Mental Health Exam 2 Flashcards
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:
- Posttraumatic stress disorder
- Behavioral addiction
- Phobic disorder
- Agoraphobia
- Agoraphobia
The legal term that describes any behavior that presents an immediate threat to another person is:
- anger
- assault
- acting out
- aggression
- Assault
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.
- Crisis
- Trigger
- Depression
- Escalation
- Depression
To assess a client’s potential for engaging in inappropriate behaviors, the caregiver should perform as soon as possible after admission a:
- physical examination
- mental status assessment
- review of laboratory tests and other results
- psychosocial examination
- mental status assessment
Periods of mental illness or dysfunction marked by an increase in the signs, symptoms, and seriousness are called:
- chronicity
- Acute episodes
- Remissions
- Exacerbations
- Exacerbations
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:
- Normal vital signs and little to no muscle tension
- increased vial signs, urinary urgency and frequency, diaphoresis, and rigid and tense muscles
- increased vital signs, followed by a drop in vital signs, and poor muscle coordination
- Slight elevation in vital signs and some tension
- increased vial signs, urinary urgency and frequency, diaphoresis, and rigid and tense muscles
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?
- Separation anxiety disorder
- Overanxious disorder
- Avoidance behaviors
- phobia
- Avoidance behaviors
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
- anger
- adjustment
- aggression
- assertiveness
- assertiveness
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:
- abuse
- neglect
- violence
- exploitation
- neglect
the child who is more likely to behave aggressively toward his or her peer is:
- Anne, who reads in her spare time
- Dale, who wrestles after school daily
- Carl, who plays tackle on the football team
- Brian, who watches 6 hours of television a day
- Brian, who watches 6 hours of television a day
Whenever a suspected victim of violence is brought into the health care system, the first priority is to:
- Ensure the client’s safety
- Assure the client’s relatives
- Ensure a thorough nursing assessment
- Ensure an examination for possible evidence
1.Ensure the client’s safety
The nurse suspects a mother of abusing her child. which behavior is the most likely cause?
- the mother is concerned about the child’s health.
- the child relates well to the nursing staff with appropriate interaction for age.
- The child appears overly compliant, passive and undemanding with the mother and staff.
- the child is at a normal level of physical, emotional, and intellectual development for his or her age.
- The child appears overly compliant, passive and undemanding with the mother and staff.
Most depressive responses in children are tied to:
- their moods
- their environment
- general events or situations
- a specific event or situation
- a specific event or situation
Clients with bipolar 1, bipolar 2, or cyclothymic disorders exhibit different types of:
- Mania
- Anxiety
- Dysthymia
- Regression
- Mania
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?
- Mild depression
- Severe depression
- Moderate depression
- A normal emotional state
2.Severe depression
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?
- Notify the physician immediately
- Notify the physician when convenient
- Give the client two aspirin tablets and monitor his headache and heart rate
- Reassure the client that these are common side effects of his medication
1.Notify the physician immediately
Clients who are taking lithium must monitor their water and salt intake because:
- Lithium competes with water in the body
- Large amounts of water concentrate lithium in the blood
- Lithium is excreted by the kidneys more rapidly than sodium
- Sodium is excreted by the kidneys more rapidly than lithium
3.Lithium is excreted by the kidneys more rapidly than sodium
antipsychotic medication; a medication that reduces or eliminates psychotic symptoms and quiets behavior is called?
chemical restraint
two medical or psychiatric disorders present at the same time…
comorbidity
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.
C. Let the client choose her own food. If she eats everything she orders, then stay with her for 1 hour after each meal.
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
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.
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
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.
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)
d. Are risk free for neuroleptic malignant syndrome (NMS)
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
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.)
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.
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
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.
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.)
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
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.)
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
D. Behavioral model
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
A. Parent-teen communication
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
C. Medically ill older adult
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
D. Major depressive episode
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
B. Bipolar disorder
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
D. Seasonal affective disorder
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
C. A male client with major depression and at risk for suicide
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.
A. Maintain stable fluid intake.
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)
C. Sertraline (Zoloft)
A client comes in demonstrating increased activity and agitation and gives much more importance to thoughts and ideas. This client is demonstrating ________.
Mania
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
B. Feminist theory
Which of the following is a common characteristic of an abused woman?
A.Nontraditional
B.Educated
C.Young
D.Nonaggressive
A. Nontraditional
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
A. History of substance abuse
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
C. Low birth-weight infant
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
B. Shaken baby syndrome
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
D. Encouraging others to stay away from the disliked person
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
A. Neglect
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
B. Atypical antipsychotic
Which theorist states that when basic needs are threatened, a person may react with anger?
A. Skinner
B. Maslow
C. Freud
D. Peplau
B. Maslow
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.
C. Aggressive behaviors are learned responses.
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
B. Escalation stage
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
C. Intermittent explosive disorder
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
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.
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
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.
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.
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.
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
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.
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.
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.
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.
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.
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)
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.
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
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.
