Mental Health Exam 2

Question 1

A female client tells her care provider that she is terrified to go to the grocery store. The care provider is aware that this client most likely has:

1. Posttraumatic stress disorder
2. Behavioral addiction
3. Phobic disorder
4. Agoraphobia

Answer 1

4. Agoraphobia

Question 2

The legal term that describes any behavior that presents an immediate threat to another person is:

1. anger
2. assault
3. acting out
4. aggression

Answer 2

2. Assault

Question 3

The client had a terrible argument with his wife during which he hit her several times. Today, he arrives from work with flowers and an expensive necklace “to make up.” His behavior is characteristic of the stage in the assault cycle known as the ____________stage.

1. Crisis
2. Trigger
3. Depression
4. Escalation

Answer 3

3. Depression

Question 4

To assess a client’s potential for engaging in inappropriate behaviors, the caregiver should perform as soon as possible after admission a:

1. physical examination
2. mental status assessment
3. review of laboratory tests and other results
4. psychosocial examination

Answer 4

2. mental status assessment

Question 5

Periods of mental illness or dysfunction marked by an increase in the signs, symptoms, and seriousness are called:

1. chronicity
2. Acute episodes
3. Remissions
4. Exacerbations

Answer 5

4. Exacerbations

Question 6

A male client with an anxiety disorder sometimes experiences panic attacks following high levels of anxiety. The nurse would expect his physiologic responses to include:

1. Normal vital signs and little to no muscle tension
2. increased vial signs, urinary urgency and frequency, diaphoresis, and rigid and tense muscles
3. increased vital signs, followed by a drop in vital signs, and poor muscle coordination
4. Slight elevation in vital signs and some tension

Answer 6

2. increased vial signs, urinary urgency and frequency, diaphoresis, and rigid and tense muscles

Question 7

a married couple who has separated and is planning to divorce seeks counseling for their 9 year old daughter. the daughter has been experiencing symptoms of severe anxiety during insignificant situations and refuses to discuss the divorce with her parents. What type of childhood anxiety is the child most likely experiencing?

1. Separation anxiety disorder
2. Overanxious disorder
3. Avoidance behaviors
4. phobia

Answer 7

3. Avoidance behaviors

Question 8

the ability to express directly one’s feelings or needs in a way that respects the rights of other people and retains the individuals dignity is called

1. anger
2. adjustment
3. aggression
4. assertiveness

Answer 8

4. assertiveness

Question 9

Harm to another’s health or welfare caused by failure to provide for basic needs or placing the person’s health or welfare at unreasonable risk is best described as:

1. abuse
2. neglect
3. violence
4. exploitation

Answer 9

2. neglect

Question 10

the child who is more likely to behave aggressively toward his or her peer is:

1. Anne, who reads in her spare time
2. Dale, who wrestles after school daily
3. Carl, who plays tackle on the football team
4. Brian, who watches 6 hours of television a day

Answer 10

4. Brian, who watches 6 hours of television a day

Question 11

Whenever a suspected victim of violence is brought into the health care system, the first priority is to:

1. Ensure the client’s safety
2. Assure the client’s relatives
3. Ensure a thorough nursing assessment
4. Ensure an examination for possible evidence

Answer 11

1.Ensure the client’s safety

Question 12

The nurse suspects a mother of abusing her child. which behavior is the most likely cause?

1. the mother is concerned about the child’s health.
2. the child relates well to the nursing staff with appropriate interaction for age.
3. The child appears overly compliant, passive and undemanding with the mother and staff.
4. the child is at a normal level of physical, emotional, and intellectual development for his or her age.

Answer 12

3. The child appears overly compliant, passive and undemanding with the mother and staff.

Question 13

Most depressive responses in children are tied to:

1. their moods
2. their environment
3. general events or situations
4. a specific event or situation

Answer 13

4. a specific event or situation

Question 14

Clients with bipolar 1, bipolar 2, or cyclothymic disorders exhibit different types of:

1. Mania
2. Anxiety
3. Dysthymia
4. Regression

Answer 14

1. Mania

Question 15

Feelings of worthlessness, guilt, and despair are expressed in a female client’s every thought, movement, and activity. Her physical appearance has declined, and she is commonly unable to eat. What is the client experiencing?

1. Mild depression
2. Severe depression
3. Moderate depression
4. A normal emotional state

Answer 15

2.Severe depression

Question 16

The client has recently started antidepressant drug therapy. He approaches the nurse complaining of a headache, palpitations, and stiffness in the neck. What is the nurse’s priority action?

1. Notify the physician immediately
2. Notify the physician when convenient
3. Give the client two aspirin tablets and monitor his headache and heart rate
4. Reassure the client that these are common side effects of his medication

Answer 16

1.Notify the physician immediately

Question 17

Clients who are taking lithium must monitor their water and salt intake because:

1. Lithium competes with water in the body
2. Large amounts of water concentrate lithium in the blood
3. Lithium is excreted by the kidneys more rapidly than sodium
4. Sodium is excreted by the kidneys more rapidly than lithium

Answer 17

3.Lithium is excreted by the kidneys more rapidly than sodium

Question 18

antipsychotic medication; a medication that reduces or eliminates psychotic symptoms and quiets behavior is called?

Answer 18

chemical restraint

Question 19

two medical or psychiatric disorders present at the same time…

Answer 19

comorbidity

Question 20

Nurse Mary is caring for a client with bulimia. Strict management of dietary intake is necessary. Which intervention is also important?

A. Fill out the client’s menu and make sure she eats at least half of what is on her tray.
B. Let the client eat her meals in private. Then engage her in social activities for at least 2 hours after each meal.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
D. Let the client eat food brought in by the family if she chooses, but she should keep a strict calorie count.

Answer 20

C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.

Question 21

Nurse Alice 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

Answer 21

Correct Answer: 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. Close monitoring of adverse events is necessary, in particular, in patients with polysubstance abuse. Patients taking disulfiram require monitoring for signs and symptoms of hepatitis, including fatigue, weakness, anorexia, nausea, vomiting, jaundice, malaise, and dark urine.

Question 22

A male client is hospitalized with fractures of the right femur and right humerus sustained in a motorcycle accident. Police suspect the client was intoxicated at the time of the accident. Laboratory tests reveal a blood alcohol level of 0.2% (200 mg/dl). The client later admits to drinking heavily for years. During hospitalization, the client periodically complains of tingling and numbness in the hands and feet. Nurse Gian realizes that these symptoms probably result from:
A. Acetate accumulation
 B. Thiamine deficiency
 C. Triglyceride buildup.
 D. A below-normal serum potassium level

Answer 22

B. Thiamine deficiency
Numbness and tingling in the hands and feet are symptoms of peripheral polyneuritis, which results from inadequate intake of vitamin B1 (thiamine) secondary to prolonged and excessive alcohol intake.

Question 23

The nurse manager on the psychiatric unit was explaining to the new staff the differences between typical and atypical antipsychotics. The nurse correctly states that atypical antipsychotics:

a. Remain in the system longer
b. Act more quickly to reduce delusions
c. Produce fewer extrapyramidal effects
d. Are risk free for neuroleptic malignant syndrome (NMS)

Answer 23

d. Are risk free for neuroleptic malignant syndrome (NMS)

Question 24

The nurse would assess for neuroleptic malignant syndrome (NMS) if a patient on haloperidol (Haldol) develops a:

a. 30 mm Hg decrease in blood pressure reading
b. Respiratory rate of 24 respirations per minute
c. Temperature reading of 104 F
d. Pulse rate of 70 beats per minute

Answer 24

C

(Increased temperature is the cardinal sign of NMS. This BP is not a significant feature of NMS. There are no significant findings to support the options related to respirations or pulse rate.)

Question 25

A female client with borderline personality disorder is admitted to the psychiatric unit. Initial nursing assessment reveals that the client’s wrists are scratched from a recent suicide attempt. Based on this finding, the nurse Lenny should formulate a nursing diagnosis of: A. Ineffective individual coping related to feelings of guilt. B. Situational low self-esteem related to feelings of loss of control. C. Risk for violence: Self-directed related to impulsive mutilating acts. D. Risk for violence: Directed toward others related to verbal threats.

Answer 25

C. Risk for violence: Self-directed related to impulsive mutilating acts. The predominant behavioral characteristic of the client with borderline personality disorder is impulsiveness, especially of a physically self-destructive sort. The observation that the client has scratched wrists doesn’t substantiate the other options. Borderline personality disorder (BPD) is 1 of 4 Cluster-B disorders that include borderline, antisocial, narcissistic, and histrionic. Borderline personality disorder (BPD) is characterized by hypersensitivity to rejection and resulting instability of interpersonal relationships, self-image, affect, and behavior

Question 26

Which of these statements made by a patient taking the MAOI phenelzine (Nardil) would warrant further instruction? a. I often forget to wear sunscreen when I go outside. b. I need to restrict the amount of sodium in my diet. c. I should not use over-the-counter cold medications. d. I usually order liver and onions when my wife and I eat out.

Answer 26

D (MAOIs require patients to observe a tyramine-free diet to prevent hypertensive crisis. Liver is a food that contains large amounts of tyramine. The remaining options have no relevance for MAOI therapy.)

Question 27

To educate a patient regarding what to expect following the administration of a benzodiazepine, the nurse must understand that benzodiazepines: a. Have a rapid onset of peak action b. Reduce availability of GABA c. Generally diminish the activity of GABA d. Interact with serotonin to increase availability

Answer 27

A (Benzodiazepines do have a more rapid onset. There is no effect on the availability or function of GABA. Benzodiazepines do not diminish GABA activity; they enhance it.)

Question 28

Which of the following theoretical models focuses on depression as a group of learned responses? A. Interpersonal model B. Psychoanalytical model C. Social model D. Behavioral model

Answer 28

D. Behavioral model

Question 29

Depression in adolescence usually is related to loneliness, family strengths, self-esteem, and which of the following? A. Parent-teen communication B. Peer relationships C. Academic issues D. Teacher-teen communication

Answer 29

A. Parent-teen communication

Question 30

Which of the following individuals is more likely to experience depression? A. Older adult with pet B. Male older adult C. Medically ill older adult D. Older adult living alone

Answer 30

C. Medically ill older adult

Question 31

A middle-aged man has lost all sources of income. He is unable to function, cares about nothing, and feels powerless. His feelings of worthlessness and despair have lasted 3 weeks. He is suffering from which of the following? A. Dysthymia B. Mild depression C. Moderate depression D. Major depressive episode

Answer 31

D. Major depressive episode

Question 32

Assessment of a client reveals severe and sudden mood swings from mania to depression. Which diagnosis should the nurse suspect? A. Dysthymic disorder B. Bipolar disorder C. Major depressive disorder D. Personality disorder

Answer 32

B. Bipolar disorder

Question 33

A client characteristically experiences fatigue, gloom, and loss of energy during the winter months. Which diagnosis should the nurse suspect? A. Cyclothymic disorder B. Mild depressive disorder C. Mood disorder D. Seasonal affective disorder

Answer 33

D. Seasonal affective disorder

Question 34

Which client would the nurse expect to prepare for electroconvulsive therapy (ECT)? A. A female client with dysthymic disorder B. A male client with major depressive disorder and history of heart disease C. A male client with major depression and at risk for suicide D. A female client with major depression and brain metastasis

Answer 34

C. A male client with major depression and at risk for suicide

Question 35

Which instruction should the nurse give a client who is prescribed lithium carbonate (lithium)? A. Maintain stable fluid intake. B. Exercise in hot weather. C. Restrict fluid. D. Restrict salt.

Answer 35

A. Maintain stable fluid intake.

Question 36

A depressed client has been prescribed a selective serotonin reuptake inhibitor. Which medication may have been prescribed? A. Amitriptyline (Elavil) B. Clonazepam (Klonopin) C. Sertraline (Zoloft) D. Lorazepam (Ativan)

Answer 36

C. Sertraline (Zoloft)

Question 37

A client comes in demonstrating increased activity and agitation and gives much more importance to thoughts and ideas. This client is demonstrating ________.

Answer 37

Mania

Question 38

Which theory states that males are socialized throughout childhood to behave more aggressively and violently? A.Anthropological theory B.Feminist theory C.Social learning theory D.Sociological theory

Answer 38

B. Feminist theory

Question 39

Which of the following is a common characteristic of an abused woman? A.Nontraditional B.Educated C.Young D.Nonaggressive

Answer 39

A. Nontraditional

Question 40

``` Which of the following is a common characteristic of an abuser? A. History of substance abuse B. Control of emotions C. Secure with self D. Blames self for own problems ```

Answer 40

A. History of substance abuse

Question 41

An abused pregnant woman gives birth to a baby girl. The nurse should suspect which of the following? A. Mother openly seeks help B. Delivery at full-term C. Low birth-weight infant D. Adequate prenatal care

Answer 41

C. Low birth-weight infant

Question 42

A nurse recognizes unexplained fussiness and irritability in an infant as well as unexplained injuries. The nurse should suspect which of the following? A. Sexual abuse B. Shaken baby syndrome C. Neglect D. Munchausen syndrome by proxy

Answer 42

B. Shaken baby syndrome

Question 43

Which of the following is a bullying behavior? A. Taking property from the disliked person B. Avoiding a disliked person C. Disliking the way the person dresses D. Encouraging others to stay away from the disliked person

Answer 43

D. Encouraging others to stay away from the disliked person

Question 44

``` The nurse should most suspect which of the following when presented with an older, mentally impaired woman who is depressed and underweight and has poor personal hygiene? A. Neglect B. Exploitation C. Physical abuse D. Emotional abuse ```

Answer 44

A. Neglect

Question 45

An abuser with severe aggression is prescribed medication for his condition. Which of the following may be prescribed? A. Antabuse B. Atypical antipsychotic C. Hypnotic D. Antipyretics

Answer 45

B. Atypical antipsychotic

Question 46

Which theorist states that when basic needs are threatened, a person may react with anger? A. Skinner B. Maslow C. Freud D. Peplau

Answer 46

B. Maslow

Question 47

A psychosocial theory of aggression is defined by which of the following statements? A. Aggressive acts are a product of cultural values, beliefs, norms, and rituals. B. Aggression is the result of having power and many resources. C. Aggressive behaviors are learned responses. D. Aggression is a natural part of all human interactions.

Answer 47

C. Aggressive behaviors are learned responses.

Question 48

A husband is yelling and swearing at his wife during an argument. He also is pacing and pounding his fist. This pattern of behavior is consistent with which stage in the assault cycle? A. Trigger stage B. Escalation stage C. Crisis stage D. Recovery stage

Answer 48

B. Escalation stage

Question 49

A person yells, curses, and strikes a bank teller for making her wait in line too long. This behavior is consistent with which of the following? A. Conduct disorder B. Oppositional defiant disorder C. Intermittent explosive disorder D. Adjustment disorder

Answer 49

C. Intermittent explosive disorder

Question 50

A client is diagnosed with dysthymic disorder. Which should a nurse classify as an affective symptom of this disorder? A. Social isolation with a focus on self B. Low energy level C. Difficulty concentrating D. Gloomy and pessimistic outlook on life

Answer 50

ANS: D The nurse should classify a gloomy and pessimistic outlook on life as an affective symptom of dysthymic disorder. Symptoms of depression can be described as alterations in four areas of human functions: affective, behavioral, cognitive, and physiological.

Question 51

A client is diagnosed with major depressive disorder. Which nursing diagnosis should a nurse assign to this client to address a behavioral symptom of this disorder? A. Altered communication R/T feelings of worthlessness AEB anhedonia B. Social isolation R/T poor self-esteem AEB secluding self in room C. Altered thought processes R/T hopelessness AEB persecutory delusions D. Altered nutrition: less than body requirements R/T high anxiety AEB anorexia

Answer 51

ANS: B A nursing diagnosis of social isolation R/T poor self-esteem AEB secluding self in room addresses a behavioral symptom of major depressive disorder. Other behavioral symptoms include psychomotor retardation, virtually nonexistent communication, maintaining a fetal position, and no personal hygiene and/or grooming.

Question 52

A nurse assesses a client suspected of having major depressive disorder. Which client symptom would eliminate this diagnosis? A. The client is disheveled and malodorous. B. The client refuses to interact with others. C. The client is unable to feel any pleasure. D. The client has maxed-out charge cards and exhibits promiscuous behaviors.

Answer 52

ANS: D The nurse should assess that a client who has maxed-out credit cards and exhibits promiscuous behavior would be exhibiting manic symptoms. According to the DSM-IV-TR, these symptoms would rule out the diagnosis of major depressive disorder.

Question 53

A nurse reviews the laboratory data of a client suspected of having major depressive disorder. Which laboratory value would potentially rule out this diagnosis? A. Thyroid-stimulating hormone (TSH) level of 6.2 U/mL B. Potassium (K+) level of 4.2 mEq/L C. Sodium (Na+) level of 140 mEq/L D. Calcium (Ca2+) level of 9.5 mg/dL

Answer 53

ANS: A According to the DSM-IV-TR, symptoms of major depressive disorder cannot be due to the direct physiological effects of a general medical condition (e.g., hypothyroidism). The diagnosis of major depressive disorder may be ruled out if the client's laboratory results indicate a high TSH level which results from a low thyroid function or hypothyroidism. In hypothyroidism, metabolic processes are slowed leading to depressive symptoms.

Question 54

A depressed client reports to a nurse a history of divorce, job loss, family estrangement, and cocaine abuse. Which theoretical principle best explains the etiology of this client's depressive symptoms? A. According to psychoanalytic theory, depression is a result of anger turned inward. B. According to object-loss theory, depression is a result of abandonment. C. According to learning theory, depression is a result of repeated failures. D. According to cognitive theory, depression is a result of negative perceptions.

Answer 54

ANS: C The nurse should assess that this client's depressive symptoms may have resulted from repeated failures. This assessment was based on the principles of learning theory. Learning theory describes a model of "learned helplessness" in which multiple life failures cause the client to abandon future attempts to succeed.

Question 55

What is the rationale for a nurse to perform a full physical health assessment on a client admitted with a diagnosis of major depressive disorder? A. The attention during the assessment is beneficial in decreasing social isolation. B. Depression can generate somatic symptoms that can mask actual physical disorders. C. Physical health complications are likely to arise from antidepressant therapy. D. Depressed clients avoid addressing physical health and ignore medical problems.

Answer 55

ANS: B The nurse should determine that a client with a diagnosis of major depressive disorder needs a full physical health assessment because depression can generate somatic symptoms that can mask actual physical disorders. Somatization is the process by which psychological needs are expressed in the form of physical symptoms.

Question 56

A nurse is planning care for a child who is experiencing depression. Which medication is approved by the U.S. Food and Drug Administration (FDA) for the treatment of depression in children and adolescents? A. Paroxetine (Paxil) B. Sertraline (Zoloft) C. Citalopram (Celexa) D. Fluoxetine (Prozac)

Answer 56

ANS: D Fluoxetine (Prozac) is FDA approved for the treatment of depression in children and adolescents. Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used in the treatment of depression. All antidepressants carry an FDA warning for increased risk of suicide in children and adolescents.

Question 57

A nurse admits an older client who is experiencing memory loss, confused thinking, and apathy. A psychiatrist suspects depression. What is the rationale for performing a mini-mental status exam? A. To rule out bipolar disorder B. To rule out schizophrenia C. To rule out senile dementia D. To rule out a personality disorder

Answer 57

ANS: C A mini-mental status exam should be performed to rule out senile dementia. The elderly are often misdiagnosed with senile dementia when depression is their actual diagnosis. Memory loss, confused thinking, or apathy symptomatic of dementia actually may be the result of depression.

Question 58

A confused client has recently been prescribed sertraline (Zoloft). The client's spouse is taking paroxetine (Paxil). The client presents with restlessness, tachycardia, diaphoresis, and tremors. What complication does a nurse suspect and what could be its possible cause? A. Neuroleptic malignant syndrome caused by ingestion of two different seratonin reuptake inhibitors (SSRIs) B. Neuroleptic malignant syndrome caused by ingestion of an SSRI and a monoamine oxidase inhibitor (MAOI) C. Serotonin syndrome caused by ingestion of an SSRI and an MAOI D. Serotonin syndrome caused by ingestion of two different SSRIs

Answer 58

ANS: D The nurse should suspect that the client is suffering from serotonin syndrome possibly caused by ingesting two different SSRIs (Zoloft and Paxil). Symptoms of serotonin syndrome include confusion, agitation, tachycardia, hypertension, nausea, abdominal pain, myoclonus, muscle rigidity, fever, sweating, and tremor.

Question 59

A client who has been taking fluvoxamine (Luvox) without significant improvement asks a nurse, "I heard about something called a monoamine oxidase inhibitor (MAOI). Can't my doctor add that to my medications?" Which is an appropriate nursing reply? A. "This combination of drugs can lead to delirium tremens." B. "A combination of an MAOI and Luvox can lead to a life-threatening hypertensive crisis." C. "That's a good idea. There have been good results with the combination of these two drugs." D. "The only disadvantage would be the exorbitant cost of the MAOI."

Answer 59

ANS: B The nurse should explain to the client that combining an MAOI and Luvox can lead to a life-threatening hypertensive crisis. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

Question 60

A psychiatrist prescribes a monoamine oxidase inhibitor (MAOI) for a client. Which foods should the nurse teach the client to avoid? A. Pepperoni pizza and red wine B. Bagels with cream cheese and tea C. Apple pie and coffee D. Potato chips and diet cola

Answer 60

ANS: A The nurse should instruct the client to avoid pepperoni pizza and red wine. Foods with high tyramine content can induce hypertensive crisis within 2 hours of ingestion. Symptoms of hypertensive crisis include severe occipital and/or temporal pounding headaches with occasional photophobia, sensations of choking, palpitations, and a feeling of "dread."

Question 61

A client who has been taking buspirone (BuSpar) as prescribed for 2 days is close to discharge. Which statement indicates to the nurse that the client has an understanding of important discharge teaching? A. "I cannot drink any alcohol with this medication." B. "It is going to take 2 to 3 weeks in order for me to begin to feel better." C. "This drug causes physical dependence and I need to strictly follow doctor's orders." D. "I can't take this medication with food. It needs to be taken on an empty stomach."

Answer 61

ANS: B Buspar takes at least 2 to 3 weeks to be effective in controlling symptoms of depression. This is important to teach clients in order to prevent potential noncompliance due to the perception that the medication is ineffective.

Question 62

A client is admitted to the psychiatric unit with a diagnosis of major depression. The client is unable to concentrate, has no appetite, and is experiencing insomnia. Which should be included in this client's plan of care? A. A simple, structured daily schedule with limited choices of activities B. A daily schedule filled with activities to promote socialization C. A flexible schedule that allows the client opportunities for decision making D. A schedule that includes mandatory activities to decrease social isolation

Answer 62

ANS: A A client diagnosed with depression has difficulty concentrating and may be overwhelmed by activity overload or the expectation of independent decision making. A simple, structured daily schedule with limited choices of activities is more appropriate.

Question 63

An isolative client was admitted 4 days ago with a diagnosis of major depressive disorder. Which nursing statement would best motivate this client to attend a therapeutic group being held in the milieu? A. "We'll go to the day room when you are ready for group." B. "I'll walk with you to the day room. Group is about to start." C. "It must be difficult for you to attend group when you feel so bad." D. "Let me tell you about the benefits of attending this group."

Answer 63

ANS: B A client diagnosed with major depressive disorder exhibits little to no motivation and must be firmly directed by staff to participate in therapy. It is difficult for a severely depressed client to make decisions, and this function must be temporarily assumed by the staff.

Question 64

Sertraline (Zoloft) has been prescribed for a client complaining of poor appetite, fatigue, and anhedonia. Which consideration should the nurse recognize as influencing this prescriptive choice? A. Zoloft is less expensive for the client. B. Zoloft is extremely sedating and will help with sleep disturbances. C. Zoloft has less adverse side effects than other antidepressants. D. Zoloft begins to improve depressive symptoms quickly.

Answer 64

ANS: C Zoloft is a selective serotonin reuptake inhibitor (SSRI) that has a relatively benign side effect profile as compared with other antidepressants.

Question 65

What client information does a nurse need to assess prior to initiating medication therapy with phenelzine (Nardil)? A. The client's understanding of the need for regular blood work B. The client's mood and affect score, using the facility's mood scale C. The client's cognitive ability to understand information about the medication D. The client's access to a support network willing to participate in treatment

Answer 65

ANS: C There are many dietary and medication restrictions when taking Nardil. A client must have the cognitive ability to understand information about the medication and which foods, beverages, and medications to eliminate when taking Nardil.

Question 66

A client diagnosed with seasonal affective disorder (SAD) states, "I've been feeling 'down' for 3 months. Will I ever feel like myself again?" Which reply by the nurse will best assess this client's symptoms. A. "Have you been diagnosed with any physical disorder within the last 3 months?" B. "Have you experienced any traumatic events that triggered this mood change?" C. "People who have seasonal mood changes often feel better when spring comes." D. "Help me understand what you mean when you say, 'feeling down'?"

Answer 66

ANS: D The nurse is using a clarifying statement in order to gather more details related to this client's mood. The diagnosis of SAD is not associated with a traumatic event.

Question 67

A nurse is implementing a one-on-one suicide observation level with a client diagnosed with major depressive disorder. The client states, "I'm feeling a lot better so you can stop watching me. I have taken up too much of your time already." Which is the best nursing reply? A. "I really appreciate your concern but I have been ordered to continue to watch you." B. "Because we are concerned about your safety, we will continue to observe you." C. "I am glad you are feeling better. The treatment team will consider your request." D. "I will forward you request to your psychiatrist because it is his decision."

Answer 67

ANS: B Often suicidal clients resist personal monitoring which impedes the implementation of a suicide plan. A nurse should continually observe a client when risk for suicide is suspected.

Question 68

A newly admitted client is diagnosed with major depressive disorder with suicidal ideations. Which would be the priority nursing intervention for this client? A. Teach about the effective of suicide on family dynamics. B. Carefully and unobtrusively observe based on assessed data, at varied intervals around the clock. C. Encourage the client to spend a portion of each day interacting within the milieu. D. Set realistic achievable goals to increase self esteem.

Answer 68

ANS: B The most effective way to interrupt a suicide attempt is to carefully, unobtrusively observe based on assessed data at varied intervals around the clock. If a nurse observes behavior that indicates self-harm, the nurse can intervene to stop the behavior and keep the client safe.

Question 69

The nurse is providing counseling to clients diagnosed with major depressive disorder. The nurse chooses to assess and attempt to modify the negative thought patterns of these clients. The nurse is functioning under which theoretical framework? A. Psychoanalytic theory B. Interpersonal theory C. Cognitive theory D. Behavioral theory

Answer 69

ANS: C When a nurse assesses and attempts to modify negative thought patterns related to depressive symptoms, the nurse is using a cognitive theory framework.

Question 70

Which client statement expresses a typical underlying feeling of clients diagnosed with major depressive disorder? A. "It's just a matter of time and I will be well." B. "If I ignore these feelings, they will go away." C. "I can fight these feelings and overcome this disorder." D. "I deserve to feel this way."

Answer 70

ANS: D Hopelessness and helplessness are typical symptoms of clients diagnosed with major depressive disorder. Depressive symptoms are often described as anger turned inward.

Question 71

A 75-year-old client diagnosed with a long history of depression is currently on doxepin (Sinequan) 100 mg daily. The client takes a daily diuretic for hypertension and is recovering from the flu. Which nursing diagnosis should the nurse assign highest priority? A. Risk for ineffective thermoregulation R/T anhidrosis B. Risk for constipation R/T excessive fluid loss C. Risk for injury R/T orthostatic hypotension D. Risk for infection R/T suppressed white blood cell count

Answer 71

ANS: C A side effect of Sinequan is orthostatic hypotension. Dehydration due to fluid loss from a combination of diuretic medication and flu symptoms can also contribute to this problem, putting this client at risk for injury R/T orthostatic hypotension.

Question 72

A client is admitted with a diagnosis of depression NOS (not otherwise specified). Which client statement would describe a somatic symptom that can occur with this diagnosis? A. "I am extremely sad, but I don't know why." B. "Sometimes I just don't want to eat because I ache all over." C. "I feel like I can't ever make the right decision." D. "I can't seem to leave the house without someone with me."

Answer 72

ANS: B When a client diagnosed with depression expresses physical complaints, the client is experiencing somatic symptoms. Somatic symptoms occur with depression because of a general slowdown of the entire body reflected in sluggish digestion, constipation, impotence, anorexia, difficulty falling asleep, and a wide variety of other symptoms.

Question 73

A client diagnosed with major depressive disorder was raised in an excessively religiously based household. Which nursing intervention would be most appropriate to address this client's underlying problem? A. Encourage the client to bring into awareness underlying sources of guilt. B. Teach the client that religious beliefs should be put into perspective throughout the life span. C. Confront the client with the irrational nature of the belief system. D. Assist the client to modify his or her belief system in order to improve coping skills.

Answer 73

ANS: A A client raised in an excessively religiously based household maybe at risk for experiencing guilt to the point of accepting liability in situations for which one is not responsible. The client may view himself or herself as evil and deserving of punishment leading to depression. Assisting the client to bring these feelings into awareness allows the client to realistically appraise distorted responsibility and dysfunctional guilt.

Question 74

A nurse is caring for four clients taking various medications including imipramine (Tofranil), doxepine (Sinequan), ziprasidone (Geodon), and tranylcypromine (Parnate). The nurse orders a special diet for the client receiving which medication? A. Tofranil B. Senequan C. Geodon D. Parnate

Answer 74

ANS: D Hypertensive crisis occurs in clients receiving monoamine oxidase inhibitor (MAOI) who consume foods or drugs high in tyramine content.

Question 75

A client admitted to the psychiatric unit following a suicide attempt is diagnosed with major depressive disorder. Which behavioral symptoms should the nurse expect to assess? A. Anxiety and unconscious anger B. Lack of attention to grooming and hygiene C. Guilt and indecisiveness D. Expressions of poor self-esteem

Answer 75

ANS: B Lack of attention to grooming and hygiene is the only behavioral symptom presented. Depressed clients do not care enough about themselves to participate in grooming and hygiene.

Question 76

A newly admitted client diagnosed with major depressive disorder states, "I have never considered suicide." Later the client confides to the nurse about plans to end it all by medication overdose. What is the most helpful nursing reply? A. "I'm glad you shared this. There is nothing to worry about. We will handle it together." B. "Bringing this up is a very positive action on your part." C. "We need to talk about the things you have to live for." D. "I think you should consider all your options prior to taking this action."

Answer 76

ANS: B By admitting to the staff a suicide plan, this client has taken responsibility for possible personal actions and expresses trust in the nurse. Therefore, the client may be receptive to continuing a safety plan. Recognition of this achievement reinforces this adaptive behavior.

Question 77

A nursing home resident has a diagnosis of dysthymic disorder. When planning care for this client, which of the following symptoms should a nurse expect the client to exhibit? (Select all that apply.) A. Sad mood on most days B. Mood rating of 2/10 for the past 6 months C. Labile mood D. Sad mood for the past 3 years after spouse's death E. Pressured speech when communicating

Answer 77

ANS: A, D The nurse should anticipate that a client with a diagnosis of dysthymic disorder would experience a sad mood on most days for more than 2 years. The essential feature of dysthymia is a chronically depressed mood which can have an early or late onset.

Question 78

An individual experiences sadness and melancholia in September continuing through November. Which of the following factors should a nurse identify as most likely to contribute to the etiology of these symptoms? (Select all that apply.) A. Gender differences in social opportunities that occur with age B. Drastic temperature and barometric pressure changes C. Increased levels of melatonin D. Variations in serotonergic functioning E. Inaccessibility of resources for dealing with life stressors

Answer 78

ANS: B, C, D The nurse should identify drastic temperature and barometric pressure changes, increased levels of melatonin, and/or variations in serotonergic functioning as contributing to the etiology of the client's symptoms. A number of studies have examined seasonal patterns associated with mood disorders and have revealed two prevalent periods of seasonal involvement: spring (March, April, May) and fall (September, October, November).

Question 79

A client is prescribed phenelzine (Nardil). Which of the following client statements should indicate to a nurse that discharge teaching about this medication has been successful? (Select all that apply.) A. "I'll have to let my surgeon know about this medication before I have my cholecystectomy." B. "Guess I will have to give up my glass of red wine with dinner." C. "I'll have to be very careful about reading food and medication labels." D. "I'm going to miss my caffeinated coffee in the morning." E. "I'll be sure not to stop this medication abruptly."

Answer 79

ANS: A, B, C, E The nurse should evaluate that teaching has been successful when the client states that phenelzine (Nardil) should not be taken in conjunction with the use of alcohol or foods high in tyramine and should not be stopped abruptly. Phenelzine is a monoamine oxidase inhibitor (MAOI) that can have negative interactions with other medications. The client needs to tell other physicians about taking MAOIs due to the risk of drug interactions.

Question 80

also known as "hair pulling disorder"

Answer 80

trichotillomania

Question 81

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder? a. Ms. T experiences panic anxiety when she encounters snakes. b. Ms. T refuses to fly in an airplane. c. Ms. T will not eat in a public place. d. Ms. T stays in her home for fear of being in a place from which she cannot escape.

Answer 81

d. Ms. T stays in her home for fear of being in a place from which she cannot escape.

Question 82

Which of the following is the most appropriate therapy for a client with agoraphobia? a. 10 mg Valium qid b. group therapy with other agoraphobics c. facing her fear in gradual step progression d. hypnosis

Answer 82

c. facing her fear in gradual step progression

Question 83

With implosion therapy, a client with phobic anxiety would be: a. taught relaxation exercises. b. subjected to graded intensities of the fear. c. instructed to stop the therapeutic session as soon as anxiety is experienced. d. presented with massive exposure to a variety of stimuli associated with the phobic object or situation.

Answer 83

d. presented with massive exposure to a variety of stimuli associated with the phobic object or situation.

Question 84

A client with OCD spends many hours each day washing her hands. What is the most likely reason she washes her hands so much? a. to relieve her anxiety. b. to reduce the probability of infection. c. to gain a feeling of control over her life. d. to increase her self-concept.

Answer 84

a. to relieve her anxiety.

Question 85

The INITIAL care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? a. keep the client's bathroom locked so she cannot wash her hands all the time. b. structure the client's schedule so that she has plenty of time for washing her hands. c. place the client in isolation until she promises to stop washing her hands so much. d. explain the client's behavior to her, since she is probably unaware that it is maladaptive.

Answer 85

b. structure the client's schedule so that she has plenty of time for washing her hands.

Question 86

Sandy, a client with OCD, says to the nurse, "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate? a. give attention to the ritualistic behaviors each time they occur, and point out their inappropriateness. b. ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement. c. set limits on the amount of time Sandy may engage in the ritualistic behavior. d. continue to allow Sandy all the time she wants to carry out the ritualistic behavior.

Answer 86

c. set limits on the amount of time Sandy may engage in the ritualistic behavior.

Question 87

Annie has hair-pulling disorder. She is receiving treatment at the mental health clinic with HRT. Which of the following elements would be included in this therapy? Select all that apply. a. awareness training b. competing response training c. social support d. hypnotherapy e. aversive therapy

Answer 87

a. awareness training b. competing response training c. social support

Question 88

Joanie is a new patient at the mental health clinic. She has been diagnosed with Body Dysmorphic Disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie? a. alprazolam (Xanax) b. diazepam (Valium) c. Fluoxetine (Prozac) d. Olanzapine (Zyprexa)

Answer 88

c. Fluoxetine (Prozac)

Question 89

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the PRIORITY nursing intervention for this client? a. stay with the client and reassure the client of her safety. b. administer a dose of diazepam. c. leave the client alone in a quiet room so that she can calm down. d. encourage the client to talk about what triggered the attack.

Answer 89

a. stay with the client and reassure the client of her safety.

Question 90

Janet has a diagnosis of Generalized Anxiety Disorder. Her physician prescribed buspirone 15 mg daily. Janet says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse? a. "Xanax is not effective for generalized anxiety disorder." b. "Buspirone must be taken daily in order to be effective." c. "I will ask the doctor is he will change your dose of buspirone to prn so you don't have to take it everyday." d. "Your friend really should be taking the Xanax every day."

Answer 90

b. "Buspirone must be taken daily in order to be effective."

Question 91

Which of the following medications can be prescribed on a PRN basis for long-term treatment of panic disorder? Select all that apply. a. clonazepam b. imipramine c. buspirone d. lithium e. clonidine f. all of the above

Answer 91

a. clonazepam b. imipramine c. buspirone

Question 92

The nurse discusses medication options with a patient diagnosed with Generalized Anxiety Disorder. Which statement by the nurse requires follow-up? a. "The major risk with anxiolytics such as Xanax are physical dependence and tolerance." b. "Buspirone is the drug of choice in the treatment of GAD." c. "SSRIs are effective in treating GAD." d. "Tricyclics are more widely used because of their tendency to produce less severe side effects."

Answer 92

d. "Tricyclics are more widely used because of their tendency to produce less severe side effects."

Question 93

A patient begins having panic attacks and tells the nurse, "My chest really hurts and my heart is pounding heavily." Which of the following medications will the nurse administer to treat the symptoms described? a. Alprazolam b. Buspirone c. Sertraline d. Propranolol

Answer 93

d. Propranolol Several studies have called attention to the effectiveness of beta blockers and alpha2-receptor agonists in the amelioration of anxiety symptoms. Propranolol is a beta blocker that has potent effects on the somatic manifestations of anxiety (e.g., palpitations, tremors), with less dramatic effects on the psychic component of anxiety.

Question 94

What is the trade name for the benzodiazepine Alprazolam?

Answer 94

Xanax

Question 95

What is the trade name for the benzodiazepine Clonazepam?

Answer 95

Klonopin

Question 96

What is the trade name for the benzodiazepine Diazepam?

Answer 96

Valium

Question 97

What is the trade name for the benzodiazepine Lorazepam?

Answer 97

Ativan

Question 98

What is the trade name for the benzodiazepine Oxazepam?

Answer 98

Serax

Question 99

What is the disadvantage of Buspirone (Buspar) in the treatment of generalized anxiety disorder?

Answer 99

There is a delay in alleviating symptoms. Effects take up to 2 weeks.

Question 100

A patient is diagnosed with trichotillomania after being hospitalized for a bleeding scalp. Which of the following treatment modalities should the nurse implement during the patient's rehabilitation? a. propranolol and implosion therapy b. antidepressants and systematic desensitization c. olanzapine and HRT d. anxiolytics and individual psychotherapy

Answer 100

c. olanzapine and HRT Behavior modifications have been used to treat trichotillomania. Various techniques have been tried, including covert desensitization and HRT. With HRT, in an attempt to extinguish the unwanted behavior, the individual learns to become more aware of the hair pulling, identifies times of occurrence, and substitutes a more adaptive coping strategy. Additionally, Olanzapine has proven to be a safe and effective treatment for trichotillomania.

Question 101

A patient is diagnosed with body dysmorphic disorder. Which of the following medications have proven to have positive results in the treatment of the disorder? a. lithium b. benzodiazepines such as alprazolam and clonazepam c. antidepressants such as clomipramine and fluoxetine d. buspirone (BuSpar)

Answer 101

c. antidepressants such as clomipramine and fluoxetine

Question 102

Which of the following drugs have been approved by the FDA for the treatment of OCD? Select all that apply. a. fluoxetine (Prozac) b. alprazolam (Xanax) c. paroxetine (Paxil) d. sertraline (Zoloft) e. lithium f. pimozide (Orap)

Answer 102

a. fluoxetine c. paroxetine d. sertraline These SSRIs have been approved by the FDA for the treatment of OCD. Common side effects include sleep disturbances, headache, and restlessness.

Question 103

A patient diagnosed with OCD is prescribed Fluoxetine (Prozac). Which of the following side effects will the patient exhibit after administration? a. sleep disturbances, headache, and restlessness b. headache, dizziness, drowsiness c. nausea, vomiting, constipation d. dizziness, dry mouth, blurred vision

Answer 103

a. sleep disturbances, headache, and restlessness

Question 104

Antidepressants may be prescribed to treat which of the following disorders? Select all that apply. a. Trichotillomania b. OCD c. Body Dysmorphic Disrder d. GAD e. Phobias

Answer 104

b. OCD c. Body Dysmorphic Disrder d. GAD e. Phobias

Question 105

The nurse is discussing behavior therapy with a patient diagnosed with trichotillomania. Which statement by the nurse requires follow-up? a. "The goal of habit reversal therapy, or HRT, is to extinguish unwanted behavior." b. "Various techniques of behavior therapy include convert desensitization and HRT." c. "We must substitute your hair-pulling behavior with a more adaptive coping strategy using HRT." d. "In covert desensitization, you will be exposed to a phobic stimulus, in either a real or an imagined situation."

Answer 105

d. "In covert desensitization, you will be exposed to a phobic stimulus, in either a real or an imagined situation."

Question 106

A patient with agoraphobia is evaluated after three weeks of rehabilitation. Which of the following outcomes shows improvement? a. The patient takes naps when feelings of anxiety occur b. The patient cannot recognize when he or she is feeling anxious c. The patient can list symptoms of anxiety d. The patient can discuss the phobia without excessive anxiety

Answer 106

d. The patient can discuss the phobia without excessive anxiety

Question 107

Which of the following medications is the #1 choice for treating GAD? a. Alprazolam (Xanax) b. Buspirone (BuSpar) c. Lorazepam (Ativan) d. Paroxetine (Paxil)

Answer 107

b. Buspirone (BuSpar)

Question 108

The nurse is discussing implosion therapy to the family of a patient diagnosed with Zoophobia. Which statement by the nurse requires follow-up? a. "Therapy is stopped when animals no longer cause severe anxiety." b. "Relaxation training is a part of this technique." c. "I will describe to the patient situations in which countless animals are present." d. "The patient will have to dedicate plenty of time for these sessions."

Answer 108

b. "Relaxation training is a part of this technique."

Question 109

Which of the following questions would the nurse utilize to gather evaluation information of a patient diagnosed with OCD? Select all that apply. a. Can the client refrain from sharing feelings of anxiety when exposed to the phobic stimulus? b. Can the patient maintain anxiety at a manageable level without medication? c. Can the patient discuss the phobic object or situation without becoming anxious? d. Can the client verbalize a need for medication when anxiety is severe? e. Can the client depend on others to help with his compulsions?

Answer 109

b. Can the patient maintain anxiety at a manageable level without medication? c. Can the patient discuss the phobic object or situation without becoming anxious?

Question 110

When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? a. leave the client alone to maintain privacy b. instruct the client regarding unit rules and regulations c. sit with the client in the day room to provide comfort d. communicate with simple words and brief messages

Answer 110

d. communicate with simple words and brief messages

Question 111

A newly admitted client diagnosed with OCD, spends 1 hour packing and unpacking, folding and refolding personal belongings. What is the most likely reason for this behavior? a. it relieves anxiety b. it fosters organizational skills c. it delays meeting unfamiliar people in the day room. d. it makes the client feel good

Answer 111

a. it relieves anxiety

Question 112

Which of the following medications would be an appropriate PRN medication for an individual with anxiety symptoms? a. Buspirone b. Alprazolam c. Fluoxetine d. Sertraline

Answer 112

b. Alprazolam

Question 113

What should the nurse plan to teach a client who is taking Alprazolam (Xanax) three times a day? a. That there is a potential for dependence and tolerance. b. The importance of discontinuing Xanax immediately if addiction is suspected. c. That increased caffeine consumption can enhance the effectiveness of Xanax. d. That Xanax is not habit forming.

Answer 113

a. That there is a potential for dependence and tolerance.

Question 114

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

Answer 114

4. Normal life-cycle transitions that overwhelm the client.

Question 115

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

Answer 115

2. Psychiatric emergency crisis

Question 116

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

Answer 116

4. The client will return to previous adaptive levels of functioning by week six.

Question 117

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

Answer 117

3. Risk for self-directed violence R/T hopelessness

Question 118

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

Answer 118

1. “Are you currently thinking about harming yourself?”

Question 119

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

Answer 119

4. With staff support, set firm limits on the behavior.

Question 120

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

Answer 120

4. "I carry mace when I jog. It makes me feel safe and secure."

Question 121

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

Answer 121

2. "This may not be the best time for you to make such an important decision."

Question 122

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

Answer 122

2. The client has a tense facial expression.

Question 123

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

Answer 123

4. Discuss the situation that led to inappropriate expressions of anger.

Question 124

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

Answer 124

3. Help the client deal with feelings and emotions.

Question 125

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

Answer 125

1. “Tell me what happened.” 2. “Which coping methods have you used, and did they work?” 3. “Describe to me what your life was like before this happened.”

Question 126

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

Answer 126

1. Maintain a calm demeanor. 2. Clearly delineate the consequences of the behavior. 4. Set limits on the behavior.

Question 127

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

Answer 127

1. Confusion 3. Boisterousness 5. Irritability

Question 128

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

Answer 128

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

Question 129

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

Answer 129

Crisis

Question 130

Which historical perspective would the nurse include when teaching about the home environment and the development of anorexia nervosa? 1. Maintains loose personal boundaries 2. Places an overemphasis on food 3. Is overprotective with emphasis on perfection 4. Condones corporal punishment

Answer 130

3. Is overprotective with emphasis on perfection

Question 131

The client's altered body image is evidenced by claims of "being obese," even though the client is emaciated. Which outcome criterion is appropriate for this client's problem? 1. The client will consume adequate calories to sustain normal weight. 2. The client will cease strenuous exercise programs. 3. The client will verbally state a misperception of body image as "fat." 4. The client will not express a preoccupation with food.

Answer 131

3. The client will verbally state a misperception of body image as "fat."

Question 132

The nurse is teaching a client diagnosed with bulimia nervosa about the symptom of tooth enamel deterioration. Which explanation for this complication of bulimia nervosa should the nurse provide? 1. The emesis is acidic and corrodes the tooth enamel. 2. Purging causes the depletion of dietary calcium. 3. Food is rapidly ingested without proper mastication. 4. Poor dental and oral hygiene leads to dental caries.

Answer 132

1. | The emesis is acidic and corrodes the tooth enamel.

Question 133

The nurse is teaching a client diagnosed with an eating disorder about behavior-modification programs. What is the priority rationale for this treatment? 1. It helps the client correct a distorted body image. 2. It addresses the underlying client anger. 3. It manages the client's psychotic behaviors. 4. It allows clients to maintain control.

Answer 133

4. | It allows clients to maintain control.

Question 134

An adolescent is diagnosed with anorexia nervosa and is hospitalized for severe malnutrition. Which body mass index (BMI) measurement would the nurse observe upon assessment of this client? 1. 30 2. 24 3. 20 4. 16

Answer 134

4. 16

Question 135

The family of a teenager diagnosed with anorexia nervosa becomes defensive when the treatment team calls for a family meeting to implement the Maudsley approach. Which is the appropriate nursing response? 1. "Tell me why this family meeting is causing you to be defensive. All clients are required to participate in two family sessions." 2. "For the plan to be successful, we need your involvement. The parents establish the rules and guidelines around eating." 3. "While the client is the primary focus, this meeting will provide your child with family support." 4. "Clients diagnosed with anorexia nervosa are part of the family system, and any alteration in family processes needs to be addressed."

Answer 135

2. | "For the plan to be successful, we need your involvement. The parents establish the rules and guidelines around eating."

Question 136

The client diagnosed with bulimia nervosa has been attending an outpatient mental health clinic for several months. Which factor should a nurse identify as an appropriate indicator of a positive client behavioral change? 1. Gained two pounds in one week 2. Focused conversations on nutritious food 3. Demonstrated healthy coping mechanisms that decreased anxiety 4. Verbalized an understanding of the etiology of the disorder

Answer 136

3. | Demonstrated healthy coping mechanisms that decreased anxiety

Question 137

``` The nurse is caring for a client diagnosed with binge eating disorder (BED). Which medication should the nurse administer to the client to decrease binging? 1. Lisdexamfetamine (Vyvanse) 2. Chlorpromazine (Thorazine) 3. Haloperidol (Haldol) 4. Diazepam (Valium) ```

Answer 137

1. | Lisdexamfetamine (Vyvanse)

Question 138

The nurse is teaching about the differences between the symptoms of anorexia nervosa and the symptoms of bulimia. Which information should the nurse include? 1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not. 2. Clients diagnosed with bulimia nervosa experience amenorrhea, whereas clients diagnosed with anorexia nervosa do not. 3. Clients diagnosed with bulimia nervosa experience hypotension, edema, and lanugo, whereas clients diagnosed with anorexia nervosa do not. 4. Clients diagnosed with anorexia nervosa have eroded tooth enamel, whereas clients diagnosed with bulimia nervosa do not.

Answer 138

1. Clients diagnosed with anorexia nervosa experience extreme nutritional deficits, whereas clients diagnosed with bulimia nervosa do not.

Question 139

``` The adolescent diagnosed with a history of anorexia nervosa comes to an outpatient clinic after being medically cleared. The client states, "Since going back to school, I am nervous, get apprehensive, and have a hard time eating food." Which nursing diagnosis would take priority at this time? 1. Imbalanced nutrition: less than body requirements 2. Disturbed body image/Low self-esteem 3. Impaired verbal communication 4. Anxiety ```

Answer 139

4. | Anxiety

Question 140

``` The nurse is caring for a client with anorexia nervosa. Which nursing interventions would the nurse add to the plan of care? (Select all that apply.) 1. Minimize the focus on food and eating 2. Limit mealtime to 30 minutes 3. Monitor for 30 minutes after eating 4. Weigh client weekly 5. If weight loss occurs, bargain for restrictions ```

Answer 140

1. Minimize the focus on food and eating 2. Limit mealtime to 30 minutes

Question 141

The nurse is teaching about the DSM-5 criteria for the diagnosis of binge eating disorder. Which statements by the staff indicate successful teaching? (Select all that apply.) 1. "Binge eating occurs exclusively during the course of bulimia nervosa." 2. "Binge eating occurs, on average, at least once a week for three months." 3. "Binge eating occurs because of an intense fear of becoming fat." 4. "Marked distress regarding binge eating is present." 5. "Marked distress regarding purging is present."

Answer 141

2. "Binge eating occurs, on average, at least once a week for three months." 4. "Marked distress regarding binge eating is present."

Question 142

The diagnosis of ____________________ nervosa includes the symptoms of gross distortion of body image, preoccupation with food, and refusal to eat.

Answer 142

anorexia

Question 143

The episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time is termed ____________________.

Answer 143

binging

Question 144

To rid the body of excessive calories, a client diagnosed with bulimia nervosa may engage in ____________________ behaviors, which include self-induced vomiting or the misuse of laxatives, diuretics, or enemas.

Answer 144

purging