound B. Mild C. Moderate D. Severe

C The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

Which statement reflects successful achievement of a therapeutic long-term goal for a client diagnosed with somatic symptom disorder? A. "I may have found a doctor who can really help me." B. "My husband is starting to believe I'm really in pain." C. "I haven't missed a day of work in the last 6 months." D. "My symptoms may not be signs of a serious cancer."

C The overall long-term goal in treating individuals with somatic symptom disorders is that people with these disorders will eventually be able to live as normal a life as possible. This includes symptom or pain reduction, improved level of independence, and a better overall quality of life. Not missing work is an indication of desired independence and overall quality of life. The remaining client statements indicate a continued belief that a health problem will be found and that the reports of pain are accepted by family.

Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty's response is vague and not focused on the question. Nurse Lally assess Marty's level of anxiety as: A. mild. B. moderate. C. severe. D. panic.

C When the client has difficulty focusing and exhibits excessive motor activity, the level of anxiety is severe. Mild anxiety is characterized by increased alertness and problem-solving ability. Moderate anxiety is characterized by the ability to focus on central concerns but the inability to problem-solve without assistance. Panic level of anxiety is characterized by complete inability to focus and reduced perceptions.

The healthcare provider is obtaining a health history from the parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following information about the child's behavior should the healthcare provider expect? Choose all answers that apply A. Speaks using delayed echolalia B. Avoids eye contact C. Interrupts conversations of others D. Often talks excessively E. Has difficulty finishing homework

C, D, E

Which behavioral assessment in a child is most consistent with a diagnosis of conduct disorder? A. Arguing with adults B. Gross impairment in communication C. Physical aggression toward others D. Refusal to separate from caretaker

C. Physical aggression toward others is a significant criterion consistent with the diagnoses of conduct disorder. Arguing with adults may indicate a lesser disorder, oppositional defiant disorder. Conduct disorder is a problem that involves violation of social rules. Gross impairment in communication and refusal to separate from a caretaker are behaviors that are more consistent with other mental disorders that can affect children.

The nurse in the substance abuse unit is trying to encourage a client to attend Alcoholics Anonymous meetings. When the client asks the nurse what he must do to become a member, the nurse should respond: A. "You must first stop drinking." B. "Your physician must refer you to this program." C. "Admit you're powerless over alcohol and that you need help." D. "You must bring along a friend who will support you."

C. "Admit you're powerless over alcohol and that you need help." The first of the "Twelve Steps of Alcoholics Anonymous" is admitting that an individual is powerless over alcohol and that life has become unmanageable. Option A: Although Alcoholics Anonymous promotes total abstinence, a client will still be accepted if he drinks. Option B: A physician referral isn't necessary to join. Option D: New members are assigned a support person who may be called upon when the client has the urge to drink.

A patient diagnosed with an anxiety disorder is prescribed a benzodiazepine. When teaching the patient about the medication, which of the following information would the healthcare provider include? A"It's important that you discontinue this medication if you begin to feel drowsy." B"You should avoid taking aspirin while you are taking this medication." C "Call our office right away if you experience increased restlessness or agitation." D"Decreasing your daily caffeine intake is not necessary when taking this medication.

C. "Call our office right away if you experience increased restlessness or agitation."

After completing chemical detoxification and a 12-step program to treat cocaine addiction, a client is being prepared for discharge. Which remark by the client indicates a realistic view of the future? A. "I'm never going to use cocaine again." B. "I know what I have to do. I have to limit my cocaine use." C. "I'm going to take 1 day at a time. I'm not making any promises." D. "I will substitute cocaine for something else"

C. "I'm going to take 1 day at a time. I'm not making any promises." Twelve-step programs focus on recovery 1 day at a time. Option A: Such programs discourage people from claiming that they will never again use a substance because relapse is common. Option B: The belief that one may use a limited amount of an abused substance indicates denial. Option D: Substituting one abused substance for another predisposes the client to cross-addiction.

28. Jose who is receiving monoamine oxidase inhibitor antidepressant should avoid tyramine, a compound found in which of the following foods? A. Figs and cream cheese B. Fruits and yellow vegetables C. Aged cheese and Chianti wine D. Green leafy vegetables

C. Aged cheese and Chianti wine contain high concentrations of tyramine.

Joy has entered the chemical dependency unit for treatment of alcohol dependency. Which of the following client's possession will the nurse most likely place in a locked area? A. Toothpaste B. Shampoo C. Antiseptic wash D. Moisturizer

C. Antiseptic wash Antiseptic mouthwash often contains alcohol & should be kept in a locked area, unless labeling clearly indicates that the product does not contain alcohol.

A male client is being admitted to the substance abuse unit for alcohol detoxification. As part of the intake interview, the nurse asks him when he had his last alcoholic drink. He says that he had his last drink six (6) hours before admission. Based on this response, nurse Lorena should expect early withdrawal symptoms to: A. Begin after seven (7) days B. Not occur at all because the time period for their occurrence has passed C. Begin anytime within the next one (1) to two (2) days D. Begin within two (2) to seven (7) days

C. Begin anytime within the next one (1) to two (2) days Acute withdrawal symptoms from alcohol may begin 6 hours after the client has stopped drinking and peak 1 to 2 days later. Delirium tremens may occur 2 to 4 days — even up to 7 days — after the last drink.

Situation: A 35-year-old male has an intense fear of riding an elevator. He claims " As if I will die inside." This has affected his studies The client is suffering from: A. Agoraphobia B. Social phobia C. Claustrophobia D. Xenophobia

C. Claustrophobia Claustrophobia is fear of closed space. Option A: Agoraphobia is fear of open space or being a situation where escape is difficult. Option B: Social phobia is fear of performing in the presence of others in a way that will be humiliating or embarrassing. Option D: Xenophobia is fear of strangers.

49. The home health psychiatric nurse visits a client with chronic schizophrenia who was recently discharged after a prolong stay in a state hospital. The client lives in a boarding home, reports no family involvement, and has little social interaction. The nurse plan to refer the client to a day treatment program in order to help him with: A. Managing his hallucinations B. Medication teaching C. Social skills training D. Vocational training

C. Day treatment programs provide clients with chronic, persistent mental illness training in social skills, such as meeting and greeting people, asking questions or directions, placing an order in a restaurant, taking turns in a group setting activity. Although management of hallucinations and medication teaching may also be part of the program offered in a day treatment, the nurse is referring the client in this situation because of his need for socialization skills. Vocational training generally takes place in a rehabilitation facility; the client described in this situation would not be a candidate for this service.

C. Encourage the client to verbalize thoughts and feelings about the trauma. Planning care for a client with post-traumatic stress disorder would involve helping the client to verbalize thoughts and feelings about the trauma. This will help the client work through the strong emotions connected with the trauma and, therefore foster the belief that she is able to cope. Options A and D: Avoiding discussion and using distraction techniques would be inappropriate. Option B may be possible later after the client is able to verbalize strong emotions.

A 39-year-old mother with obsessive-compulsive disorder has become immobilized by her elaborate hand washing and walking rituals. Nurse Trish recognizes that the basis of O.C. disorder is often: A. Problems with being too conscientious B. Problems with anger and remorse C. Feelings of guilt and inadequacy D. Feeling of unworthiness and hopelessness

C. Feelings of guilt and inadequacy Option C: Ritualistic behavior seen in this disorder is aimed at controlling guilt and inadequacy by maintaining an absolute set pattern of behavior.

Nurse Wilma is teaching a client about disulfiram (Antabuse), which the client is taking to deter his use of alcohol. She explains that using alcohol when taking this medication can result in: A. Abdominal cramps and diarrhea. B. Drowsiness and decreased respiration. C. Flushing, vomiting, and dizziness. D. Increased pulse and blood pressure.

C. Flushing, vomiting, and dizziness. Disulfiram (Antabuse) prevents complete alcohol metabolism in the body. Therefore when alcohol is consumed, the client has a hypersensitivity reaction. Flushing, vomiting, and dizziness are associated with the incomplete breakdown of alcohol metabolites.

The parents of a child diagnosed with attention deficit hyperactivity disorder (ADHD) report that their child has difficulty taking turns when playing games. The healthcare provider will document this finding as which of these behavioral problems? A. Hyperactivity B. Inattentiveness C. Impulsiveness D. Aggression

C. Impulsiveness

Cely is experiencing alcohol withdrawal exhibits tremors, diaphoresis, and hyperactivity. Blood pressure is 190/87 mmHg and pulse is 92 bpm. Which of the medications would the nurse expect to administer? A. Naloxone (Narcan) B. Benztropine (Cogentin) C. Lorazepam (Ativan) D. Haloperidol (Haldol)

C. Lorazepam (Ativan) Option C: The nurse would most likely administer benzodiazepine, such as lorazepan (ativan) to the client who is experiencing symptom: The client's experiences symptoms of withdrawal because of the rebound phenomenon when the sedation of the CNS from alcohol begins to decrease.

Nurse Julie recommends that the family of a client with substance-related disorder attend a support group, such as Al-Anon and Alateen. The purpose of these groups is to help family members understand the problem and to: A. Change the problem behaviors of the abuser. B. Learn how to assist the abuser in getting help. C. Maintain focus on changing their own behaviors. D. Prevent substance problems in vulnerable family members.

C. Maintain focus on changing their own behaviors. Family support groups, such as Al-Anon and Alateen, emphasize the importance of changing one's own behavior rather than trying to change the behavior of the individual with a substance abuse problem.

Clonidine (Catapres) can be used to treat conditions other than hypertension. Nurse Sally is aware that the following conditions might the drug be administered? A. Phencyclidine (PCP) intoxication B. Alcohol withdrawal C. Opiate withdrawal D. Cocaine withdrawal

C. Opiate withdrawal Clonidine is used as adjunctive therapy in opiate withdrawal. Option A: Benzodiazepines and neuroleptic agents are typically used to treat PCP intoxication. Option B: Benzodiazepines, such as chlordiazepoxide (Librium), and neuroleptic agents, such as haloperidol, are used to treat alcohol withdrawal. Option D: Antidepressants and medications with dopaminergic activity in the brain, such as fluoxetine (Prozac), are used to treat cocaine withdrawal.

C. Physical aggression toward others Physical aggression toward others is a significant criterion consistent with the diagnoses of conduct disorder.

A female client begins to experience alcoholic hallucinosis. Nurse Joy is aware that the best nursing intervention at this time? A. Keeping the client restrained in bed B. Checking the client's blood pressure every 15 minutes and offering juices C. Providing a quiet environment and administering medication as needed and prescribed D. Restraining the client and measuring blood pressure every 30 minutes

C. Providing a quiet environment and administering medication as needed and prescribed Manifestations of alcoholic hallucinosis are best treated by providing a quiet environment for reducing stimulation and administering prescribed central nervous system depressants in dosages that control symptoms without causing over-sedation. Option A: Although bed rest is indicated, restraints are unnecessary unless the client poses a danger to himself or others. Also, restraints may increase agitation and make the client feel trapped and helpless when hallucinating. Option B: Offering juice is appropriate, but measuring blood pressure every 15 minutes would interrupt the client's rest. Option D: To avoid overstimulating the client, the nurse should check blood pressure every 2 hours.

A client who abuses alcohol and cocaine tells a nurse that he only uses substances because of his stressful marriage and difficult job. Which defense mechanisms is this client using? A. Displacement B. Projection C. Rationalization D. Sublimation

C. Rationalization Rationalization is the defense mechanism that involves offering excuses for maladaptive behavior. The client is defending his substance abuse by providing reasons related to life stressors. This is a common defense mechanism used by clients with substance abuse problems.

Nurse Rob has observed a co-worker arriving to work drunk at least three times in the past month. Which action by Nurse Rob would best ensure client safety and obtain necessary assistance for the co-worker? A. Ignore the co worker's behavior, and frequently assess the clients assigned to the co-worker. B. Make general statements about safety issues at the next staff meeting. C. Report the coworker's behavior to the appropriate supervisor. D. Warn the co-worker that this practice is unsafe.

C. Report the coworker's behavior to the appropriate supervisor. The nurse is obligated by ethical considerations of client safety, as well as by nurse practice acts in many states, to report substance abuse in health care workers. Most healthcare facilities have an employee assistance program to help workers with substance abuse problems. Option A: Ignoring the co worker's behavior would be a form of enabling behavior (codependency) on the staff nurse's part. Option B: Making general statements about safety in a staff meeting avoids dealing with the problem. Option D: Warning the co-worker is inadequate; it does not ensure client safety or helps him receive necessary aid.

A client is experiencing anxiety attack. The most appropriate nursing intervention should include? A. Turning on the television B. Leaving the client alone C. Staying with the client and speaking in short sentences D. Ask the client to play with other clients

C. Staying with the client and speaking in short sentences Option C: Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm and medicating as needed.

Nurse John is aware that the therapy that has the highest success rate for people with phobias would be: A. Psychotherapy aimed at rearranging maladaptive thought process B. Psychoanalytical exploration of repressed conflicts of an earlier development phase C. Systematic desensitization using relaxation technique D. Insight therapy to determine the origin of the anxiety and fear

C. Systematic desensitization using relaxation technique The most successful therapy for people with phobias involves behavior modification techniques using desensitization.

23. Which of the following drugs have been known to be effective in treating obsessive-compulsive disorder (OCD)? A. Divalproex (depakote) and Lithium (lithobid) B. Chlordiazepoxide (Librium) and diazepam (valium) C. Fluvoxamine (Luvox) and clomipramine (anafranil) D. Benztropine (Cogentin) and diphenhydramine (benadryl)

C. The antidepressants fluvoxamine and clomipramine have been effective in the treatment of OCD.

When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? A. The client eliminates all anxiety from daily situations B. The client ignores feelings of anxiety C. The client identifies anxiety-producing situations D. The client maintains contact with a crisis counselor

C. The client identifies anxiety-producing situations Option C: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus.

39. A client with depression has been hospitalized for treatment after taking a leave of absence from work. The client's employer expects the client to return to work following inpatient treatment. The client tells the nurse, "I'm no good. I'm a failure". According to cognitive theory, these statements reflect: A. Learned behavior B. Punitive superego and decreased self-esteem C. Faulty thought processes that govern behavior D. Evidence of difficult relationships in the work environment

C. The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation - issues that are typically examined using a cognitive theory approach. Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Issues involving ego development are the focus of psychoanalytic theory. Option 4 is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment.

38. A nurse who explains that a client's psychotic behavior is unconsciously motivated understands that the client's disordered behavior arises from which of the following? A. Abnormal thinking B. Altered neurotransmitters C. Internal needs D. Response to stimuli

C. The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The remaining responses do not address the internal forces thought to motivate behavior.

11. Nurse John is aware that the therapy that has the highest success rate for people with phobias would be: A. Psychotherapy aimed at rearranging maladaptive thought process B. Psychoanalytical exploration of repressed conflicts of an earlier development phase C. Systematic desensitization using relaxation technique D. Insight therapy to determine the origin of the anxiety and fear

C. The most successful therapy for people with phobias involves behavior modification techniques using desensitization.

6. When working with children who have been sexually abused by a family member it is important for the nurse to understand that these victims usually are overwhelmed with feelings of: A. Humiliation B. Confusion C. Self blame D. Hatred

C. These children often have nonsexual needs met by individual and are powerless to refuse.Ambivalence results in self-blame and also guilt.

10. Nurse Ronald could evaluate that the staff's approach to setting limits for a demanding, angry client was effective if the client: A. Apologizes for disrupting the unit's routine when something is needed B. Understands the reason why frequent calls to the staff were made C. Discuss concerns regarding the emotional condition that required hospitalizations D. No longer calls the nursing staff for assistance

C. This would document that the client feels comfortable enough to discuss the problems that have motivated the behavior.

C. Total abstinence Option C: Total abstinence is the only effective treatment for alcoholism.

33. Important teaching for women in their childbearing years who are receiving antipsychotic medications includes which of the following? A. Increased incidence of dysmenorrhea while taking the drug B. Occurrence of incomplete libido due to medication adverse effects C. Continuing previous use of contraception during periods of amenorrhea D. Instruction that amenorrhea is irreversible

C. Women may experience amenorrhea, which is reversible, while taking antipsychotics. Amenorrhea doesn't indicate cessation of ovulation thus, the client can still be pregnant.

The nurse is providing care for a client undergoing opiate withdrawal. Opiate withdrawal causes severe physical discomfort and can be life-threatening. To minimize these effects, opiate users are commonly detoxified with: A. barbiturates. B. amphetamines. C. methadone. D. benzodiazepines.

C. methadone. Methadone is used to detoxify opiate users because it binds with opioid receptors at many sites in the central nervous system but doesn't have the same deleterious effects as other opiates, such as cocaine, heroin, and morphine. Options A, B, and D: Barbiturates, amphetamines, and benzodiazepines are highly addictive and would require detoxification treatment.

C: Appropriate nursing interventions for an anxiety attack include using short sentences, staying with the client, decreasing stimuli, remaining calm and medicating as needed.

A 15-year-old client is brought to the clinic by her mother. Her mother expresses concern about her daughter's weight loss and constant dieting. The nurse conducts a health history interview. Which of the following comments indicates that the client may be suffering from anorexia nervosa? A. "I like the way I look. I just need to keep my weight down because I'm a cheerleader." B. "I don't like the food my mother cooks. I eat plenty of fast food when I'm out with my friends." C. "I just can't seem to get down to the weight I want to be. I'm so fat compared to other girls." D. "I do diet around my periods; otherwise, I just get so bloated."

C: Low self-esteem is the highest risk factor for anorexia nervosa. Constant dieting to get down to a "desirable weight" is characteristic of the disorder. Feeling inadequate when compared to peers indicates poor self-esteem. Option A: Most clients with anorexia nervosa don't like the way they look, and their self-perception may be distorted. A girl with cachexia may perceive herself to be overweight when she looks in the mirror. Option B: Preferring fast food over healthy food is common in this age-group. Option D: Because of the absence of body fat necessary for proper hormone production, amenorrhea is common in a client with anorexia nervosa.

When planning the discharge of a client with chronic anxiety, Nurse Chris evaluates achievement of the discharge maintenance goals. Which goal would be most appropriately having been included in the plan of care requiring evaluation? A. The client eliminates all anxiety from daily situations B. The client ignores feelings of anxiety C. The client identifies anxiety-producing situations D. The client maintains contact with a crisis counselor

C: Recognizing situations that produce anxiety allows the client to prepare to cope with anxiety or avoid specific stimulus.

When determining whether a client has anorexia nervosa or bulimia nervosa, the nurse should identify those characteristics that relate only to anorexia nervosa. Select all that apply.

Cachexia Delayed psychosexual development

A nurse who works in a mental health facility determines that the priority nursing intervention for a newly admitted client with bulimia nervosa is to:

Check on the client continually.

A nurse is assessing a client with a diagnosis of primary insomnia. Which findings from the client's history may be the cause of this disorder? Select all that apply.

Chronic stress Excessive caffeine Environmental noise/distractors

A client is anxious, and the health care provider prescribes Alprazolam (Xanax) 5 mg by mouth 3 times a day. What should the nurse do before administering this prescription?

Clarify the prescription with the health care provider The prescribed dosage is excessive, and it must be questioned before its administration. Ventilation of feelings does not affect the need to question the prescription. Therapeutic dosages of Alprazolam (Xanax) range from 0.75 mg to 4 mg daily; the maximal daily dose for panic attacks is 8 mg.

The school nurse asseses Brook, a child newly diagnosed with attention deficit hyperactivity disorder (ADHD). Which of the following symptoms are characteristic of the disorder? Select all that apply. A Constant fidgeting and squirming B Excessive fatigue and somatic complaints C Difficulty paying attention to details D Easily distracted E Running away F Talking constantly, even when inappropriate

Constant fidgeting and squirming Difficulty paying attention to details Easily distracted Talking constantly, even when inappropriate These behaviors are all characteristic of ADHD and indicate that the child is inattentive, hyperactive, and impulsive. Options B and E are signs of emotional distress in a child and could be associated with a number of different psychiatric diagnoses.

The nurse is caring for a client with dementia whose expression of emotions is altered. Which behavior is unexpected with this client?

Curiosity

A 20 year old client was diagnosed with dependent personality disorder. Which behavior is most likely to be evidence of ineffective individual coping? A. Recurrent self-destructive behavior B. Avoiding relationship C. Showing interest in solitary activities D. Inability to make choices and decision without advice

A 23 year old client has been admitted with a diagnosis of schizophrenia says to the nurse "Yes, it's march, March is little woman". That's literal you know". These statement illustrate: A. Neologisms B. Echolalia C. Flight of ideas D. Loosening of association

A 60 year old female client who lives alone tells the nurse at the community health center "I really don't need anyone to talk to". The TV is my best friend. The nurse recognizes that the client is using the defense mechanism known as? A. Displacement B. Projection C. Sublimation D. Denial

During electroconvulsive therapy (ECT) the client recieves oxygen by mask via positive pressure ventilation. The nurse assisting with this procedure knows that positive pressure ventilation is necessary because? A. anesthesia is administered during the procedure B. Decrease oxygen to the brain increases confusion and disorientation C. Grand mal seizure activity depresses respirations D. Muscle relaxations given to prevent injury during seizure activity depress respirations.

Mario is complaining to other clients about not being allowed by staff to keep food in his room. Which of the following interventions would be most appropriate? A. Allowing a snack to be kept in his room B. Reprimanding the client C. Ignoring the clients behavior D. Setting limits on the behavior

Nurse Monet is caring for a female client who has suicidal tendency. When accompanying the client to the restroom, Nurse Monet should. . . . A. Give her privacy B. Allow her to urinate C. Open the window and allow her to get some fresh air D. Observe her

Nurse Penny is aware that the symptoms that distinguish post traumatic stress disorder from other anxiety disorder would be: A. Avoidance of situation and certain activities that resemble the stress. B. Depression and a blunted affect when discussing the traumatic situation C. Lack of interest in family and others D. Re-experiencing the trauma in dreams or flashback

Nurse Perry is aware that language development in autistic child resembles: A. Scanning Speech B. Speech lag C. Shuttering D. Echolalia

Nurse Tina is caring for a client with depression who has not responded to antidepressant medication. The nurse anticipates that what treatment procedure may be prescribed? A. Neuroleptic Medication B. Short term seclusion C. Psychotherapy D. Electroconvulsive therapy

Nurse Tina is caring for client with delirium and states that "look at the spiders on the wall". What should the nurse respond to the client? A. "You're having hallucination, there are no spiders in this room at all." B. "I can see the spiders on the wall, but they are not going to hurt you." C. "Would you like me to kill the spiders." D. "I know you are frightened, but I do not see spiders on the wall."

To establish open and trusting relationship with a female client who has been hospitalized with severe anxiety, the nurse in charge should? A. Encourage the staff to have frequent interaction with the client B. Share an activity with the client C. Give client feedback about behavior D. Respect client's need for personal space

To further assess a client's suicidal potential. Nurse Katrina should be especially alert to the client expression of: A. Frustration and fear of death B. Anger and resentment C. Anxiety and loneliness D. Helplessness and hopelessness

Which of the following foods would the nurse Trish eliminate from the diet of a client in alcohol withdrawal? A. Milk B. Orange Juice C. Soda D. Regular Coffee

Which of the following would Nurse Hazel to assess for a client who is exhibiting late signs of heroin withdrawal? A. Yawning and diaphoresis B. Restlessness and irritability C. Constipation and steatorrhea D. Vomiting and Diarrhea

Nurse Daya, a school nurse, is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for 2 months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness. A Decrease repetitive behaviors B Decreased signs of anxiety C Increased depressed mood D Increased ability to concentrate on tasks

D Increased ability to concentrate on tasks Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug's effectiveness.

Nurse Daya, a school nurse, is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for 2 months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness. A. Decrease repetitive behaviors B. Decreased signs of anxiety C. Increased depressed mood D. Increased ability to concentrate on tasks

D Methylphenidate (Ritalin) is used as a method of treatment of ADHD. Evidence of increased ability to concentrate on tasks while taking this medication would establish the drug's effectiveness.

The nurse evaluates the treatment of Mrs. Montez with somatoform disorder as successful if: A. Mrs. Montez practices self-medication rather than changing health care providers. B. Mrs. Montez recognizes that physical symptoms increase anxiety level. C. Mrs. Montez researches treatment protocols for various illnesses. D. Mrs. Montez verbalizes anxiety directly rather than displacing it.

D Mrs. Montez with somatoform disorder unconsciously displaces anxiety onto physical symptoms. The ability to recognize and verbalize anxious feelings directly rather than displacing them is a criterion of treatment success. Options A and C indicate continuation of the problem.

The therapeutic approach in the care of an autistic child include the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child

D The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechannelled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.

A patient is receiving care after being diagnosed with generalized anxiety disorder (GAD). Which of these statements made by the patient indicate to the healthcare provider that the patient is beginning to show signs of improvement? A. "As long as I take my medication, I can deal with anxiety." B. "Now I know that my anxiety is caused by a lack of sleep." C. "Situations that cause anxiety can always be avoided." D. "I can tell when I'm beginning to experience anxiety."

D. "I can tell when I'm beginning to experience anxiety."

The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? A. "I guess you're worried about something, aren't you? b. "Can I get you some medication to help calm you?" c. "Have you been pacing for a long time?" d. "I notice that you're pacing. How are you feeling?"

D. "I notice that you're pacing. How are you feeling?" By acknowledging the observed behavior and asking the client to express his feelings the nurse can best assist the client to become aware of his anxiety.

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is prescribed methylphenidate (Ritalin), immediate release (IR) tablets. When teaching the parents about the medication, which of the following will the healthcare provider include? A. "Call our office if your child becomes dizzy because it can cause low blood pressure." B. "The best time to administer the medication is just before bedtime." C. "Administer the medication daily, along with the evening meal." D. "We will need to periodically monitor your child's height and weight."

D. "We will need to periodically monitor your child's height and weight."

15. Andy is admitted to the psychiatric unit with a diagnosis of borderline personality disorder. Nurse Hilary should expects the assessment to reveal: A. Coldness, detachment and lack of tender feelings B. Somatic symptoms C. Inability to function as responsible parent D. Unpredictable behavior and intense interpersonal relationships

D. A client with borderline personality displays a pervasive pattern of unpredictable behavior, mood and self image. Interpersonal relationships may be intense and unstable and behavior may be inappropriate and impulsive.

Initial intervention for a client with a specific phobia should be to: A. Encourage to verbalize his fears as much as he wants. B. Assist him to find meaning to his feelings in relation to his past. C. Establish trust through a consistent approach. D. Accept her fears without criticizing.

D. Accept her fears without criticizing. The client cannot control her fears although the client knows it's silly and can joke about it. Option A: Allow expression of the client's fears but he should focus on other productive activities as well. Options B and C: These are not the initial interventions.

The nurse describes a client as anxious. Which of the following statement about anxiety is true? A. Anxiety is usually pathological B. Anxiety is directly observable C. Anxiety is usually harmful D. Anxiety is a response to a threat

D. Anxiety is a response to a threat Anxiety is a response to a threat arising from internal or external stimuli.

40. The nurse describes a client as anxious. Which of the following statement about anxiety is true? A. Anxiety is usually pathological B. Anxiety is directly observable C. Anxiety is usually harmful D. Anxiety is a response to a threat

D. Anxiety is a response to a threat arising from internal or external stimuli.

When planning care for a patient diagnosed with autistic spectrum disorder (ASD), which of the following ethical principles will guide care that promotes the welfare of the patient? A. Nonmaleficence B. Justice C. Veracity D. Beneficence

D. Beneficence

9. Nurse Trish suggests a crisis intervention group to a client experiencing a developmental crisis. These groups are successful because the: A. Crisis intervention worker is a psychologist and understands behavior patterns B. Crisis group supplies a workable solution to the client's problem C. Client is encouraged to talk about personal problems D. Client is assisted to investigate alternative approaches to solving the identified problem

D. Crisis intervention group helps client reestablish psychologic equilibrium by assisting them to explore new alternatives for coping. It considers realistic situations using rational and flexible problem solving methods.

A man is admitted to the nursing care unit with a diagnosis of cirrhosis. He has a long history of alcohol dependence. During the late evening following his admission, he becomes increasingly disoriented and agitated. Which of the following would the client be least likely to experience? A. Diaphoresis and tremors. B. Increased blood pressure and heart rate. C. Illusions. D. Delusions of grandeur.

D. Delusions of grandeur Delusions of grandeur are symptomatic of manic clients, not clients withdrawing from alcohol. The symptoms and history of alcohol abuse suggest this client is in alcohol withdrawal. Option A: Diaphoresis and tremors occur in the first phase of alcohol withdrawal. Option B: The blood pressure and heart rate increase in the first phase of alcohol withdrawal. Option C: Illusions are common in persons withdrawing from alcohol. Illusions occur most often in dim artificial lighting where the environment is not perceived accurately.

A client is admitted for detoxification after a cocaine overdose. The client tells the nurse that he frequently uses cocaine but he can control his use if he chooses. Which coping mechanism is he using? A. Withdrawal B. Logical thinking C. Repression D. Denial

D. Denial Denial is an unconscious defense mechanism in which emotional conflict and anxiety are avoided by refusing to acknowledge feelings, desires, impulses, or external facts that are consciously intolerable. Option A: Withdrawal is a common response to stress, characterized by apathy. Option B: Logical thinking IS the ability to think rationally and make responsible decisions, which would lead the client to admitting the problem and seeking help. Option C: Repression is suppressing past events from the consciousness because of guilty association.

A 60-year-old female client who lives alone tells the nurse at the community health center "I really don't need anyone to talk to". The TV is my best friend. The nurse recognizes that the client is using the defense mechanism known as? A. Displacement B. Projection C. Sublimation D. Denial

D. Denial Option D: The client statement is an example of the use of denial, a defense that blocks problem by unconscious refusing to admit they exist.

A client voluntarily admits himself to the substance abuse unit. He confesses that he drinks 1 qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? A. Vomiting, diarrhea, and bradycardia B. Dehydration, temperature above 101° F (38.3° C), and pruritus C. Hypertension, diaphoresis, and seizures D. Diaphoresis, tremors, and nervousness

D. Diaphoresis, tremors, and nervousness Alcohol withdrawal syndrome includes alcohol withdrawal, alcoholic hallucinosis, and alcohol withdrawal delirium (formerly delirium tremens). Signs of alcohol withdrawal include diaphoresis, tremors, nervousness, nausea, vomiting, malaise, increased blood pressure and pulse rate, sleep disturbance, and irritability. Option A: Although diarrhea may be an early sign of alcohol withdrawal, tachycardia — not bradycardia — is associated with alcohol withdrawal. Option B: Dehydration and an elevated temperature may be expected, but a temperature above 101° F indicates an infection rather than alcohol withdrawal. Pruritus rarely occurs in alcohol withdrawal. Option C: If withdrawal symptoms remain untreated, seizures may arise later.

A male adult client voluntarily admits himself to the substance abuse unit. He confesses that he drinks one (1) qt or more of vodka each day and uses cocaine occasionally. Later that afternoon, he begins to show signs of alcohol withdrawal. What are some early signs of this condition? A. Vomiting, diarrhea, and bradycardia B. Dehydration, temperature above 101° F (38.3° C), and pruritus C. Hypertension, diaphoresis, and seizures D. Diaphoresis, tremors, and nervousness

Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is: A. Urticaria B. Vertigo C. Sedation D. Diarrhea

D. Diarrhea Diarrhea is a common physiological response to stress and anxiety.

21. Nurse Jessie is assessing a client suffering from stress and anxiety. A common physiological response to stress and anxiety is: A. Uticaria B. Vertigo C. Sedation D. Diarrhea

D. Diarrhea is a common physiological response to stress and anxiety.

44. Which of the following is the most distinguishing feature of a client with an antisocial personality disorder? A. Attention to detail and order B. Bizarre mannerisms and thoughts C. Submissive and dependent behavior D. Disregard for social and legal norms

D. Disregard for established rules of society is the most common characteristic of a client with antisocial personality disorder. Attention to detail and order is characteristic of someone with obsessive compulsive disorder. Bizarre mannerisms and thoughts are characteristics of a client with schizoid or schizotypal disorder. Submissive and dependent behaviors are characteristic of someone with a dependent personality.

29. Erlinda, age 85, with major depression undergoes a sixth electroconvulsive therapy (ECT) treatment. When assessing the client immediately after ECT, the nurse expects to find: A. Permanent short-term memory loss and hypertension B. Permanent long-term memory loss and hypomania C. Transitory short-term memory loss and permanent long-term memory loss D. Transitory short and long term memory loss and confusion

D. ECT commonly causes transitory short and long term memory loss and confusion, especially in geriatric clients. It rarely results in permanent short and long term memory loss.

Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent? A. Suspiciousness, dilated pupils and incomplete BP B. Agitation, hyperactivity and grandiose ideation C. Combativeness, sweating, and confusion D. Emotional lability, euphoria, and impaired memory

D. Emotional lability, euphoria, and impaired memory Signs of anxiety agent overdose include emotional lability, euphoria, and impaired memory.

After seeking help at an outpatient mental health clinic, Ruby who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, Ruby returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for Ruby? A. Recommending a high-protein, low-fat diet. B. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle. C. Allowing the client time to heal. D. Exploring the meaning of the traumatic event with the client.

D. Exploring the meaning of the traumatic event with the client. The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become depressed or engage in self-destructive behavior such as substance abuse. Option A: A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem. Option B: The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. Option C: The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep.

A patient is diagnosed with agoraphobia. Which of the following would the healthcare identify as a characteristic of this disorder? A. Refuses to use a public restroom B. Avoids interacting with strangers C. Avoids being in the presence of clowns D. Fears the use of public transportation

D. Fears the use of public transportation

43. The nurse is caring for a client with an autoimmune disorder at a medical clinic, where alternative medicine is used as an adjunct to traditional therapies. Which information should the nurse teach the client to help foster a sense of control over his symptoms? A. Pathophysiology of disease process B. Principles of good nutrition C. Side effects of medications D. Stress management techniques

D. In autoimmune disorders, stress and the response to stress can exacerbate symptoms. Stress management techniques can help the client reduce the psychological response to stress, which in turn will help reduce the physiologic stress response. This will afford the client an increased sense of control over his symptoms. The nurse can address the remaining answer choices in her teaching about the client's disease and treatment; however, knowledge alone will not help the client to manage his stress effectively enough to control symptoms.

25. Which nursing action is most appropriate when trying to diffuse a client's impending violent behavior? A. Place the client in seclusion B. Leaving the client alone until he can talk about his feelings C. Involving the client in a quiet activity to divert attention D. Helping the client identify and express feelings of anxiety and anger

D. In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statement as "What happened to get you this angry?" may help the client verbalizes feelings rather than act on them

Nurse Daya, a school nurse, is meeting with the school and health treatment team about a child who has been receiving methylphenidate (Ritalin) for two (2) months. The meeting is to evaluate the results of the child's medication use. Which behavior change noted by the teacher will help determine the medication's effectiveness. A. Decrease repetitive behaviors B. Decreased signs of anxiety C. Increased depressed mood D. Increased ability to concentrate on tasks

D. Increased ability to concentrate on tasks

18. Which of the following statements should be included when teaching clients about monoamine oxidase inhibitor (MAOI) antidepressants? A. Don't take aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs) B. Have blood levels screened weekly for leucopenia C. Avoid strenuous activity because of the cardiac effects of the drug D. Don't take prescribed or over the counter medications without consulting the physician

D. MAOI antidepressants when combined with a number of drugs can cause life-threatening hypertensive crisis. It's imperative that a client checks with his physician and pharmacist before taking any other medications.

Which medication is commonly used in treatment programs for heroin abusers to produce a non-euphoric state and to replace heroin use? A. Diazepam B. Carbamazepine C. Clonidine D. Methadone

D. Methadone Methadone maintenance programs are used to provide a heroin-depleted individual with a medically controlled dose of methadone to produce a noneuphoric state that will prevent withdrawal symptoms. This method of treatment is advocated to help heroin abusers avoid criminal activities associated with obtaining heroin; it also prevents diseases associated with I.V. use of heroin.

13. In the diagnosis of a possible pervasive developmental autistic disorder. The nurse would find it most unusual for a 3 year old child to demonstrate: A. An interest in music B. An attachment to odd objects C. Ritualistic behavior D. Responsiveness to the parents

D. One of the symptoms of autistic child displays a lack of responsiveness to others. There is little or no extension to the external environment.

A client with a history of polysubstance abuse is admitted to the facility. She complains of nausea and vomiting 24 hours after admission. The nurse assesses the client and notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through which of the following withdrawals? A. Alcohol withdrawal B. Cannabis withdrawal C. Cocaine withdrawal D. Opioid withdrawal

D. Opioid withdrawal The symptoms listed are specific to opioid withdrawal. Option A: Alcohol withdrawal would show elevated vital signs. Option B: There is no real withdrawal from cannabis. Option C: Symptoms of cocaine withdrawal include depression, anxiety, and agitation.

After being robbed and beaten by an unknown assailant, a patient is diagnosed with post-traumatic stress disorder (PTSD). When developing a plan of care for the patient, which of these interventions will the healthcare provider plan to implement first? A. Ensure the patient is taking medications as prescribed B. Assist the patient in recalling the details of the event C. Teach the patient coping skills to deal with anxiety D. Promote the establishment of a trusting relationship

D. Promote the establishment of a trusting relationship

Nurse Penny is aware that the symptoms that distinguish post-traumatic stress disorder from other anxiety disorder would be: A. Avoidance of situation & certain activities that resemble the stress B. Depression and a blunted affect when discussing the traumatic situation C. Lack of interest in family & others D. Re-experiencing the trauma in dreams or flashback

D. Re-experiencing the trauma in dreams or flashback Option D: Experiencing the actual trauma in dreams or flashback is the major symptom that distinguishes post-traumatic stress disorder from other anxiety disorder.

The therapeutic approach in the care of an autistic child includes the following EXCEPT: A. Engage in diversionary activities when acting -out B. Provide an atmosphere of acceptance C. Provide safety measures D. Rearrange the environment to activate the child

D. Rearrange the environment to activate the child The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. Option A: Angry outburst can be re-channelled through safe activities. Option B: Acceptance enhances a trusting relationship. Option C: Ensure safety from self-destructive behaviors like head banging and hair pulling.

D. Rearrange the environment to activate the child The child with autistic disorder does not want change. Maintaining a consistent environment is therapeutic. A. Angry outburst can be rechanneled through safe activities. B. Acceptance enhances a trusting relationship. C. Ensure safety from self-destructive behaviors like head banging and hair pulling.

Which of the following foods would the nurse Trish eliminate from the diet of a client in alcohol withdrawal? A. Milk B. Orange Juice C. Soda D. Regular Coffee

D. Regular Coffee Option D: Regular coffee contains caffeine which acts as psychomotor stimulants and leads to feelings of anxiety and agitation. Serving coffee top the client may add to tremors or wakefulness

A female client is brought by ambulance to the hospital emergency room after taking an overdose of barbiturates is comatose. Nurse Trish would be especially alert for which of the following? A. Epilepsy B. Myocardial Infarction C. Renal failure D. Respiratory failure

D. Respiratory failure Barbiturates are CNS depressants; the nurse would be especially alert for the possibility of respiratory failure. Respiratory failure is the most likely cause of death from barbiturate overdose.

The child with conduct disorder will likely demonstrate: A. Easy distractibility to external stimuli. B. Ritualistic behaviors C. Preference for inanimate objects. D. Serious violations of age related norms.

D. Serious violations of age-related norms. This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. Option A: This is characteristic of attention deficit disorder. Options B and C: These are noted among children with autistic disorder.

31. Nurse Fred is assessing a client who has just been admitted to the ER department. Which signs would suggest an overdose of an antianxiety agent? A. Suspiciousness, dilated pupils and incomplete BP B. Agitation, hyperactivity and grandiose ideation C. Combativeness, sweating and confusion D. Emotional lability, euphoria and impaired memory

D. Signs of anxiety agent overdose include emotional lability, euphoria and impaired memory.

Which is the desired outcome in conducting desensitization: A. The client verbalize his fears about the situation B. The client will voluntarily attend group therapy in the social hall. C. The client will socialize with others willingly D. The client will be able to overcome his disabling fear.

D. The client will be able to overcome his disabling fear. The client will overcome his disabling fear by gradual exposure to the feared object. Options A, B, and C are not the desired outcome of desensitization.

45. Which nursing diagnosis is most appropriate for a client with anorexia nervosa who expresses feelings of guilt about not meeting family expectations? A. Anxiety B. Disturbed body image C. Defensive coping Powerlessness

D. The client with anorexia typically feels powerless, with a sense of having little control over any aspect of life besides eating behavior. Often, parental expectations and standards are quite high and lead to the clients' sense of guilt over not measuring up.

34. A client refuses to remain on psychotropic medications after discharge from an inpatient psychiatric unit. Which information should the community health nurse assess first during the initial follow-up with this client? A. Income level and living arrangements B. Involvement of family and support systems C. Reason for inpatient admission D. Reason for refusal to take medications

D. The first are for assessment would be the client's reason for refusing medication. The client may not understand the purpose for the medication, may be experiencing distressing side effects, or may be concerned about the cost of medicine. In any case, the nurse cannot provide appropriate intervention before assessing the client's problem with the medication. The patient's income level, living arrangements, and involvement of family and support systems are relevant issues following determination of the client's reason for refusing medication. The nurse providing follow-up care would have access to the client's medical record and should already know the reason for inpatient admission.

3. A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently hospitalized client for signs of opiate withdrawal. These signs would include: A. Rhinorrhea, convulsions, subnormal temperature B. Nausea, dilated pupils, constipation C. Lacrimation, vomiting, drowsiness D. Muscle aches, papillary constriction, yawning

D. These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates.

Which of the following defense mechanisms may be observed in a patient diagnosed with obsessive-compulsive disorder (OCD)? A. A. Projection B. Regression C. Denial D. Undoing

D. Undoing

The healthcare provider is assessing a child who has a diagnosis of autistic spectrum disorder (ASD). Which of these clinical findings supports this diagnosis? A. Annoys others deliberately B. Utilizes manipulative behavior C. Cries for attention at inappropriate times D. Uninterested in playing with others

D. Uninterested in playing with others

Which of the following assessment would provide the best information about the client's physiologic response and the effectiveness of the medication prescribed specifically for alcohol withdrawal? A. Sleeping pattern B. Mental alertness C. Nutritional status D. Vital signs

D. Vital signs Monitoring of vital signs provides the best information about the client's overall physiologic status during alcohol withdrawal & the physiologic response to the medication used.

A client is admitted to the substance abuse unit for alcohol detoxification. Which of the following medications is the nurse most likely to administer to reduce the symptoms of alcohol withdrawal? A. naloxone (Narcan) B. haloperidol (Haldol) C. magnesium sulfate D. chlordiazepoxide (Librium)

D. chlordiazepoxide (Librium) Chlordiazepoxide (Librium) and other tranquilizers help reduce the symptoms of alcohol withdrawal. Naloxone (Narcan) is administered for narcotic overdose. Haloperidol (Haldol) may be given to treat clients with psychosis, severe agitation, or delirium. Magnesium sulfate and other anticonvulsant medications are only administered to treat seizures if they occur during withdrawal.

The nurse is caring for a client who she believes has been abusing opiates. Assessment findings in a client abusing opiates such as morphine include: A. dilated pupils and slurred speech. B. rapid speech and agitation. C. dilated pupils and agitation. D. euphoria and constricted pupils

D. euphoria and constricted pupils. Option D: Assessment findings in a client abusing opiates include agitation, slurred speech, euphoria, and constricted pupils.

A 38-year-old client is admitted for alcohol withdrawal. The most common early sign or symptom that this client is likely to experience is: A. impending coma. B. manipulating behavior. C. suppression. D. perceptual disorders.

D. perceptual disorders. Perceptual disorders, especially frightening visual hallucinations, are very common with alcohol withdrawal Option A: Coma isn't an immediate consequence. Option B: Manipulative behaviors are part of the alcoholic client's personality but aren't signs of alcohol withdrawal. Option C: Suppression is a conscious effort to conceal unacceptable thoughts, feelings, impulses, or acts and serves as a coping mechanism for most alcoholics.

Nurse Christine is teaching an adolescent health class about the dangers of inhalant abuse; the nurse warns about the possibility of: A. Contracting an infectious disease, such as hepatitis or AIDS B. Recurrent flashback events C. Psychological dependence after initial use D. Sudden death from cardiac or respiratory depression

D. sudden death from cardiac or respiratory depression Inhalants are CNS depressants; if taken in an excess amount, they can cause cardiac and respiratory depressions. It is impossible to control the inhalant dosage; therefore, death can occur.

To establish an open and trusting relationship with a female client who has been hospitalized with severe anxiety, the nurse in charge should? A. Encourage the staff to have frequent interaction with the client B. Share an activity with the client C. Give client feedback on behavior D. Respect client's need for personal space

D: Moving to a client's personal space increases the feeling of threat, which increases anxiety.

Nurse Perry is aware that language development in autistic child resembles: A. Scanning speech B. Speech lag C. Shuttering D. Echolalia

D: The autistic child repeat sounds or words spoken by others.

A nurse is making a home visit to a young male client manifesting chronic symptoms of AIDS. The nurse assesses the client for signs of altered mental health function associated with AIDS. Select all that apply.

Delusions Memory loss Hopelessness Paranoid thinking

An adolescent with a conduct disorder is undergoing behavioral therapy in an attempt to limit behaviors that violate societal norms. A specific outcome criterion unique to adolescents with this problem is:

Demonstration of respect for the rights of others

One morning a client tells the nurse, "My legs are turning to rubber because I have an incurable disease called schizophrenia." The nurse identifies that this as an example of:

Depersonalization

A client's antidepressant medication therapy has recently been modified to substitute a tricyclic antidepressant for the monoamine oxidase inhibitor (MAOI) prescribed 2 years ago. In light of this assessment data, collected during the follow-up appointment, the nurse should first:

Determine exactly when the client began taking the amitriptyline (Elavil).

Stimulant medication for ADHD/ADD that is approved for 3 yo?

Dextroamphetamine (Dexedrine) *Stimulant *Give last dose in early afternoon SIDE EFFECTS: appetite suppression, insomnia *full drug effect takes 2 days *Approved for 3+

When caring for clients with the diagnosis of anorexia nervosa or bulimia nervosa, it is important that the nurse understand the sociocultural influences related to eating disorders in the United States. What are these influences? Select all that apply.

Diet industry Fashion trends Competitive women's athletics

The only survivor of a motor vehicle collision is found to have posttraumatic stress disorder. The client verbalizes that one long-term goal is to have a sense of control over personal feelings related to the trauma. What should the nurse include in the client's plan of care?

Discussing life situations that the client is able to manage

A practitioner prescribes divalproex (Depakote) for a client with the diagnosis of bipolar I disorder, manic episode. What side effects of this medication might the client report during a follow-up visit?

Dizziness, nausea, and vomiting

Shortly after admission an adolescent falls to the floor and exhibits tonic-clonic movements. There is no verbal response, but a nurse observes that the client is still chewing gum. What should the nurse do next?

Document the observation.

A parent of a 17-year-old girl who has been hospitalized for extremely disturbed acting-out behavior leaves a gift for the daughter but says, "I'm too busy to visit today." The daughter becomes upset and tearful after being given the message and opening the package. What does the nurse conclude that the parent's actions represent?

Double-bind message

Which of the following statements about ADHD in children is false? A Black parents tend to be less sure of potential causes of and treatments for ADHD than white parents, and they are less likely to connect ADHD to their child's school experiences. B Because of its frequent genetic etiology, ADHD in a child is likely foreshadowed by ADHD in other family members. C The chances of successful treatment are adversely affected if the parent responsible for implementing the treatment has untreated ADHD. D More than 40% of respondents in the recent National Stigma Study-Children (NSS-C) believe that children will face rejection in school for receiving mental health treatment and that negative ramifications will continue into adulthood. More than half expected psychiatric medications to cause zombie-like effect. E The Multimodal Treatment Study of Children with ADHD suggests that pharmacological treatment of ADHD is as effective as behavioral therapy alone.

E The Multimodal Treatment Study of Children with ADHD suggests that pharmacological treatment of ADHD is as effective as behavioral therapy alone.

A client is brought to the emergency department by friends because of increasingly bizarre behavior. Which signs does the nurse identify that indicate that the client was using cocaine? Select all that apply.

Euphoria Agitation Hypervigilance Impaired judgment

A client with a diagnosis of schizophrenia, undifferentiated type, is being admitted to the psychiatric unit. What clinical manifestations does the nurse expect when assessing this client? Select all that apply.

Excited behaviors Loose associations Inappropriate affect

A client with obsessive-compulsive disorder is working toward discussing how his anxiety influences his feelings and the ability to function. What should the nurse include when planning care for this client? Select all that apply.

Exploration of anxiety-provoking situations Assisting the client in examining personal standards

When a nurse is admitting an older client to the mental health unit, it is important to identify any signs of dementia. What signs and symptoms denote the presence of dementia of the Alzheimer type? Select all that apply.

Forgetfulness Expressive aphasia

A 13-year-old student visits the school nurse numerous times over the course of several weeks. The student has reported, "I worry about my parents because I don't want them to get a divorce. They tell me that they're happy, but I can't stop worrying. I'm having trouble sleeping, I'm always tired, and my grades have dropped." Which condition does the nurse consider that this student may be experiencing?

Generalized anxiety

A client is admitted to the psychiatric hospital after many self-inflicted nonlethal injuries over the preceding month. Of which level of suicidal behavior is the client's behavior reflective?

Gestures

A 25-year-old male client is being treated for an anxiety disorder and issues related to impaired social interaction. The client accuses the health care providers of being homosexuals. This behavior indicatesthat the client is most likely:

Having difficulty handling unacceptable feelings about himself

A school nurse is caring for a 12-year-old child with school phobia. What should the school nurse anticipate will be included in the initial treatment plan?

Having the child present somewhere in the school building during the day

A disturbed male client, unprovoked, attacks another client. A short-term initial plan for this client should include:

Having the client sit with a staff member in whom he trusts

A hospitalized client hurriedly approaches the nurse, saying that it sounds like there is a roaring fire in the bathroom. In reality, the client's roommate has just turned the shower on full force. What term best describes this experience?

Illusion

A depressed client is admitted to the mental health unit. What factor should the nurse consider most important when evaluating the client's current risk for suicide?

Impending anniversary of the loss of a loved one

Family education on ADHD medications

In general, stimulants can decrease appetite so regular monitoring of appetite, weight and height important Short-acting stimulants can cause rebound hyperactivity Stimulants can result in increase in motor and phonic tics - Insomnia can occur (timing of administration important) Periodic drug holidays should be considered to evaluate continued need for meds and adverse effects Use of stimulant meds does not increase risk for substance abuse Can improve inattention, hyperactivity and impulsiveness but may not improve interpersonal relationships - Adolescents known to "share"/sell meds- monitor closely

An older client is admitted to the hospital with the diagnosis of dementia of the Alzheimer type and depression. Which signs of depression does the nurse identify? Select all that apply.

Increased appetite Neglect of personal hygiene "I don't know" answers to questions "I can't remember" answers to questions

A client with a history of alcohol abuse was admitted 2 days ago for treatment of a gastrointestinal bleed. She has remained in bed as her pulse rate and blood pressure has gradually increased. She now has a low-grade fever. Place the following nursing interventions in the appropriate order to best minimize the client's risk for injury.

Initiate seizure precautions

What are the main side effects of the medications used for ADHD/ADD?

Insomnia Decreased appetite Weight loss Headache Inhibits Growth

A client is admitted to the psychiatric unit during the first episode of an acute psychotic disorder. The plan of care calls for psychiatric, medical, and neurological evaluation. What essential intervention should be included in the plan?

Instituting psychopharmacologic prescriptions and supportive communication

An agitated, acting-out, delusional client is receiving large doses of haloperidol (Haldol), and the nurse is concerned because this drug can produce untoward side effects. Which clinical manifestations should alert the nurse to stop the drug immediately? Select all that apply.

Jaundice Tachycardia

A client has been in the alcohol detoxification unit for 5 days. In the evening the client complains of numbness and tingling in the feet and legs. What is the most appropriate nursing intervention?

Keeping the bed linens off the client's legs with a mechanical aid

Schizophrenia is associated with negative symptoms. In the assessment of a client with schizophrenia, which symptoms are classified as negative symptoms? Select all that apply.

Lack of energy Poor grooming

A client is admitted to an alcohol rehabilitation center. On the fourth day after admission, the nurse detects a strong odor of alcohol on the client's breath. What is the nurse's first action?

Locating and removing the alcoholic substance

A nurse is caring for an angry, hostile client with the diagnosis of borderline personality disorder. What is probably an issue for this client?

Low self-esteem

A nurse determines that a client is pretending to be ill. What does this behavior usually indicate?

Malingering

B. Interview Martin with his parents together, observing their interaction.

Martin Sanchez is a nine (9)-year-old child admitted to a psychiatric treatment unit accompanied by Mr. and Mrs. Sanchez. To establish trust and position of neutrality, which action would the nurse take? A. Encourage Mr. and Mrs. Sanchez to leave while Martin is being interviewed. B. Interview Martin with his parents together, observing their interaction. C. Provide diversion for Martin, and interview Mr. and Mrs. Sanchez alone. D. Review the clinical record prior to interviewing Mr. and Mrs. Sanchez.

A client is not responding to antidepressant medications for treatment of major depression with suicidal ideation. After learning about electroconvulsive therapy (ECT), the client discusses the advantages and disadvantages with the primary nurse. The nurse concludes that the client understands the disadvantages of ECT when he states that one major disadvantage of ECT is that:

Memory is impaired just before and after the treatment.

A nurse is assigned to care for a group of clients who have been found to have depression. Which clinical manifestations does the nurse anticipate? Select all that apply.

Neglect of personal hygiene "I don't know" answers to questions Apathetic response to the environment

B. Family history of mental illness

D. Increased ability to concentrate on tasks

B. Generational boundaries

B. Decrease stimulation in the environment, and provide a time-out.

A. It will assist the child to develop more adaptive coping methods.

Personality disorders are identified in the DSM-V in clusters. How should the nurse describe the behaviors of an individual with a cluster A personality disorder?

Odd and eccentric

To help a disturbed, acting-out child develop a trusting relationship, the nurse should:

Offer periodic support and emphasize safety in play activities.

A client with a history of gambling is experiencing legal difficulties for embezzling money and has been required to obtain counseling. During an intake interview the client says, "I never would have done this if I'd been paid what I am worth." What factor will create the greatest difficulty in helping this client develop insight?

Projection of reasons for difficulties onto others

The nurse manager of a psychiatric unit informs the primary nurse that a client will be admitted to the unit within an hour. The client's admission diagnosis is paranoid schizophrenia. What classic clinical findings should the nurse anticipate? Select all that apply.

Prominent delusions Auditory hallucinations

When planning care for a 72-year-old client who has been admitted to the hospital because of bizarre behavior, forgetfulness, and confusion, the nurse should give priority to:

Promoting a structured environment

Which intervention will the nurse implement when assisting a child with a history of aggressive behavior to regain control in the triggering phase of an assault cycle?

Provide the child with a quiet, low stimulus environment.

Two weeks after a client has been admitted to the mental health hospital, the client's depression begins to lift. The nurse encourages involvement with unit activities, primarily because this type of activity:

Provides for group interaction

A nurse is caring for a client with bipolar I disorder. What should the plan of care for this client include? Select all that apply.

Providing a structured environment for the client Ensuring that the client's nutritional needs are met

What should the nurse do when a client with the diagnosis of schizophrenia talks about being controlled by others?

React to the feeling tone of the client's delusion.

A 30-year-old female client asks the nurse to change her room, stating that she hates her roommate and can't stand to be in the same room with her. Just as she finishes speaking, her roommate enters and the client tells her she missed her and has been all over the unit looking for her. The nurse recognizes that the client is using:

Reaction formation

A 54-year-old client has demonstrated increasing forgetfulness, irritability, and antisocial behavior. After being found walking down a street, disoriented and semi-naked, the client is admitted to the hospital, and a diagnosis of dementia of the Alzheimer type is made. The client expresses fear and anxiety. What is the best approach for the nurse to take?

Reassuring the client with the frequent presence of staff

An older client with vascular dementia has difficulty following simple directions for selecting clothes to be worn for the day. The nurse identifies that these problems as the result of:

Receptive aphasia

What defense mechanism should the nurse anticipate that a client with the diagnosis of schizophrenia, undifferentiated type, will most often exhibit?

Regression

What should be the nurse's first intervention in the care of a client with a generalized anxiety disorder?

Removing as many stimuli from the client's environment as possible

Respect client's need for personal space Option D: Moving to a client's personal space increases the feeling of threat, which increases anxiety.

The multidisciplinary team decides to use a behavior modification approach for a young woman with anorexia nervosa. Which planned nursing intervention is an appropriate approach to use with this client?

Restricting the client to her room until she has gained 2 lb

What is the priority nursing intervention in the planning of nursing care for an adolescent client with anorexia nervosa?

Rewarding weight gain by increasing privileges

A client is admitted to the drug detoxification unit for cocaine withdrawal. What is the nurse's primary concern while working with clients withdrawing from cocaine?

Risk for self-injury

During the intake interview at a mental health clinic, a client in withdrawal reveals to the nurse long-term, high-dose cocaine use. Which signs and symptoms support the conclusion that the client has been abusing cocaine for a prolonged time? Select all that apply.

Sadness Psychomotor retardation

A client's severe anxiety and panic are often considered "contagious." What action should be taken when a nurse's personal feelings of anxiety are increasing?

Saying, "Another staff member is coming in. I'll leave and come back later."

The nurse notes that a young female client with anorexia nervosa telephones home just before each mealtime. She ignores reminders to eat and continues talking until the other clients are finished eating. She then refuses to eat food that has gotten cold. The nurse should initially:

Schedule a family meeting to discuss the problem.

A hyperactive, self-destructive child is to be discharged from an inpatient setting in a few days. In preparation for the child's discharge, it is most important for the nurse to plan to:

Schedule a team conference with the child and the parents.

The ritual of a male client with obsessive-compulsive disorder involves washing the hands every 30 minutes. The client becomes anxious and agitated if he is unable to perform this ritual. What should the nurse in the mental health daycare center do?

Set a contract with the client stating the frequency of the ritual.

A client has been attending weekly outpatient psychotherapy sessions for several months. The nurse psychotherapist has been working with the client to help lessen obsessive-compulsive behaviors that have interfered with the client's work performance. What information about the client best validates the client's improvement?

She receives a letter from a supervisor at work stating that her job performance has improved.

A severely depressed client is to have electroconvulsive therapy (ECT). What should a nurse include when discussing this therapy with the client?

Sleep will be induced and the treatment will not cause pain.

A client comes to a mental health center with severe anxiety, evidenced by crying, hand-wringing, and pacing. What should the first nursing intervention be?

Staying physically close to the client

Adderall

Stimulates the cerebral cortex, brainstem, *RAS* Meds that stimulate the immature RAS in children: normalization of RAS enables person with ADHD to sit & listen and to tune out extraneous stimuli -an indirect result is a decrease in hyperactivity and impulsivity (the ability to attend to and focus decreases the behavioral symptoms)

What manifestations does the nurse expect to identify when taking a health history from a client with moderate dementia? Select all that apply.

Sundowning Exaggeration of premorbid traits

A nurse is teaching a group of recently hired staff members about conscious and unconscious defense mechanisms that are used to defend the self against anxiety. What is an example of a conscious defense mechanism that the nurse should include?

Suppression

A health care provider prescribes lithium carbonate for a client with bipolar disorder, depressive episode. What instructions should the nurse include when teaching the client about lithium? Select all that apply.

Take the medication with food. It may take several weeks for beneficial results to occur. You do not have to restrict your intake of dietary sodium.

When implementing a tertiary preventive program for cognitively impaired individuals the nurse should:

Teach children how to feed themselves.

What should the nurse do when an adolescent girl with the diagnosis of anorexia nervosa starts to discuss food and eating?

Tell the client gently but firmly to direct her discussion of food to the nutritionist.

The nurse is talking with a delusional client who has been hospitalized for 2 weeks. In the middle of the conversation the client suddenly stops talking, seems preoccupied, and then states, "I hear voices." Because the nurse has already assessed the content of the hallucinations, what is the most therapeutic response?

Telling the client, "I didn't hear any voices," and then focusing on the conversation

B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain."

The community nurse visits the home of George, a child recently diagnosed with autism. The parents express feelings of shame and guilt about having somehow caused this problem. Which statement by the nurse would best help alleviate parental guilt? A. "Autism is a rare disorder. Your other children shouldn't be affected." B. "The specific cause of autism is unknown. However, it is known to be associated with problems in the structure of and chemicals in the brain." C. "Sometimes a lack of prenatal care can be cause of autism." D. "Although autism is genetically inherited if you didn't have testing you could not have known this would happen."

A client with the diagnosis of borderline personality disorder has been exhibiting manipulative, inappropriate behavior and consistently attempting to take advantage of the other clients. What should the nurse consider first before confronting the client?

The depth of their working relationship

The nurse is acting as group leader for the weekly gathering of clients with bipolar disorder and their families. When the wife of one client expresses concern that, "he's not taking the medications right and will never get better," other family members begin to express their concerns about medication effectiveness. Several clients respond that the family members just don't understand what they are dealing with. Place the following nursing interventions in the appropriate order to best address the issues being expressed.

The nurse needs to reestablish a tone of mutual respect, trust, and confidentiality among the group's members. Restating expectations and guidelines will assist in achieving that goal. Identifying concerns in a manner that allows all members to be involved will help eliminate misconceptions and flawed assumptions. The nurse can them accurately assess the problems and concerns. Providing time for the discussion of specific concerns by both family and clients supports effective discussion of the problems and concerns. Identifying positive outcomes facilitates hope and focuses attention on the plan of care. Once communication and specific concerns are addressed, the members can turn their attention to the task of refocusing on the plan of care.

A. Actively listens to the parents' concern before planning interventions.

The parents of Suzanne, a child with attention deficit hyperactivity disorder, tell the nurse they have tried everything to calm their child and nothing has worked. Which action by the nurse is most appropriate initially? A. Actively listen to the parents' concern before planning interventions. B. Encourage the parents to discuss these issues with the mental health team. C. Provide literature regarding the disorder and its management. D. Tell the parents they are overacting to the problem.

A, C, and F

A, C, D, and F

What is the prognosis for a normal productive life for a child with autism?

Unlikely because of interference with so many parameters of function

C. Physical aggression toward others

E. The Multimodal Treatment Study of Children with ADHD suggests that pharmacological treatment of ADHD is as effective as behavioral therapy alone.

Which of the following statements about ADHD in children is false? A. Black parents tend to be less sure of potential causes of and treatments for ADHD than white parents, and they are less likely to connect ADHD to their child's school experiences. B. Because of its frequent genetic etiology, ADHD in a child is likely foreshadowed by ADHD in other family members. C. The chances of successful treatment are adversely affected if the parent responsible for implementing the treatment has untreated ADHD. D. More than 40% of respondents in the recent National Stigma Study-Children (NSS-C) believe that children will face rejection in school for receiving mental health treatment and that negative ramifications will continue into adulthood. More than half expected psychiatric medications to cause a zombie-like effect. E. The Multimodal Treatment Study of Children with ADHD suggests that pharmacological treatment of ADHD is as effective as behavioral therapy alone.

A nurse who is assessing a recently hospitalized client with a diagnosis of opioid addiction should look for signs of withdrawal. What are these signs? Select all that apply.

Yawning Muscle aches

Ritalin

a cerebral stimulant (blocks reuptake of dopamine) that increases concentration & attention span while decreasing impulsivity ( does this well, i.e. focuses attention!)

4.Which of the following statements by Kevin's mother best indicates an accurate understanding of the treatment that has been planned for Kevin? a. "Kevin's medication, plus decreasing his environmental stimuli, will help him control his behavior. b. "If I can keep Kevin on a special restricted diet, he will outgrow his ADHD in 5 to 8 years. c. "Kevin's medication will make him behave appropriately and like other kids his age." d. "I am already looking forward to Kevin's puberty, when his bothersome symptoms will disappear."

a. "Kevin's medication, plus decreasing his environmental stimuli, will help him control his behavior. b&d- ADHD is life-long and child will not outgrow it c.Medications will help him focus but not help with his behavioral issues

Which of the following best indicates to the school nurse that the time of Kevin's methylphenidate (Ritalin) administration may need to be adjusted? a. Kevin has not eaten his lunch in several days, stating, "I am just not hungry." b. Kevin's math grade has risen from 62% to 82% since the beginning of the school year. c. According to Kevin's mother, he has been sleeping well every night. d. At noon recess, Kevin has been socializing effectively with his peers.

a. (loss of appetite is a potential side effect)

A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now. I have to go. I don't want any more treatment. I have things that I have to do right away." The client has not been diagnosed and is scheduled for an important diagnostic test to be performed in an hour. After the nurse discusses the client's concerns with the client, the client dresses and begins to walk out of the hospital room. What action should the nurse take? a. Call the nursing supervisor b. Call security and block all exits c. Restrain the client until the provider can be reached d. Tell the client that they cannot return to the hospital if they leave now.

a. Call the nursing supervisor Most facilities have documents for the patient to sign if leaving AMA

The nurse determines that the wife of an alcoholic client is benefiting from attending an Al-Anon group if the nurse hears the wife make which statement? a. I no longer feel I deserve the beatings my husband inflicts on me b. My attendance at the meetings has helped me to see that I provoke my husbands violence c. I enjoy attending the meetings because they get me out of the house and away from my husband d. I can tolerate my husband's destructive behaviors now that I know they are common among alcoholics

a. I no longer feel I deserve the beatings my husband inflicts on me

The spouse of a client admitted to the mental health unit for alcohol withdrawal says to the nurse, "I should get out of this bad situation." Which is the most helpful response by the nurse? a. Why don't you tell your spouse about this? b. What do you find difficult about this situation? c. This is not the best time to make that decision. d. I agree with you. You should get out of this situation.

b. What do you find difficult about this situation? This lets the client work through the problem and search for a solution

While talking with the school nurse, Kevin's mother states, "I feel like I caused Kevin's problems." Which suggestion by the nurse would be most appropriate? a. "You shouldn't feel that way. No one really knows what causes ADHD?" b. "There's no reason to feel that way. Most experts feel there is no connection between heredity or parenting skills and ADHD." c. "Sometimes parents feel that way. I can give you information about a support group for parents of children with ADHD." d. "It may be true that ADHD is inherited, but there is nothing you can do about that now."

c. "Sometimes parents feel that way. I can give you information about a support group for parents of children with ADHD." A & B is not appropriate in NCLEX. You should never tell someone how to feel D is not appropriate because there are always more things to do- keep hope

A child diagnosed with ADHD and Type I Diabetes is prescribed Ritalin. Which nursing intervention related to both diagnoses takes priority? Teach the child & family to: a.Take the Ritalin in the morning because it can affect sleep. b.To report restlessness, insomnia, & dry mouth to the health care provider. c.Monitor fasting blood sugar levels regularly. d.Take Ritalin exactly as prescribed.

c.Monitor fasting blood sugar levels regularly ADHD medications suppress appetite so child with T1D could become hypoglycemic

Kevin's mother states that Kevin has difficulty remembering to complete tasks, such as brushing his teeth, putting dirty clothes in his hamper, and feeding his dog. Which of the following would be the most appropriate suggestion based on his developmental stage and diagnosis? a. Give Kevin a small amount of money every time he remembers to follow through on a task. b. Punish Kevin by placing him in "time out" each time he forgets to complete his assigned chores. c. Take away some of Kevin's privileges whenever he does not complete his chores. d. Suggest they make a chart to collect sticker tokens for task completion, which can then be traded in for special privileges.

d. (positive reinforcement of socially appropriate behavior) - Studies support that Best outcomes occur with combination of therapies, i.e. medication, counseling and behavior modification

The nurse is monitoring a hospitalized client who abuses alcohol. Which findings should alert the nurse to the potential for alcohol withdrawal delirium? a. Hypotension, ataxia, hunger b. Stupor, lethargy, muscular rigidity c. Hypotension, coarse hand tremors, lethargy d. Hypertension, changes in level of consciousness, hallucinations

sas 23

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