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339 Cards in this Set
- Front
- Back
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What is a somatic symptom disorder?
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client has physical symptoms suggesting medical disease without demonstrable organic pathology or pathophysiological mechanism
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What are the types of somatic symptom disorders?
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* Somatic Symptoms Disorder
* Illness Anxiety Disorder * Conversion Disorder |
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Describe somatic symptoms disorder
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* History of many physical complaints beginning before 30 years of age
* occurs over several years * result in treatment being sought or significant impairment in social, occupational, or other important areas of functioning * high stress in life * more common in lower socioeconomic or rural areas |
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Describe illness anxiety disorder
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* A preoccupation with the fear of contracting, or the belief of having, a serious disease.
* The fear becomes disabling and persists despite reassurance that no organic pathology can be detected. * Not a conscious belief. Often have had or Family member died from a medical condition |
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Describe conversion disorder
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A loss of or change in body function resulting from a psychological conflict, the physical symptoms of which cannot be explained by any known medical disorder or pathophysiological mechanism. They tend to not be disturbed by the condition.
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What are some examples of conversion disorder?
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* Blindness
* Paralysis * Aphonia (can't talk) * Anosmia (can't smell) * Pseudocyesis (false pregnancy) |
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What is the etiology of somatic symptom disorders?
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* Genetics may play a role
* Decreased levels of serotonin and endorphins may also play a role (particularly the pain disorder) |
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What are the three kinds of gains associated with a somatic symptom disorder?
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* Primary gain – Does not have to deal with current responsibilities
* Secondary gain – Attention * Tertiary gain – the family does not have to deal with communication issues, they focus on the patient |
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A client is experiencing pain that has no organic etiology. This pain allows the client to avoid going to work at a job he hates. What best describes what this client is experiencing?
A. The client is experiencing altered social interaction. B. The client is experiencing disturbed thought processes. C. The client is experiencing primary gain. D. The client is experiencing secondary gain. |
C. Primary gain – not going to work |
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A client, experiencing lower extremity paralysis, is admitted to a medical unit. Extensive tests confirm disability but rule out any underlying organic pathology. The nurse concludes that this is most suggestive of which disorder?
A. Conversion disorder B. Illness anxiety disorder C. Malingering – factitious disorder (faking it) D. Somatic symptom disorder |
A. Conversion disorder. No use of his legs with no organic pathology
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What are the types of dissociative disorders?
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* Dissociative Amnesia
* Dissociative Identity Disorder * Depersonalization / DerealizationDisorder |
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What is dissociative amnesia?
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There is no physical trauma, but is often associated with a traumatic event. Cannot recall important personal data. No medical condition or substance use. Three kinds:
* Localized – cannot remember around, say a car accident. Temporary * selective – may be missing part of an event * generalized – complete, have no idea who they are |
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According to psychodynamic theory, which primary defense mechanism would the nurse expect to find in a client with dissociative amnesia?
A.Suppression B.Sublimation C.Displacement D.Repression |
D. repression – unconscious
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What is dissociative fugue?
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Symptoms of dissociative fugue might include the following: Sudden and unplanned travel away from home. Inability to recall past events or important information from the person's life. Confusion or loss of memory about his or her identity, possibly assuming a new identity to make up for the loss.
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Describe dissociative identity disorder
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* Characterized by existence of two or more personalities within a single individual (multiple personality disorder)
* Transition from one personality to another usually sudden, often dramatic, and usually precipitated by stress * Often created to cope with major trauma as a child |
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Describe depersonalization disorder
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Characterized by persistent feelings of
* Unreality – don’t feel like themselves (outside themselves) * Detachment from oneself or one’s body * Observing oneself from outside the body |
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What nursing diagnoses could be used for somatic symptom disorder?
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* Ineffective coping
* Deficient knowledge * Chronic pain |
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What nursing diagnosis could be used for illness anxiety disorder?
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* Fear (of serious disease)
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What nursing diagnoses could be used for conversion disorder?
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* Disturbed sensory perception
* Self–care deficit |
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Describe factitious disorder
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Making up medical conditions for attention (used to be Munchausen's syndrome). Done to someone else, is Factitious disorder by proxy (was Munchausen's by proxy)
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What nursing diagnosis would be used for factitious disorder?
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Ineffective coping
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What would the outcomes be for the nursing care of a patient with somatic symptom disorder?
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* Copes effectively without resorting to physical symptoms
* Verbalizes relief from pain * Has decreased frequency of physical complaints and interprets bodily sensations rationally * Is free of physical disability |
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What is the nursing process (planning and implementation) for a patient with a somatic symptom disorder?
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* aimed at relief of discomfort from the physical symptom
* Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than preoccupation with physical symptoms (exercise, calming music, relaxation, etc) |
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When working with a client diagnosed with a somatic symptom disorder, which is the most appropriate nursing action?
A.Avoid discussing social and personal problems. B.Focus on the physical symptoms. C.Always meet the client’s dependency needs. D.Gradually minimize time focusing on physical symptoms. |
D. Gradually minimize time focusing on symptoms
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What nursing diagnoses could be used for dissociative amnesia?
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* Disturbed thought processes
* Powerlessness |
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What nursing diagnoses could be used for depersonalization disorder?
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* Ineffective coping
* Disturbed sensory perception |
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What nursing diagnoses could be used or Dissociative Identity disorder?
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* Risk for suicide
* Disturbed personal identity |
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What is the nursing care of a patient with dissociative disorder?
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* aimed at restoring normal thought process
* Assistance is provided to the client in an effort to determine strategies for coping with stress by means other than dissociation from the environment |
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What are the outcomes planned for a patient with a dissociative disorder?
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* Can recall events associated with stressful situation
* Can recall all events of past life * Can verbalize anxiety that precipitated the dissociation * Can demonstrate coping methods to avert dissociative behaviors * Verbalizes existence of multiple personalities * Is able to maintain a sense of reality during stressful situations |
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What are the medical treatment modalities for somatic symptoms disorders? |
* Individual psychotherapy * Group psychotherapy * Behavior therapy * EMDR * Psychopharmacology (antidepressants or anxiolytics)
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What are the medical treatment modalities for dissociative disorders?
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* Individual psychotherapy
* Hypnosis * Integration therapy (DID) * Cognitive Therapy * Group/Family Therapy * Psychopharmacology |
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What is abreaction?
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Bringing someone with a dissociative disorder through repressed trauma again. They often feel as though they are being traumatized again. Often done through hypnosis.
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What is integration?
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Uniting the personalities of a patient with dissociative identity disorder into the whole being again.
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What are the different types of personality disorders?
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* Paranoid personality disorder
* Schizoid Personality disorder * Schizotypal Personality disorder * Antisocial Personality disorder * Borderline Personality disorder * Histrionic Personality disorder * Narcissistic Personality disorder * Avoidant Personality disorder * Dependent Personality disorder * Obsessive – Compulsive personality disorder |
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Describe paranoid personality disorder
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* Pervasive, persistent, and inappropriate mistrust of others.
* Assume others are out to hurt or exploit them. * More common in men. * Insensitive to others * does not accept own responsibility for behavior * attributes shortcomings to others |
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Describe schizoid personality disorder
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* cannot form personal relationships
* more in men * emotionally cold and aloof * possible hereditary factor * childhood was bleak, cold and lacked nurturing |
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Describe schizotypal personality disorder
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* A worse form of schizoid personality disorder
* Patient is aloof and isolated, apathetic, bland * they have magical thinking * they have ideas of reference * they have illusions * they have depersonalization * exhibit bizarre speech pattern * possible hereditary factors * possible physiological differences * childhood was indifferent and formal causing discomfort with personal affection |
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Describe antisocial personality disorder
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* Exploitative
* socially irresponsible * without remorse * disregard for the rights of others * doesn't maintain employment * fails to conform to the law * manipulates others for personal gain * fails to develop stable relationships * person to be afraid of |
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Describe borderline personality disorder
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* Characterized by a pattern of intense and chaotic relationships with affective instability
* Fluctuating and extreme attitudes regarding other people * Highly impulsive * Emotionally unstable * Directly and indirectly self–destructive * Lacks a clear sense of identity * very manipulative – will split the staff * more women than men |
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Describe histrionic personality disorder
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* Behavior is: Excitable Emotional Colorful Dramatic Extroverted (drama queen)
* attention seeking * strongly dependent * difficulty paying attention to detail * gregarious * seductive * possible hereditary factors * possible link to noradrenergic and serotonergic systems |
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Describe the narcissistic personality disorder
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* exaggerated sense of self–worth
* lacks empathy * believe they have the inalienable right to receive special consideration * overly self centered * Exploit others in an effort to fulfill their own desires * Mood, which is often grounded in grandiosity, is usually optimistic, relaxed, cheerful, and carefree * criticism from others may cause rage, shame or humiliation * as child, fears, failure or needs were met with disdain * Donald Trump to a "T" |
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Describe Avoidant Personality disorder
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* Socially withdrawn
* extreme sensitivity to rejection * equal among men and women * awkward in social situations * want close relationships but avoid them for fear of rejection * perceived as timid, cold, withdrawn, strange * lonely and feel unwanted * no clear cause * parental rejection, biological, genetic factors |
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When assessing a client diagnosed with narcissistic personality disorder, the nurse expects to identify which characteristic behavior?
A.Odd beliefs and magical thinking B.Grandiose sense of self importance C.Pattern of intense and chaotic relationships D.Submissive and clinging behaviors |
B. Grandiose sense of self importance
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Describe dependent personality disorder
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* relies on others for support
* common * more common in women (and youngest of siblings) * lack self confidence * easily hurt by criticism * avoids positions of responsibility * assume passive roles in relationships * Stimulation and nurturance are experienced exclusively from one source |
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Describe obsessive compulsive personality disorder
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* inflexible
* work over pleasure * common * more common in men (and oldest siblings) * socially polite and formal * rank – conscious (authority figures) * calm on the surface, but conflicted, hostile and ambivalent underneath * frequently punished and controlled by parents |
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A client diagnosed with a personality disorder is cold,aloof, and avoids others on the unit. The nurse recognizes that this behavioris symptomatic of which personality disorder?
A.Schizoid personality disorder B.Dependent personality disorder C.Borderline personality disorder D.Antisocial personality disorder |
A. Schizoid
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A client diagnosed with borderline personality disorder is admitted to a psychiatric unit. Which behavior pattern would the nurse expect to observe?
A.Social isolation B.Suspiciousness of others C.Bizarre speech patterns D.Generates conflict among the staff |
D. generates conflict among the staff
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In assessing a client diagnosed with borderline personality disorder, which characteristic would the nurse expect toobserve?
A.Predictability B.Controlled anger C.Little tolerance for being alone D.Stable and satisfactory relationships |
C. Little tolerance for being alone
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An individual, with a history of antisocial personality disorder, was arrested for driving under the influence of alcohol and causing a serious car accident. Which comment on this behavior would be expected?
A.“It's not my fault.” B.“I'm too ashamed to talk about it.” C.“I just don't remember doing it.” D.“I'm really sorry about all the people I've hurt.” |
A. Not my fault. Antisocials don't accept responsibility for their own behavior
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Which personality disorders are seen most often in the unit?
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Antisocial and borderline personalities.
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What are the nursing diagnoses that could be used for borderline personality disorder?
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1. Risk for self–mutilation
2. Risk for suicide 3. Risk for other–directed violence 4. Complicated grieving 5. Impaired social interaction 6. Disturbed Personality identity 7. Anxiety 8. Chronic low self esteem |
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What are the nursing diagnoses that could be used for antisocial personality disorder?
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1. Risk for self–directed violence
2. Defensive coping 3. Chronic Low self esteem 4. Ineffective Health Maintenance |
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What are some other names for antisocial personality disorder?
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* Sociopathic behavior
* Psychopathic behavior |
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When is antisocial personality disorder mainly seen in the clinical setting?
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* It is usually only seen in clinical settings when these individuals are admitted by court order for psychological evaluation.
* They are most frequently encountered in prisons, jails, and rehabilitation services. |
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What is the aim for nursing interventions for borderline personality disorder?
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* Protection of the client from self–harm
* assist the client to advance in the development of personality by confronting his or her true source of internalized anger |
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What is the aim for nursing interventions for antisocial personality disorder?
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* protecting others from the client’s aggression and hostility
* delay gratification by setting limits on unacceptable behavior |
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What is anorexia nervosa?
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A morbid fear of obesity with symptoms of
* gross distortion of body image * preoccupation with food * refusal to eat |
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What does 'emaciated' mean?
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Excessively thin
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How is weight loss accomplished with anorexia nervosa?
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* reduced food intake
* excessive exercise * vomiting * use of laxatives or diuretics |
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What symptoms occur when weight loss is excessive?
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* hypothermia
* bradycardia * hypotension * edema * lanugo * amenorrhea |
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What is bulimia nervosa?
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an episodic, uncontrolled, compulsive, rapid ingestion of large quantities of food over a short period of time (binging), followed by inappropriate compensatory behaviors to rid the body of the excess calories, possibly by vomiting, laxatives, enemas, excessive exercise, fasting among others. Typically occurs in late adolescence or early adulthood with estimates up to 4 percent of young women
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What is the BMI criteria for anorexia nervosa?
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* Mild: greater than or equal to a BMI of 17
* Moderate: 16 to 16.99 * Severe: 15 – 15.99 * Extreme: less than 15 |
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A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy?
A. Even if my anxiety improves, I will need to continue this therapy for 6 weeks. B. The therapist will focus on my past relationships during our sessions. C. Psychoanalysis will help me reduce my anxiety by changing my behavior. D. This therapy will address my conscious feelings about stressful experiences. |
B. Classical psychoanalysis places a common focus on past relationships to identify the cause of the anxiety disorder.
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A Nurse is discussing free association as a therapeutic tool with a client who has major depression disorder. Which of the following client statements indicates understanding of this technique?
A. I will write down my dreams as soon as I wake up. B. I may begin to associate my therapist with important people in my life. C. I can learn to express myself in a nonaggressive manner. D. I should say the first thing that comes to mind. |
D. Free Association is the spontaneous, uncensored verbalization of whatever comes to a client's mind.
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A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following are appropriate to include in the plan of care? Select all that apply.
A. Priority restructuring B. Monitoring thoughts C. Diaphragmatic breathing D. Journal keeping E. Meditation |
A, B & D
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A nurse is caring for a client who has a new prescription for disulfiram (Antabuse) for the treatment of his alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. This form of treatment is an example of which of the following?
A. Aversion therapy B. flooding C. Biofeedback D. Dialectical behavior therapy |
A. Aversion therapy pairs a maladaptive behavior with unpleasant stimuli to promote a change in behavior.
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A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following is appropriate when implementing this form of therapy?
A. Demonstrate riding in an elevator, and then ask the client to imitate the behavior. B. Advise the client to say "stop" out loud every time he begins to feel an anxiety response related to an elevator. C. Gradually expose the client to an elevator while practicing relaxation techniques. D. Stay with the client in an elevator until his anxiety response diminishes. |
C. Systematic desensitization is the planned, progressive exposure to anxiety–provoking stimuli. During this exposure, relaxation techniques suppress the anxiety response.
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A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates a need for further teaching?
A. I can promote my client's sense of control by establishing a schedule. B. Self–assessment will help me cope with emotional reactions to client care C. I should practice limit–setting to help prevent client manipulation. D. Maintaining professional boundaries is a priority of client care. |
A. Rather than establishing a schedule, the nurse should ask for the client's input and offer realistic choices to promote the client's sense of control.
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A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder?
A. I'm scared that you're going to leave me. B. I'll go to group therapy if you'll let me smoke. C. I need to feel that everyone admires me. D. I sometimes feel better if I cut myself |
A. Clients who have avoidant personality disorder often have a fear of abandonment. Therefore, this type of statement is expected.
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A charge nurse is preparing a staff education session on personality disorders. Which of the following should be included as personality characteristics associated with all of the personality disorders? Select all that apply.
A. Difficulty in getting along with other members of a group. B. Belief in the ability to become invisible during times of stress. C. Display of defense mechanisms when routines are changed. D. Claiming to be more important than other persons. E. Difficulty understanding why it is inappropriate to have a personal relationship with staff. |
A, C, E
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A nurse is caring for a client who has borderline personality disorder. The client says "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms?
A. Regression B. Splitting C. Undoing D. Identification |
B. Splitting occurs when a person is unable to see both positive and negative qualities at the same time. The client who has borderline personality disorder tends to see a person as all bad one time and all good another time.
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A nurse is assisting with a court–ordered evaluation of a client who has antisocial personality disorder. When assessing this client, which of the following are expected findings? Select all that apply.
A. Demonstrates extreme anxiety when placed in a social situation B. Has difficulty making even simple decisions C. Attempts to convince other clients to give him their belongings D. Becomes agitated if his personal area is not neat and orderly E. Blames others for his past and current problems |
C. Exploitation and manipulation of others
E. Failure to accept personal responsibility |
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A nurse is preparing to obtain a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions are appropriate for the nurse to include in the assessment? Select all that apply.
A. What is your relationship like with your family? B. Why do you want to lose weight? C. Would you describe your current eating habits? D. At what weight do you believe you will look better? E. Can you discuss your feelings about your appearance? |
A, C, E
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A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing?
A. Life isn't worth living if I gain weight. B. Don't pretend like you don't know how fat I am. C. If I could be skinny, I know I'd be popular D. When I look in the mirror, I see myself as obese. |
A. This statement reflects the cognitive distortion of catastrophizing because the client's perception of her appearance or situation is much worse than her current condition.
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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? Select all that apply.
A. Amenorrhea B. Hypokalemia C. Mottling of the skin D. Slightly elevated body weight E. Presence of lanugo on the face |
B. Hypokalemia is expected due to vomiting
D. This is a typical weight for a bulimic. The others are expected findings of anorexia nervosa. |
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A nurse is caring for a client who has bulimia nervosa and who has stopped purging behavior. The client tells the nurse that she is afraid she is going to gain weight. Which of the following is an appropriate response by the nurse?
A. Many clients are concerned about their weight. However, the dietitian will ensure that you don't get too many calories in your diet. B. Instead of worrying about your weight, try to focus on other problems at this time. C. I understand you have concerns about your weight, but first, let's talk about your recent accomplishments. D. You are not overweight, and the staff will ensure that you do not gain weight while you are in the hospital. We know that is important to you. |
C. This statement acknowledges the client's concern and then focuses the conversation on the client's accomplishments, which can promote client self–esteem and self–image.
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A nurse on an acute care unit is planning care for a client who has anorexia nervosa with binge–eating and purging behavior. Which of the following nursing actions is appropriate to include in the client's plan of care?
A. Allow the client to select preferred meal times. B. Establish consequences for purging behavior. C. Provide the client with a high–fat diet at the start of treatment. D. Implement one–to–one observation during meal times. |
D. The nurse should closely monitor the client during and after meals to prevent purging.
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What ages is typically affected by anorexia nervosa?
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occurs predominantly in girls and women ages 12 to 30 years
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What is obesity defined as?
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a body mass index of 30 or greater
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How many Americans are overweight?
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68.5% with 35% in the obese range
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Which is characteristic of the diagnosis of anorexia nervosa?
A.Obsession with weight gain B.Body image disturbance C.Disregard for the feelings of others D.Healthy family relationships |
B. Body Image Disturbance
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Describe a girl afflicted with bulimia.
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* Average weight range
* May have depression, anxiety or abuse substances * May have dehydration or electrolyte imbalances due to excessive vomiting or laxative or diuretic abuse. |
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Which assessment finding would the nurse expect in clients diagnosed with bulimia?
A.They are below normal weight. B.They binge when they experience hunger. C.They will be highly motivated to seek help. D.They are within their normal weight range. |
D. They are within normal weight range.
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What are obese people at higher risk for?
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• Hyperlipidemia
• Diabetes mellitus • Osteoarthritis • Angina • Respiratory insufficiency |
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What is Binge Eating Disorder?
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•The individual binges on large amounts of food, as in bulimia nervosa.
•BED differs from bulimia nervosa in that the individual does not engage in behaviors to rid the body of the excess calories. •Can lead to obesity |
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What are the nursing diagnoses for eating disorders?
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* Imbalanced nutrition:less than body requirements related to refusal to eat
* Deficient fluid volume (risk for or actual) related to decreased fluid intake, self–induced vomiting, and laxative and/or diuretic abuse * Ineffective denial related to delayed ego development and fear of losing the only aspect of life over which he or she perceives some control (eating) * Imbalanced nutrition:more than body requirements related to compulsive overeating * Disturbed body image/low self–esteem related to retarded ego development, dysfunctional family system, or feelings of dissatisfaction with body appearance * Anxiety (moderate to severe) related to feelings of helplessness and lack of control over life events |
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A client is 5’8’’ tall and weighs 105pounds. The client has been taking laxatives daily, and self–induces vomiting after eating. Which is the priority nursing diagnosis for this client?
A.Ineffective denial B.Disturbed body image C.Low self–esteem D.Imbalanced nutrition: less than body requirements |
D.Imbalanced nutrition: less than body requirements
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What is nursing care of the client with an eating disorder aimed at?
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* restoring nutritional balance.
* Emphasis is also placed on helping the client gain control over life situations in ways other than inappropriate eating behaviors. * Self–esteem and positive self–image are promoted in ways that relate to aspects other than appearance. |
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What psychopharmacology would be used for anorexia nervosa?
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* Fluoxetine (Prozac)
* Clomipramine (Anafranil) * Cyproheptadine (Periactin) * Chlorpromazine (Thorazine) * Olanzapine (Zyprexa) |
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What psychopharmacology would be used for bulimia nervosa?
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* Fluoxetine (Prozac)
* Imipramine (Tofranil) * Desipramine (Norpramine) * Amitriptyline (Elavil) * Nortriptyline (Aventyl) * Phenelzine (Nardil) |
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What psychopharmacology would be used for binge eating disorder?
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* Topiramate (Topamax)
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What psychopharmacology would be used for obesity?
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* Fluoxetine (Prozac)
* Various anorexiants (CNS stimulants) * Lorcaserin (Belviq) * Phentermine/topiramate (Qsymia) |
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How does behavior modification work with patients with anorexia or bulimia?
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For the program to be successful, the client must perceive that he or she is in control of the treatment.
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For treatment of anorexia. Successes have been observed when the client:
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* Is allowed to contract for privileges based on weight gain
* Has input into the care plan * Clearly sees what the treatment choices are |
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For treatment of anorexia. Success is expected when the client has control over:
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* Eating
* Amount of exercise pursued * Whether to induce vomiting |
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For treatment of anorexia. Success is expected when the client and staff agree about:
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* Goals
* System of rewards |
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What are the clusters for personality disorders and what do they mean?
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* Cluster A are odd, eccentric thinking, or behavior, personality disorders
* Cluster B are dramatic, overly emotional or unpredictable thinking, or behavior, personality disorders * Cluster C are anxious, fearful thinking, or behavior, personality disorders |
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What personality disorders are part of Cluster A?
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* Paranoid
* Schizoid * Schizotypal |
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What personality disorders are part of Cluster B?
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* Antisocial
* Borderline * Histrionic * Narcissistic |
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What personality disorders are part of Cluster C?
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* Avoidant
* Dependent * Obsessive–Compulsive |
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What is delirium?
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A disturbance in attntial and awareness and a change in cognition that develop rapidly over a short period.
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What are the symptoms of delirium?
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* difficulty sustaining attention
* extremely distractible * disorganized thinking * rambling speech * disoriented to time & place * impaired short term memory * disturbed wake/ sleep cycle |
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What are some causes of delirium?
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* Systemic infections
* febrile illness * metabolic disturbances * hepatic encephalopathy * head trauma * seizures * migraines * brain abscess * stroke * post op states * electrolyte imbalance * substance intoxication, withdrawal or meds |
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What is neurocognitive disorder?
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A disorder of cognitive function closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning and speaking. Classified as mild or major, depending on the severity of the symptoms.
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Are there reversible NCDs?
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Yes, they can be a result of
* cerebral lesions * depression * side effects of certain medications * normal pressure hydrocephalus * vitamin or nutritional deficiencies (B12, folate) * CNS infections or metabolic disorders |
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A family member wants to know the difference between Alzheimer's disease and delirium. Which explanation should the nurse provide to the family member?
1) Delirium is a reversible condition, whereas Alzheimer's disease is not. 2) The treatment for Alzheimer's disease is more aggressive than is the treatment for delirium. 3) There are more stigmas associated with a diagnosis of Alzheimer's disease than there are for delirium. 4) Changes in cognition develop rapidly with Alzheimer's disease and slowly with delirium. |
1) Delirium is a reversible condition, whereas Alzheimer's disease is not.
Alzheimer's disease is irreversible, whereas delirium is reversible in most cases |
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A client is newly diagnosed with the second stage of Alzheimer's disease. Which cognitive change would a nurse observe?
1) Memory disturbance 2) Confabulation 3) Apraxia 4) Inability to plan or organize |
1. In the second stage of the illness, losses in short–term memory are common and the individual may begin to lose things or forget names of people. It is at this stage that a diagnosis may be considered.
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Hospitalized and assessed to be in the fourth stage of Alzheimer's disease, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting?
1) Aphasia 2) Confabulation 3) Delirium 4) Apraxia |
2. Confabulation is a behavioral reaction to memory loss in which the client fills in memory gaps with information about events that have not occurred. During the fourth stage of Alzheimer's disease, a client will use confabulation in an effort to maintain self–esteem.
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When teaching a family about Alzheimer's disease, what information should the nurse include?
1) Alzheimer's disease is self–limiting and will resolve over time. 2) Alzheimer's disease has an abrupt onset and runs a variable course. 3) Alzheimer's disease has a slow, insidious onset. 4) Alzheimer's disease causes a rapid functional and cognitive decline. |
3. Alzheimer's disease is characterized by a slow, insidious onset, with progressive loss of cognitive abilities.
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Which statement is true about vascular neurocognitive disorder (NCD)?
1) Vascular NCD is reversible. 2) Vascular NCD is characterized by plaques and tangles in the brain. 3) Vascular NCD involves a gradual, progressive cognitive deterioration. 4) Vascular NCD involves a variable pattern of cognitive functioning. |
4. In vascular NCD, clients suffer the equivalent of small strokes that destroy many areas of the brain. The pattern of deficits is variable, depending on which regions of the brain have been affected.
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A nursing home resident is often argumentative with other residents and staff and frequently exhibits loss of emotional control. Which nursing intervention should the nurse implement?
1) Confront the argumentative behavior. 2) Redirect attention and set limits to curtail maladaptive, abusive behavior. 3) Administer as needed (prn) medications to subdue the client. 4) Isolate the client until the behavior improves. |
2. Maladaptive, abusive behavior must be curtailed through setting limits and redirecting attention. Setting limits provides a sense of security and stability for the client and maintains a safe environment.
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A client is admitted with middle– to late–stage Alzheimer's disease. Which client information should the nurse assess to effectively plan the client's care?
1) The client's past successful coping mechanisms 2) The client's willingness to participate in goal setting and treatment planning 3) The client's changes in level of functioning, including strengths and weaknesses 4) The client's attitude toward illness |
3. Nursing assessments should include both strengths and weaknesses of the client. This assessment must be ongoing in order to adapt nursing care to the client's current level of functioning.
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Family members are considering home care for a client diagnosed with major neurocognitive disorder due to Alzheimer's disease. Which initial nursing intervention would be most appropriate before the family makes that decision?
1) Teach the family about the disease process and the skills necessary to manage client care. 2) Encourage the family to address any unresolved issues or resentments with the client. 3) Determine the extent of the family's financial resources. 4) Include the client in the decision–making process. |
1. To make the best immediate decisions for this client, the family must be knowledgeable about the disease process of Alzheimer's disease and the skills needed to care for their family member. With this knowledge, they can make informed decisions about treatment.
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A client is in the third stage of Alzheimer's disease. Which characteristic is indicative of this stage?
1) The client has no apparent cognitive decline. 2) The client loses the ability to perform some activities of daily living. 3) The client is unable to plan or organize, and work performance declines. 4) The client is bedfast and aphasic. |
3. Interference with work performance becomes noticeable to coworkers, and the ability to plan and/or organize declines in the third stage of Alzheimer's disease.
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A client diagnosed with substance abuse is experiencing delirium related to alcohol withdrawal syndrome. Which nursing intervention should be prioritized?
1) Maintain seizure precautions. 2) Restrict fluid intake. 3) Increase sensory stimuli. 4) Apply ankle and wrist restraints. |
1. Symptoms of substance–withdrawal delirium develop during the first week of reduction or termination of sustained, usually high–dose use of certain substances, such as alcohol, sedatives, hypnotics, or anxiolytics. Clients experiencing alcohol withdrawal are at high risk for seizures. This is a priority intervention because seizures can be life threatening.
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A client has recently been diagnosed with mild to moderate Alzheimer's disease. Which medication would the nurse expect the physician to order for this client's cognitive impairment?
1) Nortriptyline (Pamelor) 2) Zalepon (Sonata) 3) Donepezil (Aricept) 4) Quetiapine (Seroquel) |
3. Aricept is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease.
* Pamelor is a tricyclic antidepressant, it does not improve cognition. * Sonata is used as a short–term management of insomnia, it does not improve cognition. * Seroquel is an antipsychotic used to treat schizophrenia and bipolar mania, it does not improve cognition. |
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Elderly patients are at risk for being diagnosed with neurocognitive disorder when, in fact, they may be suffering from depression. Which of the following features differentiate neurocognitive disorder from depression? Select all that apply.
1) Deficits in memory are progressive in neurocognitive disorder. 2) There are no changes in mood with neurocognitive disorder. 3) Disorientation to time and place is not characteristic of depression. 4) Depression symptoms worsen as the day progresses. 5) Wandering occurs in neurocognitive disorder but not in depression. |
1, 3, 5.
* Emotional responses are affected in neurocognitive disorder as well as in depression.` * Depression symptoms tend to be worst in the morning and lift as the day progresses. The opposite is true in neurocognitive disorder. |
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A patient is diagnosed with major neurocognitive disorder, and the family has asked the nurse what that means. Which of the following teaching points are accurate descriptors to share with this family? Select all that apply.
1) These are disorders in which there is persistent difficulty with intellectual functions. 2) Several functions such as memory, language, visuospatial skills, emotions, and personality are compromised. 3) The symptoms appear rapidly and are often reversible. 4) Major neurocognitive disorder is always the result of cerebrovascular disease. 5) Major neurocognitive disorder is defined as a disorder in which there are changes in level of consciousness and the symptoms are worse in the morning but improve as the day progresses. |
1 & 2
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A client is admitted to the hospital with possible Alzheimer's disease. The family asks the nurse what tests will be performed to determine this diagnosis. What is the correct nursing response?
1) Dexamethasone suppression test 2) Magnetic resonance imaging (MRI) 3) Thematic apperception test 4) Family kinetic drawing |
2. An MRI can reveal atrophy, widened cortical sulci and enlarged cerebral ventricles. This degenerative pathology is indicative of Alzheimer's disease.
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Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply.
1) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely. |
2, 3 & 4
It is not realistic to expect that all stressors can be removed and benzos are addictive |
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After undergoing a complete diagnostic work–up, a client is diagnosed with post–traumatic stress disorder (PTSD). What must the nurse understand about the symptoms of PTSD before planning care?
1) Symptoms are psychological coping mechanisms. 2) Symptoms result in feelings of invulnerability. 3) Symptoms are a means to manipulate others. 4) Symptoms develop from a nonspecific psychic event. |
1. Symptoms of PTSD include psychological numbing, flashbacks, nightmares, and explosive anger. These symptoms are coping mechanisms used to deal with anxiety by blocking memories of traumatic events. Resolution of the post–trauma response is largely dependent on the effectiveness of the coping strategies employed.
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Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders?
1) Facilitate the client's development of insight and self–awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms. 3) Use behavioral therapies such as systematic desensitization and implosion. 4) Conduct psychological tests to support proper diagnosis of the anxiety disorder. |
1. Self–awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. The nurse generalist plays a key role in helping clients develop this awareness and insight.
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Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply.
1) Assessing the nurse's own level of anxiety 2) Using a calm, matter–of–fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins |
1, 2 & 3
Observing in real life is not realistic and meds should only be considered if other interventions fail |
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A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess?
1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span |
2. Sweating and palpitations
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A newly admitted client diagnosed with obsessive–compulsive disorder (OCD) spends 1 hour packing and unpacking and folding and refolding personal belongings. What is the most likely reason for this behavior?
1) It relieves anxiety. 2) It fosters organizational skills. 3) It delays meeting unfamiliar people in the dayroom. 4) It makes the client feel good. |
1. It relieves anxiety
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A despondent college student, being treated for a panic disorder, tells the nurse, "I've had it! For no reason, my heart pounds and I can't seem to breathe. It's not worth it." Based on this information, which nursing diagnosis takes priority?
1) Ineffective Airway Clearance 2) Ineffective Coping 3) Risk for Suicide 4) Knowledge Deficit |
3. Because the client is despondent and makes statements such as "I've had it!" and "It's not worth it," an indication of self–harm must be considered. Although other nursing diagnoses may be valid and appropriate, the safety of the client is always the nurse's first priority.
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The nurse is assessing a patient who is diagnosed with obsessive–compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion?
1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done." |
1. A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior.
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After losing a child in a car accident, a client diagnosed with post–traumatic stress disorder (PTSD) asks the nurse, "Why did I live and my beautiful daughter die?" Which is the client experiencing?
1) Survivor's guilt 2) Anger 3) Denial 4) Suppression |
1. The statement presented in the question indicates that the client is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others die and the individual survives.
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A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety?
1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin) |
3. Diazepam is an antianxiety agent.
* Chlorpromazine is an antipsychotic medication. * Clozapine is an antipsychotic medication. * Methylphenidate is a central nervous system stimulant used to treat attention deficit–hyperactivity disorder. |
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For the past year, a college student continually and unrealistically worries about academic performance and love–life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis?
1) Post–traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive–compulsive disorder (OCD) |
2. GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object, as in phobia, or event, as in PTSD.
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A 60–year–old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply.
1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status |
1, 2, 3 & 4
* Marital status is not directly linked to an increase in anxiety disorders, so although this is demographic data routinely collected during assessment, it would not necessarily contribute to identifying the cause of this patient's symptoms. |
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A client is experiencing a panic attack. He states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority?
1) Stay with the client and offer support. 2) Distract the client by redirecting him to physical activities. 3) Teach about the etiology and management of panic disorders. 4) Encourage the client to express his feelings. |
1. During a panic attack, the client is experiencing extreme levels of anxiety. The symptoms experienced may mimic life–threatening physiological symptoms, such as chest pain and feelings of suffocation and/or impending doom. Clients need reassurance that these symptoms are psychologically, not physiologically, based. It is a priority to be present for the client and offer this support.
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A nursing student diagnosed with acute test anxiety is prescribed propranolol (Inderal). What is the rationale for this treatment?
1) Inderal is a mood stabilizer that will decrease situational anxiety. 2) Inderal is an antihypertensive medication. Question this order. 3) Inderal has potent effects on the somatic manifestations of anxiety. 4) Inderal is an anxiolytic used specifically for generalized anxiety. |
3. Propranolol is an antihypertensive medication. Research studies show that propranolol is effective in decreasing anxiety symptoms. It has potent effects on the somatic manifestations of anxiety, such as palpitations and tremors, but has less dramatic effects on the psychic components of anxiety. It is most effective in the treatment of acute situational anxiety, such as performance anxiety and/or test anxiety.
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Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________.
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Agoraphobia.
DSM–5 diagnostic criteria for agoraphobia identify that fear or anxiety must occur in at least two of five situations to diagnose agoraphobia; fear of public transportation and being in crowds are two of those criteria. |
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A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented?
1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals. |
2. The initial intervention is to rule out organic factors contributing to the paralysis. Once this has been identified, a plan of care can be effectively established.
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A client experiencing numbness of the extremities, trembling, fear of dying, and dizziness is admitted to the emergency room with a diagnosis of panic disorder. Which nursing intervention takes priority?
1) Discuss functional coping mechanisms. 2) Determine the source of the problem. 3) Quickly administer an anxiolytic medication. 4) Establish a trusting nurse–client relationship. |
3. Anxiolytic medications work quickly to decrease anxiety levels by depressing the central nervous system. Control of the client's physical symptoms of extremity numbness, trembling, and hyperventilation must take priority to maintain physiological and psychosocial integrity.
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A noncompliant client has a nursing diagnosis of "Social Isolation related to anxiety evidenced by remaining in room during group activities." Which short–term outcome is appropriate for this client?
1) The client will attend three group sessions. 2) The client will understand and accept social withdrawal as a personality trait. 3) The client will remain safe throughout the hospital stay. 4) The client will request as needed (prn) anxiety medication prior to attending group sessions. |
4. Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation.
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A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply.
1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response. |
2, 4, 5
The client recognizes that the fear is excessive or unreasonable and the client avoids, not tolerates the feared situation |
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An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four–point restraints will be applied?
1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions." |
2. It is important to provide safeguards in order to protect clients who are out of control. The nurse is educating the client in a nonjudgmental, objective manner.
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Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following?
1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution |
1. Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions.
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Jennifer is a 25–year–old woman of average height and weight who reports to the mental health clinic with complaints that she has been unable to go to work for the last 2 weeks because she can't get her "appearance right." She reports that she repetitively checks the mirror and has to redo her make–up every 5 or 10 minutes. Jennifer is most likely experiencing which of these disorders?
1) Social anxiety disorder 2) Panic disorder 3) Eating disorder 4) Body dysmorphic disorder |
4. Repetitive mirror–checking and excessive grooming R/T perception of flawed appearance that interferes with social, occupational, or other areas of functioning are symptoms of body dysmorphic disorder.
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Gary is admitted to the mental health center for treatment of obsessive–compulsive disorder. He tells the nurse that he has a repetitive fear that he has forgotten to lock the doors to his home. Which symptom of this disorder is Gary describing?
1) An obsession 2) A compulsion 3) Auditory hallucinations 4) Claustrophobia |
1. An obsession is a recurrent, intrusive, stressful thought, and this is what Gary is describing in the scenario.
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A type of therapy in which a client is directed to imagine or actually participate in real–life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________.
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Implosion therapy or flooding
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When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply.
1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages. |
2, 4 & 5
Nurse should not leave client alone and client is not in any condition to receive instruction – it may increase the anxiety |
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Which nursing intervention takes priority for a client experiencing moderate anxiety?
1) Explore the etiology of the anxiety. 2) Investigate decompensation behaviors. 3) Focus on anxiety reduction. 4) Accept the level of anxiety. |
3. Reducing anxiety to a tolerable level should be the nurse's first priority. After reassuring the client of his or her safety and security, the nurse should convey an accepting attitude to facilitate trust. Once the anxiety level has decreased, the client can then begin exploring the triggers that induce anxiety.
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What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day?
1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming |
1. Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction.
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The nurse, Robert, is conducting a relaxation group for patients at the mental health center who have been identified as struggling with anxiety disorders. He intends to implement a quality improvement initiative by using an anxiety screening tool to evaluate whether patients report less anxiety at the completion of the program. Which of these would be accepted, reliable tools for that purpose? Select all that apply.
1) Cosmopolitan's "How anxious are you?" quiz. 2) Zung's Self–Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory 5) Folstein's Mini–Mental Status Exam |
2, 3 & 4
* Cosmopolitan is a magazine, this is not a reliable tool * Folstein's mini–mental status exam is recognized as a reliable tool to evaluate cognitive function rather than symptoms of anxiety. |
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A client is experiencing gamophobia. Which fear would the nurse expect to assess?
1) Fear of strangers 2) Fear of marriage 3) Fear of numbers 4) Fear of insanity |
2. Fear of marriage
* Xenophobia is the fear of strangers. * Numerophobia is the fear of numbers. * Dementophobia is the fear of insanity. |
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Jennifer is working with the nurse on her care plan related to post trauma syndrome. Jennifer repeatedly asks the nurse why she is writing down everything and who will be seeing this information. Which of these interpretations by the nurse reflects an understanding of the post trauma patient?
1) Post trauma patients may be suspicious of others in their environment. 2) Post trauma patients need a lot of redirection. 3) Female post trauma patients are often very confused about details. 4) Post trauma patients are always confrontational and challenging with health care professionals. |
1. An understanding that post trauma patients may be suspicious of others in the environment will assist the nurse in responding to the patient in a manner that promotes trust between them.
* Redirection may not address the issue at hand * There is no gender–specific confusion * Some may be confrontational, but it is not always the case |
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One type of intervention useful for patients with adjustment disorders is a short–term therapy focused on problem–solving skills and restoring adaptive functioning. This type of therapy is ____________________.
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Crisis Intervention
* The goal of this therapy is to mobilize resources needed to resolve the crisis situation. It is relevant in the treatment of adjustment disorders since a lack of adequate coping skills and resources contributes to the development of this condition. |
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The nurse is conducting an assessment for a patient diagnosed with PTSD. She recognizes that people with PTSD are at high risk for several comorbid conditions. Which of the following will she need to assess carefully because of the high risk in people with PTSD?Select all that apply.
1) Trichotillomania 2) Depression and suicide ideation 3) Substance abuse 4) Verbal or physical aggression 5) Narcissistic Personality Disorder |
2, 3 & 4
* Trichotillomania (hair pulling) is associated with anxiety but is not recognized as a common comorbid condition of PTSD * Narcissistic Personality is an exaggerated sense of self worth, those with PTSD typically have a low self worth and survivor's guilt |
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A patient who has recently been diagnosed with PTSD asks the nurse what his options are for treatment of this disorder. Which of the following items should the nurse include in teaching the patient about primary treatments for PTSD? Select all that apply.
1) Prolonged exposure therapy 2) Cognitive therapy 3) ECT 4) Antipsychotic medication 5) EMDR |
1, 2 & 5
* Electroconvulsive therapy is used to treat depression, not PTSD * Antipsychotic meds may be used but is not a primary treatment for PTSD |
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Jared returned from active duty in the military and has been diagnosed with PTSD. Which of the following interventions has been strongly advocated for as an effective strategy in this population?
1) Group therapy with patients who have a variety of diagnoses 2) Group therapy with patients who have anger management issues 3) Group therapy with patients who have experienced similar traumas 4) Group therapy with patients who have experienced different types of trauma |
3. This type of group therapy is strongly recommended so that veterans may be able to share experiences with other veterans (and therefore similar traumatic events) to decrease feelings of isolation.
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The family of a patient being treated for PTSD asks the nurse to describe EMDR (eye movement desensitization and reprocessing), since it is being recommended for this patient. Which of the following teaching points are accurate descriptions of this intervention? Select all that apply.
1) EMDR has been shown to be effective in the treatment of all mental illnesses, including schizophrenia. 2) The process involves rapid eye movement while processing painful memories. 3) This process is contraindicated for patients with retinal detachment or glaucoma. 4) This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 5) The biological mechanism that makes EMDR effective is that it releases opioid–like chemicals in the brain. |
2, 3 & 4
* Has not been proven to be beneficial for all mental illnesses and The exact biological mechanisms by which EMDR has a therapeutic effect are currently unknown. |
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The nurse is developing a plan of care for a patient diagnosed with PTSD. Which of the following variables will have an impact on the patient's response to interventions? Select all that apply.
1) Patient's self–esteem 2) Socioeconomic status 3) History of psychopathology 4) Amount of control over recurrence 5) Temperament 6) Immediate crisis debriefing |
1, 2, 3, 4 & 5
* Crisis debriefing is more often used as a preventive strategy and has received mixed reviews about whether it is beneficial for that purpose. Since the patient is already suffering from PTSD, this variable is not relevant to the person's long–term response to the trauma. |
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An adult male has sought counseling at a community mental health center for PTSD. He reports during assessment that he witnessed the murder of a close friend last year in a random, drive–by shooting in his neighborhood. Since this loss he has had recurrent nightmares, explosive episodes, and frequently incapacitating anxiety. Which of the following nursing diagnoses would be appropriate, based on this assessment data? Select all that apply.
1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares. 2) Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 3) Isolation R/T unresolved anxiety, as evidenced by complaints of incapacitating anxiety. 4) Risk for suicide R/T survivor guilt. |
1 & 2
* No evidence currently, of the other diagnoses |
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What are the progressives stages of decline for Alzheimer's Disease?
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Stage 1: No apparent symptoms
Stage 2: Forgetfulness (may maintain lists, often not observed by others) Stage 3: Mild cognitive decline (starts to interfere with work and is observed by others) Stage 4: Mild to moderate Cognitive decline (forgets major events in personal history, may use confabulation) Stage 5: Moderate Cognitive decline (start to lose ability to handle ADLs independently) Stage 6: Moderate to Severe Cognitive decline (cannot manage ADLs, incontinence, worse later in the day – "sundowning") Stage 7: Severe Cognitive Decline (bed bound, aphasic, contractures, doesn't recognize family) |
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What happens with vascular NCD?
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The patient suffers a series of small strokes that destroy areas of the brain. Occurs in "steps" rather than a gradual deterioration.
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What is the most common mental illness in the elderly?
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Depression. It is often misdiagnosed and treated inadequately because it is often thought to be dementia, so it is often called "pseudodementia".
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What is agoraphobia?
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A fear of being separated from a source of security. It's literal translation from Greek is "Fear of the marketplace".
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What is social anxiety disorder?
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an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others
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What is obsessive compulsive disorder (OCD)?
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the presence of obsessions, compulsions, or both, the severity of which is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning
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What is body dysmorphic disorder?
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the exaggerated belief that the body is deformed or defective in some specific way
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A patient admitted to the psychiatric unit, who has been experiencing flashbacks and troubling nightmares, reports to the nurse that he just awoke from a nightmare and is still having chest pain. Which of these nursing interventions is a priority?
1) Encourage the patient to return to bed and try to calm down. 2) Administer prn antianxiety medication as ordered. 3) Assess the patient's cardiovascular status. 4) Encourage the patient to reflect on the troubling dream. |
3. This intervention is the most important priority since complaints of chest pain should not be assumed to be solely anxiety symptoms. The patient may be having a heart attack.
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A female patient, Sally, was admitted to the psychiatric inpatient unit with PTSD following a rape 6 months ago in which she suffered several physical injuries. This evening she was approached from behind by a male patient who touched her on the shoulder, and Sally began screaming "I'm going to kill you for what you did to me!" Which of these immediate interventions by the nurse demonstrates a safe and effective care environment? Select all that apply.
1) Place the patient in seclusion for the safety of others. 2) Offer the patient reassurance that she is in a safe environment. 3) Tell the patient to share the details that she remembers about the traumatic event. 4) Stay with the patient. 5) Acknowledge and validate the patient's feelings as they are expressed. |
2, 4 & 5
No reason to believe the patient is a danger to others and now is not the time to go over the details of the traumatic event |
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John has been in counseling for an adjustment disorder related to losing his management position in a health care facility. He tells the counselor he feels ready to terminate counseling. Which of these statements by the patient supports his readiness to terminate counseling?
1) "Counseling isn't going to get me another job, so what's the point?" 2) "I don't feel angry anymore and I've learned how to relax better." 3) "I've decided I'm never going to work again, so I'm applying for disability." 4) "As long as I continue to take antianxiety medication, I'll be okay." |
2. demonstrates progression through the grieving process
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A patient with PTSD who has been having nightmares is prescribed propranolol to treat PTSD symptoms. He asks the nurse why this medication was ordered since he doesn't have high blood pressure. Which of the following is the most appropriate response by the nurse at this point?
1) Call the doctor and question this order. 2) Discontinue the medication and check the patient's blood pressure. 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 4) Explain that this medication is used to treat hypertension that often accompanies PTSD. |
3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD.
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The nurse is conducting an intake assessment for a patient with PTSD. Which of the following pieces of information support this diagnosis? Select all that apply.
1) The patient reports having nightmares but can't remember what they are about. 2) The patient states that he heard a loud noise when he was walking down the street and thought he was back in the war zone where he had last been deployed. 3) The patient took antidepressants when he was in junior high school and reports they didn't help. 4) The patient denies any history of substance abuse or dependence. |
1 & 2
Nightmares are common and not remembering the details as well as often reliving the trauma |
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Carol has sought treatment for an adjustment disorder after divorcing her husband of 30 years. The nurse assesses that Carol is experiencing complicated grieving. Which of the following would be an appropriate intervention to address Carol's symptoms?
1) Explore with Carol the stages of normal grieving. 2) Tell Carol that expressing anger will only keep her fixated at that stage of grieving. 3) Encourage Carol that these symptoms usually go away on their own. 4) All of the above. |
1. It is appropriate to encourage exploration and identification of which stage of grieving Carol is currently experiencing.
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Beth is being treated for an adjustment disorder following a job demotion 2 months ago. Since the demotion, she has frequently called in sick, complains of incapacitating migraines, and has been disciplined for yelling at her boss. Her husband asks the nurse why his wife is still having so much trouble functioning, since he knows people who have lost their jobs entirely and have since resolved their concerns. Which of these statements by the nurse accurately reflects understanding of the dynamics of different kinds of stressors in patient recovery?
1) Women have more difficulty managing work–related stressors than men. 2) Ongoing stressors are associated with more maladaptive behaviors than sudden–shock types of stressors. 3) Job demotion is associated with longer–term recovery because it is so uncommon. 4) Carol probably had pre–existing difficulties managing stressors as a child. |
2) Ongoing stressors are associated with more maladaptive behaviors than sudden–shock types of stressors.
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During a psychiatric nursing assessment, Sally reports to the nurse that she was sexually assaulted 6 months ago and since then has had trouble concentrating at work. Her employer tells her he is sensitive to the amount of stress she is under, since she also recently went through a divorce, but that she needs to seek help for her anxiety and depression to avoid further consequences at work. Which of these data support the diagnosis of PTSD according to DSM–5 criteria? Select all that apply.
1) She directly experienced a traumatic event. 2) She is a single female. 3) She has had difficulty concentrating at work. 4) Her anxiety and depression are interfering with job functioning. 5) Her symptoms have been present for more than 6 months. |
1, 3, 4 & 5
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One type of intervention useful for patients with adjustment disorders is a short–term therapy focused on problem–solving skills and restoring adaptive functioning. This type of therapy is ____________________.
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Crisis Intervention – The goal of this therapy is to mobilize resources needed to resolve the crisis situation. It is relevant in the treatment of adjustment disorders since a lack of adequate coping skills and resources contributes to the development of this condition.
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A client diagnosed with autism spectrum disorder was recently admitted to the hospital. This client grabs a toy and hits another child. Which is the most appropriate nursing action?
1) Isolate the client for 24 hours. 2) Encourage the client to explain the hostile behavior. 3) Assume a nonpunitive attitude and remove the client from the conflict. 4) Call the parents for input regarding behavioral management. |
3. The nurse must intervene, using a nonpunitive approach, to provide a safe environment by removing the client from the conflict. The client diagnosed with autism spectrum disorder cannot be expected to limit personal behavior.
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Jeremy is a 7–year–old boy diagnosed with separation anxiety disorder. The nurse recommends that the parents have him evaluated for a group play therapy program. The parents question the nurse about the benefits of play therapy for Jeremy, since he has never had problems playing with other children. Which of the following teaching points made by the nurse are evidence–based statements according to Landreth and Bratton (2007) about the benefits of group play therapy? Select all that apply.
1) Play provides a means for children to express their inner feelings. 2) Playing with toys allows children to transfer anxieties and fears to objects rather than people. 3) Play allows children the opportunity to change unmanageable situations into manageable ones through symbolic representation. 4) Play therapy allows children the opportunity to relax and avoid discussing anxieties and fears. 5) Play therapy is designed to help children learn age–appropriate games and activities. |
1, 2 & 3
Play therapy is used for problem solving |
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Which approach should the nurse use when planning client care for an adolescent diagnosed with conduct disorder?
1) The client and the entire family should all be included when planning care. 2) The adolescent is the identified client and should be the sole focus of care. 3) Teaching parenting skills should be the primary intervention. 4) Responsibility for treatment choices rests solely with the adolescent. |
1. Family dynamics have been implicated as contributors in predisposition to development of conduct disorders. Therefore, the family should be included when planning client care.
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An adolescent diagnosed with attention–deficit/hyperactivity disorder (ADHD) is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance?
1) Mandate that the client remain in her room until all homework is complete. 2) Remove privileges if homework is not completed within a 2–hour period. 3) Encourage dividing tasks into smaller, attainable steps and reward successful completion. 4) Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin). |
3. A client with a short attention span can be overwhelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self–esteem and provide incentives for future positive behaviors.
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Joey, a 12–year–old boy diagnosed with ADHD, is being assessed to determine appropriateness for behavioral therapy–based group treatment. The nurse should also assess for symptoms of which disorders that commonly co–occur with ADHD? Select all that apply.
1) Oppositional defiant disorder (ODD) 2) Narcissistic personality disorder 3) Schizophrenia 4) Conduct disorder 5) Substance abuse |
1, 4 & 5
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Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)?
1) Psychosis 2) A decreased intelligence quotient (IQ) 3) Sore throat 4) A decrease in rate of growth and development |
4) A decrease in rate of growth and development
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The disorder that is characterized by the presence of multiple motor tics and one or more vocal tics is called ____________.
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Tourette's Disorder
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Conduct disorder is a precursor to the diagnosis of which personality disorder?
1) Narcissistic personality disorder 2) Antisocial personality disorder 3) Histrionic personality disorder 4) Obsessive–compulsive disorder |
2. Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others. Conduct disorder is a precursor to the diagnosis of antisocial personality disorder. A diagnosis of antisocial personality disorder would not be assigned until a client is 18 years of age or older.
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A client is admitted to an inpatient adolescent psychiatric unit for treatment of oppositional defiant disorder (ODD). The nurse anticipates this client to exhibit which characteristic?
1) Cruelty to animals 2) Use of weapons to inflict harm 3) Negativistic, disobedient behaviors toward authority figures 4) Destruction of property |
3. Negativistic, disobedient behaviors toward authority figures are diagnostic criteria for the diagnosis of ODD.
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A client diagnosed with attention–deficit/hyperactivity disorder (ADHD) is prescribed the neurotransmitter–altering drug methylphenidate (Ritalin). Another client, diagnosed with narcolepsy, also receives Ritalin. Why is Ritalin given for these two opposing problems?
1) ADHD responds positively to a decreased level of neurotransmitters, whereas narcolepsy responds positively to an increased level of neurotransmitters. 2) Narcolepsy responds positively to a decreased level of neurotransmitters, whereas ADHD responds positively to an increased level of neurotransmitters. 3) Both ADHD and narcolepsy respond positively to a decreased level of neurotransmitters. 4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. |
4. When given Ritalin, clients diagnosed with either ADHD or narcolepsy will experience an increased level of neurotransmitters. However, behaviorally, their response is opposing. The client diagnosed with ADHD will experience a calming effect, whereas the client diagnosed with narcolepsy will be stimulated. Central nervous system stimulation is an expected response. The exact mechanism that produces the therapeutic effect in clients diagnosed with ADHD is unknown.
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A frightened young woman calls the ED and tearfully tells the nurse, "I've been raped. Please help me!" Which nursing questions take priority?
1) "Are you injured, and are you in a safe place?" 2) "Do you know your whereabouts, and do you have transportation?" 3) "Have you notified the police and do you know your assailant?" 4) "Have you bathed, douched, or changed your clothes?" |
1. Safety first
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The nurse is planning care for Carla, who, despite suffering several broken bones as a result of spousal abuse, has decided not to leave her husband. In order to provide patient–centered care, the nurse must understand that which of these factors may contribute to the victim's desire to stay in the relationship? Select all that apply.
1) Fear of retaliation 2) Grandiose delusions 3) Concern for children 4) Lack of financial resources 5) Large support networks |
1, 3 & 4
Grandiose delusions are symptoms of a psychosis, not abuse, and lack of support, not a large support network would be a reason to stay |
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A young mother in a severely abusive relationship is admitted to psychiatric unit after an attempted suicide. The client tells the nurse, "I'm sure things will be better between us once I go home." Which is the most appropriate nursing response?
1) "Research shows that men who batter get worse rather than improve." 2) "Aren't you concerned about your children?" 3) "You really shouldn't return home to that violent situation." 4) "Let's develop a safety plan in case he becomes violent in the future." |
4. It is critical to stress to the client the importance of safety. The client must be made aware of the variety of resources that are available to her. Most major cities in the United States now have houses or shelters where women can go to be assured of protection for them and their children. Helping the client develop a safety strategy will increase her sense of control and decrease her sense of powerlessness.
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Tori has been talking to the nurse about her husband's behavior. She claims that although her husband is very controlling, he can't be described as manifesting intimate partner violence because he has never struck her. Which of these responses by the nurse is an accurate description of intimate partner violence?
1) Intimate partner violence is only physical abuse, but controlling behavior is dysfunctional, too. 2) The National Coalition Against Domestic Violence describes battering as different from intimate partner violence. 3) The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control. 4) Intimate partner violence relates to only acts of fatal violence. |
3. This statement is correct. It is important to educate clients that domestic violence extends beyond just physical abuse. This education lays the foundation for accurate assessment and empowerment of the client to problem–solve.
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A 12–year–old female suddenly refuses to change for gym or participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms?
1) Sexual abuse 2) Emotional neglect 3) Physical neglect 4) Incest |
1) Sexual abuse
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Dolores is seeing the nurse at the community mental health clinic for depression and reveals that her husband was physically abusive to her but "things are better now because he felt terrible and he has been great to me ever since." Which of the phases in the cycle of battering is Dolores describing?
1) The tension–building phase 2) The acute battering incident 3) The "honeymoon" phase 4) The resolution phase |
3. Dolores is describing the "honeymoon" phase, in which the batterer expresses remorse, promises the abuse will never occur again, and appears, at least temporarily, to be the "ideal" husband.
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Veronica presents at the emergency room with multiple bruises, a black eye, and a broken leg, which her husband states were the result of falling on a patch of ice. He requests to stay with her, and the nurse notices that Veronica appears fearful. Which of these is the best approach to conducting assessment?
1) Tell the husband how much you appreciate his support and engage him in the assessment process. 2) Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone. 3) Ask Veronica if she would like her husband to be present throughout the interview. 4) Confront the husband about the suspiciousness of Veronica's injuries. |
2. Conducting the assessment in private is essential in order to provide an environment where the patient feels empowered to answer questions honestly. This response diplomatically redirects the husband so that private assessment can occur.
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After an examination and treatment for rape, the nurse prepares to discharge a client from the ED. Which discharge teaching should the nurse provide? (If one part of an answer is incorrect, the entire answer is incorrect.)
1) Information on available community resources 2) The names and phone numbers of local attorneys who defend rape victims 3) When to return to the ED for follow–up care 4) The phone number of the battered women's shelter and the crisis intervention center |
1. The client must be made aware of the variety of resources that are available to her. These may include crisis hotlines, community groups for women who have been abused, shelters, and counseling services. Knowledge of available community resources decreases the victim's sense of powerlessness, but true empowerment comes only when she chooses to use the knowledge for her own benefit.
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From a biological theory perspective, which predisposes individuals to be abusive?
1) Unmet needs for security, resulting in an underdeveloped ego and a weak super ego 2) Imitation of individuals who have a predisposition toward aggressive behavior 3) Various levels of norepinephrine, dopamine, and serotonin 4) The influence of culture and social structure |
3. This is a biological perspective.
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Chronic failure of a parent or caretaker to provide a child in his or her care with hope, love, and support necessary for developing a sound, healthy personality is defined as ____________.
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Emotional Neglect
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Sarah convinces her husband to make an appointment at the health center and tells the intake nurse that her husband has been exhibiting violent behavior for the first time in their 14–year marriage. Which of the following should the nurse explore when assessing the husband for the origins of his behavior? Select all that apply.
1) History or evidence of brain diseases such as encephalitis or epilepsy 2) Substance use and medication history 3) Evidence of PTSD 4) History of abuse in his family of origin 5) Evidence of codependent personality traits in Sarah |
1, 2, 3 & 4
Codependent personality traits do not cause a person to become violent |
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The expression of power and dominance by means of sexual violence is called ____________.
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Rape
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What is the anxiety disorder called where a person pulls out their hair?
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Trichotillomania
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What is the difference between acute stress disorder and PTSD?
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Acute Stress Disorder (ASD) lasts up to 1 month. If the symptoms last longer, then it is considered PTSD.
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When teaching a client diagnosed with alcoholism about nutritional needs, which nutritional concept should the nurse emphasize?
1) Eat a high–protein, low–carbohydrate diet to promote lean body mass. 2) Increase sodium–rich foods to increase iodine levels. 3) Provide multivitamin supplements, including thiamine and folic acid. 4) Restrict fluid intake to decrease renal load. |
3. Provide multivitamin supplements to avoid Wernicke – Korsakoff syndrome caused by a thiamine deficiency
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A client is brought to the ED. The client is aggressive, has slurred speech, and exhibits impaired motor coordination. Blood alcohol level is 347 mg/dL. Among the physician's orders is thiamine. Which is the rationale for this intervention?
1) To prevent nutritional deficits 2) To prevent pancreatitis 3) To prevent alcoholic hepatitis 4) To prevent Wernicke's encephalopathy |
4. Prevent Wernicke's encephalopathy
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Which nursing intervention relates to rehabilitative care for a recovering alcoholic?
1) Providing a safe and supportive environment during alcohol withdrawal 2) Teaching about physical symptoms 3) Providing client and family education and assistance during treatment 4) Encouraging continued participation in AA |
4. Encouraging continued participation in AA
1 deals with withdrawal not rehab care 2 deals with withdrawal as well 3 deals with treatment not rehab care |
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Which symptom would the nurse expect to observe in a client experiencing opioid intoxication?
1) Insomnia 2) Abdominal cramps 3) Muscle aches 4) Impaired judgment |
4. impaired judgement
1 opioids cause drowsiness 2 & 3 opioids relieve pain |
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The nurse is assessing a client who is a substance abuser. The client states, "I use every day, but it rarely interferes with my work." The nurse determines that the client is using which defense mechanism?
1) Projection 2) Denial 3) Reaction formation 4) Displacement |
2. Denial
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Paula is attending an education class on addictive disorders. She suspects that her husband may be abusing opiates since he has been taking pills given to him by his brother and she knows the brother had been taking oxycodone for back pain. She asks the nurse how to interpret her husband's behaviors. Which of the following observations by Paula are consistent with opioid intoxication? Select all that apply.
1) "Sometimes he seems euphoric and other times he acts like he doesn't care about anything." 2) "Last night he went out without a coat on and it was 15 degrees outside." 3) "While we were talking at dinner his speech was rapid and he seemed hyperalert to everything in the environment." 4) "He's been having trouble remembering things." 5) "Sometimes it looks like his pupils are very small." |
1, 2, 4, 5
3 would be caused by a stimulant not a CNS depressant |
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A client is diagnosed with stimulant use disorder: cocaine and antisocial personality disorder. The client eagerly participates in therapy and becomes charming and ingratiating to the primary nurse. Which best describes these client behaviors?
1) The client has not completed the cocaine withdrawal process. 2) The client is probably hiding something. 3) The client is exhibiting characteristics of antisocial personality disorder. 4) The client is exhibiting symptoms of cocaine dependence. |
3) The client is exhibiting characteristics of antisocial personality disorder.
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A client diagnosed with chronic alcohol use disorder complains of feeling tremulous. The client's BP is now 170/110, P 116, R 30, T 97°F. The nurse anticipates which medication would give the client the most immediate relief from these symptoms?
1) Benztropine (Cogentin), 2 mg PO 2) Oxazepam (Serax), 30 mg PO 3) Lorazepam (Ativan), 1 mg IM 4) Meperidine (Demerol), 100 mg IM |
3. Ativan
1 is used for the reversal of extrapyramidal symptoms associated with neuroleptic use 2 is used for alcohol withdrawal but is taken orally so wouldn't have as fast a relief 4, this drugs is not used for alcohol withdrawal |
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A client diagnosed with chronic alcoholism has an order for disulfiram (Antabuse), 375 mg PO AM daily. On hand are 250–mg tablets. How many tablets would the nurse administer daily? ________tablets.
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Xmg = 375mg X 1/250mg = 375/250 = 1.5
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A client is being discharged from an alcohol treatment program. The client's wife states, "I'm so afraid that when my husband leaves here, he'll relapse. How can I deal with this?" Which nursing statement would be most appropriate?
1) "Many family members of alcoholics find the Al–Anon support group to be helpful." 2) "You could try going out and having a few beers with him when he gets the urge to drink." 3) "Just make sure he doesn't drink at home. Find all of his hidden bottles and empty them." 4) "Tell your husband that if he drinks again, you will leave him." |
1. recommending An–anon
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A client who is going through alcohol detoxification states, "I see bugs crawling on the wall." Which is the best nursing response?
1) "I'll remove the bugs from the wall." 2) "You are confused because of your alcoholism." 3) "There are no bugs on the wall. I'll stay with you until you feel less anxious." 4) "You do not see any bugs on the wall." |
3) "There are no bugs on the wall. I'll stay with you until you feel less anxious."
This response presents objective reality and may help decrease the client's anxiety by the nurse's therapeutic offering of self. |
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Which client and family teaching is most important regarding the cause of substance addiction?
1) An individual's social and cultural environment can be implicated in the cause of substance addiction. 2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction. 3) Evidence of a genetic link accounts for most cases of substance addiction. 4) Reinforcing properties of the substance encourage progression from use to addiction. |
2) Biological, psychological, and sociocultural factors can all be implicated in the cause of substance addiction.
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A client who is unable to control binge drinking requires increased amounts of alcohol to achieve the same level of intoxication. The client is experiencing marital strife and legal problems. The client's behaviors meet the criteria for which DSM–5 diagnostic category?
1) Dual diagnosis 2) Alcohol use disorder 3) Neurocognitive disorder 4) Alcohol intoxication |
2) Alcohol use disorder
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Which is the most serious symptom experienced during alcohol withdrawal?
1) Blackout 2) Acute withdrawal delirium 3) Hypotension 4) Seizure |
4) Seizure
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Paul, a 65–year–old Caucasian, is being seen at the health clinic for hypertension and has a history of alcohol use disorder. Which of the following observations by the nurse are consistent with physical complications associated with chronic alcohol use disorders? Select all that apply.
1) His skin is yellow. 2) He has a butterfly–shaped rash on his cheeks and nose. 3) His abdomen is distended. 4) He is coughing up blood. 5) He complains of acute pain in his left eye. |
1, 3 and 4
1. Yellowish skin is evidence of jaundice, which is secondary to cirrhosis of the liver. Cirrhosis of the liver is a common manifestation of end–stage alcoholic liver disease. 2.Although facial flushing is a common manifestation in chronic alcohol use disorders, a distinctly butterfly–shaped rash may be indicative of other autoimmune conditions such as lupus erythematosis. 3. Abdominal distention can be a manifestation of alcoholic hepatitis, cirrhosis of the liver, and pancreatitis, all of which are complications of alcohol use disorder. Further assessment is warranted. 4. Coughing up blood may be evidence of several complications of alcoholism, including esophageal varices, which can culminate in potentially fatal hemorrhage. Further assessment is warranted to evaluate for these as well as other potential causes of coughing up blood. 5.A complaint of pain or pressure in or behind one's eyes is not directly associated with alcoholism but suggests a potentially emergent concern that requires further assessment. |
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Janice is a nurse whose husband is in rehab for alcohol use disorder. While attending a family group, Janice makes several statements about their relationship. Which of these statements would suggest Janice is exhibiting codependent behavior? Select all that apply.
1) "My husband has to accept responsibility for his behavior and the consequences of his drinking." 2) "I know I shouldn't go out drinking with him, but I'm afraid he'll leave me if I don't." 3) "My father was the same way and I learned its better just to keep your mouth shut so you don't get hit." 4) "If he didn't have me monitoring his every move he'd probably be dead already." 5) "I need to make sure I'm protecting myself and my children." |
2, 3 & 4
1 displays healthy boundaries 5 displaying healthy responsibility not codepency |
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The ED nurse assesses a confused client diagnosed with alcohol use disorder and notes the use of confabulation. Which complication of alcohol use disorder would the nurse suspect?
1) Korsakoff's psychosis 2) Vascular neurocognitive disorder 3) Wernicke's encephalopathy 4) Esophageal varices |
1. The symptoms described are those associated with Korsakoff's psychosis. Korsakoff's psychosis is identified by a syndrome of confusion, loss of memory, and confabulation. Confabulation is the creating of imaginary events to fill in memory gaps.
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An impaired nurse is admitted to an inpatient substance abuse treatment facility. Which applies to his situation?
1) The nurse must relinquish his driver's license to the office of motor vehicles. 2) The nurse is mandated to comply with treatment and prescribed therapies. 3) The nurse is not mandated to meet specific requirements, because all civil rights are ensured. 4) The nurse must relinquish his registered nurse (RN) license to the state board of nursing. |
3) The nurse is not mandated to meet specific requirements, because all civil rights are ensured.
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A client with chronic alcoholism says to the nurse, "I'm tired of using and I want to stop. Is there a medication that can help me maintain sobriety?" About which medication would the nurse provide information?
1) Carbamazepine (Tegretol) 2) Clonidine (Catapres) 3) Disulfiram (Antabuse) 4) Folic acid (Folvite) |
3) Disulfiram (Antabuse)
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On admission, a client experienced severe alcohol withdrawal symptoms. Four days later, the nurse notes a decrease in withdrawal symptoms. Which nursing intervention is most appropriate?
1) Withhold potentially addictive as needed (prn) medications. 2) Increase prn medications because potentially fatal complications can still occur. 3) Ask the doctor to prescribe a less addictive medication to reduce potential for dependence. 4) Monitor for withdrawal complications and administer medications on the basis of client symptoms. |
4) Monitor for withdrawal complications and administer medications on the basis of client symptoms.
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Which would the nurse consider a priority intervention when planning care for a medically unstable client diagnosed with alcohol use disorder?
1) Simplifying the environment 2) Addressing physical needs 3) Providing opportunities for success experiences 4) Establishing a trusting interpersonal relationship |
2) Addressing physical needs – the patient is medically unstable
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Which issues influence an individual's predisposition to substance–related disorders? Select all that apply.
1) Genetic history 2) Fixation at the oral stage of psychosexual development 3) Punitive ego 4) Personality traits 5) Behavior modeling |
1, 2, 4 & 5
3 A psychodynamic approach to the etiology of substance abuse focuses on a punitive superego, not ego |
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Pamela has sought treatment for ongoing substance use disorder. She asks the nurse what treatment options are available to help her combat this problem. Which of these options would be accurate for the nurse to include in patient education? Select all that apply.
1) ECT 2) Self–help groups 3) Deterrent therapy 4) Substitution pharmacotherapy 5) Vitamin supplements |
2, 3 & 4
ECT helps with depression – this question didn't address depression Vitamin supplements help to restore to health, not combat substance abuse |
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Which primary factor is critical in maintaining abstinence for the client diagnosed with alcohol use disorder?
1) Attendance at Alcoholics Anonymous (AA) meetings 2) Personal commitment to change 3) Family involvement 4) Compliance with pharmacological therapy |
2) Personal commitment to change
The first step in the recovery process necessitates that the client accept ownership of the problem and establish a behavioral change commitment to continued abstinence. |
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A client diagnosed with schizophrenia hears another patient say "You'll be tied up for another hour" and becomes agitated because he interprets that to mean he will literally be tied up. Which cognitive symptom of schizophrenia is this client manifesting?
1) Nihilistic delusions 2) Concrete thinking 3) Circumstantiality 4) Perseveration |
2) Concrete thinking
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Several types of delusions may occur in an individual with schizophrenia. Which of the following types of delusion place the patient at greatest risk for agitation or aggression?
1) Delusions of grandeur 2) Delusions of persecution 3) Delusions of reference 4) Nihilistic delusions |
2) Delusions of persecution
Delusions of grandeur they have a false belief of their importance Delusions of reference they believe that everything in their environment refers to them (the tv anchorman is sending them personal messages) In nihilistic delusions an individual has a false belief that the self, others, or the world is nonexistent. These delusions do not necessarily increase the person's risk for agitation or aggression. |
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A client is experiencing extrapyramidal symptoms secondary to neuroleptic drug therapy. The physician ordered biperiden (Akineton), 2 mg tid IV. If a 5–mg/mL vial is used, what is the total amount, in milliliters per day, that the nurse will administer? _________ mL/day.
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Xml = 2mg x 1/5mg = 2/5 = .40 X 3 times a day = 1.2 mL/ day
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To deal with a client's hallucinations therapeutically, which nursing intervention should be implemented?
1) Reinforce the perceptual distortions until the client develops new defenses. 2) Provide an unstructured environment. 3) Avoid making connections between anxiety–producing situations and hallucinations. 4) Use empathic listening and redirect the client's attention to reality–based interaction. |
4) Use empathic listening and redirect the client's attention to reality–based interaction.
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A patient with schizophrenia says, "I don't like group therapies. I don't want to go." When the nurse conveys to the patient that he or she values the patient as the primary decision maker about the plan of care, the nurse is manifesting the QSEN competency of ____________.
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Patient–Centered Care
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The family of a patient with schizophrenia requests information about Assertive Community Treatment (ACT). Which of the following responses by the nurse are consistent with this treatment model? Select all that apply.
1) "This model of treatment is based in the hospital and provides group education about how to assert oneself in the community." 2) "This is a program of case management that takes a team approach in providing comprehensive community–based psychiatric services." 3) "This model is designed to meets the needs of people with conditions ranging from mild depression to severe and persistent illnesses such as schizophrenia." 4) "One of the primary goals of ACT is to lessen the family's burden of providing care." |
2 & 4
This program is not assertiveness training and it helps patients with severe, persistent mental illness |
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A patient on antipsychotic medication reports to the nurse that her muscles feel very stiff, and she appears diaphoretic. Her temperature is 105 degrees. Her symptoms are indicative of the potentially fatal adverse reaction to antipsychotic medication known as ____________.
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Although neuroleptic malignant syndrome is rare, its rapid progression and potential to cause death make it a priority to assess for regularly and to intervene aggressively when symptoms are apparent. Antipsychotic medication should be immediately discontinued.
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A client has been admitted to the inpatient psychiatric unit and is manifesting mutism. His diagnosis is schizophrenia with catatonia. What would the nurse expect to observe?
1) Frenzied and purposeless movements 2) Exaggerated suspiciousness 3) Stuporous withdrawal 4) Sexual preoccupation |
3) Stuporous withdrawal
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A client who has been taking chlorpromazine (Thorazine) for several months presents in the ED with extrapyramidal symptoms of restlessness, drooling, and tremors. What medication will the nurse expect the physician to order?
1) Paroxetine (Paxil) 2) Carbamazepine (Tegretol) 3) Benztropine (Cogentin) 4) Lorazepam (Ativan) |
3) Benztropine (Cogentin)
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A client is admitted with a diagnosis of schizoaffective disorder. Which symptoms are characteristic of this diagnosis?
1) Strong ego boundaries and abstract thinking 2) Acute dystonias and tardive dyskinesia 3) Altered mood and thought disturbances 4) Substance abuse and cachexia |
3) Altered mood and thought disturbances
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A nursing home resident who has been taking antipsychotic medications for several months complains to the nurse of a stiff neck and difficulty swallowing. These symptoms are indicative of which condition?
1) Dysphonia 2) Tardive dyskinesia 3) Akathisia 4) Echolalia |
2) Tardive dyskinesia
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The family of a patient who has been prescribed antipsychotic medication tells the nurse they understand there are potentially fatal side effects with these medications. They ask the nurse for information about what they should look for that could signal potentially dangerous or fatal side effects. Which of the following responses by the nurse are accurate with regard to the family's question? Select all that apply.
1) "If the patient has acute muscle spasms or the patient's eyes appear to be rolling back, emergency intervention should be sought." 2) "If the patient has an unusually high fever and complains of muscle rigidity, any further antipsychotic medication should be discontinued and immediate emergency intervention should be sought." 3) "If the patient complains of sore throat, fever, and malaise, the doctor should be contacted to evaluate for a possible dangerous side effect of the medication." 4) "If the male patient begins to show signs of breast enlargement or the female patient experiences amenorrhea, take the patient immediately to the ER." 5) "If the patient's psychotic symptoms appear to be absent, call the doctor immediately." |
1, 2 & 3
1. – acute dystonia – needs cogentin 2. – neuroleptic malignant syndrome 3. – agranulocytosis 4. – not fatal 5. – that's what you HOPE for! |
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A client diagnosed with schizophrenia experiences identity confusion and communicates with the nurse using echolalia. What is the client attempting to do by using this form of speech?
1) Identify with the person speaking 2) Imitate the nurse's movements 3) Alleviate alogia 4) Alleviate avolition |
1) Identify with the person speaking – they are repeating the words the nurse is saying
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In planning care to reinforce reality for a client diagnosed with schizophrenia, the nurse should include which intervention?
1) Explore the client's expressions of distorted thinking. 2) Discuss perceptions and thinking that are in touch with reality. 3) Encourage the client to share delusional thinking in group discussions. 4) Ask the client why distorted thinking and bizarre behavior have occurred |
2) Discuss perceptions and thinking that are in touch with reality.
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Some patients with schizophrenia express lack of insight or awareness that there is anything wrong or that any disorder is present. This symptom is referred to as ____________.
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Anosognosia
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A client diagnosed with schizophrenia manifests the symptom of mutism. Which nursing intervention would assist the client in communicating with others?
1) Providing assistance with self–care needs 2) Using clear, concrete statements 3) Conveying acceptance of the client's need for false beliefs 4) Attempting to decode incomprehensible communication patterns |
2) Using clear, concrete statements
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The nurse is conducting an admission assessment for Mark, who is diagnosed with schizoaffective disorder. When asking the patient about his relationships with family members, the patient begins responding to someone else's voice (although there is no one else present) and begins pacing around the room. Which of these are appropriate interpretations of the patient's behavior? Select all that apply.
1) Mark is hallucinating. 2) Mark is agitated. 3) Mark is a victim of abuse. 4) Mark is delusional. 5) Mark is anxious about discussing family relationships. |
1, 2 & 5
3. My not necessarily be abused 4. delusions are false beliefs |
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A client is experiencing paranoia and states, "The FBI and phone company are plotting against me." Which charting entry best describes this client's symptom?
1) "Experiencing delusions of grandeur." 2) "Experiencing erotomanic delusions." 3) "Experiencing delusions of persecution." 4) "Experiencing somatic delusions." |
3) "Experiencing delusions of persecution."
1 – delusions of grandeur is when they feel they're far more important than they are 2 – erotomanic delusions – is when they think someone important is in love with them 4. – somatic delusions is when they think they have some physical defect |
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A client diagnosed with schizophrenia is experiencing disorganized thinking. Which technique should the nurse use to promote communication?
1) Giving broad openings 2) Probing 3) Verbalizing the implied 4) Using open–ended questions |
3) Verbalizing the implied
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A withdrawn client, newly diagnosed with schizophrenia, is experiencing delusional thinking. Which nursing intervention is most appropriate?
1) Present objective reality. 2) Use self–disclosure. 3) Use physical touch for reassurance. 4) Provide an in–depth explanation of unit rules and regulations. |
1) Present objective reality.
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Which medication does the nurse determine will give the client the most immediate relief from neuroleptic–induced extrapyramidal side effects?
1) Lorazepam (Ativan), 1 mg PO 2) Diazepam (Valium), 5 mg PO 3) Haloperidol (Haldol), 2 mg IM 4) Benztropine (Cogentin), 2 mg PO |
4) Benztropine (Cogentin), 2 mg PO
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A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication?
1) "If you forget to take your morning dose of Haldol, double the dose at bedtime." 2) "Limit your alcohol intake to no more than 3 ounces per day." 3) "When you go home, sit outside and enjoy the sunshine." 4) "Do not stop taking Haldol abruptly." |
4) "Do not stop taking Haldol abruptly."
Never double up on the dose Should never be used with alcohol It causes photosensitivity |
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A client diagnosed with schizophrenia states, "My roommate is plotting to have others kill me." Which is the appropriate nursing response?
1) "I know you believe that to be true, but I find that hard to believe." 2) "What would make you think such a thing?" 3) "I know your roommate. He would do no such thing." 4) "I can see why you feel that way." |
1) "I know you believe that to be true, but I find that hard to believe."
This client is experiencing a persecutory delusion. This nursing response is an example of voicing doubt, which expresses uncertainty as to the reality of the client's perceptions. This is an appropriate therapeutic communication technique in dealing with clients experiencing delusional thinking. |
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The client hears the word match. The client says, "A match. Tomorrow is the end of the world. Nothing is better than hot coffee." Which communication pattern does the nurse identify?
1) Word salad 2) Clang association 3) Loose association 4) Ideas of reference |
3) Loose association
Word salad is words put together with no meaning Clang association are words that sound alike or rhyme Ideas of reference is the delusional belief that people are talking about them |
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The nurse is providing care for an emaciated client experiencing an acute phase of catatonic stupor. Which nursing intervention would take priority when meeting this client's needs?
1) Minimize attempts to communicate with the client. 2) Assist the client to ambulate. 3) Provide nutrient–dense foods and beverages. 4) Place the patient is seclusion for safety. |
3) Provide nutrient–dense foods and beverages.
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A patient admitted to the psychiatric unit and diagnosed with schizophrenia reports to the nurse that there are people playing drums in his chest. Which of these would be appropriate interventions by the nurse? Select all that apply.
1) Check the patient's vital signs. 2) Tell the patient that these are tactile hallucinations and that he need not be concerned. 3) Ask the patient to describe more completely what he is feeling. 4) Give the patient prn Cogentin as ordered. 5) Encourage the patient to discuss this with the music therapist |
1, 3
Nurse doesn't know what the patient is feeling. He may be having a heart attack or tachycardia |
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A client who is experiencing command hallucinations is hospitalized after jumping from a bridge. The client's parents insist that their son fell rather than jumped. Which of the following likely explain the parents' response? Select all that apply.
1) The parents are in denial about the reality of their son's mental illness. 2) The parents are grieving over the loss of their expectations for their child. 3) The parents do not understand the extent or seriousness of mental illness. 4) The parents reject the idea of their son having a mental illness. 5) The parents are showing support for their son. |
1, 2, 3, 4
5 is the parents protecting themselves not supporting their son |
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The family of a client diagnosed with schizophrenia tells the nurse that they were at a NAMI meeting and heard that the recovery model for intervention with people with schizophrenia is gaining recognition as a desirable approach. They ask the nurse to describe this model. Which of these responses by the nurse are accurate statements about the recovery model? Select all that apply.
1) This model supports that recovery is an obtainable objective for people with schizophrenia. 2) This approach engages the client in an Alcoholics Anonymous (AA)–like 12–step program for recovery. 3) The recovery model actively engages the client in determining the goals for the treatment plan. 4) The recovery model should not be confused with providing a "cure" for schizophrenia. 5) The recovery model is controversial because it stigmatizes the person with schizophrenia. |
1, 3 & 4
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Janice is diagnosed with major depressive disorder and is beginning to participate in a cognitive therapy group. As the nurse is orienting Janice to the group, which of the following statements about cognitive therapy are accurate? Select all that apply.
1) Cognitive therapy is designed to focus on emotional dysregulation. 2) Cognitive distortions, such as negative expectations about oneself, serve as the basis for depression. 3) Cognitive therapy focuses on altering mood by changing the way one thinks. 4) Cognitive distortions arise out of a defect in cognitive development. 5) Cognitive therapy explores pent–up rage that has been turned against oneself because of identification with the loss of a loved object. |
2, 3 & 4
Focuses on cognitive distortions, not emotional dysregulation The concept of rage turned inward is based in psychoanalytical theory, not cognitive theory. |
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A client has a history of major depressive disorder (MDD). Police escort the client to the ED after finding the client nude at an ATM, screaming for money to pay off credit card debt. What would make the ED psychiatrist question the client's prior diagnosis?
1) The client is experiencing symptoms of mania. 2) The client is experiencing symptoms of a severe anxiety disorder. 3) The client is experiencing symptoms of an amnestic disorder. 4) The client is experiencing symptoms of a histrionic personality disorder. |
1) The client is experiencing symptoms of mania.
The criteria for MDD includes one never having had a manic episode |
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The nurse is conducting an assessment for Leroy, a 65–year–old man who presented at the health clinic with complaints of depression. He lists several medications he has been taking. Of the following medications on his list, which are known to produce a depressive syndrome? Select all that apply.
1) Prednisone 2) Cimetidine (Tagamet) 3) Ampicillin 4) Ibuprofen (Advil) 5) Aspirin |
1,2,3 & 4
All but aspirin can cause depression |
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Shelly is a patient on the inpatient psychiatric unit and was diagnosed with major depressive disorder. She is staying in her room and sleeping most of the day. Which of the following approaches by the nurse would best facilitate getting Shelly involved in the occupational therapy group on the unit?
1) "Would you like to go to occupational therapy? It is starting right now." 2) "Let me know what activities you want to be involved in and I'll give you a schedule." 3) "If you don't go to occupational therapy today, you will have to stay in your room for the entire evening." 4) "Occupational therapy is starting in 30 minutes; I'll help you get ready." |
4) "Occupational therapy is starting in 30 minutes; I'll help you get ready."
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Susan is being seen in the emergency department. Her sister brought her in with concern that Susan is depressed and might be suicidal. Which of the following questions are priorities for the nurse to ask when assessing for suicide risk? Select all that apply.
1) "Why are you feeling depressed and suicidal?" 2) "Are you having thoughts of hurting or killing yourself?" 3) "When you have these thoughts, do you have a plan in mind?" 4) "Do you ever feel like you want to hurt someone else?" 5) "Are you currently using any drugs or alcohol?" |
2, 3 & 5
1 is irrelevant 4 is about hurting others, not herself |
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Ursula has sought counseling for persistent depressive disorder. She identifies that she has "always had low self–esteem" and says "I just let people walk all over me." The nurse is providing psycho–educational groups on improving self–esteem. Ursula would likely benefit from education on which of the following topics?
1) Antipsychotic medications 2) Anger management 3) Assertive communication 4) Alcoholics Anonymous groups |
3) Assertive communication
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Cliff has been attending group counseling for depression and has been expressing more hopelessness in the last few days. When the nurse provides the group with a homework assignment to be completed and returned to the group the next day, Cliff responds "I don't need to bother." Which of these responses by the nurse is most appropriate?
1) "Are you having suicidal thoughts?" 2) "Trust me, it will be beneficial." 3) "Why don't you want to cooperate?" 4) "This assignment will help you combat the hopelessness." |
1) "Are you having suicidal thoughts?"
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Bill is a 70–year–old man who is diagnosed with major depressive disorder. He is married and has two adult children who are alcoholics. He currently lives in a rural neighborhood and works part–time at a convenience mart. Which of these demographics is a risk factor for suicide?
1) 70–year–old male 2) Parent of alcoholic children 3) Lives in a rural neighborhood 4) Works part–time |
1) 70–year–old male
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Lamont has been scheduled for electroconvulsive therapy (ECT) and asks the nurse, "Is it true what I heard, that ECT causes brain damage?" Which of these would be the most appropriate, evidence–based response by the nurse?
1) "ECT has no effect on brain function at all." 2) "ECT has only been shown to cause brain damage in the elderly population." 3) "There is no evidence that ECT causes permanent changes in brain structure or function." 4) "Current evidence suggests that brain damage after ECT treatments is related to the anesthetic agents, not the treatment itself." |
3) "There is no evidence that ECT causes permanent changes in brain structure or function."
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Emily has been receiving treatment for major depressive disorder over several weeks. She is taking an antidepressant and attending cognitive behavioral therapy group once a week. When the nurse evaluates her progress in treatment, which of the following are indications that the depression is improving? Select all that apply.
1) Emily is taking the antidepressant medication as ordered. 2) Emily is expressing hope that she can return to her university classes soon and continue her education. 3) Emily demonstrates ability to make decisions concerning her own self–care. 4) Emily reports that suicide ideas have subsided. 5) Emily is engaging in activities that she enjoys. |
2, 3,4 & 5
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A client being treated for depression asks the nurse what causes this illness. Which response by the nurse is the most accurate, evidence–based statement?
1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors." 2) "Depression has been proven to be the result of an imbalance in certain neurotransmitters." 3) "Depression is transmitted by a specific gene for the illness." 4) "Depression has been proven to develop as a result of negative thinking patterns." |
1) "The etiology of depression is unclear. Evidence supports there may be several different causative factors."
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Hannah is being evaluated for postpartum depression after she reported to her family physician that she just doesn't think she can take care of her baby. She expresses fear that God will take her children from her for being a bad mother. Which of the following is the highest priority for the nurse to assess during the initial interview?
1) The number of children Hannah is currently trying to care for. 2) Availability of support systems in Hannah's family. 3) Risks for suicide and/or infanticide. 4) What time of day the symptoms occur. |
3) Risks for suicide and/or infanticide.
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A client has been diagnosed with major depression. The psychiatrist prescribes imipramine (Tofranil). Which of the following medication information should the nurse include in discharge teaching? Select all that apply.
1) "The medication may cause dry mouth." 2) "The medication may cause urinary incontinence." 3) "The medication should not be discontinued abruptly." 4) "The medication may cause photosensitivity." 5) "The medication may cause nausea." |
1, 3, 4 & 5
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Chloe is suffering from depression and not responding to antidepressant treatment. She asks the nurse to tell her more about transcranial magnetic stimulation (TMS). Which of the following responses is accurate with regard to this treatment modality?
1) TMS uses magnetic energy to induce a seizure. 2) One study concluded that electroconvulsive therapy was more effective than TMS for short–term treatment of depression. 3) TMS is a safe and inexpensive treatment for depression. 4) TMS has been demonstrated to be more effective than any other treatment modality for depression. |
2) One study concluded that electroconvulsive therapy was more effective than TMS for short–term treatment of depression.
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Tara experienced the death of a parent 2 years ago. She has not been able to work since the death, cannot look at any of the parent's belongings, and cries daily for hours at a time. Which nursing diagnosis most accurately describes Tara's problem?
1) Post–trauma syndrome R/T parent's death. 2) Anxiety R/T parent's death. 3) Coping, ineffective, R/T parent's death. 4) Grieving, complicated, R/T parent's death. |
4) Grieving, complicated, R/T parent's death.
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A client is being treated with sertraline (Zoloft) for major depression. The client tells the nurse, "I've been taking this drug for only a week, but I'm sleeping better and my appetite has improved." Which is the most appropriate response by the nurse?
1) "It will take a minimum of 3 to 4 weeks for therapeutic effects to occur." 2) "Sleep disturbances and appetite problems are not affected by Zoloft." 3) "A change in your environment and activity is the reason for this improvement." 4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week." |
4) "The initiation of Zoloft therapy can improve insomnia and appetite within 1 week."
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When teaching about the tricyclic group of antidepressant medications, which information should the nurse include?
1) Strong or aged cheese should not be eaten while the client is taking this group of medications. 2) The full therapeutic potential of tricyclics may not be reached for 4 weeks. 3) Tricyclics may cause hypomania or recent memory impairment. 4) Tricyclics should not be given with antianxiety agents. |
2) The full therapeutic potential of tricyclics may not be reached for 4 weeks.
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The physician orders fluoxetine (Prozac) for a client diagnosed with depression. Which information is true about this medication?
1) Prozac is a tricyclic antidepressant. 2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun. 3) Aged cheese, yogurt, soy sauce, and bananas should not be eaten while the client is taking this drug. 4) Prozac may be administered in combination with monoamine oxidase inhibitors (MAOIs). |
2) The therapeutic effect of Prozac occurs 2 to 4 weeks after treatment is begun.
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A client is prescribed citalopram (Celexa), 20 mg daily. Available are six 10–mg tablets. This medication will supply the client with the necessary dosage for ________ days.
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Three
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A client diagnosed with major depression is being discharged from the hospital with a prescription for fluoxetine (Prozac). The nurse's discharge teaching should include which of the following? Select all that apply.
1) "It may take a few weeks before you begin to feel better; however, continue taking Prozac as prescribed." 2) "Make sure that you follow up with scheduled outpatient psychotherapy." 3) "If significant mood elevation is noted, your psychiatrist may discontinue this medication within 6 months to a year." 4) "You should avoid foods with tyramine, including beer, beans, processed meats, and red wine." 5) "You can discontinue the Prozac when you are feeling better." |
1, 2, & 3
Foods with tyramine should be avoided with MAO inhibitors Prozac should not be discontinued abruptly |
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Harold is admitted to the psychiatric unit with bipolar I disorder: manic episode in a highly agitated state. His speech is rapid and incoherent, he is pacing and in constant motion, and he is loudly proclaiming that his "lawyers are on the way and every one of you is going to be sued for malpractice." Which of the following nursing interventions are appropriate in this situation? Select all that apply.
1) Provide an environment with low levels of stimulation. 2) Set limits on Harold's threats by instructing him that he is not permitted to sue the staff. 3) Convey a calm attitude and voice when communicating with Harold. 4) Put Harold in seclusion with restraints for the protection of himself and others. 5) Offer activities that will provide safe outlets for Harold's agitation and excessive energy. |
1, 3, & 5
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Barbara asks to speak to the nurse about her husband, who has been diagnosed with bipolar I disorder. She tells the nurse she is thinking of divorcing her husband because his agitation "comes out of nowhere" and is "impossible to manage." She also admits to being "fed up with his extramarital affairs" and says "I just don't know what to say anymore." The nurse recognizes that family psychoeducational treatment is important in improving adjustment and preventing relapses. Which of the following are components of family psychoeducational treatment that will be beneficial to Barbara on the basis of her expressed concerns? Select all that apply.
1) Problem–solving skills training 2) Communication training 3) Education about the illness 4) Codependency education 5) Divorce training |
1, 2, & 3
She does not seem to be displaying codependency behaviors or mentioning them and divorce training is out of the scope of psychoeducational treatment |
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A client demonstrating manic behavior has become demanding and hyperactive. Which is the most appropriate nursing intervention to address these client behaviors?
1) Help lessen the client's feelings of guilt and rejection. 2) Warn the client that restraints may be necessary if behavior does not improve. 3) Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner. 4) Introduce the client to peers in order to increase interpersonal contacts. |
3) Maintain a supportive, structured environment, setting firm limits in a nonthreatening manner.
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A client diagnosed with bipolar disorder is experiencing hyperactive behavior and weight loss. Which nutritional intervention would be most therapeutic for this client?
1) Allow the client full kitchen privileges to eat anything as needed (prn). 2) Initiate tube feedings with nutritional supplements. 3) Provide small, frequent feedings of finger foods. 4) Provide a quiet place where the client can sit down to eat meals. |
3) Provide small, frequent feedings of finger foods.
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To assist the psychiatrist in determining appropriate medication needs, the nurse has been asked to assess whether a patient is in a hypomanic or an acute manic state. Which of the following symptoms are consistent with hypomania? Select all that apply.
1) Cheerful mood, but underlying irritability surfaces rapidly when needs are not fulfilled 2) Fragmented cognition and perception; often psychotic 3) Delusions of grandeur 4) Easily distracted, which sometimes interferes with completing goal–directed activity 5) Extroverted and sociable |
1, 4 & 5
psychosis and delusions of grandeur are symptoms of acute mania |
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Cameron, who has been treated with lithium for several months, was recently placed on sodium–depleting diuretics by his family physician. He now presents in the ER with tremors, psychomotor retardation, confusion, and giddiness. What is the most likely reason for his symptoms?
1) Cameron's lithium level has dropped R/T sodium depletion and he is experiencing a return of manic symptoms. 2) Cameron is experiencing extrapyramidal symptoms R/T a drug:drug interaction. 3) Cameron is experiencing lithium toxicity R/T sodium depletion. 4) Cameron is experiencing psychosis R/T lithium toxicity. |
3) Cameron is experiencing lithium toxicity R/T sodium depletion.
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The psychiatrist has asked the nurse to make an assessment of how well Aaron is responding to the lithium he is being prescribed. Which of the following observations by the nurse suggest that Aaron's manic episode is subsiding? Select all that apply.
1) Aaron is able to finish his meals seated at a table. 2) Aaron is sleeping an average of six hours per night. 3) Aaron demonstrates an ability to listen and respond appropriately to questions. 4) Aaron complains of feeling less energetic and creative. 5) Aaron states he doesn't want to keep taking lithium. |
1, 2, 3 & 4
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Elizabeth has been taking lithium for 4 weeks and complains that she thinks she might have lithium toxicity. Which of these findings by the nurse are consistent with lithium toxicity? Select all that apply.
1) Elizabeth has had very little urine output in the last 24 hours. 2) Elizabeth has had several bouts of diarrhea in the last 24 hours. 3) Elizabeth's lithium level is 1.2 mEq/L. 4) Elizabeth's temperature is 99.6°F. 5) Elizabeth complains of less energy since she started taking lithium. |
2) Elizabeth has had several bouts of diarrhea in the last 24 hours.
Excessive urine output, not scant, is a characteristic of lithium toxicity The therapeutic level of lithium is up to 1.5 Elevated temperature is not a symptom of lithium toxicity. Less energy is a side effect of lithium, not a symptom of lithium toxicity |
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The parents of a teenage son who was recently diagnosed with bipolar disorder ask the nurse to provide them with information about this illness, since they had previously been told their son had ADHD. Which of the following is evidence–based information that can be shared with the family? Select all that apply.
1) ADHD is the most common comorbid condition in children and adolescents with bipolar disorder. 2) Bipolar disorder in children and adolescents is an acute condition that they usually outgrow. 3) There is evidence to support that psychosocial therapy enhances the effectiveness of pharmacological therapy in treatment of bipolar disorder in children and adolescents. 4) Stimulants used in the treatment of ADHD can exacerbate mania in children and adolescents with bipolar disorder. 5) Medication discontinuation can be considered after the patient has been in remission for two months. |
1, 3, & 4
Bipolar is not outgrown Medication discontinuation can be considered after the patient has been in remission for 12 to 24 months |
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A client diagnosed with bipolar disorder has been hospitalized for 2 weeks. The client asks the nurse, "Do you think that the doctor is ever going to discharge me?" Which is the appropriate nursing response?
1) "Ask your doctor when you can be discharged." 2) "Tell me more about your feelings about being hospitalized." 3) "You are not ready to go yet." 4) "Let the doctor know your feelings." |
2) "Tell me more about your feelings about being hospitalized."
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The wife of a patient being treated with lithium for bipolar disorder states to the nurse, "My husband has been on lithium for 3 days and he's still as manic as ever." Which of the following is important for the nurse to include in patient/family education about lithium?
1) Lithium prevents relapse into depression but has no direct effects on manic episodes. 2) Lithium takes up to 3 weeks to reach peak effectiveness. 3) Lithium is a neurotransmitter that can trigger mania in some individuals. 4) Lithium can be rendered ineffective if the patient restricts sodium intake. |
2) Lithium takes up to 3 weeks to reach peak effectiveness.
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Donald's wife asks the nurse why her husband has been ordered an anticonvulsant when he's never had a seizure and his real problem is bipolar disorder. Which of these teaching points by the nurse are accurate? Select all that apply.
1) The mechanism of action for anticonvulsants in bipolar disorder is unclear. 2) Anticonvulsants are used to prevent seizures that may be an undesired effect of other medications the patient is taking. 3) Anticonvulsants have demonstrated mood stabilizing effects in patients with bipolar disorder. 4) The FDA does require that antiepileptic medications carry a warning label indicating an increased risk for suicidal thoughts and behavior. 5) Anticonvulsants are prescribed to prevent alcohol withdrawal, which is common in patients with bipolar disorder. |
1, 3, & 4
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Tori has been diagnosed with bipolar I disorder and presents at her clinic appointment with complaints of feeling depressed and hopeless. What is the most important assessment for the nurse to make at this point?
1) If Tori has been taking her medication 2) If Tori is having thoughts of suicide 3) If Tori has had any new stressors in her life 4) If Tori is using alcohol |
2) If Tori is having thoughts of suicide
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A client is diagnosed with bipolar disorder. Which medication is the drug of choice for this diagnosis?
1) Risperidone (Risperdal) 2) Clozapine (Clozaril) 3) Lorazepam (Ativan) 4) Lithium carbonate (Eskalith) |
4) Lithium carbonate (Eskalith)
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A client newly diagnosed in a manic episode of bipolar disorder tells the nurse, "Now that I'm only sleeping 4 hours a night, I can get so much more work accomplished." Which ego defense mechanism is this client using?
1) Denial 2) Intellectualization 3) Rationalization 4) Suppression |
2) Intellectualization
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The activity therapist is planning an individualized program for a client diagnosed with bipolar I disorder: manic episode who is exhibiting hostility and excessive energy. Which activity would be most appropriate?
1) Writing memoirs 2) Team sports 3) Ping–pong 4) Walking |
4) Walking
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A patient arrives in the emergency department with impaired consciousness, nystagmus, and seizures. It is determined that he is suffering from lithium toxicity. With these symptoms, his lithium level would be expected to be above___________mEq/L.
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3.5
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Sophie is admitted to an inpatient psychiatric unit in an acute manic episode. She is morbidly obese and believes she is a famous ballerina. She repeatedly runs from one end of the unit to the other and attempts to twirl around while standing on chairs in the patient lounge. She is prescribed temazepam (Restoril) for sleep, and since her admission she has generally slept for five to six hours each night. What should the nurse consider to be the priority nursing diagnosis?
1) Risk for Injury related to excessive hyperactivity. 2) Disturbed Sleep Pattern related to manic hyperactivity. 3) Imbalanced Nutrition, Less than Body Requirements, related to inadequate intake. 4) Situational Low Self–esteem related to embarrassment secondary to high–risk behaviors. |
1) Risk for Injury related to excessive hyperactivity.
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The physician has ordered lithium carbonate (Eskalith) for a client diagnosed with bipolar disorder. What is the most likely rationale for prescribing this drug?
1) Decrease hyperactivity 2) Control anger 3) Elevate the mood 4) Diminish anxiety |
1) Decrease hyperactivity
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Kelly has come to the mental health clinic for an assessment at the request of her husband. Kelly refuses to talk to the nurse until her personal assistant arrives. She states, "Apparently you don't know that I'm a famous person, and when my fans get here, you'll be glad my personal assistant is here to manage the crowd." The nurse meets with the husband to begin the assessment process. Which of the following observations by the husband are consistent with symptoms of a manic episode? Select all that apply.
1) "She has concocted this story about having a personal assistant and being a famous person; none of it is true." 2) "She has over–extended our credit cards, buying huge quantities of unnecessary items." 3) "Ever since we married, she has had periods where she makes superficial cuts on her wrists and becomes convinced I'm going to divorce her." 4) "I've noticed her behaving in a very provocative manner around other men." 5) "When we go to a party she drinks more alcohol than anyone there and inevitably becomes loud and obnoxious." |
1, 2 & 4
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A client who is prescribed lithium carbonate is being discharged from inpatient care. Which medication information should the nurse teach this client?
1) "Do not alter your dietary sodium intake." 2) "Have serum lithium levels checked every 6 months." 3) "Limit fluid intake to 1,000 mL per day." 4) "Adjust the dose if you feel out of control." |
1) "Do not alter your dietary sodium intake."
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A client is diagnosed with bipolar disorder. The family describes the client as being "on the move." The client sleeps 3 to 4 hours nightly, spends excessively, and has recently lost 10 pounds. During the initial client assessment, which client response would the nurse expect?
1) Short, polite responses to interview questions. 2) Introspection related to present situation. 3) Inability to remain seated and racing thoughts. 4) Feelings of helplessness and hopelessness. |
3) Inability to remain seated and racing thoughts.
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A suicidal client with a history of manic behavior is admitted to the ED. The client's diagnosis is documented as "bipolar I disorder: depressed." What is the rationale for this diagnosis versus a diagnosis of major depressive disorder?
1) The physician does not believe the client is suffering from major depression. 2) The client has experienced a manic episode in the past. 3) The client does not exhibit psychotic symptoms. 4) There is no history of major depression in the client's family. |
2) The client has experienced a manic episode in the past.
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A patient being treated with lamotrigine (Lamictal) develops a purplish skin rash that is blistering. This is a rare but potentially life–threatening reaction to the medication known as___________ syndrome.
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Steven's–Johnson
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Haley is a 35–year–old woman being assessed for complaints of racing thoughts, impulsive agitation, and distractibility. She denies having ever been diagnosed with a mental disorder. Which of the following items are important for the nurse to include in Haley's initial assessment to assist in identifying the correct diagnosis? Select all that apply.
1) Family history of thyroid disorders 2) Family history of depression or bipolar disorders 3) Medications and other substances currently being taken 4) Birth order 5) Interest in attending group therapy |
1, 2, & 3
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Name the anxiolytics |
Chlordiazepoxide (Librium) Clonazepam (Klonopin) Lorazepam (Ativan) Alpralozam (Xanax) Diazepam (Valium) (CCLAD - getting nervous, you sweat and take your jacket off) |
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What are the indications for the anxiolytics, or minor tranquilizers? |
* Anxiety disorders or symptoms * Acute alcohol withdrawal * skeletal muscle spasms * convulsive disorders * status epilipticus * pre-op sedation |
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What classification are most anxiolytics? |
Benzodiazepines |
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Name a common anxiolytic that is not a benzodiazepine. |
BuSpar (Buspirone) |
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What are some common side effects of benzodiazepines (most anxiolytics)? |
* drowsiness * dry mouth * N/V * Dependence * Tolerance |
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What are the nursing implications for benzodiazepines (most anxiolytics)? |
* Instruct the client not to drive while taking * Because of tolerance and dependence, if on long term therapy - do not discontinue abruptly * Other CNS depressants will potentiate - do not drink alcohol or other CNS depressant meds * Orthostatic hypotension - get up slowly * Blood dyscrasias can happen - fever or sore throat should be reported to MD ASAP * Decreased effects are noted with cigarette smoking and caffeine consumption |
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What are the nursing implications for BuSpar? |
They take 10 to 14 days to have the therapeutic affects - not a PRN med |
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What action does the anxiolytics perform? |
* bind to the benzo receptor site on the GABA receptor complex * increases receptor affinity for GABA |
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What are the classes of antidepressants? |
* Tricyclics * SSRIs * MAO Inhibitors * Heterocyclics * SNRIs |
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Name some Tricyclics |
* Amitriptyline * Amoxapine * Clomipramine (Anafranil) * Imipramine (Tofranil) * Desipramine (Norpramin) (incomplete list) |
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Name some SSRIs. |
* Fluoxetine (Prozac) * Paroxetine (Paxil) * Sertraline (Zoloft) * Citalopram (Celexa) * Fluvoxamine (Luvox) (incomplete list) |
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Name the MAO inhibitors. |
* Isocarboxazid (Marplan) * Phenelzine (Nardil) * Tranylcypromine (Parnate) * Selegiline TransdermalSystem (Emsam) (complete list from text) The low tyramine diet is the PITS!! |
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Name the heterocyclics. |
* Bupropion (Wellbutrin) * Maprotiline * Mirtazapine (Remeron) * Nefazodone * Trazadone (complete list from text) |
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Name the SNRIs |
* Levomilnacipran (Fetzima) * Desvenlafaxine (Pristiq) * Duloxetine (Cymbalta) * Venlafaxine (Effexor) (complete list from text) |
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What are the indications for antidepressants? |
* Major Depressive Disorder * Dysthymia * Major Depression with melancholia or psychotic symptoms * Depression associated with organic disease, Alcoholism, Schizophrenia or intellectual disability * Depressive phase of bipolar * Depression accompanied by anxiety |
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What action do antidepressants take? |
* increase the concentration of norepinephrine, serotonin, and/or dopamine by blocking the reuptake of the neurotransmitters or by inhibiting an enzyme that is known to inactivate norepinephrine, serotonin and dopamine (MAO inhibitors) |
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What contraindications are there for antidepressants? |
* All antidepressants are subject to an increased risk of suicidal ideation. A sudden lift in mood should be monitored * All antidepressants should not be taken with MAOIs * Antidepressants should be administered with caution to the elderly and those with renal, hepatic or cardiac insufficiency |
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What is unique about MAO inhibitors? |
A low tyramine diet is necessary to avoid a hypertensive crisis. No cheese, deli meat, wine, soy sauce, among others. |
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What are the side effects of all antidepressants? |
* Dry mouth (xerostomia) * Sedation * Nausea * Discontinuation syndrome |
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What are the side effects of tricyclics and heterocyclics? |
* Blurred vision * Constipation * Urinary retention * Orthostatic hypotension * reduction of seizure threshold * tachycardia or arrhythmias * photosensitivity * weight gain |
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What are the side effects of SSRIs and SNRIs? |
* Insomnia / agitation * Headache * Weight loss * Sexual dysfunction * Serotonin syndrome (may occur when two drugs that potentiate serotonergic neurotransmission are used concurrently) |
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What are the side effects of MAO inhibitors? |
* Hypertensive Crisis * Priapism * Hepatic Failure |
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What are the nursing implications for antidepressants? |
Educate patient on; * Do not stop meds abruptly * Move slowly when rising * If an erection occurs longer than 1 hr seek medical attention * Protect from the sun * Eat healthy * Watch for signs of hepatic failure * Avoid alcohol * Do not take OTC meds without MD's approval * High fever - seek medical attention ASAP |
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What are the signs of serotonin syndrome? |
* Agitation or restlessness * Confusion * Rapid heart rate and high blood pressure * Dilated pupils * Loss of muscle coordination or twitching muscles * Muscle rigidity * Heavy sweating * Diarrhea * Headache * Shivering/ Goose bumps |
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Name the mood-stabilizing agents. |
* Lithium carbonate(Eskalith, Lithobid) * Carbamazepine(Tegretol) - anticonvulsant * Clonazepam(Klonopin) - anticonvulsant * Valproic acid(Depakene;Depakote) - anticonvulsant * Topiramate(Topamax) - anticonvulsant * Oxcarbazepine(Trileptal) - anticonvulsant * Verapamil(Calan, Isoptin) - antihypertensive * Olanzapine(Zyprexa) - antipsychotic * Aripiprazole(Abilify) * Chlorpromazine (Thorazine) * Quetiapine(Seroquel) * Risperidone(Risperdal) (not a complete list) |
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What are the indications for mood-stabilizing agents? |
* Prevention and treatment of manic episodes of bipolar disorder * Alcohol Dependence * Bulimia * Management of alcohol withdrawal * Acute manic episodes * Adjunct therapy in schizophrenia * Binge eating disorder * Weight loss in obesity * OCD (not a complete list) |
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What are the actions of mood-stabilizing agents? |
May modulate the effects of various neurotransmitters such as norepinephrine, serotonin,dopamine, glutamate, and GABA that are thought to play a role in the symptomatology of bipolar disorder (may take1–3 weeks for symptoms to subside). Not totally clear |
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What are the precautions for Lithium? |
* No caffeine * stable amount of sodium daily (alert MD is vomiting or diarrhea occur) * Carry a card alert that lithium is being taken * Do not discontinue med * Do not drive or operate heavy machinery * Be aware of symptoms of toxicity - alert MD if; - ataxia, blurred vision,tinnitus, excessive output of urine, increasing tremors, or mental confusion * Have serum levels checked every 1-2 months |
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What are the precautions for anticonvulsants? |
* do not discontinue meds * do not drive or operate heavy machinery * do not drink alcohol or take other meds without MD notification * carry a card that IDs meds taken * Report the following symptoms to the MD immediately: skin rash, unusual bleeding, spontaneous bruising, sore throat, fever, malaise, dark urine, and yellow skin or eyes. |
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What are the precautions for calcium channel blockers? |
* take meds with meals if GI upset occurs * use caution driving or operating heavy machinery * do not discontinue meds * Report these symptoms to MD immediately: irregular heartbeat,shortness of breath, swelling of the hands and feet,pronounced dizziness, chest pain, profound mood swings, or severe and persistent headache. * rise slowly * avoid other meds without MD approval * carry a card alerting meds being taken |
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What are the indications for antipsychotics? |
* treatment of schizophrenia and other psychotic disorders * some used for bipolar * some as antiemetics (thorazine) * intractable hiccoughs * control of tics and vocal utterances such as in Tourette's (pimozide, haldol) |
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What is the action of typical antipsychotics? |
* blocking postsynaptic dopamine receptors in the basal ganglia, hypothalamus, limbic system, brainstem, and medulla. * demonstrate varying affinity for cholinergic, alpha1-adrenergic, and histaminic receptors. * may also be related to inhibition of dopamine-mediated transmission of neural impulses at the synapses. |
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What is the action of atypical antipsychotics? |
* are weaker dopamine receptor antagonists than the conventional antipsychotics,but are more potent antagonists of the serotonin type 2A (5HT2A) receptors. * exhibit antagonism for cholinergic, histaminic, and adrenergic receptors. |
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Who should not take antipsychotics? |
* Those with known hypersensitivity * comatose or CNS depressed patients * those with blood dyscrasias * those with Parkinson's * Those with narrow-angle Glaucoma * Those with liver, renal or cardiac insufficiency * Those with poorly controlled seizure disorder * Those on meds that affect the QT interval * Elderly with psychosis from an NCD |
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What are the interactions of antipsychotics? |
* additive hypotensive effects when taken with antihypertensives * additive CNS effects with taken with CNS depressants * additive anticholinergic effects with other drugs with anticholinergic properties * additive effects that prolong QT interval when taken with other drugs that prolong QT interval * Increased effects of some other drugs and decreased effects of other drugs |
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What is dystonia? |
When the sternocleidomastoid muscle freezes up and causes the patient to turn their head to the side. Is dangerous for swallowing pills - could choke. Is caused by antipsychotic meds. |
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What are the side effects of antipsychotic drugs? |
* Extrapyramidal symptoms (EPS) such as; - Dystonia or ocular gyrate crisis (neck or eyes) - Pseudoparkinsonism - shuffling - Akathesia - restless leg movement (Thorazine shuffle) - Tardive Dyskinesia (permanent!) * Agranulocytosis (shown by drop in WBCs) - may appear to be a cold (fever!) * Neuroleptic Malignant Syndrome |
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What are antiparkinsonian agents? |
Drugs used for the treatment of parkinsonism of various causesand drug-induced extrapyramidalreactions. * Benztropine (Cogentin) * Diphenhydromine (Benedryl) * trihexyphenidyl (artane) |
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What is the action of antiparkinsonian agents? |
Works to restore the natural balance of acetylcholineand dopamine in the CNS |
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What is the planning/ implementation of antiparkinsonian agents? |
Monitor client for; * Nausea * GI upset * sedation * dizziness * exacerbation of psychoses * orthostatic hypotension |
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What is Neuroleptic Malignant Syndrome? |
Symptoms include severe parkinsonian muscle rigidity, very high fever, tachycardia, tachypnea, fluctuations in blood pressure, diaphoresis, and rapid deterioration of mental status to stupor and coma |
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What are the sedative-hypnotics? |
* Barbiturates * Benzodiazepines * Misc. (Lunesta, Ambien, Sonata and Ramelteon) - Ramelteon is not a controlled substance and does not produce tolerance or physical dependence) |
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What are the barbiturates? |
* Anything *barbtital * Amobarbital * Butabarbital (Butisol) * Pentobarbital (Nembutal) * Phenobarbital (Luminal,Solfoton) * Secobarbital (Seconal) |
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What is the action of the sedative-hypnotics? |
Depression of the CNS |
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Name some typical antipsychotics. |
* Chlorpromazine (Thorazine) * Haloperidol (Haldol) * Pimozide (Orap) |
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Name some atypical antipsychotics. |
* Aripiprazole (Abilify) * Clozapine (Clozaril) * Olanzapine (Zyprexa) * Quetiapine (Seroquel) * Risperidone (Risperdal) |
