Morgan Baldwin CSUSM ABSN Summer Semester 2024 Psych NURS 360 Exam 2 Final Exam

Which of the following parts of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain? Frontal lobe Thalamus Hypothalamus Limbic system Limbic system Which of the following parts of the brain is concerned with visual reception and interpretation? Frontal lobe Parietal lobe Temporal lobe Occipital lobe Occipital lobe Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling? Frontal lobe Parietal lobe temporal lobe Occipital lobe Frontal lobe Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex? Temporal lobe Thalamus Limbic system Hypothalamus Thalamus Which of the following parts of the brain deals with sensory perception and interpretation? Hypothalamus Cerebellum Parietal lobe Hippocampus Parietal lobe Which of the following parts of the brain is concerned with hearing, short-term memory, and sense of smell? Temporal lobe Parietal lobe Cerebellum Hypothalamus Temporal lobe Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system, as well as regulation of appetite and temperature? Temporal lobe Parietal lobe Cerebellum Hypothalamus Hypothalamus At a synapse, the determination of further impulse transmission is accomplished by means of which of the following? Potassium ions Interneurons Neurotransmitters The myelin sheath Neurotransmitters A decrease in which of the following neurotransmitters has been implicated in depression? Gamma-aminobutyric acid, acetylcholine, and aspartate Norepinephrine, serotonin, and dopamine Somatostatin, substance P, and glycine Glutamate, histamine, and opioid peptides Norepinephrine, serotonin, and dopamine Which of the following hormones has been implicated in the etiology of mood disorder with seasonal affective disorder? Increased levels of melatonin Decreased levels of oxytocin Decreased levels of prolactin Increased levels of thyrotropin Increased levels of melatonin Psychotropic medications may act at the neural synapse to accomplish which of the following? (Select all that apply.) Inhibit the reuptake of certain neurotransmitters, creating more availability Inhibit catabolic enzymes, promoting more availability of a neurotransmitter Block receptors, resulting in less neurotransmitter activity Add synthetic neurotransmitters found in the drug Inhibit the reuptake of certain neurotransmitters, creating more availability Inhibit catabolic enzymes, promoting more availability of a neurotransmitter Block receptors, resulting in less neurotransmitter activity Psychoneuroimmunology is a branch of science that involves which of the following? (Select all that apply.) The impact of psychoactive medications at the neural synapse The relationships between the immune system, the nervous system, and psychological processes including mental illness The correlation between psychosocial stress and the onset of illness The potential role of viruses in the onset of schizophrenia The genetic factors that influence the prevention of mental illness The relationships between the immune system, the nervous system, and psychological processes including mental illness The correlation between psychosocial stress and the onset of illness The potential role of viruses in the onset of schizophrenia How do anti-anxiety medications, such as benzodiazepines, produce a calming effect? Depressing the CNS Decreasing levels of norepinephrine and serotonin in the brain Decreasing levels of dopamine in the brain Inhibiting production of the enzyme MAO Depressing the CNS There is a narrow margin between the therapeutic and toxic levels of lithium carbonate. Symptoms of toxicity are most likely to appear when the serum levels exceed: 0.15 mEq/L 1.5 mEq/L 15.0 mEq/L 150 mEq/L 1.5 mEq/L Initial symptoms of lithium toxicity include: Constipation, dry mouth Dizziness, thirst Vomiting, diarrhea Anura, arrhythmias Vomiting, diarrhea Antipsychotic medications are thought to decrease psychotic symptoms by: Blocking reuptake of norepinephrine and serotonin Blocking the action of dopamine in the brain Inhibiting production of the enzyme MAO Depressing the CNS Blocking the action of dopamine in the brain Part of the nurse's ongoing assessment of the client taking antipsychotic medications is to observe for extrapyramidal symptoms. Which of the following are examples of extrapyramidal symptoms? Muscular weakness, rigidity, tremors, facial spasms Dry mouth, blurred vision, urinary retention, orthostatic hypotension Amenorrhea, gynecomastia, retrograde ejaculation Elevated blood pressure, severe occipital headache, stiff neck Muscular weakness, rigidity, tremors, facial spasms A client who is prescribed haloperidol is observed to be staring at the ceiling and says he cannot move his eyes. The nurse notices that he also appears to have muscle spasms in his legs and hands. What is the most appropriate action for the nurse to take at this point? Conduct an AIMS test. Administer PRN benztropine (Cogentin). Withhold the next dose of antipsychotic medication. Contact the physician. Administer PRN benztropine (Cogentin). A client reports to the nurse that she has been on her antidepressant medication (fluoxetine) for almost 2 weeks and does not feel much better. Which of these actions by the nurse demonstrates the best clinical judgment? Educate the client that this medication may not be fully effective for up to 4 weeks Hold the next dose and contact the physician to recommend an alternative antidepressant. Check the client's vital signs and check labs for therapeutic blood levels. Assess whether the client is aware of mood swings or history of bipolar disorder in her family. Educate the client that this medication may not be fully effective for up to 4 weeks A client who was recently prescribed an MAOI tells the nurse that he drinks 3 to 4 cups of coffee with each meal. Which of these actions by the nurse demonstrates the best clinical judgment? Instruct the client that he only needs to avoid foods high in tyramine; coffee consumption is not an issue with this medication. Inform the client that foods or beverages with high caffeine content increase the risk for serious hypertension and arrhythmias. Inform the client that caffeine interferes with the effectiveness of this medication. Instruct the client that red wines are a better beverage choice because they do not contain tyramine. Inform the client that caffeine interferes with the effectiveness of this medication. A young adult client has been prescribed an SSRI antidepressant, which she has been taking for 1 week. She reports that she feels like she is getting worse and feels like nothing is going to help. Which of these actions by the nurse is a priority? Educate the client that SSRIs have a lag period before full therapeutic effectiveness is apparent. Ask the client to describe why she thinks she is depressed. Contact the physician to recommend a different medication. Conduct a suicide risk assessment. Conduct a suicide risk assessment. A licensed practical nurse who is administering medications reports to the RN in charge that he forgot to give the last scheduled dose of bupropion to a client. He asks the RN if he should give the client two doses at the next scheduled time. Which of these responses by the nurse demonstrates the best clinical judgment? "Yes, that would be fine. Just make sure the client stays in bed since this is a sedating medication." "No. Doses of this medication should not be doubled since that poses an increased risk for seizures." "Yes, as long as the client has not changed his sodium intake recently." "No, doses should not be doubled because there is an increased risk of tolerance and addiction." "No. Doses of this medication should not be doubled since that poses an increased risk for seizures." Mrs. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of the store disorder? Mrs. t experiences panic anxiety when she encounters snakes Mrs. t refuses to fly in an airplane Mrs. t will not eat in a public place Mrs. t stays in her home for fear of being in a place from which she cannot escape Mrs. t stays in her home for fear of being in a place from which she cannot escape Which of the following is most appropriate therapy for a client with agoraphobia? 10 milligram Valium four times a day group therapy with other people with agoraphobia facing the fear in gradual step progression hypnosis facing the fear in gradual step progression With implosion therapy, a client with phobic anxiety would be: taught relaxation exercises subjected to graded intensities of the fear instructed to stop the therapeutic session as soon as anxiety is experienced presented with intense exposure to a variety of stimuli associated with the phobic object or situation presented with intense exposure to a variety of stimuli associated with the phobic object or situation A client with OCD spends many hours each day washing her hands. The most likely reason she washes her hands so much is that it: relieve her anxiety reduces the probability of infection gives her a feeling of control over her life increases her self concept relieve her anxiety A client is receiving treatment at the mental health clinic with habit reversal therapy period which of the following elements would be included in this therapy? (select all the apply.) awareness training competing response training social support hypnotherapy aversive therapy awareness training competing response training social support The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions? Keep the client's bathroom locked so she cannot wash her hands all the time structure the client's schedule so that she has plenty of time for washing her hands place the client in isolation until she promises to stop washing her hands so much explain the client's behavior to her, because she is probably unaware that it is maladaptive structure the client's schedule so that she has plenty of time for washing her hands A client with OCD says to the nurse "I've been here four days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill at ease with the staff or other patients anymore period" in light of this change which nursing intervention is most appropriate? Give attention to the ritualistic behaviors each time they occur, and point out their inappropriateness ignore the ritualistic behaviors, and they will be eliminated for lack of reinforcement set limits on the amount of time the client may engage in ritualistic behavior continue to allow the client all the time she wants to carry out the ritualistic behavior set limits on the amount of time the client may engage in ritualistic behavior a new client at the mental health clinic is diagnosed with body dysmorphic disorder. Which of the following nursing interventions is the priority? Support the client's efforts to seek corrective surgery recommend the client see a physician for treatment with antipsychotic medication encourage the client to describe reasons for seeking treatment reinforced to the client that their body is perfectly normal encourage the client to describe reasons for seeking treatment A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for the client? Stay with the client and reassure of safety administer a dose of diazepam leave the client alone in a quiet room so that she can calm down encourage the client to talk about what triggered the attack Stay with the client and reassure of safety A client diagnosed with a generalized anxiety disorder has been prescribed Buspirone 50 milligram daily. He says to the nurse, "why do I have to take this every day? My friend's doctor ordered Xanax for him, and he only takes it when he is feeling anxious." which of the following would be an appropriate response by the nurse? Xanax is not effective for generalized anxiety disorder Buspirone must be taken daily in order to be effective I will ask the doctor if he will change your dose of Buspirone to PRN so that they don't have to take it every day your friend really should be taking Xanax everyday Buspirone must be taken daily in order to be effective Which of the following is a correct assumption regarding the concept of crisis? a. Crises occur only in individuals with psychopathology. b. The stressful event that precipitates crisis is seldom identifiable. c. A crisis situation contains the potential for psychological growth or deterioration. d. Crises are chronic situations that recur many times during an individual's life. c. A crisis situation contains the potential for psychological growth or deterioration. Crises occur when an individual: a. Is exposed to a precipitating stressor: b. Perceives a stressor to be threatening. c. Has no support systems d. Experiences a stressor and perceives coping strategies to be ineffective. d. Experiences a stressor and perceives coping strategies to be ineffective. Which of the following events would likely precipitate a crisis? (Select all that apply) a. First-time parenthood when the parents perceive they have inadequate support and education. b. Receiving a pay raise when the worker perceived they had to work very hard to accomplish their financial goals. c. A natural disaster such as a forest fire in which lives and property were lost. d. A peer or family member dies by suicide. a. First-time parenthood when the parents perceive they have inadequate support and education. c. A natural disaster such as a forest fire in which lives and property were lost. d. A peer or family member dies by suicide. Which of the following is a desired outcome of working with an individual who has witnessed a traumatic event and is now experiencing panic anxiety? a. The individual will experience no anxiety. b. The individual will demonstrate hope for the future. c. The individual will identify that anxiety is at a manageable level. d. The individual will verbalize the acceptance of self as worthy. c. The individual will identify that anxiety is at a manageable level. The client, a firefighter who responded to an industrial explosion, lost a coworker and close friend when they entered a building that collapsed. The client reports that since this event, he has had frequent nightmares and anxiety attacks. He says to the mental health worker, "I should have died, but instead I lost my best friend!" This statement suggests that the client is experiencing: a. Spiritual distress. b. Night terrors. c. Survivor's guilt. d. Suicidal ideation. c. Survivor's guilt. A client whose home was destroyed during a tornado expresses to the nurse that she has been having disabling anxiety and nightmares for the last 2 weeks following this disaster. The most appropriate crisis intervention would be to: a. Encourage her to recognize how lucky she is to be alive. b. Discuss stages of grief and feelings associated with each. c. Identify community resources that can help Amanda. d. Suggest that she find a place to live that provides a storm shelter. b. Discuss stages of grief and feelings associated with each. A teenager tells the high school nurse that her parents are drinking alcohol every day and she doesn't know what to do. Her grades are starting to drop, and she complains of feeling anxious and overwhelmed. The most appropriate nursing action in response to the client's complaint would be to: a. Facilitate arrangements for her to start attending lateen meetings. b. Help her identify the positive things in her life and recognize that her situation could be a lot worse than it is. c. Teach her about the effects of alcohol on the body and that it can be hereditary. d. Refer her to a psychiatrist for private therapy to learn to cope with her home situation. a. Facilitate arrangements for her to start attending lateen meetings. A college student, who is an only child and attending school 500 miles away from his parents, reports to the nurse practitioner at the student health center that he has been having difficulty making decisions and will not undertake anything new without first consulting his mother. He has recently started having anxiety attacks. Which nursing action is most appropriate in response to this client's maturational crisis? a. Suggest that he move to a college closer to home. b. Help him to explore unresolved dependency issues. c. Help him find someone in the college town from whom he could seek assistance rather than calling his mother regularly. d. Recommend that the college physician prescribe an antianxiety medication for him. b. Help him to explore unresolved dependency issues. A client is brought to the emergency department by her college roommate and appears to be emotionless. The client reports that she was raped at a party earlier that evening. Which of these actions by the nurse is a priority? a. Ask the client if she would like to shower before she is examined. b. Confront the client about her apparent lack of emotion and ask if this was consensual sex. c. Affirm the client for seeking help and ask her to describe what happened. d. Ask the roommate if the client is typically so emotionless. c. Affirm the client for seeking help and ask her to describe what happened. A client is admitted to the inpatient psychiatric unit after a suicide attempt. He reports that he has a history of depression but he became acutely suicidal after he recently lost his job. Which of these nursing actions is a priority in response to this client's psychiatric crisis? a. Assess why the client lost his job. b. Ensure that the client remains safe and free from further self-injury. c. Explore career interests and other job opportunities. d. Assess for substance use disorder. b. Ensure that the client remains safe and free from further self-injury. A client, age 27, was brought to the emergency department by two police officers. He smelled strongly of alcohol and was combative. His blood alcohol level was measured at 293 mg/dL. His girlfriend reported that he drinks excessively every day and is verbally and physically abusive. The nurse assigns the nursing diagnosis of "risk for other-directed violence." What would be appropriate outcome objectives for this diagnosis? (Select all that apply.) a. The client will not verbalize anger or hit anyone b. The client will verbalize anger rather than hit others. c. The client will not harm self or others. d. The client will be restrained if he becomes verbally or physically abusive. b. The client will verbalize anger rather than hit others. c. The client will not harm self or others. A client with a history of violence has been hospitalized on the psychiatric unit. He becomes agitated and begins to threaten the staff and other clients. When all other interventions fail, the client is placed in restraints in the seclusion room for his and others' protection. Which of the following are interventions for the client in restraints? (Select all that apply.) a. Check temperature and pulse of extremities. b. Document all observations. c. Explain to the client that restraint is his punishment for violent behavior. d. Provide ongoing assessment and observation. e. Withhold food and fluids until the client is calm and can be released from restraints. a. Check temperature and pulse of extremities. b. Document all observations. d. Provide ongoing assessment and observation. Which of these procedures is important immediately following an episode of violence on the unit? (Select all that apply.) a. Document all observations and occurrences. b. Conduct a debriefing with the staff. c. Discuss what occurred with other clients who witnessed the incident. d. Warn the client that it could happen again if he becomes violent. a. Document all observations and occurrences. b. Conduct a debriefing with the staff. c. Discuss what occurred with other clients who witnessed the incident. A client and his girlfriend had an argument during her visit to the psychiatric unit. Which behavior by the client would indicate he is learning to adaptively problem- solve his frustrations? a. The client requests to be put in restraints to prevent hurting his girlfriend. b. When his girlfriend leaves, the client goes to the exercise room to try to release his anger with physical activity. c. The client says to the nurse, "I guess I'm going to have to dump that broad!" d. The client says to his girlfriend, "You'd better leave before I do something I'm sorry for." b. When his girlfriend leaves, the client goes to the exercise room to try to release his anger with physical activity. Which of the following assessment data would the nurse consider as risk factors for possible violence in a client? (Select all that apply.) a. A diagnosis of somatization disorder b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence b. A diagnosis of schizophrenia or bipolar disorder c. Substance intoxication d. Argumentative and demanding behavior e. Past history of violence A client who was hospitalized with alcohol intoxication and violent behavior is sitting in the dayroom watching TV with the other clients when the nurse approaches with his 5 p.m. dose of haloperidol. The client says, "I feel in control now. I don't need any drugs." Which of these responses by the nurse demonstrates the best clinical judgment? a. Instruct him that he must take the medication because of his history of violence. b. Instruct him that if he will not take the medication orally, he will be restrained and given an intramuscular injection. c. Accept the client's refusal and document assessment of the client's mood and behavior. d. Secretly crush the medication into a beverage and offer it to the client. c. Accept the client's refusal and document assessment of the client's mood and behavior. A client with a history of violence is yelling in the dayroom and knocking over chairs. The nurse observes his increased agitation, clenched fists, and loud, demanding voice. He is challenging and threatening staff and the other clients. The nurse's priority intervention would be to: a. Call for assistance. b. Draw up a syringe of prn haloperidol. c. Ask the client if he would like to talk about his anger. d. Tell the client if he does not calm down, he will have to be restrained. a. Call for assistance. When it has been assessed that a client is in control and no longer requires restraint, what should the nurse do next? a. Remove the restraints. b. Medicate the client before removing restraints. c. With assistance, remove one restraint and assess the client's level of self-control. d. Tell the client he will have to wait until the doctor comes in. c. With assistance, remove one restraint and assess the client's level of self-control. A client who has been in restraints is now calm. He apologizes to the nurse and says, "I hope I didn't hurt anyone." Which of these actions by the nurse demonstrates the best clinical judgment? a. Ignore the patient's comment to extinguish his aggressive behavior. b. Affirm to the patient that everyone loses control sometimes and tell him not to worry about it. c. Reinforce that it is fortunate that no one was hurt and assist the client to explore alternative behaviors when he becomes angry. d. Set firm limits with the client, instructing him that if he becomes angry again he will be secluded and restrained c. Reinforce that it is fortunate that no one was hurt and assist the client to explore alternative behaviors when he becomes angry. A client is noted to be pacing with clenched fists and saying, "I'm not putting up with this anymore. They've been trying to trick me all along." Which of these actions by the nurse is most appropriate at this point? a. Gently touch the client's shoulder and reassure him that no one is trying to trick him b. Ask the client to describe what's upsetting him. c. Offer the client medication. d. Don't intervene but continue to watch the client from a distance. b. Ask the client to describe what's upsetting him. One way to promote adequate nutritional intake for a client in an acute manic episode who is not eating is to: a. Sit with the client during meals to reinforce the importance of eating everything on the tray. b. Have family members bring food from home so the client will have only favorite foods. c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run" d. Restrict the client to their room until they begin to gain weight. c. Provide high-calorie, nutritious finger foods and snacks that can be eaten "on the run" The physician orders lithium carbonate 600 mg tid for a newly diagnosed patient with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. The therapeutic range for acute mania is: a. 0.5 to 1.5 mEq/L b. 10 to 15 mEq/L c. 0.5 to 1.0 mEq/L d. 5 to 10 mEq/L a. 0.5 to 1.5 mEq/L Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) a. Olanzapine (Zyprexa) b. Oxycodone (OxyContin) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) E. Tranylcypromine (Parnate) a. Olanzapine (Zyprexa) c. Carbamazepine (Tegretol) d. Gabapentin (Neurontin) A client who is experiencing a manic episode is admitted to the psychiatric unit after being brought to the emergency department by a family member. The client yells, "My family is trying to make it look like I'm insane! They just want to take all my money;" This behavior is an example of. a. A delusion of grandeur b. A delusion of persecution c. A delusion of reference d. A delusion of control or influence b. A delusion of persecution What is the most common comorbid condition in children with bipolar disorder? a. Schizophrenia b. Substance disorders c. Oppositional defiant disorder d. Attention deficit-hyperactivity disorder d. Attention deficit-hyperactivity disorder A nurse is educating a patient about his lithium therapy and explaining the signs and symptoms of lithium toxicity. Which of the following would she instruct the patient to be on the alert for? a. Fever, sore throat, malaise b. Tinnitus, severe diarrhea, ataxia c. Occipital headache, palpitations, chest pain d. Skin rash, marked rise in blood pressure, bradycardia b. Tinnitus, severe diarrhea, ataxia A client is brought to the emergency department by a family member who reports that the client stopped taking mood stabilizer medication a few months ago and is now agitated, pacing, demanding, and speaking very loudly. Her family member reports that she eats very little, is losing weight, and almost never sleeps. What is the priority nursing diagnosis? a. Imbalanced nutrition: Less than body requirements related to not eating b. Risk for injury related to hyperactivity c. Disturbed sleep pattern related to agitation d. Ineffective coping related to denial of depression b. Risk for injury related to hyperactivity A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? a. Tell the client she cannot wear this outfit while she is in the hospital. b. Do nothing, and allow her to learn from the responses of her peers. c. Quietly walk with her back to her room and help her change into something more appropriate d. Explain to her that if she wears this outfit, she must remain in her room. c. Quietly walk with her back to her room and help her change into something more appropriate The nurse is providing medication education to a client on lithium. Which of the following are important points to include? (Select all that apply.) a. Significant reductions in sodium intake increase the risk for lithium toxicity. b. Weight loss is a common side effect of lithium. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well. a. Significant reductions in sodium intake increase the risk for lithium toxicity. c. Serum lithium levels will need to be checked at regular intervals throughout treatment. d. Lithium therapy should be continued even during periods when the patient feels well. A client admitted to the inpatient psychiatric unit with bipolar disorder tells the nurse, "I need to sit in on change-of-shift report because I have been appointed director of this unit." Which action by the nurse demonstrates the best clinical judgment at this point? a. Invite the client to sit in on the change-of-shift report, but do not share any confidential client information. b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available. c. Tell the client that she is delusional but that these symptoms will go away with medication. d. Place the client in seclusion for protection of self and others. b. Instruct the client that this is not permitted and redirect the client to other unit activities that are available. A client is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for several years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? a. Several hours after the last drink b. 2 to 3 days after the last drink c. 4 to 5 days after the last drink d. 6 to 7 days after the last drink a. Several hours after the last drink Symptoms of alcohol withdrawal include: a. Euphoria, hyperactivity, and insomnia. b. Depression, suicidal ideation, and hypersomnia. c. Diaphoresis, nausea and vomiting, and tremors. d. Unsteady gait, nystagmus, and profound disorientation. c. Diaphoresis, nausea and vomiting, and tremors. Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? a. Haloperidol (Haldol) b. Chlordiazepoxide (Librium) c. Methadone (Dolophine) d. Cannabidiol (Epidiolex) b. Chlordiazepoxide (Librium) A client who has been admitted to the chemical dependence treatment unit after being disciplined for drinking on the job states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know." Which defense mechanism is the client using? a. Denial b. Projection c. Displacement d. Rationalization a. Denial A client who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job states to the nurse, "I don't have a problem with alcohol. My boss is a jerk! I haven't missed any more days than my coworkers." What is the nurse's best response? a. "Maybe your boss is mistaken, Dan." b. "You are here because your drinking was interfering with your work." c. "Get real! You're an alcoholic and you know it!" d. "Why do you think your boss is a jerk?" b. "You are here because your drinking was interfering with your work." A client who has been admitted to intensive outpatient treatment for substance use disorder arrives for group therapy and appears groggy with constricted pupils. The client denies using substances. Which of the following would be the best intervention at this time? a. Ask the client to empty his pockets. b. Smell his breath for evidence of alcohol. c. Conduct a drug screen to assess for the presence of opioids. d. Discharge the client for failure to comply with treatment expectations. c. Conduct a drug screen to assess for the presence of opioids. A client admitted to the inpatient detoxification program for alcohol withdrawal approaches the nurse complaining of nausea and feeling shaky. The nurse notices that the client has hand tremors and appears diaphoretic. Which of these nursing interventions is a priority? a. Check the client's temperature. b. Send a urine sample to the laboratory for a random drug screen. c. Ask the client if there is anything that he is particularly stressed about. d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms. d. Administer prn benzodiazepine that was ordered for management of withdrawal symptoms. A client comes into the emergency department stating that he is "crashing" and feels like he'd "be better off dead." Which of these nursing interventions is a priority? a. Instruct the client not to worry; these are temporary signs of withdrawal and should go away in a few days. b. Request an order for amphetamines to ease the client's withdrawal symptoms. c. Assess the client's risk for suicide. d. Instruct the physician that the client may need naloxone. c. Assess the client's risk for suicide. A client is brought to the emergency department unconscious by a friend who says he was injecting heroin. The client is assessed to have a weak pulse. Which of these interventions are priorities? a. Administer naloxone and rescue breathing. b. IV benzodiazepines and continuous monitoring of vital signs. c. Ask the friend how much heroin he took and confirm with a laboratory drug screen. d. Initiate cardiopulmonary resuscitation and prepare to use an external defibrillator. a. Administer naloxone and rescue breathing. A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. After the nurse completes an assessment, the physician asks if there are any physical signs of long- term chronic alcohol abuse. Which of these findings should the nurse include in reporting to the physician? (Select all that apply.) a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count a. The client reports weak leg muscles, and his gait is unsteady. b. The client's abdomen is distended. c. The client reports he was coughing up some blood. d. The client reports he has double vision. e. Blood tests reveal a low white blood cell count A client enters the emergency department and reports, "My bed is on fire, and my stomach, and we're all dead." The nurse's initial response is to call the psychiatric unit to secure an inpatient bed for this patient. The nurse's action is an example of: a. Prompt, appropriate referral. b. Patient-centered care. c. Stigmatization. d. Collaboration. c. Stigmatization. One of the outcomes of diagnostic overshadowing in clients with mental illness is: a. Better quality of life. b. Increased access to resources. c. More comprehensive care. d.Increased risk for death. d. Increased risk for death. The nurse is reviewing discharge instructions with a client who is being discharged following a total knee replacement. Knowing that the client has a history of bipolar disorder, the nurse asks the client what needs they perceive they have for follow-up care related to this mental illness. This is an example of: a. Patient-centered care. b. Diagnostic overshadowing. c. Stigmatization. d. Discrimination. a. Patient-centered care. Screening for substance use and suicide risk should be conducted in which of the following settings? a. Emergency departments b. Primary care settings c. Medical units d. All of the above d. All of the above A client presents in the emergency department loudly proclaiming with rapid speech, "If I don't get more pain medication right now I'm going to call the attorney general and sue the entire health-care network." Which of the following should the nurse include in the initial screening and assessment? (Select all that apply.) a. Substance use b. Pain c. Mental illness d. Prior history of convictions e. Availability of an inpatient psychiatric bed a. Substance use b. Pain c. Mental illness A client was admitted to the intensive care unit after a single-car accident in which he struck a cement wall He is now responsive and wants to be discharged within the next couple of days. Which of the following are priorities for screening? (Select all that apply.) a. Traumatic brain injury b. Chronic pain c. Sexual dysfunction d. Depression and risk for suicide a. Traumatic brain injury d. Depression and risk for suicide The nurse manager recognizes a need to improve mental health and substance use screening and referral services for their clients in the public health clinic. Which of the following is a priority to begin an effective process for implementation? a. Provide a list of referral sources that are readily available to staff. b. Educate staff about the importance of prioritizing these public health concerns. c. Explore the literature for evidence-based screening tools. d. Inform the staff that they have been stigmatizing patients and this will not be tolerated. b. Educate staff about the importance of prioritizing these public health concerns. A client on a medical unit is identified to be having suicidal ideation. Which of the following is a priority in managing his immediate care? a. Screen for depression b. Provide sedative medication c. Refer him to another setting d. Continuous monitoring and observation d. Continuous monitoring and observation A client, who is a veteran of the war in Irag, is diagnosed with PTSD. He says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in the client? a. Repressed anger b. Survivor's guilt c. Intrusive thoughts d. Spiritual distress b. Survivor's guilt Which of the following treatment regimens would most appropriately be ordered for a client with PTSD? a. Paroxetine and group therapy b. Diazepam and implosion therapy c. Alprazolam and behavior therapy d. Carbamazepine and cognitive behavior therapy a. Paroxetine and group therapy Which of the following may be influential in the predisposition to PTSD? a. Unsatisfactory parent-child relationship b. Excess of the neurotransmitter serotonin c. Distorted, negative cognitions d. Severity of the stressor and availability of support systems d. Severity of the stressor and availability of support systems Which of the following is true regarding the diagnosis of adjustment disorder? a. The client will require long-term psychotherapy to achieve relief. b. The client likely inherited a genetic tendency for the disorder. c. Symptoms will likely remit once the client has accepted the changes that precipitated the difficulties with adjustment. d. Adjustment disorders are not typically related to an identified stressor. c. Symptoms will likely remit once the client has accepted the changes that precipitated the difficulties with adjustment. The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to: a. Increase energy and elevate mood. b. Increase suicidal ideation. c. Prevent psychotic symptoms. d. Help the client adjust to change. a. Increase energy and elevate mood. Trauma-informed care is a philosophical approach that includes which of the following principles? (Select all that apply.) a. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. b. Medications need to be given before any other interventions are considered. c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. d. Trauma-informed care is based on the principle that traumas are not correlated with depression or increased risk for suicide. a. Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. c. Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. A client experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to: a. Administer alprazolam as ordered prn for anxiety. b. Call the physician and report the incident. C. Stay with the client and reassure him of his safety. d. Have the client listen to a tape of relaxation exercises. C. Stay with the client and reassure him of his safety. A client who recently left her husband of 10 years is admitted to the hospital with a diagnosis of adjustment disorder with depressed mood. She acknowledges that she was very dependent on him and is having difficulty adjusting to an independent lifestyle. What is the priority nursing diagnosis for this client? a. Risk-prone health behavior related to loss of dependency b. Complicated grieving related to breakup of marriage c. Ineffective communication related to problems with dependency d. Social isolation related to depressed mood b. Complicated grieving related to breakup of marriage A client, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse? A. "Cheer up. You have a lot to be happy about. b. 'You are grieving the loss of your marriage. It's natural for you to feel bad." C. "Try not to dwell on how you feel. If you don't think about it, you'll feel better. d. "You did the right thing. Knowing that should make you feel better." b. 'You are grieving the loss of your marriage. It's natural for you to feel bad." A client, age 16 years, has recently been diagnosed with diabetes mellitus. She must watch her diet and take an oral hypoglycemic medication daily. She has become very depressed, and her mother reports that she refuses to change her diet and often skips her medication. She has been hospitalized for stabilization of her blood glucose level. The psychiatric nurse practitioner has been called in as a consultant. Which of the following nursing diagnoses by the psychiatric nurse would be a priority for the client at this time? a. Anxiety related to hospitalization, evidenced by noncompliance b. Low self-esteem related to feeling different from her peers, evidenced by social isolation c. Risk for suicide related to new diagnosis of diabetes mellitus d. Risk-prone health behavior related to denial of the seriousness of her illness, evidenced by refusal to follow diet and take medication d. Risk-prone health behavior related to denial of the seriousness of her illness, evidenced by refusal to follow diet and take medication A client with multiple cuts and abrasions arrives at the emergency department with her three small children. She tells the nurse her husband inflicted the wounds. In the interview, she tells the nurse, "He's been getting more and more violent lately. He's been under a lot of stress at work the last few weeks, so he drinks a lot when he gets home. He always gets mean when he drinks. I was getting scared. So I just finally told him I was going to take the kids and leave. He got furious when I said that and began beating me with his fists." With knowledge about the cycle of battering, what does this situation represent? a. Phase I. Attempting to stay out of his way and keep everything calm. b. Phase I. A minor battering incident for which she assumes all the blame. c. Phase II. The acute battering incident that was provoked by her threat to leave. d. Phase III. The honeymoon phase where the husband believes that he has "taught her a lesson and she won't act up again. c. Phase II. The acute battering incident that was provoked by her threat to leave. A battered woman presents to the emergency department with multiple cuts and abrasions. Her right eye is swollen shut. She says that her husband did this to her. What is the priority nursing intervention? a. Tending to the immediate care of her wounds b. Providing her with information about a safe place to stay c. Administering the prn tranquilizer ordered by the physician d. Explaining how she may go about bringing charges against her husband a. Tending to the immediate care of her wounds A child aged 5, is sent to the school nurse's office with an upset stomach, she has vomited and soiled her blouse. when the nurse removes her blouse, she notices that the child has numerous bruises on her arms and torso in various stages of healing. She also notices some small scars, and her abdomen protrudes from her small thin frame. From the objective physical assessment, the nurse should search further for: a. Physical and sexual abuse. b. Physical abuse and neglect. c. Emotional neglect. d. Sexual and emotional abuse. b. Physical abuse and neglect. A school nurse notices bruises and sears on a child's body, but the child refuses to say how she received them. Which of the following is an evidence-based approach for further assessment by the nurse? a. Have her evaluated by the school psychologist. b. Tell her she may select a "treat" from the treat box (e.g., sucker, balloon, junk jewelry) if she answers the nurse's questions. c. Explain to her that if she answers the questions, she may stay in the nurse's office and not have to go back to class. d. Use a "family" of dolls to role-play the child's family with her. d. Use a "family" of dolls to role-play the child's family with her. The nurse is providing education to a support group for survivors of rape. Which of the following items is evidence-based information to include in this teaching? a. Rapists typically drink alcohol and are not in control of their actions. b. Rape is usually an event that occurs between two people who are sexually frustrated. c. Men who are born into poverty are predisposed to becoming rapists after puberty. d. Rape is an expression of power and dominance by means of sexual aggression and violence. d. Rape is an expression of power and dominance by means of sexual aggression and violence. A client arrives at the emergency department and tells the nurse her husband inflicted the cuts to her face that required sutures. She says, "I didn't want to come. I'm really okay. He only does this when he has too much to drink. I just shouldn't have yelled at him." The best response by the nurse is: a. "How often does he drink too much?" b. "It is not your fault. You did the right thing by coming here." c. "How many times has he done this to you?" d. "He is not a good husband. You have to leave him before he kills you." b. "It is not your fault. You did the right thing by coming here." A woman who has a long history of being battered by her husband is staying at the women's shelter. She has received emotional support from staff and peers and has been made aware of the alternatives open to her. Nevertheless, she decides to return to her home and marriage. The best response by the nurse to the woman's decision is: a. "I just can't believe you have decided to go back to that horrible man." b. "I'm just afraid he will kill you or the children when you go back." c. "What makes you think things have changed with him?" d. "I hope you have made the right decision. Call this number if you need help." d. "I hope you have made the right decision. Call this number if you need help." A school nurse notices bruises and scars on a child's body. The nurse suspects that the child is being physically abused. Which action by the nurse is a priority at this point? a. As a health-care worker, report the suspicion to child protective services. b. Check the child again in a week and see if there are any new bruises. c. Meet with the child's parents and ask them how she got the bruises. d. Initiate paperwork to have the child placed in foster care. a. As a health-care worker, report the suspicion to child protective services. A college-age client is brought to the emergency department by her roommate after she confided that she was raped by her date who invited her to a frat party. The client says to the nurse, "It's all my fault. I shouldn't have gone to a party where I knew there was going to be alcohol." Which of these is the best response by the nurse? a. "Yes, you're right. You put yourself in a very vulnerable position when you allowed him to get you drunk." b. "You are not to blame for his behavior. You obviously made some right decisions because you survived the attack." c. "There's no sense looking back now. Just look forward, and make sure you don't put yourself in the same situation again." d. "You'll just have to see that he is arrested so he won't do this to anyone else." b. "You are not to blame for his behavior. You obviously made some right decisions because you survived the attack." A young man who has just undergone a sexual assault is brought into the emergency department by a friend. What is the priority nursing intervention? a. Help him to bathe and clean himself up. b. Provide physical and emotional support during evidence collection. c. Provide him with a written list of community resources for survivors of rape. d. Discuss the importance of a follow-up visit to evaluate for sexually transmitted diseases. c. Provide him with a written list of community resources for survivors of rape. Recent research on the RAISE approach to the treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits c. Rapid high-dose loading with antipsychotic medication d. Court-ordered sanctions for treatment e. Recovery-focused psychotherapy a. Early intervention at the first episode of psychosis b. Support for employment or educational pursuits c. Rapid high-dose loading with antipsychotic medication Which of the following symptom profiles would you expect when assessing a client with somatic symptom disorder? a. Multiple somatic symptoms in several body systems b. Fear of having a serious disease c. Loss or alteration in sensorimotor functioning d. Belief that his or her body is deformed or defective in some way a. Multiple somatic symptoms in several body systems Which of the following ego defense mechanisms describes the underlying psychodynamics of somatic symptom disorder? a. Denial of depression b. Repression of anxiety c. Suppression of grief d. Displacement of anger b. Repression of anxiety Nursing care for a client with somatic symptom disorder should focus on helping the client to: a. Eliminate stressors. b. Discontinue focusing on numerous physical complaints. c. Take medication only as prescribed. d. Learn more adaptive coping strategies. d. Learn more adaptive coping strategies. A client diagnosed with somatic symptom disorder states, "My doctor thinks I should see a psychiatrist. I can't imagine why he would make such a suggestion." What is the most common basis for the client's statement? a. Lack of trust in the physician. b. Lack of understanding about the correlation of symptoms and stress. c. Lack of understanding about the role of a psychiatrist. d. Lack of financial resources. b. Lack of understanding about the correlation of symptoms and stress. What is the ultimate goal of therapy for a client with dissociative identity disorder? a. Integration of the personalities into one b. The ability to switch from one personality to another voluntarily c. The ability to select one personality as the dominant self d. Recognition that the various personalities exist a. Integration of the personalities into one The ultimate goal of therapy for a client with dissociative identity disorder is most likely achieved through: a. Crisis intervention and directed association. b. Psychotherapy and hypnosis. c. Psychoanalysis and free association. d. Insight psychotherapy and dextroamphetamines. b. Psychotherapy and hypnosis. Lucille has a diagnosis of illness anxiety disorder. Which of the following symptoms would be consistent with this diagnosis? a. Complains of a multitude of incapacitating physical symptoms b. Manifests with pseudoseizures or pseudocyesis C. Takes substances to induce vomiting to convince the nurse that she needs treatment d. Expresses persistent fears of having life-threatening disease d. Expresses persistent fears of having life-threatening disease A client diagnosed with somatic symptom disorder tells the nurse about a pain in her side. She says she has not experienced it before. Which is the most appropriate response by the nurse? a. "I don't want to hear about another physical complaint. You know they are all in your head. It's time for group therapy now." b. 'Let's sit down here together and you can tell me about this new pain you are experiencing. You'll just have to miss group therapy today." c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes." d. "I will call your physician and see if he will order a new pain medication for your side. The one you have now doesn't seem to provide relief. Why don't you get some rest for now?" c. "I will report this pain to your physician. In the meantime, group therapy starts in 5 minutes." A client with a history of childhood physical and sexual abuse was diagnosed with dissociative identity disorder 6 years ago and has been admitted to the psychiatric unit following a suicide attempt. What is the priority nursing diagnosis for this client? a. Disturbed personal identity related to childhood abuse b. Disturbed sensory perception related to repressed anxiety c. Impaired memory related to disturbed thought processes d. Risk for suicide related to unresolved grief d. Risk for suicide related to unresolved grief In establishing trust with a client diagnosed with dissociative identity disorder, the nurse should: a. Respond as if the client did not have multiple personalities. b. Listen nonjudgmentally and respond empathically when the client transitions to different personality states. c. Ignore behaviors that the client attributes to other subpersonalities. d. Explain to the client that they must remain in their primary identity state while communicating with the nurse. e. All of the above b. Listen nonjudgmentally and respond empathically when the client transitions to different personality states. Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with the use of amphetamines that makes this practice undesirable? a. Bradycardia b. Amenorrhea c. Tolerance d. Convulsions c. Tolerance The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts? a. The patient's family should be actively involved in each phase of treatment. b. Parents should be prohibited from involvement in helping their child eat since there are often control issues. c. Adolescents need to work on developing healthy self-identities before they can begin to gain weight. d. Individual psychotherapy is the most effective treatment for adolescents with anorexia nervosa. a. The patient's family should be actively involved in each phase of treatment. A client has sought help for his concern that he is binge eating and feels like it has "gotten out of control." He asks the nurse what can be done to help him. Which of the following is the most accurate response? a. "Nothing can be done." b. "Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors." c. "The primary problem is obesity. I can help you set up a calorie-restricted diet." d. "Medications can help with weight loss, but there are no medications effective for reducing binge eating." b. "Some medications and psychological treatments have demonstrated effectiveness in reducing binge eating behaviors." Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? a. Tachycardia, hypertension, hyperthermia b. Bradycardia, hypertension, hyperthermia c. Bradycardia, hypotension, hypothermia d. Tachycardia, hypotension, hypothermia c. Bradycardia, hypotension, hypothermia Which medication has been used with some success in clients with anorexia nervosa? a. Lorcaserin (Belvig) b. Diazepam (Valium) C. Fluoxetine (Prozac) d. Carbamazepine (Tegretol) C. Fluoxetine (Prozac) A client is hospitalized on the psychiatric unit with a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with this client's diagnosis? a. Binging, purging, obesity, hyperkalemia b. Binging, purging, normal weight, hypokalemia c. Binging, laxative abuse, amenorrhea, severe weight loss d. Binging, purging, severe weight loss, hyperkalemia b. Binging, purging, normal weight, hypokalemia A 14-year-old client has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refuses to eat. What is the priority nursing diagnosis for this client? a. Complicated grieving b. Imbalanced nutrition: Less than body requirements. c. Interrupted family processes d. Anxiety (severe) b. Imbalanced nutrition: Less than body requirements. The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? a. "You know that if you don't eat, you will die." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." c. "You might as well leave if you are not going to follow your therapy regimen. d. "You don't have to eat if you don't want to. It is your choice." b. "If you continue to refuse to take food orally, you will be fed through a nasogastric tube." A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? a. "Don't worry. The dietitian will ensure you don't get too many calories in your diet." b. "Don't worry about your weight. We are going to work on other problems while you are in the hospital." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." d. "You are not fat, and the staff will ensure that you do not gain weight while you are in the hospital, because we know that is important to you." c. "I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment." A client presents in the emergency department with complaints of suicidal ideation. The following information is collected by the nurse. Which of these assessment findings suggests that bulimia nervosa might be a health problem? (Select all that apply.) a. Parotid glands appear enlarged. b. Teeth have a "moth-eaten" pattern of tooth decay. c. Client reports that she takes laxatives daily. d. Client's weight is within the expected range. a. Parotid glands appear enlarged. b. Teeth have a "moth-eaten" pattern of tooth decay. c. Client reports that she takes laxatives daily. d. Client's weight is within the expected range. A client diagnosed with borderline personality disorder manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline patient except: a. Refusal to stay in a room alone, stating, "It's so lonely." b. Asking the nurse for cigarettes after 30 minutes, knowing the assigned nurse has explained she must wait 1 hour. c. Stating to the nurse, "I really like having you for my nurse. You're the best one around here." d. Cutting arms with razor blade after discussing dismissal plans with physician. a. Refusal to stay in a room alone, stating, "It's so lonely." A client on the psychiatric unit has a diagnosis of antisocial personality disorder. Which of the following characteristics is consistent with this diagnosis? a. Lack of guilt for wrongdoing b. Insight into his own behavior c. Ability to learn from past experiences d. Compliance with authority a. Lack of guilt for wrongdoing A nurse on the psychiatric unit documents that the client was attempting to use "splitting" behaviors with staff. This should be interpreted to mean that the client is: a. Trying to keep staff away from other patients. b. Characterizing staff members as either all good or all bad. c. Having brief psychotic episodes. d. Manifesting two or more distinct subpersonalities when communicating with staff. b. Characterizing staff members as either all good or all bad. According to researchers, which of the following is a common theme in the health history of the client with BPD? a. Autism b. Attention deficit-hyperactivity disorder c. Positive and fulfilling interpersonal relationships d. Early childhood trauma d. Early childhood trauma Which of the following behavioral patterns is characteristic of individuals with narcissistic personality? a. Overly self-centered and exploitative of others b. Suspicious and mistrustful of others c. Rule conscious and disapproving of change d. Anxious and socially isolated a. Overly self-centered and exploitative of others We have an expert-written solution to this problem! Which of the following behavioral patterns is characteristic of individuals with schizotypal personality? a. Belittling themselves and their abilities b. A lifelong pattern of social withdrawal c. Suspicious and mistrustful of others d. Overreacting inappropriately to minor stimuli b. A lifelong pattern of social withdrawal We have an expert-written solution to this problem! A client