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96 Cards in this Set
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- Back
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What is delirium? |
A disturbance in attntial and awareness and a change in cognition that develop rapidly over a short period. |
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What are the symptoms of delirium? |
* difficulty sustaining attention * extremely distractible * disorganized thinking * rambling speech * disoriented to time & place * impaired short term memory * disturbed wake/ sleep cycle |
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What are some causes of delirium? |
* Systemic infections * febrile illness * metabolic disturbances * hepatic encephalopathy * head trauma * seizures * migraines * brain abscess * stroke * post op states * electrolyte imbalance * substance intoxication, withdrawal or meds |
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What is neurocognitive disorder? |
A disorder of cognitive function closely linked to particular areas of the brain that have to do with thinking, reasoning, memory, learning and speaking. Classified as mild or major, depending on the severity of the symptoms. |
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Are there reversible NCDs? |
Yes, they can be a result of * cerebral lesions * depression * side effects of certain medications * normal pressure hydrocephalus * vitamin or nutritional deficiencies (B12, folate) * CNS infections or metabolic disorders |
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A family member wants to know the difference between Alzheimer's disease and delirium. Which explanation should the nurse provide to the family member? 1) Delirium is a reversible condition, whereas Alzheimer's disease is not. 2) The treatment for Alzheimer's disease is more aggressive than is the treatment for delirium. 3) There are more stigmas associated with a diagnosis of Alzheimer's disease than there are for delirium. 4) Changes in cognition develop rapidly with Alzheimer's disease and slowly with delirium. |
1) Delirium is a reversible condition, whereas Alzheimer's disease is not. Alzheimer's disease is irreversible, whereas delirium is reversible in most cases |
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A client is newly diagnosed with the second stage of Alzheimer's disease. Which cognitive change would a nurse observe? 1) Memory disturbance 2) Confabulation 3) Apraxia 4) Inability to plan or organize |
1. In the second stage of the illness, losses in short-term memory are common and the individual may begin to lose things or forget names of people. It is at this stage that a diagnosis may be considered. |
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Hospitalized and assessed to be in the fourth stage of Alzheimer's disease, a client, when asked about the previous evening, describes a wonderful evening spent on a cruise. Which symptom is the client exhibiting? 1) Aphasia 2) Confabulation 3) Delirium 4) Apraxia |
2. Confabulation is a behavioral reaction to memory loss in which the client fills in memory gaps with information about events that have not occurred. During the fourth stage of Alzheimer's disease, a client will use confabulation in an effort to maintain self-esteem. |
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When teaching a family about Alzheimer's disease, what information should the nurse include? 1) Alzheimer's disease is self-limiting and will resolve over time. 2) Alzheimer's disease has an abrupt onset and runs a variable course. 3) Alzheimer's disease has a slow, insidious onset. 4) Alzheimer's disease causes a rapid functional and cognitive decline. |
3. Alzheimer's disease is characterized by a slow, insidious onset, with progressive loss of cognitive abilities. |
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Which statement is true about vascular neurocognitive disorder (NCD)? 1) Vascular NCD is reversible. 2) Vascular NCD is characterized by plaques and tangles in the brain. 3) Vascular NCD involves a gradual, progressive cognitive deterioration. 4) Vascular NCD involves a variable pattern of cognitive functioning. |
4. In vascular NCD, clients suffer the equivalent of small strokes that destroy many areas of the brain. The pattern of deficits is variable, depending on which regions of the brain have been affected. |
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A nursing home resident is often argumentative with other residents and staff and frequently exhibits loss of emotional control. Which nursing intervention should the nurse implement? 1) Confront the argumentative behavior. 2) Redirect attention and set limits to curtail maladaptive, abusive behavior. 3) Administer as needed (prn) medications to subdue the client. 4) Isolate the client until the behavior improves. |
2. Maladaptive, abusive behavior must be curtailed through setting limits and redirecting attention. Setting limits provides a sense of security and stability for the client and maintains a safe environment. |
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A client is admitted with middle- to late-stage Alzheimer's disease. Which client information should the nurse assess to effectively plan the client's care? 1) The client's past successful coping mechanisms 2) The client's willingness to participate in goal setting and treatment planning 3) The client's changes in level of functioning, including strengths and weaknesses 4) The client's attitude toward illness |
3. Nursing assessments should include both strengths and weaknesses of the client. This assessment must be ongoing in order to adapt nursing care to the client's current level of functioning. |
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Family members are considering home care for a client diagnosed with major neurocognitive disorder due to Alzheimer's disease. Which initial nursing intervention would be most appropriate before the family makes that decision? 1) Teach the family about the disease process and the skills necessary to manage client care. 2) Encourage the family to address any unresolved issues or resentments with the client. 3) Determine the extent of the family's financial resources. 4) Include the client in the decision-making process. |
1. To make the best immediate decisions for this client, the family must be knowledgeable about the disease process of Alzheimer's disease and the skills needed to care for their family member. With this knowledge, they can make informed decisions about treatment. |
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A client is in the third stage of Alzheimer's disease. Which characteristic is indicative of this stage? 1) The client has no apparent cognitive decline. 2) The client loses the ability to perform some activities of daily living. 3) The client is unable to plan or organize, and work performance declines. 4) The client is bedfast and aphasic. |
3. Interference with work performance becomes noticeable to coworkers, and the ability to plan and/or organize declines in the third stage of Alzheimer's disease. |
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A client diagnosed with substance abuse is experiencing delirium related to alcohol withdrawal syndrome. Which nursing intervention should be prioritized? 1) Maintain seizure precautions. 2) Restrict fluid intake. 3) Increase sensory stimuli. 4) Apply ankle and wrist restraints. |
1. Symptoms of substance-withdrawal delirium develop during the first week of reduction or termination of sustained, usually high-dose use of certain substances, such as alcohol, sedatives, hypnotics, or anxiolytics. Clients experiencing alcohol withdrawal are at high risk for seizures. This is a priority intervention because seizures can be life threatening. |
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A client has recently been diagnosed with mild to moderate Alzheimer's disease. Which medication would the nurse expect the physician to order for this client's cognitive impairment? 1) Nortriptyline (Pamelor) 2) Zalepon (Sonata) 3) Donepezil (Aricept) 4) Quetiapine (Seroquel) |
3. Aricept is used to improve cognition in clients diagnosed with mild to moderate dementia associated with Alzheimer's disease. * Pamelor is a tricyclic antidepressant, it does not improve cognition. * Sonata is used as a short-term management of insomnia, it does not improve cognition. * Seroquel is an antipsychotic used to treat schizophrenia and bipolar mania, it does not improve cognition. |
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Elderly patients are at risk for being diagnosed with neurocognitive disorder when, in fact, they may be suffering from depression. Which of the following features differentiate neurocognitive disorder from depression? Select all that apply. 1) Deficits in memory are progressive in neurocognitive disorder. 2) There are no changes in mood with neurocognitive disorder. 3) Disorientation to time and place is not characteristic of depression. 4) Depression symptoms worsen as the day progresses. 5) Wandering occurs in neurocognitive disorder but not in depression. |
1, 3, 5. * Emotional responses are affected in neurocognitive disorder as well as in depression.` * Depression symptoms tend to be worst in the morning and lift as the day progresses. The opposite is true in neurocognitive disorder. |
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A patient is diagnosed with major neurocognitive disorder, and the family has asked the nurse what that means. Which of the following teaching points are accurate descriptors to share with this family? Select all that apply. 1) These are disorders in which there is persistent difficulty with intellectual functions. 2) Several functions such as memory, language, visuospatial skills, emotions, and personality are compromised. 3) The symptoms appear rapidly and are often reversible. 4) Major neurocognitive disorder is always the result of cerebrovascular disease. 5) Major neurocognitive disorder is defined as a disorder in which there are changes in level of consciousness and the symptoms are worse in the morning but improve as the day progresses. |
1 & 2 |
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A client is admitted to the hospital with possible Alzheimer's disease. The family asks the nurse what tests will be performed to determine this diagnosis. What is the correct nursing response? 1) Dexamethasone suppression test 2) Magnetic resonance imaging (MRI) 3) Thematic apperception test 4) Family kinetic drawing |
2. An MRI can reveal atrophy, widened cortical sulci and enlarged cerebral ventricles. This degenerative pathology is indicative of Alzheimer's disease. |
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Which of the following are realistic outcomes that can be used to evaluate care of a client with an anxiety disorder? Select all that apply. 1) The client successfully removes all stressors that precipitate anxiety. 2) The client recognizes symptoms of escalating anxiety. 3) The client can maintain anxiety at a manageable level. 4) The client demonstrates adaptive coping strategies for dealing with anxiety. 5) The client commits to staying on benzodiazepines indefinitely. |
2, 3 & 4 It is not realistic to expect that all stressors can be removed and benzos are addictive |
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After undergoing a complete diagnostic work-up, a client is diagnosed with post-traumatic stress disorder (PTSD). What must the nurse understand about the symptoms of PTSD before planning care? 1) Symptoms are psychological coping mechanisms. 2) Symptoms result in feelings of invulnerability. 3) Symptoms are a means to manipulate others. 4) Symptoms develop from a nonspecific psychic event. |
1. Symptoms of PTSD include psychological numbing, flashbacks, nightmares, and explosive anger. These symptoms are coping mechanisms used to deal with anxiety by blocking memories of traumatic events. Resolution of the post-trauma response is largely dependent on the effectiveness of the coping strategies employed. |
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Which of the following is a primary function of nurse generalists in helping clients with anxiety and related disorders? 1) Facilitate the client's development of insight and self-awareness in relation to his or her illness. 2) Decide which antianxiety agent is most appropriate to treat the symptoms. 3) Use behavioral therapies such as systematic desensitization and implosion. 4) Conduct psychological tests to support proper diagnosis of the anxiety disorder. |
1. Self-awareness and insight into an individual's stressors and anxiety responses lay the foundation for effective treatment and intervention. The nurse generalist plays a key role in helping clients develop this awareness and insight. |
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Paula, who complains of "always being stressed out" and appears to be easily distracted, is seeking counseling for stress management. Which of the following nurse actions will be essential when intervening with Paula? Select all that apply. 1) Assessing the nurse's own level of anxiety 2) Using a calm, matter-of-fact approach 3) Assessing Paula's level of anxiety before initiating education 4) Observing how Paula interacts with coworkers in stressful situations 5) Administering antianxiety agents (as prescribed) before the session begins |
1, 2 & 3 Observing in real life is not realistic and meds should only be considered if other interventions fail |
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A client is experiencing a panic attack. What physical symptoms would the nurse expect to assess? 1) Intense fear and helplessness 2) Sweating and palpitations 3) Psychomotor agitation 4) A narrowed perceptual field and a decreased attention span |
2. Sweating and palpitations |
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A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) spends 1 hour packing and unpacking and folding and refolding personal belongings. What is the most likely reason for this behavior? 1) It relieves anxiety. 2) It fosters organizational skills. 3) It delays meeting unfamiliar people in the dayroom. 4) It makes the client feel good. |
1. It relieves anxiety |
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A despondent college student, being treated for a panic disorder, tells the nurse, "I've had it! For no reason, my heart pounds and I can't seem to breathe. It's not worth it." Based on this information, which nursing diagnosis takes priority? 1) Ineffective Airway Clearance 2) Ineffective Coping 3) Risk for Suicide 4) Knowledge Deficit |
3. Because the client is despondent and makes statements such as "I've had it!" and "It's not worth it," an indication of self-harm must be considered. Although other nursing diagnoses may be valid and appropriate, the safety of the client is always the nurse's first priority. |
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The nurse is assessing a patient who is diagnosed with obsessive-compulsive disorder. Which of the patient's statements would the nurse correctly identify as a compulsion? 1) "I can't stop washing my hands." 2) "I can't stop thinking that I'm going to get deathly ill." 3) "I need drugs to help me with this anxiety." 4) "These symptoms are interfering with my ability to get my work done." |
1. A compulsion is a repetitive, ritualistic act, the purpose of which is to reduce anxiety associated with obsessive thoughts. Compulsive handwashing is an example of this behavior. |
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After losing a child in a car accident, a client diagnosed with post-traumatic stress disorder (PTSD) asks the nurse, "Why did I live and my beautiful daughter die?" Which is the client experiencing? 1) Survivor's guilt 2) Anger 3) Denial 4) Suppression |
1. The statement presented in the question indicates that the client is experiencing survivor's guilt. Survivor's guilt is a common situation that occurs when an individual experiences a traumatic event in which others die and the individual survives. |
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A client has made an appointment to see a primary care provider because of increased anxiety. Which medication would likely be prescribed for anxiety? 1) Chlorpromazine (Thorazine) 2) Clozapine (Clozaril) 3) Diazepam (Valium) 4) Methylphenidate (Ritalin) |
3. Diazepam is an antianxiety agent. * Chlorpromazine is an antipsychotic medication. * Clozapine is an antipsychotic medication. * Methylphenidate is a central nervous system stimulant used to treat attention deficit-hyperactivity disorder. |
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For the past year, a college student continually and unrealistically worries about academic performance and love-life performance. The student is irritable and suffers from severe insomnia. This behavior is associated with which Axis I diagnosis? 1) Post-traumatic stress disorder (PTSD) 2) Generalized anxiety disorder (GAD) 3) Social phobia disorder 4) Obsessive-compulsive disorder (OCD) |
2. GAD may be diagnosed when excessive, unrealistic worry and anxiety become chronic and last for at least 6 months. The anxiety experienced is generalized rather than specific. The anxiety is not associated with a specific object, as in phobia, or event, as in PTSD. |
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A 60-year-old woman presents at the emergency department with complaints of anxiety unlike anything she has experienced before. She is unable to identify a precipitating stressor related to her anxiety. In addition to psychosocial assessment, which of the following assessments should the nurse conduct in order to facilitate accurate diagnosis? Select all that apply. 1) Vital signs 2) History of substance use 3) Blood sugar 4) History of thyroid disorders 5) Marital status |
1, 2, 3 & 4 * Marital status is not directly linked to an increase in anxiety disorders, so although this is demographic data routinely collected during assessment, it would not necessarily contribute to identifying the cause of this patient's symptoms. |
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A client is experiencing a panic attack. He states, "I'm losing control. I feel like I'm going crazy." Which nursing intervention takes priority? 1) Stay with the client and offer support. 2) Distract the client by redirecting him to physical activities. 3) Teach about the etiology and management of panic disorders. 4) Encourage the client to express his feelings. |
1. During a panic attack, the client is experiencing extreme levels of anxiety. The symptoms experienced may mimic life-threatening physiological symptoms, such as chest pain and feelings of suffocation and/or impending doom. Clients need reassurance that these symptoms are psychologically, not physiologically, based. It is a priority to be present for the client and offer this support. |
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A nursing student diagnosed with acute test anxiety is prescribed propranolol (Inderal). What is the rationale for this treatment? 1) Inderal is a mood stabilizer that will decrease situational anxiety. 2) Inderal is an antihypertensive medication. Question this order. 3) Inderal has potent effects on the somatic manifestations of anxiety. 4) Inderal is an anxiolytic used specifically for generalized anxiety. |
3. Propranolol is an antihypertensive medication. Research studies show that propranolol is effective in decreasing anxiety symptoms. It has potent effects on the somatic manifestations of anxiety, such as palpitations and tremors, but has less dramatic effects on the psychic components of anxiety. It is most effective in the treatment of acute situational anxiety, such as performance anxiety and/or test anxiety. |
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Caroline reports to the nurse that she has an intense fear of riding the bus and being in crowds. The type of phobia she is describing is____________. |
Agoraphobia. DSM-5 diagnostic criteria for agoraphobia identify that fear or anxiety must occur in at least two of five situations to diagnose agoraphobia; fear of public transportation and being in crowds are two of those criteria. |
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A client developed paralysis of the lower extremities after experiencing a severe psychic trauma. Which nursing intervention would be initially implemented? 1) Encourage the client to talk about feelings. 2) Assess the client for organic causes of paralysis. 3) Provide range of motion (ROM) to the lower extremities. 4) Encourage discussion of future goals. |
2. The initial intervention is to rule out organic factors contributing to the paralysis. Once this has been identified, a plan of care can be effectively established. |
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A client experiencing numbness of the extremities, trembling, fear of dying, and dizziness is admitted to the emergency room with a diagnosis of panic disorder. Which nursing intervention takes priority? 1) Discuss functional coping mechanisms. 2) Determine the source of the problem. 3) Quickly administer an anxiolytic medication. 4) Establish a trusting nurse–client relationship. |
3. Anxiolytic medications work quickly to decrease anxiety levels by depressing the central nervous system. Control of the client's physical symptoms of extremity numbness, trembling, and hyperventilation must take priority to maintain physiological and psychosocial integrity. |
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A noncompliant client has a nursing diagnosis of "Social Isolation related to anxiety evidenced by remaining in room during group activities." Which short-term outcome is appropriate for this client? 1) The client will attend three group sessions. 2) The client will understand and accept social withdrawal as a personality trait. 3) The client will remain safe throughout the hospital stay. 4) The client will request as needed (prn) anxiety medication prior to attending group sessions. |
4. Acknowledging the need for prn medications prior to attending group sessions indicates a positive outcome for the client problem of social isolation. |
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A client has an irrational fear of height (acrophobia). According to the diagnostic criteria for specific phobias, which of the following symptoms would the nurse expect to assess? Select all that apply. 1) The client does not recognize that the fear is excessive or unreasonable. 2) Exposure to the phobic stimulus provokes an immediate anxiety response. 3) The client tolerates the presence of a specific feared object or situation. 4) The client exhibits marked and persistent fear that is excessive or unreasonable. 5) The client reports that even anticipation of being exposed to heights provokes an anxiety response. |
2, 4, 5 The client recognizes that the fear is excessive or unreasonable and the client avoids, not tolerates the feared situation |
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An angry client, throwing objects and scratching eyes, is escorted to the seclusion room by security. Which nursing statement best explains to the client why four-point restraints will be applied? 1) "Restraints are the consequences for what you are doing." 2) "Restraints are a means of providing safety for you and others on the unit." 3) "Restraints are the only way to manage anger." 4) "Restraints are necessary because there is not enough staff on duty to provide other interventions." |
2. It is important to provide safeguards in order to protect clients who are out of control. The nurse is educating the client in a nonjudgmental, objective manner. |
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Forrest is seeking treatment for an anxiety disorder after his wife tells him she wants a divorce. He reports to the nurse "I know it sounds crazy but I feel like everybody hates me." According to cognitive theory this statement would be an example of which of the following? 1) Cognitive distortion 2) Sublimation 3) Delusion of grandeur 4) Delusion of persecution |
1. Forrest's statement is an example of overgeneralizing, which is a cognitive distortion or irrational thought. Cognitive distortions, according to cognitive theory, are counterproductive thinking patterns that lead to maladaptive behaviors and emotions. |
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Jennifer is a 25-year-old woman of average height and weight who reports to the mental health clinic with complaints that she has been unable to go to work for the last 2 weeks because she can't get her "appearance right." She reports that she repetitively checks the mirror and has to redo her make-up every 5 or 10 minutes. Jennifer is most likely experiencing which of these disorders? 1) Social anxiety disorder 2) Panic disorder 3) Eating disorder 4) Body dysmorphic disorder |
4. Repetitive mirror-checking and excessive grooming R/T perception of flawed appearance that interferes with social, occupational, or other areas of functioning are symptoms of body dysmorphic disorder. |
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Gary is admitted to the mental health center for treatment of obsessive-compulsive disorder. He tells the nurse that he has a repetitive fear that he has forgotten to lock the doors to his home. Which symptom of this disorder is Gary describing? 1) An obsession 2) A compulsion 3) Auditory hallucinations 4) Claustrophobia |
1. An obsession is a recurrent, intrusive, stressful thought, and this is what Gary is describing in the scenario. |
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A type of therapy in which a client is directed to imagine or actually participate in real-life situations that he or she finds intensely frightening, and to do this for prolonged periods of time, is called____________. |
Implosion therapy or flooding |
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When caring for a client who is experiencing a panic attack, which of the following nursing actions should be implemented? Select all that apply. 1) Leave the client alone to maintain privacy. 2) Reduce stimuli in the immediate environment. 3) Instruct the client regarding unit rules and regulations. 4) Administer antianxiety medication as ordered. 5) Communicate with simple words and brief messages. |
2, 4 & 5 Nurse should not leave client alone and client is not in any condition to receive instruction - it may increase the anxiety |
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Which nursing intervention takes priority for a client experiencing moderate anxiety? 1) Explore the etiology of the anxiety. 2) Investigate decompensation behaviors. 3) Focus on anxiety reduction. 4) Accept the level of anxiety. |
3. Reducing anxiety to a tolerable level should be the nurse's first priority. After reassuring the client of his or her safety and security, the nurse should convey an accepting attitude to facilitate trust. Once the anxiety level has decreased, the client can then begin exploring the triggers that induce anxiety. |
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What should the nurse plan to teach a client who is taking alprazolam (Xanax) three times a day? 1) That there is a potential for dependence and tolerance 2) The importance of discontinuing Xanax immediately if addiction is suspected 3) The importance of increasing the amount of caffeine consumption 4) That Xanax is not habit forming |
1. Xanax is a benzodiazepine and has addictive properties. It is the responsibility of the nurse to teach the client about dependence, tolerance, and other signs and symptoms of addiction. |
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The nurse, Robert, is conducting a relaxation group for patients at the mental health center who have been identified as struggling with anxiety disorders. He intends to implement a quality improvement initiative by using an anxiety screening tool to evaluate whether patients report less anxiety at the completion of the program. Which of these would be accepted, reliable tools for that purpose? Select all that apply. 1) Cosmopolitan's "How anxious are you?" quiz. 2) Zung's Self-Rated Anxiety Scale 3) Hamilton Anxiety Rating Scale 4) Beck Anxiety Inventory 5) Folstein's Mini-Mental Status Exam |
2, 3 & 4 * Cosmopolitan is a magazine, this is not a reliable tool * Folstein's mini-mental status exam is recognized as a reliable tool to evaluate cognitive function rather than symptoms of anxiety. |
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A client is experiencing gamophobia. Which fear would the nurse expect to assess? 1) Fear of strangers 2) Fear of marriage 3) Fear of numbers 4) Fear of insanity |
2. Fear of marriage * Xenophobia is the fear of strangers. * Numerophobia is the fear of numbers. * Dementophobia is the fear of insanity. |
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Jennifer is working with the nurse on her care plan related to post trauma syndrome. Jennifer repeatedly asks the nurse why she is writing down everything and who will be seeing this information. Which of these interpretations by the nurse reflects an understanding of the post trauma patient? 1) Post trauma patients may be suspicious of others in their environment. 2) Post trauma patients need a lot of redirection. 3) Female post trauma patients are often very confused about details. 4) Post trauma patients are always confrontational and challenging with health care professionals. |
1. An understanding that post trauma patients may be suspicious of others in the environment will assist the nurse in responding to the patient in a manner that promotes trust between them. * Redirection may not address the issue at hand * There is no gender-specific confusion * Some may be confrontational, but it is not always the case |
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One type of intervention useful for patients with adjustment disorders is a short-term therapy focused on problem-solving skills and restoring adaptive functioning. This type of therapy is ____________________. |
Crisis Intervention * The goal of this therapy is to mobilize resources needed to resolve the crisis situation. It is relevant in the treatment of adjustment disorders since a lack of adequate coping skills and resources contributes to the development of this condition. |
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The nurse is conducting an assessment for a patient diagnosed with PTSD. She recognizes that people with PTSD are at high risk for several comorbid conditions. Which of the following will she need to assess carefully because of the high risk in people with PTSD?Select all that apply. 1) Trichotillomania 2) Depression and suicide ideation 3) Substance abuse 4) Verbal or physical aggression 5) Narcissistic Personality Disorder |
2, 3 & 4 * Trichotillomania (hair pulling) is associated with anxiety but is not recognized as a common comorbid condition of PTSD * Narcissistic Personality is an exaggerated sense of self worth, those with PTSD typically have a low self worth and survivor's guilt |
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A patient who has recently been diagnosed with PTSD asks the nurse what his options are for treatment of this disorder. Which of the following items should the nurse include in teaching the patient about primary treatments for PTSD? Select all that apply. 1) Prolonged exposure therapy 2) Cognitive therapy 3) ECT 4) Antipsychotic medication 5) EMDR |
1, 2 & 5 * Electroconvulsive therapy is used to treat depression, not PTSD * Antipsychotic meds may be used but is not a primary treatment for PTSD |
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Jared returned from active duty in the military and has been diagnosed with PTSD. Which of the following interventions has been strongly advocated for as an effective strategy in this population? 1) Group therapy with patients who have a variety of diagnoses 2) Group therapy with patients who have anger management issues 3) Group therapy with patients who have experienced similar traumas 4) Group therapy with patients who have experienced different types of trauma |
3. This type of group therapy is strongly recommended so that veterans may be able to share experiences with other veterans (and therefore similar traumatic events) to decrease feelings of isolation. |
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The family of a patient being treated for PTSD asks the nurse to describe EMDR (eye movement desensitization and reprocessing), since it is being recommended for this patient. Which of the following teaching points are accurate descriptions of this intervention? Select all that apply. 1) EMDR has been shown to be effective in the treatment of all mental illnesses, including schizophrenia. 2) The process involves rapid eye movement while processing painful memories. 3) This process is contraindicated for patients with retinal detachment or glaucoma. 4) This process is thought to relieve anxiety so that the trauma can be processed from a more detached perspective. 5) The biological mechanism that makes EMDR effective is that it releases opioid-like chemicals in the brain. |
2, 3 & 4 * Has not been proven to be beneficial for all mental illnesses and The exact biological mechanisms by which EMDR has a therapeutic effect are currently unknown. |
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The nurse is developing a plan of care for a patient diagnosed with PTSD. Which of the following variables will have an impact on the patient's response to interventions? Select all that apply. 1) Patient's self-esteem 2) Socioeconomic status 3) History of psychopathology 4) Amount of control over recurrence 5) Temperament 6) Immediate crisis debriefing |
1, 2, 3, 4 & 5 * Crisis debriefing is more often used as a preventive strategy and has received mixed reviews about whether it is beneficial for that purpose. Since the patient is already suffering from PTSD, this variable is not relevant to the person's long-term response to the trauma. |
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An adult male has sought counseling at a community mental health center for PTSD. He reports during assessment that he witnessed the murder of a close friend last year in a random, drive-by shooting in his neighborhood. Since this loss he has had recurrent nightmares, explosive episodes, and frequently incapacitating anxiety. Which of the following nursing diagnoses would be appropriate, based on this assessment data? Select all that apply. 1) Post Trauma Syndrome R/T distressing events, as evidenced by recurrent nightmares. 2) Complicated grieving R/T loss of a friend in the traumatic event, as evidenced by explosive outbursts and reports of incapacitating anxiety. 3) Isolation R/T unresolved anxiety, as evidenced by complaints of incapacitating anxiety. 4) Risk for suicide R/T survivor guilt. |
1 & 2 * No evidence currently, of the other diagnoses |
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What are the progressives stages of decline for Alzheimer's Disease? |
Stage 1: No apparent symptoms Stage 2: Forgetfulness (may maintain lists, often not observed by others) Stage 3: Mild cognitive decline (starts to interfere with work and is observed by others) Stage 4: Mild to moderate Cognitive decline (forgets major events in personal history, may use confabulation) Stage 5: Moderate Cognitive decline (start to lose ability to handle ADLs independently) Stage 6: Moderate to Severe Cognitive decline (cannot manage ADLs, incontinence, worse later in the day - "sundowning") Stage 7: Severe Cognitive Decline (bed bound, aphasic, contractures, doesn't recognize family) |
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What happens with vascular NCD? |
The patient suffers a series of small strokes that destroy areas of the brain. Occurs in "steps" rather than a gradual deterioration. |
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What is the most common mental illness in the elderly? |
Depression. It is often misdiagnosed and treated inadequately because it is often thought to be dementia, so it is often called "pseudodementia". |
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What is agoraphobia? |
A fear of being separated from a source of security. It's literal translation from Greek is "Fear of the marketplace". |
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What is social anxiety disorder? |
an excessive fear of situations in which a person might do something embarrassing or be evaluated negatively by others |
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What is obsessive compulsive disorder (OCD)? |
the presence of obsessions, compulsions, or both, the severity of which is significant enough to cause distress or impairment in social, occupational, or other important areas of functioning |
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What is body dysmorphic disorder? |
the exaggerated belief that the body is deformed or defective in some specific way |
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A patient admitted to the psychiatric unit, who has been experiencing flashbacks and troubling nightmares, reports to the nurse that he just awoke from a nightmare and is still having chest pain. Which of these nursing interventions is a priority? 1) Encourage the patient to return to bed and try to calm down. 2) Administer prn antianxiety medication as ordered. 3) Assess the patient's cardiovascular status. 4) Encourage the patient to reflect on the troubling dream. |
3. This intervention is the most important priority since complaints of chest pain should not be assumed to be solely anxiety symptoms. The patient may be having a heart attack. |
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A female patient, Sally, was admitted to the psychiatric inpatient unit with PTSD following a rape 6 months ago in which she suffered several physical injuries. This evening she was approached from behind by a male patient who touched her on the shoulder, and Sally began screaming "I'm going to kill you for what you did to me!" Which of these immediate interventions by the nurse demonstrates a safe and effective care environment? Select all that apply. 1) Place the patient in seclusion for the safety of others. 2) Offer the patient reassurance that she is in a safe environment. 3) Tell the patient to share the details that she remembers about the traumatic event. 4) Stay with the patient. 5) Acknowledge and validate the patient's feelings as they are expressed. |
2, 4 & 5 No reason to believe the patient is a danger to others and now is not the time to go over the details of the traumatic event |
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John has been in counseling for an adjustment disorder related to losing his management position in a health care facility. He tells the counselor he feels ready to terminate counseling. Which of these statements by the patient supports his readiness to terminate counseling? 1) "Counseling isn't going to get me another job, so what's the point?" 2) "I don't feel angry anymore and I've learned how to relax better." 3) "I've decided I'm never going to work again, so I'm applying for disability." 4) "As long as I continue to take antianxiety medication, I'll be okay." |
2. demonstrates progression through the grieving process |
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A patient with PTSD who has been having nightmares is prescribed propranolol to treat PTSD symptoms. He asks the nurse why this medication was ordered since he doesn't have high blood pressure. Which of the following is the most appropriate response by the nurse at this point? 1) Call the doctor and question this order. 2) Discontinue the medication and check the patient's blood pressure. 3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. 4) Explain that this medication is used to treat hypertension that often accompanies PTSD. |
3) Explain that propranolol has been shown to be effective in reducing nightmares associated with PTSD. |
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The nurse is conducting an intake assessment for a patient with PTSD. Which of the following pieces of information support this diagnosis? Select all that apply. 1) The patient reports having nightmares but can't remember what they are about. 2) The patient states that he heard a loud noise when he was walking down the street and thought he was back in the war zone where he had last been deployed. 3) The patient took antidepressants when he was in junior high school and reports they didn't help. 4) The patient denies any history of substance abuse or dependence. |
1 & 2 Nightmares are common and not remembering the details as well as often reliving the trauma |
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Carol has sought treatment for an adjustment disorder after divorcing her husband of 30 years. The nurse assesses that Carol is experiencing complicated grieving. Which of the following would be an appropriate intervention to address Carol's symptoms? 1) Explore with Carol the stages of normal grieving. 2) Tell Carol that expressing anger will only keep her fixated at that stage of grieving. 3) Encourage Carol that these symptoms usually go away on their own. 4) All of the above. |
1. It is appropriate to encourage exploration and identification of which stage of grieving Carol is currently experiencing. |
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Beth is being treated for an adjustment disorder following a job demotion 2 months ago. Since the demotion, she has frequently called in sick, complains of incapacitating migraines, and has been disciplined for yelling at her boss. Her husband asks the nurse why his wife is still having so much trouble functioning, since he knows people who have lost their jobs entirely and have since resolved their concerns. Which of these statements by the nurse accurately reflects understanding of the dynamics of different kinds of stressors in patient recovery? 1) Women have more difficulty managing work-related stressors than men. 2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. 3) Job demotion is associated with longer-term recovery because it is so uncommon. 4) Carol probably had pre-existing difficulties managing stressors as a child. |
2) Ongoing stressors are associated with more maladaptive behaviors than sudden-shock types of stressors. |
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During a psychiatric nursing assessment, Sally reports to the nurse that she was sexually assaulted 6 months ago and since then has had trouble concentrating at work. Her employer tells her he is sensitive to the amount of stress she is under, since she also recently went through a divorce, but that she needs to seek help for her anxiety and depression to avoid further consequences at work. Which of these data support the diagnosis of PTSD according to DSM-5 criteria? Select all that apply. 1) She directly experienced a traumatic event. 2) She is a single female. 3) She has had difficulty concentrating at work. 4) Her anxiety and depression are interfering with job functioning. 5) Her symptoms have been present for more than 6 months. |
1, 3, 4 & 5 |
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One type of intervention useful for patients with adjustment disorders is a short-term therapy focused on problem-solving skills and restoring adaptive functioning. This type of therapy is ____________________. |
Crisis Intervention - The goal of this therapy is to mobilize resources needed to resolve the crisis situation. It is relevant in the treatment of adjustment disorders since a lack of adequate coping skills and resources contributes to the development of this condition. |
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A client diagnosed with autism spectrum disorder was recently admitted to the hospital. This client grabs a toy and hits another child. Which is the most appropriate nursing action? 1) Isolate the client for 24 hours. 2) Encourage the client to explain the hostile behavior. 3) Assume a nonpunitive attitude and remove the client from the conflict. 4) Call the parents for input regarding behavioral management. |
3. The nurse must intervene, using a nonpunitive approach, to provide a safe environment by removing the client from the conflict. The client diagnosed with autism spectrum disorder cannot be expected to limit personal behavior. |
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Jeremy is a 7-year-old boy diagnosed with separation anxiety disorder. The nurse recommends that the parents have him evaluated for a group play therapy program. The parents question the nurse about the benefits of play therapy for Jeremy, since he has never had problems playing with other children. Which of the following teaching points made by the nurse are evidence-based statements according to Landreth and Bratton (2007) about the benefits of group play therapy? Select all that apply. 1) Play provides a means for children to express their inner feelings. 2) Playing with toys allows children to transfer anxieties and fears to objects rather than people. 3) Play allows children the opportunity to change unmanageable situations into manageable ones through symbolic representation. 4) Play therapy allows children the opportunity to relax and avoid discussing anxieties and fears. 5) Play therapy is designed to help children learn age-appropriate games and activities. |
1, 2 & 3 Play therapy is used for problem solving |
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Which approach should the nurse use when planning client care for an adolescent diagnosed with conduct disorder? 1) The client and the entire family should all be included when planning care. 2) The adolescent is the identified client and should be the sole focus of care. 3) Teaching parenting skills should be the primary intervention. 4) Responsibility for treatment choices rests solely with the adolescent. |
1. Family dynamics have been implicated as contributors in predisposition to development of conduct disorders. Therefore, the family should be included when planning client care. |
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An adolescent diagnosed with attention-deficit/hyperactivity disorder (ADHD) is having difficulty maintaining concentration in the inpatient milieu. Which nursing intervention would help improve the client's task performance? 1) Mandate that the client remain in her room until all homework is complete. 2) Remove privileges if homework is not completed within a 2-hour period. 3) Encourage dividing tasks into smaller, attainable steps and reward successful completion. 4) Seek a physician's order to discontinue the stimulant methylphenidate (Ritalin). |
3. A client with a short attention span can be overwhelmed with large tasks. Rewards for task completion are more successful than punishments for task completion failure. Positive reinforcements increase self-esteem and provide incentives for future positive behaviors. |
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Joey, a 12-year-old boy diagnosed with ADHD, is being assessed to determine appropriateness for behavioral therapy–based group treatment. The nurse should also assess for symptoms of which disorders that commonly co-occur with ADHD? Select all that apply. 1) Oppositional defiant disorder (ODD) 2) Narcissistic personality disorder 3) Schizophrenia 4) Conduct disorder 5) Substance abuse |
1, 4 & 5 |
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Which is a potential side effect from the prolonged use of methylphenidate (Ritalin)? 1) Psychosis 2) A decreased intelligence quotient (IQ) 3) Sore throat 4) A decrease in rate of growth and development |
4) A decrease in rate of growth and development |
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The disorder that is characterized by the presence of multiple motor tics and one or more vocal tics is called ____________. |
Tourette's Disorder |
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Conduct disorder is a precursor to the diagnosis of which personality disorder? 1) Narcissistic personality disorder 2) Antisocial personality disorder 3) Histrionic personality disorder 4) Obsessive-compulsive disorder |
2. Antisocial personality disorder is a pattern of socially irresponsible, exploitative, and guiltless behavior that reflects a disregard for the rights of others. Conduct disorder is a precursor to the diagnosis of antisocial personality disorder. A diagnosis of antisocial personality disorder would not be assigned until a client is 18 years of age or older. |
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A client is admitted to an inpatient adolescent psychiatric unit for treatment of oppositional defiant disorder (ODD). The nurse anticipates this client to exhibit which characteristic? 1) Cruelty to animals 2) Use of weapons to inflict harm 3) Negativistic, disobedient behaviors toward authority figures 4) Destruction of property |
3. Negativistic, disobedient behaviors toward authority figures are diagnostic criteria for the diagnosis of ODD. |
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A client diagnosed with attention-deficit/hyperactivity disorder (ADHD) is prescribed the neurotransmitter-altering drug methylphenidate (Ritalin). Another client, diagnosed with narcolepsy, also receives Ritalin. Why is Ritalin given for these two opposing problems? 1) ADHD responds positively to a decreased level of neurotransmitters, whereas narcolepsy responds positively to an increased level of neurotransmitters. 2) Narcolepsy responds positively to a decreased level of neurotransmitters, whereas ADHD responds positively to an increased level of neurotransmitters. 3) Both ADHD and narcolepsy respond positively to a decreased level of neurotransmitters. 4) Both ADHD and narcolepsy respond positively to an increase in levels of neurotransmitters. |
4. When given Ritalin, clients diagnosed with either ADHD or narcolepsy will experience an increased level of neurotransmitters. However, behaviorally, their response is opposing. The client diagnosed with ADHD will experience a calming effect, whereas the client diagnosed with narcolepsy will be stimulated. Central nervous system stimulation is an expected response. The exact mechanism that produces the therapeutic effect in clients diagnosed with ADHD is unknown. |
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A frightened young woman calls the ED and tearfully tells the nurse, "I've been raped. Please help me!" Which nursing questions take priority? 1) "Are you injured, and are you in a safe place?" 2) "Do you know your whereabouts, and do you have transportation?" 3) "Have you notified the police and do you know your assailant?" 4) "Have you bathed, douched, or changed your clothes?" |
1. Safety first |
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The nurse is planning care for Carla, who, despite suffering several broken bones as a result of spousal abuse, has decided not to leave her husband. In order to provide patient-centered care, the nurse must understand that which of these factors may contribute to the victim's desire to stay in the relationship? Select all that apply. 1) Fear of retaliation 2) Grandiose delusions 3) Concern for children 4) Lack of financial resources 5) Large support networks |
1, 3 & 4 Grandiose delusions are symptoms of a psychosis, not abuse, and lack of support, not a large support network would be a reason to stay |
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A young mother in a severely abusive relationship is admitted to psychiatric unit after an attempted suicide. The client tells the nurse, "I'm sure things will be better between us once I go home." Which is the most appropriate nursing response? 1) "Research shows that men who batter get worse rather than improve." 2) "Aren't you concerned about your children?" 3) "You really shouldn't return home to that violent situation." 4) "Let's develop a safety plan in case he becomes violent in the future." |
4. It is critical to stress to the client the importance of safety. The client must be made aware of the variety of resources that are available to her. Most major cities in the United States now have houses or shelters where women can go to be assured of protection for them and their children. Helping the client develop a safety strategy will increase her sense of control and decrease her sense of powerlessness. |
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Tori has been talking to the nurse about her husband's behavior. She claims that although her husband is very controlling, he can't be described as manifesting intimate partner violence because he has never struck her. Which of these responses by the nurse is an accurate description of intimate partner violence? 1) Intimate partner violence is only physical abuse, but controlling behavior is dysfunctional, too. 2) The National Coalition Against Domestic Violence describes battering as different from intimate partner violence. 3) The U.S. Department of Justice defines intimate partner violence as any pattern of abusive behavior used to control an intimate partner, which can include physical, psychological, and other threats of intimidation or control. 4) Intimate partner violence relates to only acts of fatal violence. |
3. This statement is correct. It is important to educate clients that domestic violence extends beyond just physical abuse. This education lays the foundation for accurate assessment and empowerment of the client to problem-solve. |
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A 12-year-old female suddenly refuses to change for gym or participate in physical activities, has difficulty walking and sitting, and will not eat her food at lunchtime. What should the school nurse consider when assessing this child's symptoms? 1) Sexual abuse 2) Emotional neglect 3) Physical neglect 4) Incest |
1) Sexual abuse |
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Dolores is seeing the nurse at the community mental health clinic for depression and reveals that her husband was physically abusive to her but "things are better now because he felt terrible and he has been great to me ever since." Which of the phases in the cycle of battering is Dolores describing? 1) The tension-building phase 2) The acute battering incident 3) The "honeymoon" phase 4) The resolution phase |
3. Dolores is describing the "honeymoon" phase, in which the batterer expresses remorse, promises the abuse will never occur again, and appears, at least temporarily, to be the "ideal" husband. |
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Veronica presents at the emergency room with multiple bruises, a black eye, and a broken leg, which her husband states were the result of falling on a patch of ice. He requests to stay with her, and the nurse notices that Veronica appears fearful. Which of these is the best approach to conducting assessment? 1) Tell the husband how much you appreciate his support and engage him in the assessment process. 2) Instruct the husband that hospital policy dictates that certain aspects of physical assessment be done in private, and interview the client alone. 3) Ask Veronica if she would like her husband to be present throughout the interview. 4) Confront the husband about the suspiciousness of Veronica's injuries. |
2. Conducting the assessment in private is essential in order to provide an environment where the patient feels empowered to answer questions honestly. This response diplomatically redirects the husband so that private assessment can occur. |
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After an examination and treatment for rape, the nurse prepares to discharge a client from the ED. Which discharge teaching should the nurse provide? (If one part of an answer is incorrect, the entire answer is incorrect.) 1) Information on available community resources 2) The names and phone numbers of local attorneys who defend rape victims 3) When to return to the ED for follow-up care 4) The phone number of the battered women's shelter and the crisis intervention center |
1. The client must be made aware of the variety of resources that are available to her. These may include crisis hotlines, community groups for women who have been abused, shelters, and counseling services. Knowledge of available community resources decreases the victim's sense of powerlessness, but true empowerment comes only when she chooses to use the knowledge for her own benefit. |
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From a biological theory perspective, which predisposes individuals to be abusive? 1) Unmet needs for security, resulting in an underdeveloped ego and a weak super ego 2) Imitation of individuals who have a predisposition toward aggressive behavior 3) Various levels of norepinephrine, dopamine, and serotonin 4) The influence of culture and social structure |
3. This is a biological perspective. |
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Chronic failure of a parent or caretaker to provide a child in his or her care with hope, love, and support necessary for developing a sound, healthy personality is defined as ____________. |
Emotional Neglect |
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Sarah convinces her husband to make an appointment at the health center and tells the intake nurse that her husband has been exhibiting violent behavior for the first time in their 14-year marriage. Which of the following should the nurse explore when assessing the husband for the origins of his behavior? Select all that apply. 1) History or evidence of brain diseases such as encephalitis or epilepsy 2) Substance use and medication history 3) Evidence of PTSD 4) History of abuse in his family of origin 5) Evidence of codependent personality traits in Sarah |
1, 2, 3 & 4 Codependent personality traits do not cause a person to become violent |
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The expression of power and dominance by means of sexual violence is called ____________. |
Rape |
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What is the anxiety disorder called where a person pulls out their hair? |
Trichotillomania |
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What is the difference between acute stress disorder and PTSD? |
Acute Stress Disorder (ASD) lasts up to 1 month. If the symptoms last longer, then it is considered PTSD. |
