Mental Health Exam 3 – Flashcards
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A client informs the nurse at the anxiety disorders clinic that he experiences palpitations, difficulty breathing, and a sense of overwhelming dread whenever he leaves his home. This problem began after he was assaulted and robbed on his way to work. He has been unable to go to his office for over a month. The client asks the nurse, "Don't you agree that not being able to go out is pretty awful?" The most therapeutic reply is: 1. "What do you mean by 'awful'?" 2. "You feel awful because you're afraid to leave home?" 3. "No, I don't think it's awful." 4. "I guess some people might say that being housebound is pretty strange."
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2
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The client in question #1 has elected to be voluntarily admitted to a private mental health unit in order to work intensively on his problem. He has refused to leave the unit for activities since the day of admission. An appropriate nursing intervention to include in the care plan is to: 1. encourage him to ask for a community pass. 2. ask another client to accompany him off the unit. 3. assist him to journal the challenges of leaving the unit. 4. point out the irrationality of his fear.
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3
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A client has sought treatment for a specific phobia: fear of cats. The nurse in the anxiety disorders clinic has established the nursing diagnosis, Anxiety related to exposure to phobic object (cats). A realistic short-term goal for this client would be: within 10 days, client will 1. avoid feared object whenever possible. 2. face feared object unassisted. 3. state that feared object no longer produces feelings of dread associated with anxiety. 4. practice relaxation techniques and report less distress related to thoughts of the feared object.
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4
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Which piece of subjective data obtained during the nurse's psychiatric assessment of a client experiencing severe anxiety would indicate the possibility of posttraumatic stress disorder? 1. "I keep washing my hands over and over." 2. "My legs feel weak most of the time." 3. "I'm afraid to go out in public." 4. "I keep reliving the rape."
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4
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For the nursing diagnosis, Powerlessness related to inability to prevent rape, an appropriate nursing intervention would be to: 1. help the client discuss how she could have prevented the rape. 2. assist the client to identify coping strategies related to feeling helpless about the rape. 3. reassure the client that she has no control over situations such as these. 4. tell the client that everyone reacts in the same way she did.
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2
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When the psychiatrist prescribes alprazolam (Xanax) for the acute anxiety experienced by a client with agoraphobia, health teaching should include instructions 1. about a tyramine-free diet 2. to adjust dose and frequency of based on level of anxiety 3. to avoid alcoholic beverages 4. to report drowsiness
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3
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Which statement made by a client who washes his or her hands compulsively identifies the thinking typical of a client with obsessive-compulsive disorder? 1. "I know I'll get my hands clean eventually; it just takes time." 2. "I need a milder soap that won't damage my hands so much." 3. "I feel so much better when my hands are clean. I can do other things." 4. "I feel driven to wash my hands, although I don't like doing it."
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4
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For the client whose nursing diagnosis is Powerlessness related to inability to control compulsive cleaning, the nurse recognizes that the client uses cleaning to: 1. temporarily reduce anxiety. 2. gain a feeling of superiority. 3. receive praise from friends and family. 4. ensure the health of household members.
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1
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For the client with ritualistic handwashing whose goal is the use of more effective coping skills, the nurse should employ the intervention of: 1. allowing the client to set own handwashing schedule. 2. encouraging client participation in unit activities. 3. encouraging the client to discuss handwashing in all groups. 4. focusing on the client's symptoms rather than on the client.
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2
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For the client with compulsive handwashing, which outcome criterion indicates that the goal of improved social interaction has been successfully met? The client 1. asks for anxiolytic medication at the first signs of anxiety. 2. spends more time talking to others in the community. 3. decreases the amount of time spent handwashing. 4. sleeps 7 to 8 hours nightly.
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2
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To help a client who compulsively makes lists, meet the goal of improved self-esteem, the nurse should: 1. assist the client to identify and develop strengths. 2. encourage the use of as-needed antianxiety medication. 3. engage in power struggles to limit list making. 4. encourage behavior changes only when client states feeling ready.
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1
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The nurse caring for a client diagnosed with generalized anxiety disorder tells a preceptor, "I find myself feeling uncomfortable and anxious around this client. When he starts trembling, perspiring and pacing, I find myself with cold clammy hands and my pulse races. I start worrying whether I'll be able to help him stay in control." In such an interaction, the client will most likely experience 1. claustrophobia 2. increased anxiety 3. fatigue 4. improved self-esteem
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2
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When the nurse diagnoses that a client is experiencing panic-level anxiety, an intervention that should be immediately implemented is to 1. teach relaxation techniques 2. place the client in four-point restraints 3. reduce stimuli 4. gather a show of force
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3
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Which of the following is a criterion for assessing the anxiety level in a client with an anxiety disorder? 1. ability to be assertive 2. ability to determine appropriateness of own behavior 3. attention span and concentration 4. sleep pattern
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3
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A client reveals that she becomes panic-stricken when she gets within visual range of a dog. The nurse can assess this behavior as being consistent with: 1. social phobia 2. simple phobia 3. agoraphobia 4. generalized anxiety disorder
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2
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When working with a client with post-traumatic stress disorder who has frequent flashbacks, as well as persistent symptoms of arousal, the least effective nursing intervention would be to 1. encourage repression of memories associated with the traumatic event 2. explain that physical symptoms are related to the psychological state 3. teach effective stress management techniques 4. discuss possible meanings of the event
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1
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The nurse has a client who checks and rechecks her home in response to an obsessive thought that her house will burn down. The nurse and client explore the likelihood whether the house will actually burn. The client states there is little likelihood of this occurring. This is making use of: 1. desensitization 2. cognitive restructuring 3. relaxation technique 4. flooding
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2
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When a client asks what causes his panic attacks, the nurse responds that research shows evidence to support the theory that panic disorders have their etiology in: 1. faulty learning 2. traumatic events 3. genetic-biological factors 4. developmental fixations
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3
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For planning purposes, the nurse caring for a client with obsessive-compulsive disorder knows that an effective treatment for obsessive-compulsive disorder is: 1. analysis 2. group therapy 3. flooding 4. clomipramine
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4
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When interviewing and planning care for a client with fear of public speaking, the nurse is aware that social phobias are often treatable using: 1. meditation 2. response prevention 3. modeling 4. beta blockers
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4
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A client tells the nurse that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nurse's reply should be based on the knowledge that buspirone 1. can be administered prn 2. does not predispose the client to blood disorders 3. is not habit-forming 4. is faster-acting
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3
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The nurse plans health teaching for a client with generalized anxiety disorder who is taking lorazepam (Ativan). Which topic should be included? 1. tyramine-free diet 2. caffeine restriction 3. skin care to prevent breakdown 4. dietary restriction of tryptophan
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2
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The care plan for a client with agoraphobia includes increasing self-esteem via cognitive restructuring. When the client tells the nurse, "I'm not smart enough to get that job," the nurse should say: 1. "It must be difficult to be in that position." 2. "You shouldn't demean your abilities." 3. "Let's think about what you just said." 4. "It seems to me that you're intelligent."
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3
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The nurse teaches a client to snap a rubber band on her wrist whenever an obsessive thought enters her mind. This technique, designed to interrupt obsessive thinking, can be identified as 1. implosion 2. flooding 3. desensitization 4. thought stopping
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4
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A nursing instructor is teaching about specific phobias. Which student statement indicates to the instructor that learning has occurred? a. "These clients recognize their fear as excessive and frequently seek treatment." b. "These clients have a panic level of fear that is overwhelming and unreasonable." c. "These clients experience symptoms that mirror a stroke." d. "These clients always experience tachycardia, dysphagia, and diaphoresis."
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b
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Which treatment should a nurse identify as most appropriate for clients diagnosed with generalized anxiety disorder (GAD)? a. Long-term treatment with diazepam (Valium). b. Acute symptom control with citalopram (Celexa). c. Long-term treatment with buspirone (BuSpar). d. Acute symptom control with ziprasidone (Geodon).
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c
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A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardic, and dyspneic. A work-up in the emergency department reveals no pathology. Which medical diagnosis should the nurse suspect, and which nursing diagnosis should be the nurse's first priority? a. Generalized anxiety disorder and a nursing diagnosis of fear. b. Disturbed sensory perception and a nursing diagnosis of panic disorder. c. Pain disorder and a nursing diagnosis of altered role performance. d. Panic disorder and a nursing diagnosis of anxiety.
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d
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A client diagnosed with panic disorder states, "When an attack happens, I feel like I am going to die." Which is the most appropriate nursing response? a. "I know it's frightening, but try to remind yourself that this will only last a short time." b. "Death from a panic attack happens so infrequently that there is no need to worry." c. "Most people who experience panic attacks have feelings of impending doom." d. "Tell me why you think you are going to die every time you have a panic attack."
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a
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A nursing instructor is teaching about the medications used to treat panic disorder. Which student statement indicates that learning has occurred? a. "Clonazepam (Klonopin) can be used, as needed, in the treatment of panic disorder." b. "Clozapine (Clozaril) is used off-label in long-term treatment of panic disorder." c. "Doxepin (Sinequan) can be used in low doses to relieve symptoms." d. "Buspirone (BuSpar) is used for immediate effect to lower anxiety."
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a
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A family member is seeking advice about an older parent who seems to worry unnecessarily about everything. The family member states, "Should I seek psychiatric help for my mother?" Which is the best nursing response? a. "My mother also worries unnecessarily. I think it is part of the aging process." b. "Anxiety is considered abnormal when it is out of proportion to the stimulus causing it and when it impairs functioning." c. "From what you have told me, you should get her to a psychiatrist as soon as possible." d. "Anxiety is a complex phenomenon and is effectively treated only with psychiatric medications."
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b
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A college student is unable to take a final exam due to severe test anxiety. Instead of studying, the student relieves stress by going to a movie. Which priority nursing diagnosis should the campus nurse assign for this client? a. Non-adherence related to test taking. b. Ineffective role performance related to helplessness. c. Ineffective coping related to anxiety. d. Powerlessness related to fear.
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c
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A client living in a beachfront community is seeking help with an extreme fear of bridges, which is interfering with daily functioning. A trained therapist decides to try systematic desensitization. Which explanation of this treatment should the nurse provide? a. "Using your imagination, we will attempt to achieve a state of relaxation." b. "Because anxiety and relaxation are mutually exclusive states, we can attempt to substitute a relaxation response for the anxiety response." c. "Through a series of increasingly anxiety-provoking steps, we will gradually increase your tolerance to anxiety." d. "In one intense session, you will be exposed to a maximum level of anxiety that you will learn to tolerate."
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c
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A client diagnosed with obsessive-compulsive disorder is admitted to a psychiatric unit. The client has an elaborate routine for toileting activities. Which would be an appropriate initial client outcome during the first week of hospitalization? a. The client will refrain from ritualistic behaviors during daylight hours. b. The client will wake early enough to complete rituals prior to breakfast. c. The client will participate in 3 unit activities by day 3. d. The client will substitute a productive activity for rituals by day 1.
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b
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A client is newly diagnosed with obsessive-compulsive disorder and spends 45 minutes folding clothes and rearranging them in drawers. Which nursing intervention best addresses this client's problem? a. Distract the client with other activities whenever ritual behaviors begin. b. Report the behavior to the psychiatrist to obtain an order for medication dosage increase. c. Lock the room to discourage ritualistic behavior. d. Discuss the anxiety-provoking triggers that precipitate the ritualistic behaviors.
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d
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A nursing instructor is teaching about the symptoms of agoraphobia. Which student statement indicates that learning has occurred? a. Onset most commonly occurs in early adolescence and persists until midlife. b. Onset most commonly occurs in the 20s and 30s and persists for many years. c. Onset most commonly occurs in the 40s and 50s and persists until death. d. Onset most commonly occurs after age 60 and persists until death.
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b
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A college student has been diagnosed with generalized anxiety disorder (GAD). Which of the following symptoms should the campus nurse expect this client to exhibit? Select all that apply. a. Fatigue b. Anorexia c. Hyperventilation d. Insomnia e. Irritability
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a,d,e
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Which factors differentiate the diagnosis of PTSD from the diagnosis of adjustment disorder (AD)? a. PTSD results from exposure to an extreme traumatic event, whereas AD results from exposure to "normal" daily events. b. AD results from exposure to an extreme traumatic event, whereas PTSD results from exposure to "normal" daily events. c. Depressive symptoms occur in PTSD but not in AD. d. Depressive symptoms occur in AD but not in PTSD.
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a
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As the sole survivor of a roadside bombing, a veteran is experiencing extreme guilt. Which nursing diagnosis would address this client's symptom? a. Anxiety b. Disturbed thought processes c. Complicated grieving d. Disturbed sensory perception
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c
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Which clinical presentation is associated with the most commonly diagnosed adjustment disorder? a. Anxiety, hopelessness, and worry b. Truancy, vandalism, and fighting c. Nervousness, worry, and jitteriness d. Depressed mood, tearfulness, and hopelessness
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d
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A client diagnosed with adjustment disorder (AD) has been assigned the nursing diagnosis of anxiety related to divorce. Which correctly written outcome addresses this client's problem? a. Rates anxiety as 3 out of 10 by discharge. b. States anxiety level has decreased by day 1. c. Accomplishes activities of daily living independently. d. Demonstrates ability for adequate social functioning by day 2.
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a
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A nurse recognizes which treatment as most commonly used for adjustment disorder (AD) and its appropriate rationale? a. Psychotherapy, to examine the stressor and confront unresolved issues. b. Fluoxetine (Prozac), to stabilize mood and resolve symptoms. c. Eye movement desensitization therapy, to reprocess traumatic events. d. Lorazepam (Ativan), a first-line treatment to address anxiety.
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a
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A nurse has been caring for a client diagnosed with PTSD. Which realistic goal should be included in this client's plan of care? a. The client will have no flashbacks. b. The client will feel a full range of emotions by discharge. c. The client will not require Ambien to obtain adequate sleep by discharge. d. The client will refrain from discussing the traumatic event.
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c
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A client diagnosed with PTSD is receiving risperidone (Risperdal). Which symptoms does the nurse identify that shows evidence for the need of this medication? a. Flat affect and anhedonia b. Persistent anorexia c. Flashbacks of killing the enemy d. Guarded behavior in relationships
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c
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A nurse is admitting a client who has been diagnosed with PTSD. Which of the following symptoms does the nurse expect to assess? Select all that apply. a. Feelings of guilt b. Aggressive behaviors affecting job performance c. Relationship problems d. High levels of anxiety e. Escalating symptoms lasting less than 1 month
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a,b,c,d
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A client has been extremely nervous ever since an individual died as a result of the client's drunk driving. When assessing for the diagnosis of adjustment disorder, within what time frame should the nurse expect the client to exhibit symptoms? a. The client should exhibit symptoms within 1 year of the accident. b. The client should exhibit symptoms within 3 months of the accident. c. The client should exhibit symptoms within 6 months of the accident. d. The client should exhibit symptoms within 9 months of the accident.
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c
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S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss. To assess S's eating patterns, what questions might the nurse ask? 1. "Do you often feel fat?" 2. "Who plans the family meals?" 3. "What do you eat in a typical day?" 4. "What do you think about your present weight?"
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3
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S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss and cessation of menses. The nurse ascertains that S perceives herself as grossly overweight and needing to lose more weight. What physical symptom of anorexia nervosa, in addition to weight loss, does S have? 1. peripheral edema 2. constipation 3. amenorrhea 4. lanugo
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3
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S, age 18, has lost 35 pounds over a summer spent looking at colleges and cooking gourmet foods for her family. She was referred to the mental health center by her physician who had performed a physical examination for school sports and was alarmed by her weight loss and cessation of menses. The nurse ascertains that S perceives herself as grossly overweight and needing to lose more weight. Based on what is currently known about S, what nursing diagnosis can be established? Imbalanced nutrition: less than body requirements related to 1. abuse of laxatives, as evidenced by electrolyte imbalances 2. physical exertion in excess of energy produced through caloric intake, as evidenced by weight loss 3. self-induced vomiting, as evidenced by swollen parotid glands 4. refusal to eat, as evidenced by loss of more than 15% of body weight
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4
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S, age 18, has been diagnosed with anorexia nervosa. A short-term goal related to the nursing diagnosis: Imbalanced nutrition: less than body requirements would be: client will 1. gain 1 to 2 pounds each week 2. state she feels better about her situation within 2 weeks 3. identify two emotional supports within 3 weeks 4. identify an alternative coping skill prior to discharge
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1
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What nursing intervention would relate to a client goal that S, a client with anorexia nervosa, will gain 1 to 2 pounds per week? 1. assessing for depression and suicidal ideation 2. observing for adverse side effects of refeeding 3. communicating empathy for S's feelings 4. focusing with client on objective facts comparing energy expenditure and caloric intake
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2
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S, a client with anorexia nervosa, is particularly resistant to the idea of weight gain. The nurse decides to encourage S to agree to a treatment contract. What is the rationale for establishing a contract with S in which she agrees to participate in measures designed to produce a specified weekly weight gain? 1. Because severe anxiety concerning eating is to be expected, objective and subjective data must be routinely collected. 2. A team approach to planning diet ensures that physical and emotional needs will be met. 3. Client involvement in decision making increases sense of control and promotes compliance with treatment. 4. Because there is increased risk of physical problems with refeeding, client permission is essential.
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3
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What behavior on the part of the nurse caring for a client with anorexia nervosa would indicate a need for supervision? 1. being consistent and reliable 2. using an accepting, nonjudgmental manner 3. being matter-of-fact and neutral 4. being flexible about limits for the client
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4
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The psychiatric clinical nurse specialist decides to use cognitive therapy techniques as she works with S, a client with anorexia nervosa. Which statement by the nurse is consistent with the use of cognitive therapy principles? 1. "You seem to feel much better about yourself when you eat something." 2. "Being thin doesn't seem to solve your problems, since you're thin, now, and still unhappy." 3. "It must be difficult to talk about private matters to someone you just met." 4. "What are your feelings about not eating the food that you prepare?"
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2
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L, age 20, is a college student who transferred from a community college in her hometown to a university 100 miles from home. L had lived at home and had been emotionally close to her mother and sister. When she transferred she broke up with her boyfriend of 2 years. L was slow to make new friends at the university. Gradually, she began to eat whenever she felt blue. She consumed large quantities of food nightly and then induced vomiting. The binge-purge cycles continued until they began to interfere with her schoolwork. L sought help from the university health clinic. During the initial interview what other issue should the nurse address in addition to L's binge-purge syndrome? 1. study habits 2. school activities 3. losses 4. student aid
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3
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What behavior might signal that the nurse treating L, a client with bulimia nervosa, is experiencing rescue feelings? 1. The nurse's comments are nonjudgmental. 2. The nurse refers L to a self-help group for individuals with eating disorders. 3. The nurse teaches L to recognize signs of increasing anxiety and ways to intervene. 4. The nurse assesses L's problem as poor eating habits and gives her a diet to follow.
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4
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A nursing diagnosis formulated for L, a client with bulimia nervosa, was Ineffective coping related to feelings of loneliness and isolation, as evidenced by use of overeating as a comfort measure followed by self-induced vomiting. Which short-term goal is related to this nursing diagnosis? 1. Client will verbalize the importance of eating a balanced diet within 2 weeks. 2. Client will identify two alternative methods of coping with loneliness and isolation within 2 weeks. 3. Client will verbalize two positive things about herself within 2 weeks. 4. Client will appropriately express angry feelings within 2 weeks.
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2
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Which nursing intervention is of highest priority for L, a client with bulimia nervosa? 1. assist client to identify triggers to binge eating 2. communicate empathy and focusing on feelings 3. assess for signs of anxiety and depression 4. explore alternative coping strategies
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1
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M was recently admitted to the eating disorders unit of the psychiatric hospital with a diagnosis of obesity related to compulsive eating. Her friend told the nurse, "I can't believe M is so heavy. When we're together, I never see her eat." This alerts the nurse to the possibility that M engages in the eating behavior of 1. purging 2. eating in secret 3. excessive exercise 4. use of eating rituals
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2
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M , a client with the diagnosis Obesity related to compulsive eating had been under a great deal of stress at work. She worked long hours to make up for a staff shortage. When she went home, she propped her feet up in front of the TV and ate until she went to bed. She felt too exhausted to exercise. She gained 25 pounds in 1 month. At 5 feet tall, she weighs 175 pounds. One of the goals for M is to help her replace compulsive eating by recognizing the anxiety that precedes binge eating and reducing it via a constructive strategy. Of the following interventions, which would operationalize this goal? 1. Teach stress reduction techniques such as relaxation and imagery. 2. Explore the client's need to single-handedly make up for a staff shortage. 3. Explore ways in which the client may feel in control of her environment. 4. Encourage the client to attend a support group such as Overeaters Anonymous.
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1
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C is admitted to the eating disorders unit. As she undresses, she removes layer after layer of clothing. The nurse realizes that she is extremely thin. Her skin has a yellow cast, her hair is limp and dry, and her body is covered by fine downy hair. Her weight is 70 pounds and her height is 5 feet 4 inches. C remains quiet and sullen during the physical assessment. In the nurse's written assessment of C's physical condition, which of the following should be recorded? 1. amenorrhea 2. alopecia 3. lanugo 4. stupor
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3
