Practice Quizlets Flashcards
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.
Increases seratonin levels
Treatment for GAD involves Cognitive restructuring. This involves :
All of the above.
What does GAD stand for?
Generalized anxiety disorder.
A client is prescribed Alprazolam (Xanax) for acute anxiety. What client history should cause a nurse to question this order?
History of alcohol dependence
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?
Fatigue, insomnia, irritability
ADAM is
the acronym for the Anxiety Disorders Association of Manitoba
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?
(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
An anxiety disorder is:
An excessive or aroused state characterized by feelings of apprehension, uncertainty and fear.
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:
Imagining negative consequences that will result from not washing.
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?”
“Is something bothering you?”
A nurse is assessing a client for recent stressful life events. She recognizes that stressful life events are both
positive and negative
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:
Severe
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 physical examination is needed to determine the etiology of the client’s problem
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?
Ask the client, “Are you thinking about harming yourself?”
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?
Relieve anxiety
Behavioural therapy for phobias may involve the following techniques:
Systematic desensitization.
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?
Accepting the client’s ritualistic behaviors
Which of the following symptom assessments would validate the diagnosis of generalized anxiety disorder? Select all that apply.
1, 2, 5
Excessive worry about items difficult to control.
Muscle tension.
Feeling “keyed up” or “on edge.”
Obsessive compulsive disorder (OCD) can be successfully treated using:
Cognitive behavioural therapy.
Antidepressant medication.
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.
An action that is acceptable in a social relationship but not in a therapeutic relationship is
giving advice
According to Rogers, a synonym for genuineness is
congruence
The phase of the nurse-client relationship that may cause anxieties to reappear and past losses to be reviewed is the
termination phase.
When a nurse is biased against a client, those feelings will likely make it difficult to
view the client with positive regard.
To help a client develop his or her resources, the nurse must first be aware of
the client’s strengths
One of the possible sources of boundary violations is placing the focus on
meeting the nurse’s needs.
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
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.
During what stage of the therapeutic nurse-client relationship is a formal or informal contract between the nurse and client established?
Orientation
The primary difference between a social and a therapeutic relationship is the
type of responsibility involved.
A client states “That nurse nevers seems comfortable being with me.” The nurse can be described as
not seeming genuine to the client.
The pre-orientation phase of the nurse-client relationship is characterized by the nurse’s focus on
self-analysis of strengths, limitations, and feelings.
The orientation phase of the nurse-client relationship focuses on
the nurse and client identifying client needs.
Client reactions of intense hostility or feelings of strong affection toward the nurse are common forms of
transference
The outcome of the nurse’s expressions of sympathy instead of empathy toward the client often leads to
decreased client communication.
The use of empathy and support begins in the stage of the nurse-client relationship termed the
orientation stage.
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
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.
The nurse is finding it difficult to provide structure and set limits for a client. The nurse should self-evaluate for
boundary blurring.
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.”
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.”
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
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
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.
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
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.
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
During an examination, the nurse can assess mental status by which test first?
conciousness
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.
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.
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
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.
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.
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.
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
In the context of cognitive therapy, anxiety is described as being the result of exaggerated …. thinking
Automatic
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
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
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.
