Practice Quizlets Flashcards
1
Q
Chuck is a 20-year-old student diagnosed of having obsessive-compulsive behavior. A psychiatrist prescribes clomipramine (Anafranil) to treat his condition. Nurse Nicolette understands the rationale for this treatment is that the clomipramine.
A
Increases seratonin levels
2
Q
Treatment for GAD involves Cognitive restructuring. This involves :
A
All of the above.
3
Q
What does GAD stand for?
A
Generalized anxiety disorder.
4
Q
A client is prescribed Alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?
A
History of alcohol dependence
5
Q
A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should a campus nurse expect this client to exhibit?
A
Fatigue, insomnia, irritability
6
Q
ADAM is
A
the acronym for the Anxiety Disorders Association of Manitoba
7
Q
The psychiatric nurse uses cognitive-behavioral techniques when working with a client who experiences panic attacks. Which of the following techniques are common to this theoretical framework?
A
(2,3,4,6)
Encouraging the client to restructure thoughts
Helping the client to use controlled relaxation breathing
Helping the client examine evidence of stress
Teaching the client about anxiety and panic
8
Q
An anxiety disorder is:
A
An excessive or aroused state characterized by feelings of apprehension, uncertainty and fear.
9
Q
The most common, and perhaps the most successful, treatment for OCD is exposure and ritual prevention. One such treatment is imaginal exposure. For example, for someone with compulsive washing, this involves:
A
Imagining negative consequences that will result from not washing.
10
Q
A client who is pacing and wringing his hands states,”I just need to walk when questioned by the nurse about what he is feeling. “Which response by the nurse is most therapeutic?”
A
“Is something bothering you?”
11
Q
A nurse is assessing a client for recent stressful life events. She recognizes that stressful life events are both
A
positive and negative
12
Q
Marty is pacing and complains of racing thoughts. Nurse Lally asks the client if something upsetting happened, and Marty’s response is vague and not focused on the question. Nurse Lally assess Marty’s level of anxiety as:
A
Severe
13
Q
A client with a history of generalized anxiety disorder enters the emergency department complaining of restlessness, irritability, and exhaustion. Vital signs are blood pressure 140/90 mm Hg, pulse 96, and respirations 20. Based on this assessed information, which assumption would be correct?
A
A physical examination is needed to determine the etiology of the client’s problem
14
Q
A client diagnosed with generalized anxiety disorder complains of feeling out of control and states, “I just can’t do this anymore.” Which nursing action takes priority at this time?
A
Ask the client, “Are you thinking about harming yourself?”
15
Q
A patient diagnosed with obsessive-compulsive disorder (OCD) continually carries a toothbrush, and will brush and floss up to fifty times each day. The healthcare provider understands that the patient’s behavior is an attempt to accomplish which of the following?
A
Relieve anxiety
16
Q
Behavioural therapy for phobias may involve the following techniques:
A
Systematic desensitization.
17
Q
Mr. Johnson is newly admitted to a psychiatric unit because of severe obsessive compulsive behavior. Which initial response by the nurse would be most therapeutic for him?
A
Accepting the client’s ritualistic behaviors
18
Q
Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply.
A
1, 2, 5
Excessive worry about items difficult to control.
Muscle tension.
Feeling “keyed up” or “on edge.”
19
Q
Obsessive compulsive disorder (OCD) can be successfully treated using:
A
Cognitive behavioural therapy.
Antidepressant medication.
20
Q
The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship?
A
Providing the client with opportunities to socialize.
21
Q
An action that is acceptable in a social relationship but not in a therapeutic relationship is
A
giving advice
22
Q
According to Rogers, a synonym for genuineness is
A
congruence
23
Q
The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the
A
termination phase.
24
Q
When a nurse is biased against a client, those feelings will likely make it difficult to
A
view the client with positive regard.
25
To help a client develop his or her resources, the nurse must first be aware of
the client's strengths
26
One of the possible sources of boundary violations is placing the focus on
meeting the nurse's needs.
27
In the process of trying new values, which step shows the highest commitment to the value?
Consistently acting in ways that repeatedly affirm the value
28
When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n)
therapeutic encounter.
29
During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established?
Orientation
30
The primary difference between a social and a therapeutic relationship is the
type of responsibility involved.
31
A client states "That nurse nevers seems comfortable being with me." The nurse can be described as
not seeming genuine to the client.
32
The pre-orientation phase of the nurse-client relationship is characterized by the nurse's focus on
self-analysis of strengths, limitations, and feelings.
33
The orientation phase of the nurse-client relationship focuses on
the nurse and client identifying client needs.
34
Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of
transference
35
The outcome of the nurse's expressions of sympathy instead of empathy toward the client often leads to
decreased client communication.
36
The use of empathy and support begins in the stage of the nurse-client relationship termed the
orientation stage.
37
A client reports that her mother-in-law is very intrusive. The nurse responds, "I know how you feel. My mother-in-law is nosy, too." The nurse is demonstrating
countertransference
38
A client tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the client may be experiencing
positive transference.
39
The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for
boundary blurring.
40
Your patient, Emma, is crying in your one-to-one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy?
Emma, that must have been such a hard situation to deal with."
41
You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse-patient relationship the issue of termination should first be discussed?
Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."
42
Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference?
My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to go 'cold turkey' and to get away from her dysfunctional family and to do it now
43
Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship?
You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living
44
Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship? (select all that apply):
-In a social relationship, both parties' needs are met; in a therapeutic relationship only the patient's needs are to be considered.
-Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic.
- In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a friend may lend the other money, etc.); in a therapeutic relationship solutions are discussed but are only implemented by the patient.
45
A woman brings her husband to the clinic for an examination. She is particularly worried because after a recent fall, he seems to have lost a great deal of his memory of recent events. Which statement reflects the nurses best course of action?
Perform a complete mental status examination
46
The nurse is conducting a patient interview. Which statement made by the patient should the nurse more fully explore during the interview?
I never did too good in school.
47
The nurse is preparing to conduct a mental status examination. Which statement is true regarding the mental status examination?
Gathering mental status information during the health history - check consciousness
48
During an examination, the nurse can assess mental status by which test first?
conciousness
49
The nurse is assessing the mental status of a child. Which statement about children and mental status is true?
All aspects of mental status in children are interdependent.
50
The nurse is assessing a 75-year-old man. As the nurse begins the mental status portion of the assessment, the nurse expects that this patient:
May take a little longer to respond, but his general knowledge and abilities should not have declined.
51
When assessing aging adults, the nurse knows that one of the first things that should be assessed before making judgments about their mental status is:
Sensory-perceptive abilities
52
A patient is admitted to the unit after an automobile accident. The nurse begins the mental status examination and finds that the patient has dysarthric speech and is lethargic. The nurses best approach regarding this examination is to:
Plan to defer the rest of the mental status examination.
53
A 19-year-old woman comes to the clinic at the insistence of her brother. She is wearing black combat boots and a black lace nightgown over the top of her other clothes. Her hair is dyed pink with black streaks throughout. She has several pierced holes in her nares and ears and is wearing an earring through her eyebrow and heavy black makeup. The nurse concludes that:
More information should be gathered to decide whether her dress is appropriate.
54
A patient has been in the intensive care unit for 10 days. He has just been moved to the medical-surgical unit, and the admitting nurse is planning to perform a mental status examination. During the tests of cognitive function, the nurse would expect that he:
Will be oriented to place and person, but the patient may not be certain of the date.
55
Which interaction is an example of dialogue that would be used in the context of behavioral therapy?
C: I can't stop pulling out my eyelashes when I'm stressed.
N: When you get this urge try locking your arms to make eyelash pulling impossible
56
In the context of cognitive therapy, anxiety is described as being the result of exaggerated .... thinking
Automatic
57
A client with a history of GAD presents with restlessness, irritability, BP of 140/90, P. 96, RR 20. What assumption is correct?
A physical examination is needed to determine etiology of client's symptoms
58
A client newly admitted to an inpatient psychiatric unit is diagnosed with OCD. Which correctly stated nursing diagnosis takes priority?
Anxiety r/t regression of ego development AEB ritualistic behaviors
59
A client diagnosed with GAD has a nursing dx of panic disorder r/t altered perception. Which short term outcome is most appropriate?
The client will be able to intervene before reaching panic levels of anxiety by discharge.
60
A nursing instructor is teaching about anxiety issues in the elderly. What student statement indicates learning has occurred?
In the elderly anxiety and depression symptoms often accompany each other
61
Which of the folowing is an example of normal anxiety?
- A mother experiences dread when she dixcovers evidence her teenage daughter has missed 2 menstrual cycles
- To help decrease her fear, an elderly woman attends daily mass and prays rosary for her grandson who is on active duty in the army
62
Recurrent and persistent thoughts, impulses, or images experienced as intrusive and stressful can be reffered to as
Obsession
63
An 82 yo client is prescribed lorazepam for sleep disturbances. Which of the following reasons would cause the nurse to question the physician's order?
b. The age of the client could indicate a decrease in hepatic and renal function
c. Metabolic changes in elderly may affect appropriate drug absorption
e. Elimination issues may cause drug accumulation
64
A nursing instructor is grading a matching test r/t various types of therapy used for anxiety disorders. Which fact has the student correctly matched with the appropriate therapy?
Client may participate in real-life situations that the or she finds extremely frightening for a prolonged period of time is implosion therapy
65
Which medication would be a first line consideration in treatment of anxiety for a client actively abusing alcohol?
Buspirone
66
A client who is being treated for an anxiety disorder with clonazepam complains that the medicaiton seems ineffective. To correctly assess the client which question should the nurse ask?
- Are you a smoker?
- How much coffee do you drink?
67
A nurse is planning to teach a client dx with agoraphobia about this disorder. Which fact should the nurse include?
The origin of agoraphobia is the true fear of being separated from a source of security
68
A psychiatrist ordered HRT for a client dx with trichotillomania. After several weeks of treatment what behaviors should the nurse expect?
A. The client is attempting to extinguish the unwanted behavior
c. The client can identify times of hair pulling
d. the client has substituted a more adaptive coping strategy
69
A client refuses to accept a promotion because his job would require crossing a high bridge daily. How should a nurse explain to the client's wife the root of this fear from a learning theory perspectice?
His mother's extreme fear of heights contributed ot his current fear.
70
An instructor is teaching about phobias and the different treatments used to decrease fear driven anxiety. Which of the following student statments about implosion therapy indicates learnign has occured?
a. A client must imagine/participate in extremely frightening situations for a prolonged period of time
d. The client continues implosion therapy until the stimulus no longer elicits anxiety
71
A client dx with OCD has an obsession iwth dirt and germs and has a continual compulsion to spray all surfaces wiht a disinfectant. How would the nurse explain the client's actions?
The compulsion to spray disinfectant relieves client's anxiety
72
Which behavior is most characteristic of agoraphobia?
remaining at home due to fear of being unable to escape from a place
73
Which of the following is the most appropriate therapy for a client with agoraphobia?
facing fears in gradual step progression
74
With implosion therapy a client with phobic anxiety would be
presented with massive exposure to a variety of stimuli associated with phobic object
75
A client wiht OCD spends many hours each day washing her hands. What is the most likely reason for this?
to relieve anxiety
76
The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions?
structure clients schedule so she has plenty of time to wash her hands
77
Which of the following actions best represents the basis or foundation of all other psychiatric nursing care?
The nurse spends time sitting with a withdrawn patient.
78
A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behaviour?
The student points out to the patient that he is making social inquiries and explores this behaviour.
79
Mary, a patient in the psychiatric unit, had a very rejecting and abusive father and a difficult childhood, but from age 10 on was raised by a very warm and supportive grandmother who recently passed away. Mary frequently comments on how hard her nurse, Jessa, works and on how other staff do not seem to care as much about their patients as Jessa does. Jessa finds herself agreeing with Mary and appreciating her insightfulness, recalling to herself that except for her former head nurse, other staff do not seem to appreciate how hard she works and seem to take her for granted. Jessa enjoys the time she spends with Mary and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jessa would most benefit her and the patient?
Jessa is experiencing counter-transference in response to Mary's meeting Jessa's needs for greater appreciation; Jessa should seek clinical supervision to explore these dynamics.
80
Which of the following statements would be appropriate during the orientation phase of the nurse-patient relationship? Select all that apply.
a. "My name is Sarah, and I am a student nurse here to learn about mental health."
b. "I will be here each Thursday from 8 a.m. until noon if you would like to talk."
e. "We will meet weekly for 1 hour, during which we will discuss how to meet your goals."
f. "Being home alone while your wife was hospitalized must have been very difficult for you."
81
A student nurse exhibits the following behaviours or actions while interacting with her patient. Which of these is appropriate as part of a therapeutic relationship?
Sitting attentively in silence with a withdrawn patient until the patient chooses to speak.
82
Which of the following is an example of an action that is acceptable in a social relationship but not in a therapeutic relationship?
a. Giving advice
83
When a nurse's bias delays the development of a therapeutic relationship, what therapeutic relationship attribute will be most affected?
View the patient with positive regard
84
To help a patient develop personal resources, the nurse must first be aware of which of the following?
The patient's strengths
85
What is the event referred to when a nurse and patient meet and genuine concern is expressed which improves the relationship?
As a therapeutic encounter
86
The nurse would address which of the following goals in attempting to establish a therapeutic nurse–patient relationship? (Select all that apply.)
a. Assisting the patient in identifying self-defeating behaviours
b. Encouraging the patient to make decisions when appropriate
d. Facilitating the patient’s communication of disturbing feelings or thoughts
87
Which of the following is the primary difference between a social and a therapeutic relationship?
Type of responsibility involved
88
Patient reactions of intense hostility or feelings of strong affection toward the nurse are common forms of which of the following?
Transference
89
The outcome of the nurse's expressions of sympathy instead of empathy toward the patient often leads to which of the following?
Decreased patient communication
90
The use of empathy and support begins in which of the following stages of the nurse-patient relationship?
Orientation stage
91
A patient tells the nurse "I really feel close to you. You are like the friend I never had." The nurse can assess this statement as indicating the patient may be experiencing which of the following?
Positive transference
92
The nurse is finding it difficult to provide structure and set limits for a patient. The nurse should self-evaluate for which of the following?
Boundary blurring
93
Randy has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses best reflects the working phase of the nurse-patient relationship?
You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."
94
how widespread is mental health?
- affects many Canadians both directly and indirectly
- about 1 in 3 Canadians
95
Mental health is the mot significant to one’s
Emotional wellbeing and QOL
96
What is the earliest form of institutional care?
- Bethlehem in 1400s
- oldest hospital for treating the mentally ill
97
What did philippe phil in France do for mental health care
- made efforts to stop abuse
- more humane approach called moral therapy/treatment
98
Who is Dorothea dix
Social reformer who visited prisons and saw mix of people including ppl with mental illness which led to idea of mental asylums
99
When was the asylum era
19th and early 20th century
100
What are the 3 treatments done in asylums
Hydrotherapy
Insulin shock
Lobotomy
101
When were antipsychotic meds introduced
1950’s
102
Two examples of antipsychotics
Chlorpromazine
Haldol
103
What does the mental health act do for pt’s rights
sets the admission and treatment requirements for patients in psych facilities
104
describe the contributions of psychoanalysis to mental health care
- made the connection of trauma & dissociation
- considered how does developmental childhood contribute to mental illness
105
describe the contributions of humanistic therapies to mental health care
- includes Maslow's hierarchy of needs
- see potential/positive in people's human behaviors
- see positive potential in human beings
106
describe the contributions of behavioral therapy to mental health care
- involved rewarding good behavior
- and negative consequences for bad behavior
107
describe the contribution of cognitive theories to mental health care
considered the relationship between negative thoughts and behaviors
108
Who was hildegard peplau
- grandmother of psych nursing
- nursing theory in Interpersonal Relations for Nursing
- described the phases of the therapeutic nurse-client relationship
- took students to talk to pts
109
When was the era of deinstitutionalization
Community care shifted in 1970’s
110
describe the impact of stigma on individuals w mental illness
often the stigma of mental illness has a greater negative impact on an individual than the illness itself
111
what is critical w mental health
adaptability
112
what is used by professionals for diagnosis of mental disorders
DSM-V
113
define mental health “problem”
diminished capacities, whether cognitive, emotional, interpersonal, etc. that interfere w person's enjoyment of life
114
define mental illness
- all diagnosable mental disorders
- health conditions characterized by major/significant alterations in thinking, mood, behavior
115
define serious mental illness
- encompass illnesses w potential to be more incapacitating
116
Who is senator Kirby?
- highlighted fragmented care
-(difficulties in access between urban and rural area)
117
What does MHCC do
Provide grants and research
118
What is the current philosophy shift in mental health care?
- Biomedical model
- Recovery ortiented practice
119
3 themes of recovery-focused practice?
- hope
- person-centered care
- consider "service users' opinions on the experience of care"
120
what is a tool used to support/facilitate recovery
recovery plans (WRAP - Wellness Recovery Action Plan)
121
what are 5 components of a therapeutic relationship
- respect
- empathy
- trust
- power
- professional intimacy
122
what are the 3 phases of a therapeutic relationship
- orientation phase
- working phase
- resolution phase
123
describe the orientation phase of a therpeutic relationship (5)
- first meeting
- involves getting to know the pt
- ensure confidentiality
- set boundaries
- establish trust
124
describe the working phase of a therapeutic relationship (3)
- involves identifying & working on problems
- outcomes & interventions planned
- goals developed
125
describe the resolution phase of a therapeutic relationship (2)
- allows the client to depend on his or her own strengths --> become independent
- relationship ends
126
what are some examples of validating statements
- "you're feelin rlly sad rn"
- "it makes sense that you're angry"
- "being afraid in these situations is not uncommon"
- i can hear how much distress this incident has caused you"
127
what are positive symptoms of psychosis?
symptoms that add to or distort the peron's normal functioning
(delusions, hallucinations, disorganized speech, thoughts, or behaviors)
128
what are negative symptoms of psychosis
symptoms that involve normal functioning becoming lost or reduced
(restricted emotion, facial expression, speech and verbal fluency, difficulty w generating ideas or thoughts)
129
what are causes and risk factors of psychosis
- genetic factors
- stressful events
- substance use
- imbalance in brain chemicals
- mental and physical disorders
130
what is trauma
a traumatic event involves a single experience or enduring repeated or multiple experiences, that completely overwhelm the individual's ability to cope or integrate the ideas & emotions involved in the experience
- it is not the event that determines whether something is traumatic, but the individuals experience and meaning they make of it
131
what is trauma informed care
- a program, organization, or system that is traum-informed realizes the widespread impact of trauma & understands potential paths for recovery
- recognizes the signs and symptoms of trauma in pts, families, staff, and others involved w the system
- responds by fully integrating knowledge about trauma into policies, procedures, and practices & seeks to actively resist re-traumatization
132
The nurse would NOT address which of the following goals in attempting to establish a therapeutic nurse-client relationship?
Providing the client with opportunities to socialize.
133
In the process of trying new values, which step shows the highest commitment to the value?
Consistently acting in ways that repeatedly affirm the value
134
When a nurse and client meet informally or have an otherwise limited but helpful relationship, the relationship is referred to as a(n)
therapeutic encounter.
135
The outcome of the nurse's expressions of sympathy instead of empathy toward the patient often leads to which of the following?
Decreased patient communication
136
Patient reactions of intense hostility or
feelings of strong affection toward the
nurse are common forms of which of the
following?
Resistance
137
What is the most helpful nursing response to a patient who reports thinking of dropping out of college because it is too stressful?
School is stressful. What do you find most stressful?
138
A nurse is caring for a patient admitted to the emergency department after a sexual assault. Which is important for the nurse to remember when caring for this patient?
The patient has experienced an adventitious crisis.
Sexual assault is an example of an adventitious crisis.
139
Which is an example of a situational crisis?
A young woman loses her home as the result of a divorce.
Situational crises involve life events such as divorce, death of a loved one, and loss of a job.
140
The nurse is caring for a hospitalized patient who is a survivor of an office fire. The patient has been physically stabilized but is experiencing symptoms of anxiety. Which would be the best intervention for this patient?
Assessing the patient's safety systems
141
A nurse is planning care for a group of survivors of a terrorist attack. Which activity would best aid in the recovery process?
Teach stress management techniques.
142
Which question should the nurse ask to assess situational supports for a patient experiencing a crisis event?
"Are there family members available to help you at this time?"
143
A patient in crisis is tearful and disorganized. What is the priority nursing intervention for this patient?
Determine the anxiety level of the patient.
144
Which goals should the nurse prioritize when planning for this patient?
The patient will remain safe from harm.
Patient safety is a priority nursing goal for a patient with suicidal thoughts.
145
A patient is faced with an unexpected event and has begun to experience severe anxiety with disorganization and suicidal ideation. The nurse understands the patient is in which crisis phase?
Phase 4
146
A nurse is caring for a patient experiencing a situational crisis. What is the priority nursing intervention?
Conduct an assessment of suicidal ideation.
147
The nurse is assessing a patient who was a victim of an earthquake. Which assessment finding requires immediate intervention by the nurse?
Conduct an assessment of suicidal ideation.
148
The patient is experiencing symptoms of panic-level anxiety.
The priorities of secondary care are maintaining patient safety and assessing the patient's coping styles.
The patient is experiencing symptoms of panic-level anxiety.
149
A nurse who is part of a mobile disaster unit is assisting in the care of a community after an earthquake and is assigned the duty of triage. Which describes a duty of a triage nurse?
Directs affected patients to appropriate areas of care
