MH final exam

Question 1

Expected findings with mania

Answer 1

restlessness, grandiosisty, flight of ideas, poor judgement, denial of illness, and attention seeking behavior

Question 2

Numerous periods with hypomanic symptoms that do not meet criteria for a hypomanic episode, AND numerous periods with depressive symptoms that do not meet criteria for a major depressive disorder, for at least 2 years (at least 1 year in children and adolescents)

Answer 2

cyclothymic disorder

Question 3

The client has one or more major depressive episode accompanied by at least one hypomanic episode

Answer 3

bipolar 2 disorder

Question 4

The client has at least one episode of mania alternating with major depression

Answer 4

bipolar 1 disorder

Question 5

fluoxetine (Prozac); SSRI used to manage a major depressive episode

Answer 5

anti-depressants

Question 6

valproate (Depakote), lamotrigine (Lamictal), carbamazepine (Tegretol); slows the entrance of sodium and calcium back into the neuron, thus extending the time it takes for the nerve to return to its active state

Answer 6

anti-epileptic medication

Question 7

lithium carbonate; exact mechanism unknown; may work by altering the distribution of calcium, sodium and magnesium ions

Answer 7

mood stabilizers

Question 8

lorazepam (Ativan), clonazepam (Klonopin); depress the CNS, increase the effects of GABA which produces relaxation and may depress the limbic system

Answer 8

anti-anxiety medications

Question 9

nursing intervention for manipulative behavior

Answer 9

Set clear, consistent, realistic, and enforceable limits, and communicate expected behaviors

Question 10

nursing intervention for deescalation technique

Answer 10

Maintain safety for the client, other clients and self; maintain a large personal space and use a nonaggressive posture. Use a calm approach and communicate with a calm, clear tone of voice; avoid verbal struggles

Question 11

nursing intervention for aggressive behavior

Answer 11

Assist the client in identifying feelings of frustration and aggression. Assist the client in identifying precipitating events or situations that lead to aggressive behavior

Question 12

nursing intervention for manipulative behavior

Answer 12

Be clear about consequences associated with exceeding set limits and follow through with consequences in a nonpunitive manner, if necessary

Question 13

manifestation of moderate to severe lithium toxicity (2-3)

Answer 13

ataxia, giddiness, tinnitus, blurred vision, large output of dilute urine, delirium, nystagmus

Question 14

manifestation of severe lithium toxicity (more than 3)

Answer 14

seizures, organ failure, renal failure, coma, death

Question 15

manifestation of mild to moderate lithium toxicity (1.5-2)

Answer 15

coarse hand tremor, diarrhea, vomiting, drowsiness, dizziness, muscular weakness, lack of coordination, dry mouth

Question 16

manifestation of therapeutic levels of lithium (0.6-1)

Answer 16

fine hand tremor, memory problems, goiter, hypothyroidism, mild diarrhea, anorexia, nausea, edema, weight gain, polydipsia, polyuria

Question 17

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 1 week and present most of the day, nearly every day (or any duration if hospitalization is necessary).

Answer 17

manic episode

Question 18

A distinct period of abnormally and persistently elevated, expansive, or irritable mood and abnormally and persistently increased activity or energy, lasting at least 4 consecutive days and present most of the day, nearly every day.

Answer 18

hypomanic episode

Question 19

are there psychotic features in a hypomanic episode?

Answer 19

No psychotic features

Question 20

are there psychotic features in a manic episode?

Answer 20

yes

Question 21

during a hypomanic episode are mood disturbances severe enough to cause impairment in social or occupational functioning?

Answer 21

Not severe enough to cause marked impairment in social or occupational functioning or to necessitate hospitalization.

Question 22

during a manic episode are mood disturbances severe enough to cause impairment in social or occupational functioning?

Answer 22

Mood disturbance is sufficiently severe to cause marked impairment in social or occupational functioning and can necessitate hospitalization to prevent harm to self or others

Question 23

type of medication that are primarily used for the treatment of persons with bipolar disorder

Answer 23

mood stabilizers

Question 24

An in-patient psychiatric client recently diagnosed with bipolar disorder has been prescribed lithium carbonate (Lithium). What should the nurse include in client teaching regarding Lithium

Answer 24

Take lithium as prescribed; must be administered in 2 to 3 doses daily due to a short half -life. Adhere to laboratory appointments needed to monitor lithium effectiveness and adverse effects. Stress side effects that require immediate notification of prescriber (vomiting, severe tremor, sedation, muscle weakness, vertigo) and stopping of medication

Question 25

What suggestions did our guest lecturer provide to help in dealing with others who display behaviors consistent with personality disorders?

Answer 25

Document everything, preferably in email and in writing. “Turn off” intimacy and maintain serious emotional boundaries. Be cautious over providing personal info, thoughts, and opinions. Keep your guard up.

Question 26

According to our guest lecturer, which personality disorder can best be described by the mantra: Loves attention (loves it, LOVES it)?

Answer 26

Histrionic personality disorder

Question 27

According to our guest lecturer, which personality disorder can best be described by the mantra: Instability, instability, instability?

Answer 27

Borderline personality disorder

Question 28

A mechanism used to symbolically negate or cancel out a previous action or experience that one finds intolerable; performing an act to make up for prior behavior

Answer 28

undoing

Question 29

The unconscious blocking of unpleasant feelings and experiences from one’s awareness

Answer 29

repression

Question 30

The inability to integrate positive and negative feelings, resulting in a tendency to view people and situations as all good or all bad; a primitive defense against fear of abandonment

Answer 30

splitting

Question 31

The voluntary blocking from one’s awareness of unpleasant feelings and experiences

Answer 31

suppression

Question 32

A retreat to an earlier level of development and the comfort measures associated with that level of functioning

Answer 32

regression

Question 33

When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include:

Answer 33

grandiosity, attention-seeking, arrogance

Question 34

high anxiety, outward signs of fear, and insecurity and inadequacy can describe which category of personality disorders?

Answer 34

Cluster C Disorders (Avoidant, Dependent, Obsessive-Compulsive)

Question 35

odd or eccentric/ have unusual beliefs can describe which category of personality disorders?

Answer 35

Cluster A Disorders (Paranoid, Schizoid, Schizotypal)

Question 36

manipulation, poor impulse control, dramatic, emotional, and erratic traits can describe which category of personality disorders?

Answer 36

Cluster B Disorders (Antisocial, Borderline, Histrionic, Narcissistic)

Question 37

When working with a client with a personality disorder, the nurse would expect to assess

Answer 37

Impaired interpersonal relationships, Inability to empathize with others, Minimal insight

Question 38

Joseph presents in the Emergency Room actively hallucinating, paranoid and makes aggressive threats to staff. What medications will likely be ordered for rapid tranquilization?

Answer 38

haloperidol (Haldol) and lorazepam (Ativan)

Question 39

A nurse teaching a patient about a tyramine-restricted diet would include which of the following foods as ones to avoid:

Answer 39

aged cheese, wine, pickled foods, and avocados

Question 40

citalopram (Celexa), fluoxetine (Prozac), sertraline (Zoloft) are what type of meds

Answer 40

selective serotonin reuptake inhibitors (SSRIs)

Question 41

Which of the following statements is true about the consequences of using atypical (second generation) antipsychotic medication versus typical (first generation) antipsychotic medication?

Answer 41

Atypical (second-generation) antipsychotics target the negative symptoms of schizophrenia as well as the positive symptoms and have fewer motor side effects

Question 42

Which of the following medications is most likely to cause extrapyramidal side effects?

Answer 42

chlorpromazine (Thorazine)

Question 43

clozapine (Clozaril), olanzapine (Zyprexa), risperidone (Risperdal) are what type of meds>?

Answer 43

atypical (second generation) antipsychotics

Question 44

is addiction a risk of using antipsychotics?

Answer 44

no

Question 45

The nurse is teaching an elderly patient about their newly prescribed medication risperidone (Risperdal). Which of the following statements by the patient would best indicate a correct understanding of the teaching?

Answer 45

“I will move slowly from lying to standing to prevent a fall”

Question 46

Tricyclic antidepressants work by:

Answer 46

Blocking reuptake of norepinephrine and serotonin at the nerve synapse

Question 47

A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client’s lithium blood level is 1.2 mEq/L. Which of the following actions should the nurse take?

Answer 47

Administer the next dose of lithium carbonate as scheduled.

Question 48

amitriptyline (Elavil) is what type of med?

Answer 48

tricyclic antidepressant (TCA)

Question 49

cautions when benzodiazepines are used as anti-anxiety medications

Answer 49

risk of dependence, caution when driving, do not use with alcohol, and do not stop abruptly

Question 50

what can happen if Nardil (phenelzine) is taken with aged cheese with red wine

Answer 50

a hypertensive crisis could occur

Question 51

David, age 24, is currently being treated for schizophrenia. He presents to the ER with symptoms of muscle rigidity, temperature of 105.2, pulse rate of 126, pulse oximetry of 89%, and a labile BP. What are you most concerned may be occurring?

Answer 51

neuroleptic malignant syndrome

Question 52

Emma is admitted to the medical unit for observation after being diagnosed with Serotonin Syndrome by her psychiatrist. Of the following combinations of medications, which was she most likely taking?

Answer 52

fluoxetine (Prozac) and sertraline (Zoloft)

Question 53

Tricyclic antidepressants have more sedating and anticholinergic effects than the SSRIs

Answer 53

true

Question 54

MAOIs work by

Answer 54

inhibiting the MAOI enzyme

Question 55

antipsychotics work by

Answer 55

blocking dopamine receptors

Question 56

SSRIs work by

Answer 56

blocking the reuptake of serotonin

Question 57

A nurse is caring for a client who has early stage Alzheimer’s Disease and a new prescription for donepezil (Aricept). The nurse should include which of the following statements when teaching the client about the medication?

Answer 57

“You can expect improvement in the patient’s ability to perform self-care and the progression of cognitive decline to slow with donepezil.”

Question 58

Forgetting events of one’s own history; difficulty performing tasks that require planning and organization; personality and behavioral changes; may be incontinent

Answer 58

moderate alzheimer’s (middle stage)

Question 59

Losing ability to converse with others; assistance required for ADLs; incontinence; losing awareness of one’s environment; progressive difficulty with physical abilities

Answer 59

severe alzheimers

Question 60

Memory lapses; losing or misplacing items; difficulty concentrating; still able to perform ADLs

Answer 60

mild alzheimer’s

Question 61

Onset: recent, may relate to life events/changes; LOC: clear; duration: variable ; may be chronic

Answer 61

depression

Question 62

Onset: insidious, slow, over years, often unrecognized; LOC: clear; duration: years; irreversible

Answer 62

dementia

Question 63

Onset: sudden; LOC: reduced; duration: hours to weeks; reversible with timely medical intervention

Answer 63

delirium

Question 64

Both the client and the family members can refuse to believe that changes, such as loss of memory, are taking place, even when those changes are obvious to others

Answer 64

denial

Question 65

The client may make up answers to fill in memory gaps

Answer 65

confabulation

Question 66

The client avoids answering questions by repeating phrases or behavior

Answer 66

perseveration

Question 67

Which of the following statements would indicate that teaching about somatic symptom disorder has been effective?

Answer 67

“I will feel better when I begin handling stress more effectively.”

Question 68

When planning care for a client with somatic symptoms disorder, the nurse would include the following interventions

Answer 68

Encourage the client to participate in daily exercise.

Help the client see the relationship between physical symptoms and life stress/events.Accept somatic symptoms as being real to the client.

Question 69

conversion disorder

Answer 69

Also known as functional neurological disorderResults when a client exhibits neurologic manifestations in the absence of a neurologic diagnosisClients who have conversion disorder transmit emotional or psychological stressors into physical manifestations

Question 70

Somatization is the expression of psychological stress through physical manifestations; the physical manifestations cannot be explained by underlying pathology

Answer 70

somatic symptom disorder

Question 71

Misrepresents physical manifestations as evidence of a serious disease process; previously known as hypochondriasis

Answer 71

illness anxiety disorder

Question 72

Previously known as Munchausen syndrome; the client falsely reports physical or psychological manifestations

Answer 72

factitious disorder

Question 73

Previously known as Munchausen syndrome by proxy; client deliberately causes injury or illness to a vulnerable person

Answer 73

factitious disorder imposed on another

Question 74

Also known as functional neurological disorder; results when a client exhibits neurologic manifestations in the absence of a neurological diagnosis

Answer 74

conversion disorder

Question 75

The client’s family asks the nurse, “What is illness anxiety disorder?” The best response by the nurse is, “Illness anxiety disorder is…

Answer 75

a persistent preoccupation with getting or having a serious disease.”

Question 76

risk factor for physical or sexual abuse

Answer 76

witnessing or experiencing traumatic events

Question 77

risk factor for Associated with some disorders, such as schizophrenia, bipolar disorder, autism spectrum disorder, ADHD, and intellectual development disorder

Answer 77

genetics

Question 78

risk factor for Severe marital discord, foster care placement, parental criminality, substance use disorders, parental depression

Answer 78

social and environmental

Question 79

risk factor for Alterations in neurotransmitters, including norepinephrine, serotonin, or dopamine

Answer 79

biochemical

Question 80

risk factor for Difficulty with assimilation, lack of cultural role models, lack of support from the dominant culture

Answer 80

cultural and ethnic

Question 81

Complex neurodevelopmental disorder thought to be of genetic origin with a wide spectrum of behaviors affecting an individual’s ability to communicate and interact with others. Cognitive and language development are typically delayed. Characteristic behaviors include inability to maintain eye contact, repetitive actions, and strict observance of routines.

Answer 81

autism spectrum disorder

Question 82

Client demonstrates persistent difficulty in acquiring reading, writing, or mathematical skills; Performance in one or more academic areas is significantly lower than the expected range for the client’s age, level of intelligence, or educational level; Clients who have specific learning disorder benefit from an individualized education program (IEP)

Answer 82

specific learning disorder

Question 83

Involves the inability of a person to control behaviors requiring sustained attention Inattention, impulsivity, and hyperactivity characteristic behaviors of ADHD; Inattention – difficulty in paying attention, listening, and focusing; Hyperactivity – fidgeting, inability to sit still, running and climbing inappropriately, difficulty with playing quietly, talking excessively; Impulsivity – difficulty waiting for turns, constantly interrupting others, acting without the consideration of consequences; Behaviors associated with ADHD must be present prior to age 12 and must be present in more than one setting to be diagnosed as ADHD.

Answer 83

attention deficit hyperactivity disorder

Question 84

Onset of deficits and impairments occurs during the developmental period of infancy or childhood; Client has intellectual deficits with mental abilities such as reasoning, abstract thinking, academic learning, and learning from prior experiences; Clients demonstrate impaired ability to maintain personal independence and social responsibility, including activities of daily living, social participation, and the need for ongoing support at school

Answer 84

intellectual development disorder

Question 85

Demonstrate a persistent pattern of behavior that violates the rights of others or rules and norms of society; Categories of conduct disorder include the following: aggression to people and animals, destruction of property, deceitfulness or theft, serious violations of rules

Answer 85

conduct disorder (child adolescent onset)

Question 86

Characterized by a recurrent pattern of the following antisocial behaviors: negativity, disobedience, hostility, defiant behaviors (especially toward authority figures), stubbornness, argumentativeness, limit testing, unwillingness to compromise, refusal to accept responsibility for misbehavior; Misbehavior usually demonstrated at home and directed toward the person best known; Child/adolescent does not see themselves as defiant; view their behavior as a response to unreasonable demands and/or circumstances; May exhibit low self-esteem, mood lability, and a low frustration threshold; May develop into conduct disorder

Answer 86

oppositional defiant disorder

Question 87

Exhibit recurrent episodic violent and aggressive behavior with the possibility of hurting people, property or animals; Characterized by aggressive overreaction to normal events followed by feelings of shame and regret; Prevents the client’s ability to have healthy relationships and/or employment; Can lead to the development of chronic disease(hypertension or diabetes mellitus)

Answer 87

intermittent explosive disorder

Question 88

Exhibit recurrent temper outbursts that are severe and do not correlate with situation; Manifested verbally and/or physically and can include aggression; Not appropriate for the client’s developmental level; Temper outbursts are present three or more times/week and are observable by others, such as parents, peers, and teachers, in at least two settings, such as home and school; Mood between the temper outbursts is angry and irritable

Answer 88

disruptive mood dysregulation disorder

Question 89

Ability to model effective coping strategies and use problem-solving skills, Ability to adapt to changes in the environment, Ability to form nurturing relationships, and Ability to distance oneself from the emotional chaos of the parent or family are examples of what type of defense mechanism

Answer 89

Resiliency is considered a protective factor for the development of mental health issues in children and adolescents.

Question 90

A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding?

Answer 90

hypokalemia and slightly elevated body weight,

Question 91

Characterized by recurrently eating large quantities of food over a short period of time without the use of compensatory behaviors

Answer 91

binge-eating disorder

Question 92

A life-threatening eating disorder characterized by the client’s restriction of nutritional intakes necessary to maintain a minimally normal body weight, intense fear of gaining weight or becoming fat, significantly disturbed perception of the shape or size of the body, and steadfast inability or refusal to acknowledge the seriousness of the problem or even that one exists

Answer 92

anorexia nervosa

Question 93

Characterized by recurrent episodes of binge eating followed by inappropriate compensatory behaviors to avoid weight gain, such as purging, fasting, or excessively exercising

Answer 93

bulimia nervosa

Question 94

developmental risk factors of bulimia nervosa

Answer 94

Self-perception of being overweight, fat, unattractive and undesirable

Question 95

family risk factors of bulimia nervosa

Answer 95

Chaotic family with loose-boundaries; parental maltreatment including possible physical or sexual abuse

Question 96

sociocultural risk factors of bulimia nervosa

Answer 96

Cultural ideal of being thin; media focus on beauty, thinness, fitness; weight-related teasing

Question 97

biologic risk factors of bulimia nervosa

Answer 97

Obesity; early dieting, possible serotonin and norepinephrine disturbances

Question 98

sociocultural risk factors for anorexia nervosa

Answer 98

Cultural ideal of being thin; media focus on beauty, thinness, fitness

Question 99

biological risk factors for anorexia nervosa

Answer 99

Obesity; dieting at an early age

Question 100

family risk factors for anorexia nervosa

Answer 100

Lacks emotional support; cannot deal with conflict

Question 101

developmental risk factors for anorexia nervosa

Answer 101

Issues of developing autonomy and having control over self and environment; developing a unique identity

Question 102

A nurse is performing an admission assessment of a client who has anorexia nervosa. Which of the following is an expected finding?

Answer 102

amenorrhea, anemia, presence of lanugo on the face