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Mental Health unit 3
| Question | Answer |
|---|---|
| When working with a client with a narcissistic personality disorder, the nurse would use which approach? | Matter-of-fact |
| Which underlying emotion is commonly seen in an avoidant personality disorder | Fear |
| Cognitive restructuring techniques include all of the following, except | relaxation |
| Transient psychotic symptoms that occur with borderline personality disorder are most likely treated with which type of drug? | Antipsychotics |
| Clients with a schizotypal personality disorder are most likely to benefit from which nursing action? | Improving community functioning |
| When interviewing any client with a personality disorder, the nurse would assess for which? | Disruption in some aspects of their life |
| The nurse would assess for which characteristics in a client with narcissistic personality disorder? | Entitlement |
| The most important short-term goal for the client who tries to manipulate others would be to | Acknowledge own behavior |
| When working with a client with a personality disorder, the nurse would expect to assess which? | Impaired interpersonal relationships Inability to empathize with others Minimal insight |
| The nurse working with a client with antisocial personality disorder would expect which behaviors? | Exploitation of other clients Seeking special privileges Superficial friendliness toward others |
| The nurse is caring for a client with a functional neurological symptom disorder. Which finding will the nurse expect during assessment? | Indifference about the physical symptom |
| Which statement would indicate that teaching about somatic symptom disorder has been effective? | “I will feel better when I begin handling stress more effectively.” |
| Paroxetine (Paxil) has been prescribed for a client with a somatic symptom illness. The nurse instructs the client to watch out for which side effect? | Nausea |
| Emotion-focused coping strategies are designed to accomplish which outcome? | Helping the client manage the intensity of symptoms |
| Which is true about clients with illness anxiety disorder? | They may interpret normal body sensations as signs of disease. |
| The client’s family asks the nurse, “What is illness anxiety disorder?” The best response by the nurse is “Illness anxiety disorder is | A persistent preoccupation with getting a serious disease.” |
| A client with somatic symptom disorder has been attending group therapy. Which statement indicates therapy is having a positive outcome for this client? | “I feel better physically just from getting a chance to talk.” |
| A client who developed numbness in the right hand could not play the piano at a scheduled recital. The consequence of the symptom, not having to perform, is best described as | Primary gain |
| When planning care for a client with somatic symptom disorder, the nurse would include which action(s)? | Encourage the client to participate in daily routine activities. Help the client see the relationship between physical symptoms and life stress/events. Validate the client’s physical and emotional distress. |
| The nurse understands that secondary gain for the client with a somatic symptom illness can include | acceptable absence from work. freedom from daily chores. increased attention from family. provision of care by others. |
| A male client is increasingly upset. He is rapidly pacing, hyperventilating, clenching his jaw, wringing his hands, and trembling. He is preoccupied with his thoughts. He is pounding his fist into his other hand. The nurse identifies his anxiety level as | severe |
| When assessing a client with anxiety, the nurse’s questions should be | specific and direct |
| The best goal for a client learning a relaxation technique is that the client will | Experience anxiety without feeling overwhelmed |
| Which of the four classes of medications used for panic disorder is considered the safest because of low incidence of side effects and lack of physiological dependence? | SSRIs |
| Which would be the best intervention for a client having a panic attack? | Remain with the client |
| A client with GAD states, “I have learned that the best thing I can do is to forget my worries.” How would the nurse evaluate this statement? | The client needs encouragement to verbalize feelings |
| A client with anxiety is beginning treatment with lorazepam (Ativan). It is most important for the nurse to assess the client’s | use of alcohol |
| Actions for a client with panic disorder would include | encouraging the client to verbalize feelings. reminding the client to practice relaxation when anxiety level is low. teaching the client reframing techniques. teaching relaxation exercises to the client. |
| When working with a client with moderate anxiety, the nurse would expect to see | increased automatisms or gestures. narrowed perceptual field. selective attention. inability to connect thoughts independently. |
| The family of a client with schizophrenia asks the nurse about the difference between conventional and atypical antipsychotic medications. The nurse’s best answer may include which information? | Atypical antipsychotics are dopamine and serotonin antagonists; conventional antipsychotics are only dopamine antagonists. |
| The nurse is planning discharge teaching for a client taking clozapine (Clozaril). Which teaching is essential to include? | Remind the client to go to the lab to have blood drawn for a white blood cell count. |
| The nurse is caring for a client who has been taking fluphenazine (Prolixin) for 2 days. The client suddenly cries out, his neck twists to one side, and his eyes appear to roll back in the sockets. Which PRN medication should the nurse administer? | Diphenhydramine (Benadryl), 25 mg IM, PRN |
| Which of the following statements would indicate family teaching about schizophrenia had been effective? | “It’s a relief to find out that we did not cause our son’s schizophrenia.” |
| When the client describes fear of leaving their apartment as well as the desire to get out and meet others, it is called | Ambivalence. |
| The client who hesitates 30 seconds before responding to any question is described as having | latency of response |
| The overall goal of psychiatric rehabilitation is for the client to gain | recovery from the illness |
| A teaching plan for the client taking an antipsychotic medication will include which instructions? | Apply sunscreen before going outdoors. Drink sugar-free beverages for dry mouth. Rise slowly from a sitting position |
| Which of the following are considered to be positive signs of schizophrenia? | Delusions Hallucinations Disorganized thinking |
| The nurse observes that a client with bipolar disorder is pacing in the hall, talking loudly and rapidly, and using elaborate hand gestures. The nurse concludes that the client is demonstrating which? | Psychomotor agitation |
| A client with bipolar disorder begins taking lithium carbonate (lithium) 300 mg four times a day. After 3 days of therapy, the client says, “My hands are shaking.” Which is the best response by the nurse? | “Fine motor tremors are an early effect of lithium therapy that usually subsides in a few weeks.” |
| What are the most common types of side effects from SSRIs? | Dizziness, drowsiness, and dry mouth |
| The nurse observes that a client with depression sat at a table with two other clients during lunch. Which is the best feedback the nurse could give the client? | “I see you were sitting with others at lunch today.” |
| Which term typifies the speech of a person in the acute phase of mania? | Flight of ideas |
| What is the rationale for a person taking lithium to have enough water and salt in their diet? | Lithium is a salt that has a greater affinity for receptor sites than sodium chloride. |
| Identify the serum lithium level for maintenance and safety. | 0.5 to 1.5 mEq/L |
| A client says to the nurse, “You are the best nurse I’ve ever met. I want you to remember me.” What is an appropriate response by the nurse? | “Are you thinking of suicide?” |
| A client with mania begins dancing around the day room. She flashed the male clients, and showed she had no underwear on. The nurse distracts her and takes her to her room to put on underwear. The nurse acted as they did to | Minimize the client’s embarrassment about her present behavior. |
| Which actions would indicate an increased suicidal risk? | An abrupt improvement in mood Calling family members to make amends Statements such as “Everything will be better soon” |
| Which activities would be appropriate for a client with mania? | Drawing a picture Modeling clay Stretching exercises |
| Treating clients with anorexia nervosa with a selective serotonin reuptake inhibitor antidepressant such as fluoxetine (Prozac) may present which problem? | Fluoxetine can cause appetite suppression and weight loss. |
| Which is an example of a cognitive–behavioral technique? | Self-monitoring |
| The nurse is working with a client with anorexia nervosa. Even though the client has been eating all the meals and snacks, their weight has remained unchanged for 1 week. Which intervention is indicated? | Supervise the client closely for 2 hours after meals and snacks. |
| KNOW | Cultures in which beauty is linked to thinness have an increased risk for eating disorders. |
| Which is not a goal for treating the severely malnourished client with anorexia nervosa? | Correction of body image disturbance |
| The nurse is evaluating the progress of a client with bulimia. Which behavior would indicate that the client is making positive progress? | The client identifies healthy ways of coping with anxiety. |
| A teenager is being evaluated for an eating disorder. Which finding would suggest anorexia nervosa? | Unrealistic perception of body size |
| A client with bulimia is learning to use the technique of self-monitoring. Which intervention by the nurse would be most beneficial for this client? | Ask the client to write about all feelings and experiences related to food. |
| A nurse doing an assessment with a client with anorexia nervosa would expect which findings? | Belief that dieting behavior is not a problem History of dieting at a young age Performance of rituals or compulsive behavior View of self as overweight or obese |
| A nurse doing an assessment with a client with bulimia would expect which findings? | Dissatisfaction with body shape and size Feelings of guilt and shame about eating behavior Near-normal body weight for height and age Strong desire to please others |
| is characterized by one or more physical symptoms that have no organic basis. | Somatic symptom disorder |
| involves unexplained, usually sudden deficits in sensory or motor function (e.g., blindness, paralysis). | Functional neurological symptom disorder These deficits suggest a neurologic disorder but are associated with psychological factor There may be an attitude of, a seeming lack of concern or distress, about the functional loss. |
| has the primary physical symptom of pain, which is generally UNRELIEVED by analgesics and greatly affected by psychological factors in terms of onset, severity, exacerbation, and maintenance. | Pain disorder |
| is preoccupation with the fear that one has a serious disease (disease conviction) or will get a serious disease (disease phobia). It is thought that clients with this disorder misinterpret bodily sensations or functions. | Illness anxiety disorder, formerly hypochondriasis, |
| Somatic symptom illnesses are more common in | women |
| is the intentional production of false or grossly exaggerated physical or psychological symptoms | Malingering People who malinger have no real physical symptoms or grossly exaggerate relatively minor symptoms |
| occurs when a person intentionally produces or feigns physical or psychological symptoms solely to gain attention. | Factitious disorder, imposed on self |
| occurs when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a “hero” for saving the victim | factitious disorder, imposed on others |
| Cluster A—odd or eccentric behaviors | Paranoid personality disorder Schizoid personality disorder Schizotypal personality disorder |
| Cluster B—erratic or dramatic behaviors | Antisocial personality disorder Borderline personality disorder Histrionic personality disorder Narcissistic personality disorder |
| Cluster C—anxious or fearful behaviors | Avoidant personality disorder Dependent personality disorder Obsessive personality disorder |
| is characterized by a negative attitude and a pervasive pattern of passive resistance to demands for adequate social and occupational performance. | Passive-aggressive behavior |
| Clients with personality disorders have a higher death rate, especially as a result of suicide | know |
| The four temperament traits are | harm avoidance, novelty seeking, reward dependence, and persistence |
| People with high harm avoidance exhibit | fear of uncertainty, social inhibition, shyness with strangers, rapid fatigability, and pessimistic worry in anticipation of problems. Those with low harm avoidance are carefree, energetic, outgoing, and optimistic |
| A high novelty-seeking temperament results in someone who is | is quick-tempered, curious, easily bored, impulsive, extravagant, and disorderly. They may be easily bored and distracted with daily life, prone to angry outbursts, and fickle in relationship |
| Reward dependence defines how | a person responds to social cues. People high in reward dependence are tenderhearted, sensitive, sociable |
| Three major character traits have been distinguished: | self-directedness, cooperativeness, and self-transcendence. |
| Detached from social relationships; restricted affect; involved with things more than people | Schizoid |
| Acute discomfort in relationships; cognitive or perceptual distortions; eccentric behavior | Schizotypal |
| Excessive emotionality and attention seeking | Histrionic |
| An anxiolytic agent, lorazepam, has been prescribed for the client. Which of the following statements by the client would indicate to the nurse that client education about this medication has been effective? | "This medication will relax me, so I can focus on problem solving." |
| A client is seeking relief for undiagnosed pain. The client was laid off four months ago from her job. The nurse's assessment is unremarkable. Which statement made by the client would most strongly suggest a somatoform disorder? | "I seem to have more pain now that I got laid off." |
| A client is seen in the primary care clinic reporting headaches. The client appears extremely distressed and insists that she must have a brain tumor. Which mental health diagnosis is most probable for this client? | Illness anxiety disorder |
| A client with recurrent headaches has been told the cause is likely psychosomatic. The client says to the nurse, "That just can't be true! My head hurts so bad sometimes that it makes me sick to my stomach." Which is the nurse's best response? | "The pain in your head is very real" |
| A client with somatic symptom illness tells the nurse that she is sick so often that her husband and children take over most of the household duties, such as cooking, cleaning, doing laundry, and so forth. Which is this evidence of? | Secondary gain |
| A client goes to the physician with hip pain. The friend that brought him tells the nurse that the client's intention is to fake chronic hip pain to apply for disability benefits from the government. Which best reflects the client's potential diagnosis? | Malingering |
| Which of the following terms is applicable when a person inflicts illness or injury on someone else to gain the attention of emergency medical personnel or to be a "hero" for saving the victim? | Munchausen's syndrome by proxy |
| A new grad nurse is scheduled to take the NCLEX-RN exam in 3 days. On awakening today, the graduate cannot see anything at all but tells fellow classmates, "Oh, don't worry; it will all work out. “The nurse is aware that this statement results from? | La belle indifference |
| The client asks the nurse, "What does somatization mean?" What should the nurse reply? | "It means that stress and/or emotions are causing your symptoms." |
| The client presented to the ER with reports of chest pain. The nurse performs a thorough physical examination for this client with a history of a somatic symptom illness. Which of the following is the best rationale for the physical exam? | Underlying pathology should be ruled out. |
| The nurse is caring for a client who was in a motorcycle accident 2 months ago. The client says he still has terrible neck pain, but he will be better once he gets "a big insurance settlement." What condition might the nurse suspect? | Malingering |
| The nurse is identifying outcomes for a client with a somatic symptom illness. Which is an appropriate outcome to include in the plan of care? | The client will verbally express his or her emotions. |
| Which is the primary gain associated with developing physical symptoms in response to stress? | Decrease anxiety |
| Which of the following accurately describes how somatic symptoms are distinguished from factitious disorders and malingering? | In malingering or factitious disorders, people willfully control the symptoms, and in somatic symptom illnesses, clients do not voluntarily control their physical symptoms. |
| Which of the following are possible with somatization? Select all that apply. | Real symptoms can begin. Real symptoms can continue. Real symptoms can worsen Unrelated symptoms can occur. |
| A client with borderline personality disorder says to the nurse, "I feel so comfortable talking with you. You seem to have a special way about you that really helps me." Which would be the most appropriate response by the nurse? | "I'm here to help you just as all the staff members are." |
| The nurse explains to the client that therapy will be a long process. Which of the following is a realistic outcome for the care of a person with a personality disorder? | Outcomes that focus on change in behavior |
| The nurse teaches an antisocial client to take a time-out in his room when challenged by another person instigating an argument. What is the main reason for the time-out? | It allows an opportunity for the client to regain control of emotions. |
| Which disorder is characterized by pervasive mistrust and suspiciousness of others? | Paranoid personality disorder |
| Which observation by the nurse is supportive of a diagnosis of avoidant personality disorder? | Client fears criticism from others, including staff. |
| Which of the following is a psychosocial explanation for the development of personality disorders? | Failure to complete a developmental task jeopardizes future personality development. |
| Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? | Discuss feelings of anger or frustration with colleagues to help them recognize and cope with their own feelings |
| Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? | Understanding that behavior changes in clients with personality disorders can occur quickly |
| Which techniques are important for nurses caring for clients with personality disorders to use in order to effectively provide care? | Employ ongoing communication with team members to remain firm and consistent about expectations for clients |
| Which would most likely be a type of behavior that would be manifested by a client who has histrionic personality disorder? | Having a tantrum if not getting enough attention |
| A client asks how his prescribed alprazolam helps his anxiety disorder. The nurse explains, that antianxiety medications such as alprazolam affect the function of which neurotransmitter that is believed to be dysfunctional in anxiety disorders? | GABA |
| A client experiences panic attacks when confronted with riding in elevators. The therapist is teaching the client ways to relax while incrementally exposing the client to getting on an elevator. This technique is called which of the following? | systematic desensitization |
| The nurse knows that which of the following are stages in Selye's general adaptation syndrome? Select all that apply. | Alarm reaction stage Resistance stage Exhaustion stage |
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Finah215