NCLEX Mental Health Test Bank: 1220 Questions with Answers and Rationales, Exams of Psychology

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NCLEX Mental Health 1 of 2 Test Bank

(1220 Questions with Answers and

Rationales).

A client is diagnosed with intermittent explosive disorder. The clinic nurse should anticipate teaching about which medication? A. Citalopram (Celexa) B. Risperidone (Risperdal) C. Fluvoxamine (Luvox) D. Isocarboxazid (Marplan) - Correct Answers ANS: B An antipsychotic like Risperdal can be prescribed for intermittent explosive disorder. An antidepressant is not the usual drug of choice for this disorder. A nurse is caring for a client who is suspected of having the diagnosis of trichotillomania. What condition must be ruled out prior to a definitive diagnosis of this disorder? A. Bipolar disorder B. Alopecia areata C. Post-traumatic stress disorder D. Body dysmorphic disorder - Correct Answers ANS: B Alopecia areata is a dermatological condition that, according to the DSM-IV diagnostic criteria for trichotillomania, must be ruled out to establish this diagnosis. A nursing instructor is teaching about the correlation between pathological gambling and abnormalities in the neurotransmitter system. What statement by the nursing student indicates that learning has occurred? A. "Pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine." B. "Pathological gamblers present with increased serotonin, increased norepinephrine, and increased dopamine." C. "Pathological gamblers present with decreased serotonin, decreased norepinephrine, and decreased dopamine."

D. "Pathological gamblers present with increased serotonin, decreased norepinephrine, and decreased dopamine." - Correct Answers ANS: A Serotonergic function is linked to behavioral initiation, inhibition, and aggression. Noradrenergic function mediates arousal and detects novel and aversive stimuli. Dopaminergic function is associated with reward and reinforcement mechanisms. Thus, pathological gamblers present with decreased serotonin, increased norepinephrine, and increased dopamine. A 13-year-old client's father has recently been deployed to Afghanistan. Since deployment, the client has begun to participate in isolative behaviors, truancy, vandalism, and fighting. The pediatric nurse practitioner should identify this behavior with which adjustment disorder? A. An adjustment disorder with anxiety B. An adjustment disorder with disturbance of conduct C. An adjustment disorder with mixed disturbance of emotions and conduct D. An adjustment disorder unspecified - Correct Answers ANS: C The predominant features of an adjustment disorder with mixed disturbance of emotions and conduct include symptoms of anxiety or depression as well as behaviors to include violations of rights of others, truancy, vandalism, and fighting. A client, who recently delivered a stillborn baby, has a diagnosis of adjustment disorder unspecified. The nurse case manager should expect which client presentation that is characteristic of this diagnosis? A. The client worries continually and appears nervous and jittery. B. The client complains of a depressed mood, is tearful, and feels hopeless. C. The client is belligerent, violates the rights of others, and defaults on legal responsibilities. D. The client complains of many physical ailments, refuses to socialize, and quits her job. - Correct Answers ANS: D The diagnosis of adjustment disorder unspecified is assigned when the maladaptive reaction is not consistent with any of the other categories. Manifestations may include physical complaints, social withdrawal, or work or academic inhibition, without significant depressed or anxious mood. A client has been extremely nervous ever since a person died as a result of the client's drunk driving. When assessing for the diagnosis of adjustment

disorder, within what timeframe should the nurse expect the client to exhibit these symptoms? A. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 1 year of the accident. B. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 3 months of the accident. C. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 6 months of the accident. D. To meet the DSM-IV criteria for adjustment disorder, the client should exhibit symptoms within 9 months of the accident. - Correct Answers ANS: B According to the DSM-IV diagnostic criteria for adjustment disorders, the development of emotional or behavioral symptoms in response to an identifiable stressor occurs within 3 months of the onset of the stressor. A 15-year-old who is angry about not being chosen as the basketball team's captain, spray paints obscene words on the newly chosen captain's car. What information would cause a school nurse to consider a diagnosis of intermittent explosive disorder? A. The destruction of property is grossly out of proportion to the precipitating factor. B. The destruction of property is not a pattern of failure to resist aggressive impulses. C. The teenager has a diagnosis of conduct disorder. D. The teenager has previously been diagnosed with Tourette's syndrome.

• Correct Answers ANS: A The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that several discrete episodes of destruction of property must occur, and the aggressive episode can not be better accounted for by another mental disorder such as conduct disorder or Tourette's syndrome. The degree of aggressiveness must be grossly out of proportion to the precipitating factor. A client has discovered that her husband is having an affair with a neighbor. During a visit to the neighbor's home, the wife steals the neighbor's diamond ring from the kitchen windowsill. What information would cause a nurse to rule out a diagnosis of kleptomania?

A. The wife did not experience a sense of relief when she took the ring. B. The wife did not experience a sense of tension immediately before stealing the ring. C. The stealing was committed to express the wife's anger. D. The ring is desired by the wife for her personal use. - Correct Answers ANS: C The DSM-IV-TR criteria for the diagnosis of kleptomania state that an individual diagnosed with this disorder experiences a sense of tension before committing theft and relief at the time of the theft. The theft cannot be committed as an act of anger or vengeance, and the object stolen cannot be needed for personal use. A 20-year-old client and a 60-year-old client have had drunk driving accidents and are both experiencing extreme anxiety. From a psychosocial theory perspective, which of these clients would be predisposed to the diagnosis of adjustment disorder? A. The 60-year-old because of memory deficits B. The 60-year-old because of decreased cognitive processing ability C. The 20-year-old because of limited cognitive experiences D. The 20-year-old because of lack of developmental maturity - Correct Answers ANS: D Research indicates that there is a predisposition to the diagnosis of adjustment disorder when there is limited developmental maturity. By comparison, the 20-year-old does not have the developmental maturity, life experiences, and coping mechanisms that the 60-year-old might possess. During her aunt's wake, before a mother can stop her 4-year-old child, the child runs up to the casket. An appointment is made with a nurse practitioner when the child starts twisting and pulling out hair. Which nursing diagnosis should the nurse practitioner assign to this child? A. Complicated grieving B. Altered family processes C. Ineffective coping D. Body image disturbance - Correct Answers ANS: C Ineffective coping is defined as an inability to form a valid appraisal of the stressors, inadequate choices of practiced responses, and/or the inability to use available resources. This child is coping with the anxiety generated by viewing her deceased aunt by pulling out hair. If this behavior continues, a

diagnosis of the impulse control disorder, trichotillomania, may be assigned. After a spouse dies, a client is diagnosed with adjustment disorder with depressed mood. Client symptoms include chronic migraines, feelings of hopelessness, social isolation, and self-care deficit. Which outcome would be most appropriate to direct the focus of this client's care? A. The client will not cope with stress by impulsive behaviors by discharge. B. The client will accomplish activities of daily living independently by discharge. C. The client will be able to cope effectively by delaying gratification by discharge. D. The client will verbalize a positive body image by discharge. - Correct Answers ANS: B Impulsive behaviors and the inability to delay gratification are symptoms of impulse control, not adjustment disorders. There is no evidence presented that the client has a body image distortion. Setting an outcome of independent self-care will direct nursing interventions toward encouraging the client to meet self-care needs. Which individual would most likely be diagnosed with intermittent explosive disorder? A. A client diagnosed with antisocial personality disorder who attacks the nursing staff B. A client diagnosed with diabetes mellitus who has a history of multiple severe assaultive acts C. A client diagnosed with schizophrenia who sets fires because of command hallucinations D. A client diagnosed with alcohol dependence who severely beats wife while intoxicated - Correct Answers ANS: B The DSM-IV-TR criteria for the diagnosis of intermittent explosive disorder state that the aggressive episodes are not better accounted for by another mental disorder like antisocial personality disorder or schizophrenia. Also, the aggressive episodes are not due to the direct physiological effect of a substance such as alcohol. A client has been diagnosed with pathological gambling. The client's family inquires about their brother's behavior that led to this diagnosis. Which of

the following information should the clinic nurse provide? (Select all that apply.) A. Your brother has been preoccupied with thoughts about gambling. B. Your brother has been gambling with increased amounts of money to gain excitement. C. Your brother has tried but failed to control his gambling. D. Your brother's gambling is a result of manic behavior. E. Your brother has lied to you about the extent of his gambling. - Correct Answers ANS: A, B, C, E The DSM-IV-TR criteria for the diagnosis of pathological gambling include all and more of the behaviors presented. The gambling behavior cannot be better accounted for by a manic episode. In evaluating nursing interventions, which of the following types of questions would a nurse use to gather information from a client diagnosed with an impulse control disorder? (Select all that apply.) A. Can the client demonstrate the ability to delay gratification? B. Does the client demonstrate evidence of progression along the grief response? C. Can the client accomplish activities of daily living independently? D. Does the client verbalize symptoms of tension preceding unacceptable behavior? E. Does the client verbalize the unacceptability of maladaptive behaviors? - Correct Answers ANS: A, D, E A client diagnosed with an impulse control disorder should not have difficulty accomplishing activities of daily living or progressing through the grief process. These types of questions would be appropriate for clients diagnosed with adjustment disorders, not impulse control disorders. A client diagnosed with an adjustment disorder asks the nurse, "Tell me about medications that will cure this problem." Which of the following are appropriate nursing replies? (Select all that apply.) A. "Medications can interfere with your ability to find a more permanent problem solution." B. "Medications may mask the real problem at the root of this diagnosis." C. "Adjustment disorders are not commonly treated with medications."

D. "Psychoactive drugs carry the potential for physiological and psychological dependence." E. "Psychoactive drugs will be prescribed only if your problems persist for more than 3 months." - Correct Answers ANS: A, B, C, D Adjustment disorder is not commonly treated with medications because of temporary effects, masking the real problem, interfering with finding a permanent solution, and the potential for addiction. A fatherless, 11-year-old African American girl lives with her grandmother after the death of her mother. Her older stepbrother is very involved in her life. How should the community health nurse view this family constellation, and why? A. Abnormal; the grandmother should be concerned with issues other than childrearing. B. Abnormal; a two-parent household is the most advantageous arrangement for parenting. C. Normal; cultural variations exist in the family life cycle. D. Normal; because of their wisdom, older adults make better parenting figures. - Correct Answers ANS: C The nurse should be aware that cultural differences and specific events may lead to variety in family constellations. This is normal. In defiance of parental wishes, a Japanese teenager succumbs to peer pressure and gets a tattoo. According to Bowen's family systems theory, how should the community health nurse interpret the teenager's action? A. The teenager is attempting to differentiate self. B. The teenager is triangulating self. C. The teenager is cutting self off emotionally. D. The teenager is exhibiting antisocial traits. - Correct Answers ANS: A The teenager is taking on some of the cultural values of peers and is beginning to develop a unique identity. This process is called differentiation and is a normal task of adolescence. A home health nurse is visiting an Asian family. A married couple, their three children, and the maternal grandparents all live in the home. How should the nurse interpret the presence of the grandparents in the home?

A. The parents have diffuse boundaries and have allowed the grandparental subsystem to be present. B. The grandparental subsystem is not successfully managing separation from the parental subsystem. C. Extended family living arrangements are common in some cultures. D. The nuclear family living arrangement is the preferred environment for childrearing. - Correct Answers ANS: C The Asian culture highly respects the elderly. Having the grandparents living in the home is not uncommon in this culture. A depressed 21-year-old client has lived with his mother ever since the death of his father 3 years ago. After the client received a college acceptance, the mother repeatedly states, "That's wonderful. I'll be fine all alone." How would the nurse interpret the mother's statements? A. The mother is withholding supportive messages. B. The mother is expressing denigrating remarks. C. The mother is communicating indirectly. D. The mother is using double-bind communication. - Correct Answers ANS: D The client's mother says she is fine with him going away to college but then tries to make him feel guilty about her being left alone. The client is in a no- win situation because his mother has given a mixed message—a double- bind communication. Which task should the nurse recognize as appropriate to stage IV of the family life cycle? A. Making adjustments within the marital system to meet the responsibilities of parenthood B. Establishing a new identity as a couple by realigning relationships with extended family C. Redefining the level of dependence so that adolescents are provided with greater autonomy D. Reestablishing the bond of the dyadic marital relationship - Correct Answers ANS: C Stage IV of the family life cycle is described as the "The Family with Adolescents." The task of this stage is to redefine the level of dependence so that adolescents are provided with greater autonomy while parents remain responsive to teenagers' dependency needs.

A clinic nurse is caring for a 40-year-old client who lives with his parents. The client's mother continues to do the client's laundry and provides spending money. Based on this situation, which family dynamic does the nurse recognize? A. Taking over B. Communicating indirectly C. Belittling feelings D. Making assumptions - Correct Answers ANS: A Taking over occurs when a family member fails to allow another member to develop a sense of responsibility and self-worth. By doing the client's laundry and managing finances, the mother is fostering the client's dependence. A 30-year-old client seeking therapy states, "My mom cries when she is not included in all my social activities and thinks of my friends as her own." How would the nurse describe the boundaries between this family's parent and child subsystems? A. The boundaries are rigid. B. The boundaries are restructured. C. The boundaries are enmeshed. D. The boundaries are disengaged. - Correct Answers ANS: C With enmeshed boundaries, family members lack individuation and experience exaggerated connectedness. The client's mother is trying to prevent independence by generating feelings of guilt. A nurse enters an inpatient room and finds the family disagreeing about the client's living arrangements after discharge. Which information should the nurse provide when teaching techniques to resolve family conflicts? A. All family members should use past incidents to make their point. B. One family member should act as a gatekeeper in order to avoid family confrontation. C. One family member should act as a compromiser to preserve harmony in the family system. D. All family members should respect differing opinions and use compromise and negotiation. - Correct Answers ANS: D

Functional families allow and respect differences among members. They learn to handle differences and conflict through negotiation and compromise. After hearing parents discuss divorce, a 5-year-old develops behavioral problems. Upon dealing with the child's behavioral issues, the marital relationship conflict decreases. The pediatric clinic nurse should recognize that this is an example of which family system concept? A. Differentiation of self B. Triangulation C. Fusion D. Emotional cutoff - Correct Answers ANS: B Triangulation occurs when a relationship between two people is dysfunctional so a third person is brought into the relationship to help stabilize it. The son and his behavioral problems redirect the focus from the couple's marital problems. An instructor is teaching about differentiated parent and adult child relationships. Students are instructed to give an example of a well- differentiated parent and adult child relationship. Which student example meets the instructor requirement? A. An adult child considers, but is not governed by, the advice of his or her parents. B. An adult child appears to listen, but ignores, the advice of his or her parents. C. An adult child respects and is governed by the wishes of his or her parents. D. An adult child never requests advice or feedback from his or her parents. - Correct Answers ANS: A The correct student example of a well-differentiated parent and adult child relationship is when an adult child considers, but is not governed by, the advice of his or her parent. The adult child should be differentiated enough not to be threatened by parental advice and should be able to consider the parental advice without feeling the advice must be followed. During family counseling a husband states, "Every time my wife and I discuss child discipline, we get into shouting matches." The nurse instructs

the couple to shout at each other for 2 weeks on Tuesdays and Thursdays for 30 minutes. What intervention is the nurse using? A. Reframing B. Restructuring the family C. Expressive psychotherapy D. Paradoxical intervention - Correct Answers ANS: D In a paradoxical intervention, the therapist requests the family to continue the maladaptive behavior. This removes control over the behavior from the family to the therapist. Clients are made more aware of the defeating behavior and this can lead to behavioral change. During family counseling a child states, "I just want to surf like other kids. Mom says it's okay, but Dad says I'm too young." The mother allows surfing when the father is absent. In the structural model of family therapy, what family interactional pattern should the nurse recognize? A. Multigenerational transmission B. Disengagement C. Mother-child subsystem D. Emotional cutoff - Correct Answers ANS: C In this situation, the mother and child have formed a subsystem in which they have aligned themselves against the father. During family counseling, a husband tells his wife to spend more time with the family, and she responds by stating, "Okay, I'll turn in my resignation tomorrow." The husband replies, "I knew it! You've always been a quitter!" How should the nurse interpret the husband's statement? A. The husband is expressing an emotional cutoff. B. The husband is expressing double-bind communication. C. The husband is expressing indirect messages. D. The husband is expressing avoidance behaviors. - Correct Answers ANS: B Double-bind communication sets up no-win situations. The husband has created a situation in which no matter what the wife does, she is wrong. A couple has been married for 20 years. They argue constantly, belittle feelings, and continuously contradict each other. During a therapy session,

the nurse documents "Marital schism." What does the nurse mean by this documentation? A. The couple has a compatible marriage relationship. B. The husband has a dominant relationship over the wife. C. The couple has an enmeshed relationship. D. The couple has an incompatible marriage relationship. - Correct Answers ANS: D A marital schism is a state of chronic disequilibrium and discord. This describes this couple's marriage. A couple is in counseling related to their dysfunctional relationship. Their daughter has recently made a suicide gesture. The nurse should recognize that this might be an example of which family system concept? A. Triangulation B. Pseudohostility C. Double-bind communication D. Pseudomutuality - Correct Answers ANS: A Triangulation occurs when a relationship between two people is dysfunctional. A third person is brought into the relationship to help stabilize it. The couple is triangulating with their daughter. The threatened daughter draws attention from her parent's interpersonal conflicts by her own dysfunctional behavior. An adolescent, his mother, and his soon-to-be stepfather have been in counseling with the nurse. Which statement by the nurse fosters positive relationships within this new family structure? A. "Your son should be consistently disciplined by only one parent." B. "You should not have any more children because your son will need your full attention." C. "You need to keep the lines of communication open between all of you." D. "Allow your son to make his own choices because this new situation will be stressful." - Correct Answers ANS: C Open lines of communication are needed for newly forming families to begin their relationship together and establish a new family structure.

A nursing instructor is teaching about the importance of healthy family member expectations for newly blended families. Which student statement indicates a need for further instruction? A. "Healthy family member expectations should be flexible." B. "Healthy family member expectations should be conforming." C. "Healthy family member expectations should be individual." D. "Healthy family member expectations should be realistic." - Correct Answers ANS: B Conforming is a behavior that interferes with adaptive functioning in terms of family member expectations. This student statement indicates a need for further instruction. Realism, flexibility, and individuality are all characteristics of healthy family member expectations. A client is angry because her husband has forgotten their anniversary. The following week, the client is still unwilling to discuss this with her husband because she is afraid she will lose control. How should the nurse interpret this client's means of coping with anger? A. Coping by attacking B. Coping by surrendering C. Coping by avoiding D. Coping by belittling - Correct Answers ANS: C When coping by avoidance, differences are never acknowledged openly. The individual who disagrees avoids discussing it for fear that the other person will withdraw love or approval or become angry in response to the disagreement. Avoidance also occurs when an individual fears loss of control of his or her temper. The nurse is to administer Xanax (alprazolam) to help a client of Japanese descent calm down. The order reads Xanax 0.25 to 1 mg by mouth as needed for agitation. What is the best dose for the nurse to give this client? ________________________ mg. - Correct Answers 2 mg. Asians have a greater sensitivity to psychotropic medication and generally require much less than other cultural groups to achieve positive results. The smallest dose is safest to start; the dosage can always be increased. However, a dose that is too high for the client is likely to cause unpleasant or even serious side effects. Those side effects likely would lead to distress and noncompliance in the future.

A client is taking diazepam (Valium) for generalized anxiety disorder. Which instruction should the nurse give to this client? Select all that apply.

1. To consult with his health care provider before he stops taking the drug.
2. To avoid eating cheese and other tyramine-rich foods. 3. To take the medication on an empty stomach.
3. Not to use alcohol while taking the drug.
4. To stop taking the drug if he experiences swelling of the lips and face and difficulty breathing. - Correct Answers 1, 4, 5. The nurse should instruct the client who is taking diazepam to take the medication as prescribed; stopping the medication suddenly can cause withdrawal symptoms. This medication is used for a short term only. The drug dose can be potentiated by alcohol and the client should not drink alcoholic beverages while taking this drug. Swelling of the lips and face and difficulty breathing are signs and symptoms of an allergic reaction. The client should stop taking the drug and seek medical assistance immediately. The client does not need to avoid eating foods containing tyramine; tyramine interacts with monoamine oxidase inhibitors, not Valium. The client can take the medication with food. An adult client diagnosed with anxiety disorder becomes anxious when she touches fruits and vegetables. What should the nurse do?
5. Instruct the woman to avoid touching these foods.
6. Ask the woman why she becomes anxious in these situations.
7. Assist the woman to make a plan for her family to do the food shopping and preparation.
8. Teach the woman to use cognitive behavioral approaches to manage her anxiety. - Correct Answers 4. Cognitive behavioral therapy is effective in treating anxiety disorders. The nurse can assist the client in identifying the onset of the fears that cause the anxiety and develop strategies to modify the behavior associated with the fears. Avoiding touching foods, asking about reasons for the anxiety, and providing ways to work around touching the foods do not deal with the anxiety and are not interventions that will help this client. A client who is pacing and wringing his hands states, "I just need to walk" when questioned by the nurse about what he is feeling. Which of the following responses by the nurse is most therapeutic?
9. "You need to sit down and relax."
10. "Are you feeling anxious?"
11. "Is something bothering you?"

4. "You must be experiencing a problem now." - Correct Answers 2. Asking, "Are you feeling anxious?" helps the client to specifically label the feeling as anxiety so that he can begin to understand and manage it. Some clients need assistance with identifying what they are feeling so they can recognize what is happening to them. Stating, "You need to sit down and relax," is not appropriate because the client needs to continue his pacing to feel better. Asking if something is bothering the client or saying that he must be experiencing a problem is vague and does not help the client identify his feelings as anxiety. A client is brought to the emergency department by his brother. The client is perspiring profusely, breathing rapidly, and complaining of dizziness and palpitations. Problems of a cardiovascular nature are ruled out, and the client's diagnosis is tentatively listed as a panic attack. After the symptoms pass, the client states, "I thought I was going to die." Which of the following responses by the nurse is best?
5. "It was very frightening for you."
6. "We would not have let you die."
7. "I would have felt the same way."
8. "But you're okay now." - Correct Answers 1. The nurse responds with the statement, "It was very frightening for you," to express empathy, thus acknowledging the client's discomfort and accepting his feelings. The nurse conveys respect and validates the client's self- worth. The other statements do not focus on the client's underlying feelings, convey active listening, or promote trust. Which of the following points should the nurse include when teaching a client about panic disorder?
9. Staying in the house will eliminate panic attacks.
10. Medication should be taken when symptoms start.
11. Symptoms of a panic attack are time limited and will abate.
12. Maintaining self-control will decrease symptoms of panic. - Correct Answers 3. It is important for the nurse to teach the client that the symptoms of a panic attack are time limited and will abate. This helps decrease the client's fear about what is occurring. Clients benefit from learning about their illness, what symptoms to expect, and the helpful use of medication. A simple biologic explanation of the disorder can convince clients to take their medication. Telling the client to stay in the house to eliminate panic attacks is not correct or helpful. Panic attacks can occur "out of the blue," and

clients with panic disorder can become agoraphobic because of fear of having a panic attack where help is not available or escape is impossible. Medication should be taken on a scheduled basis to block the symptoms of panic before they start. Taking medication when symptoms start is not helpful. Telling the client to maintain self-control to decrease symptoms of panic is false information because the brain and biochemicals may account for its development. Therefore, the client cannot control when a panic attack will occur. A client with panic disorder is taking alprazolam (Xanax) 1 mg P.O. three times daily. The nurse understands that this medication is effective in blocking the symptoms of panic because of its specific action on which of the following neurotransmitters?

1. Gamma-aminobutyrate.
2. Serotonin.
3. Dopamine.
4. Norepinephrine. - Correct Answers 1. Alprazolam, a benzodiazepine used on a short-term or temporary basis to treat symptoms of anxiety, increases gamma-aminobutyrate, a major inhibitory neurotransmitter. Because gamma-aminobutyric acid is increased and the reticular activating system is depressed, incoming stimuli are muted and the effects of anxiety are blocked. Alprazolam does not directly target serotonin, dopamine, or norepinephrine. A client is diagnosed with Generalized Anxiety Disorder (GAD) and given a prescription for venlafaxine (Effexor). Which of the following information should the nurse include in a teaching plan for this client? Select all that apply.
5. Various strategies for reducing anxiety.
6. The benefits and mechanisms of actions of Effexor in treating GAD.
7. How Effexor will eliminate his anxiety at home and work.
8. The management of the common side effects of Effexor.
9. Substituting adaptive coping strategies for maladaptive ones.
10. The positive effects of Effexor being evident in 4 to 5 days. - Correct Answers 1, 2, 4, 5. It is appropriate to provide education on medication mechanisms, benefits, and managing side effects. No medication will eliminate all anxiety, so teaching about anxiety reduction and adaptive coping is needed. Effexor is a serotonin-norepinephrine reuptake inhibitor antidepressant and it will take 2 to 4 weeks to feel the effects.

While a client is taking alprazolam (Xanax), which of the following should the nurse instruct the client to avoid?

1. Chocolate.
2. Cheese.
3. Alcohol.
4. Shellfish. - Correct Answers 3. Using alcohol or any central nervous system depressant while taking a benzodiazepine, such as alprazolam, is contraindicated because of additive depressant effects. Ingestion of chocolate, cheese, or shellfish is not problematic. Which of the following statements by a client who has been taking buspirone (BuSpar) as prescribed for 2 days indicates the need for further teaching?
5. "This medication will help my tight, aching muscles."
6. "I may not feel better for 7 to 10 days."
7. "The drug does not cause physical dependence."
8. "I can take the medication with food." - Correct Answers 1. Buspirone, a nonbenzodiazepine anxiolytic, is particularly effective in treating the cognitive symptoms of anxiety, such as worry, apprehension, difficulty with concentration, and irritability. BuSpar is not effective for the somatic symptoms of anxiety (muscle tension). Therapeutic effects may be experienced in 7 to 10 days, with full effects not occurring for 3 to 4 weeks. This drug is not known to cause physical or psychological dependence. It can be taken with food or small meals to reduce gastrointestinal upset. A week ago, a tornado destroyed the client's home and seriously injured her husband. The client has been walking around the hospital in a daze without any outward display of emotions. She tells the nurse that she feels like she's going crazy. Which of the following actions should the nurse use first?
9. Explain the effects of stress on the mind and body.
10. Reassure the client that her feelings are typical reactions to serious trauma.
11. Reassure the client that her symptoms are temporary. 4. Acknowledge the unfairness of the client's situation. - Correct Answers 2. The nurse initially reassures the client that her feelings and behaviors are typical reactions to serious trauma to help decrease anxiety and maintain self-esteem. Explaining the effects of stress on the body may be helpful

later. Telling the client that her symptoms are temporary is less helpful. Acknowledging the unfairness of the client's situation does not address the client's needs at this time. After being discharged from the hospital with acute stress disorder, a client is referred to the outpatient clinic for follow-up. Which of the following is most important for the client to use for continued alleviation of anxiety?

1. Recognizing when she is feeling anxious.
2. Understanding reasons for her anxiety.
3. Using adaptive and palliative methods to reduce anxiety.
4. Describing the situations preceding her feelings of anxiety. - Correct Answers 3. The client with anxiety may be able to learn to recognize when she is feeling anxious, understand the reasons for her anxiety, and be able to describe situations that preceded her feelings of anxiety. However, she is likely to continue to experience symptoms unless she has also learned to use adaptive and palliative methods to reduce anxiety. A client with acute stress disorder states to the nurse, "I keep having horrible nightmares about the car accident that killed my daughter. I shouldn't have taken her with me to the store." Which of the following responses by the nurse is most therapeutic?
5. "Don't keep torturing yourself with such horrible thoughts."
6. "Stop blaming yourself. It's only hurting you."
7. "Let's talk about something that is a bit more pleasant." 4. "The accident just happened and could not have been predicted." - Correct Answers 4. Saying, "The accident just happened and could not have been predicted," provides the client with an objective perception of the event instead of the client's perceived role. This type of statement reflects active listening and helps to reduce feelings of blame and guilt. Saying, "Don't keep torturing yourself," or "Stop blaming yourself," is inappropriate because it tells the client what to do, subsequently delaying the therapeutic process. The statement, "Let's talk about something that is a bit more pleasant," ignores the client's feelings and changes the subject. The client needs to verbalize feelings and decrease feelings of isolation. The client, a veteran of the Vietnam war who has posttraumatic stress disorder, tells the nurse about the horror and mass destruction of war. He states, "I killed all of those people for nothing." Which of the following responses by the nurse is appropriate?

1. "You did what you had to do at that time."
2. "Maybe you didn't kill as many people as you think."
3. "How many people did you kill?"
4. "War is a terrible thing." - Correct Answers 1. The nurse states, "You did what you had to do at that time," to help the client evaluate past behavior in the context of the trauma. Clients commonly feel guilty about past behaviors when viewing them in the context of current values. The other statements are inappropriate because they do not help the client to evaluate past behavior in the context of the trauma. A client with acute stress disorder has avoided feelings of anger toward her rapist and cannot verbally express them. The nurse suggests which of the following activities to assist the client with expressing her feelings?
5. Working on a puzzle.
6. Writing in a journal.
7. Meditating.
8. Listening to music. - Correct Answers 2. Writing in a journal can help the client safely express feelings, particularly anger, when the client cannot verbalize them. Safely externalizing anger by writing in a journal helps the client to maintain control over her feelings. When developing the plan of care for a client with acute stress disorder who lost her sister in a boating accident, which of the following should the nurse initiate?
9. Helping the client to evaluate her sister's behavior.
10. Telling the client to avoid details of the accident.
11. Facilitating progressive review of the accident and its consequences.
12. Postponing discussion of the accident until the client brings it up. - Correct Answers 3. The nurse should facilitate progressive review of the accident and its consequences to help the client integrate feelings and memories and to begin the grieving process. Helping the client to evaluate her sister's behavior, telling the client to avoid details of the accident, or postponing the discussion of the accident until the client brings it up is not therapeutic and does not facilitate the development of trust in the nurse. Such actions do not facilitate review of the accident, which is necessary to help the client integrate feelings and memories and begin the grieving process.

116.A newly admitted 20-year-old client, diagnosed with Post Traumatic Stress Disorder (PTSD), reluctantly reveals that she escaped from a satanic cult 2 years ago. The mother has been in the cult since the client was 3 years old and refused to leave with the client. The client says, "Nobody will ever believe the horrible things the men did to me and my mother never stopped them." Which of the following responses is appropriate for the nurse to make?

1. "I'll believe anything you tell me. You can trust me."
2. "I can't understand why your mother didn't protect you. It's not right."
3. "Tell me about the cult. I didn't know there were any near here."
4. "It must be difficult to talk about what happened. I'm willing to listen." - Correct Answers 4. Survivors of trauma/ torture have a lot of difficulty with trust and do not readily talk about the horrible events. Therefore, empathy and a willingness to listen without pressuring the client are crucial. Option 1 may or may not be possible and does not convey the empathy. It is sometimes difficult to believe what satanic cults can do to children. Option 2 diverts attention from the client to the mother. Option 3 shows more interest in the cult than the client. A client diagnosed with Post Traumatic Stress Disorder is readmitted for suicidal thoughts and continued trouble sleeping. She states that when she closes her eyes, she has vivid memories about being awakened at night. "My dad would be on top of me trying to have sex with me. I couldn't breathe." Which of the following suggestions would be appropriate for the nurse to make for the insomnia? Select all that apply.
5. Trying relaxation techniques to help decrease her anxiety before bedtime.
6. Taking the quetiapine (Seroquel) 25 mg as needed as ordered by the physician.
7. Staying in the dayroom and trying to sleep in the recliner chair near staff.
8. Listening to calming music as she tries to fall asleep.
9. Processing the content of her flashbacks no less than hour before bedtime.
10. Leaving her door slightly open to decrease noise during the nightly checks. - Correct Answers 1, 2, 4, 6. Relaxation techniques and listening to calming music decrease anxiety and promote sleep. Seroquel is often effective in decreasing nightmare and flashbacks and has a beneficial side effect of drowsiness. Leaving her door slightly open will decrease the noise of making 15 minute checks at night.

Staying in the dayroom in a recliner with all the noise and lights is not likely to help. Processing memories an hour or two before bedtime doesn't allow enough time to calm down before sleep. A client with posttraumatic stress disorder needs to find new housing and wants to wait for a month before setting another appointment to see the nurse. The nurse interprets this action as which of the following?

1. A method of avoidance.
2. A detriment to progress.
3. The end of treatment.
4. A necessary break in treatment. - Correct Answers 4. The nurse judges the client's request for an interruption in treatment as a necessary break in treatment. A "time-out" is common and necessary to enable the client to focus on pressing problems and solutions. It is not necessarily a method of avoidance, a detriment to progress, or the end of treatment. A problem like housing can be very stressful and require all of the client's energy and attention, with none left for the emotional stress of treatment. The nurse should warn a client who is taking a benzodiazepine about using which of the following medications in combination with his current medication? 1. Antacids.
5. Acetaminophen (Tylenol).
6. Vitamins.
7. Aspirin. - Correct Answers 1. Combining a benzodiazepine with an antacid impairs the absorption rate of the benzodiazepine. Acetaminophen, vitamins, and aspirin are safe to take with a benzodiazepine because no major drug interactions occur. Which of the following client statements indicates the need for additional teaching about benzodiazepines?
8. "I can't drink alcohol while taking diazepam (Valium)."
9. "I can stop taking the drug anytime I want."
10. "Valium can make me drowsy, so I shouldn't drive for a while."
11. "Valium will help my tight muscles feel better." - Correct Answers 2. Valium, like any benzodiazepine, cannot be stopped abruptly. The client must be slowly tapered off of the medication to decrease withdrawal symptoms, which would be similar to withdrawal from alcohol. Alcohol in combination with a benzodiazepine produces an increased central nervous system depressant effect and therefore should be avoided. Valium can

cause drowsiness, and the client should be warned about driving until tolerance develops. Valium has muscle relaxant properties and will help tight, tense muscles feel better. A client is diagnosed with agoraphobia without panic disorder. Which type of therapy is most effective for this illness?

1. Insight therapy.
2. Group therapy.
3. Behavior therapy.
4. Psychoanalysis. - Correct Answers 3. The nurse should suggest behavior therapy, which is most successful for clients with phobias. Systematic desensitization, flooding, exposure, and self-exposure treatments are most therapeutic for clients with phobias. Self- exposure treatment is being increasingly used to avoid frequent therapy sessions. Insight therapy, exploration of the dynamics of the client's personality, is not helpful because the process of anxiety underlies the disorder. Group therapy or psychoanalysis, which deals with repressed, intrapsychic conflicts, is not helpful for the client with phobias because it does not help to manage the underlying anxiety or disorder. The client diagnosed with a fear of eating in public places or in front of other people has finished eating lunch in the dining area in the nurse's presence. Which of the following statements by the nurse should reinforce the client's positive action?
5. "It wasn't so hard, now was it?"
6. "At supper, I hope to see you eat with a group of people."
7. "You must have been hungry today."
8. "It is progress for you to eat in the dining room with me." - Correct Answers 4. Saying, "It's a sign of progress to eat in the dining area with me," conveys positive reinforcement and gives the client hope and confidence, thus reinforcing the adaptive behavior. Stating, "It wasn't so hard, now was it," decreases the client's self-worth and minimizes his accomplishment. Stating, "At supper, I hope to see you eat with a group of people," will overwhelm the client and increase anxiety. Stating, "You must have been hungry today," ignores the client's positive behavior and shows the nurse's lack of understanding of the dynamics of the disorder. The client diagnosed with agoraphobia refuses to walk down the hall to the group room. Which of the following responses by the nurse is appropriate?

1. "I know you can do it."
2. "Try holding onto the wall as you walk."
3. "You can miss group this one time."
4. "I'll walk with you." - Correct Answers 4. The nurse should walk with the client to activate adaptive coping for the client experiencing high anxiety and decreased motivation and energy. Stating, "I know you can do it," "Try holding on to the wall," or "You can miss group this one time," maintains the client's avoidance, thus reinforcing the client's behavior, and does not help the client begin to cope with the problem. A client diagnosed with Obsessive-Compulsive Disorder has been taking sertraline (Zoloft) but would like to have more energy every day. At his monthly checkup, he reports that his massage therapist recommended he take St. John's Wort to help his depression. The nurse should tell the client:
5. "St. John's Wort is a harmless herb that might be helpful in this instance."
6. "Combining St. John's Wort with the Zoloft can cause a serious reaction called Serotonin Syndrome."
7. "If you take St. John's, we'll have to decrease the dose of your Zoloft."
8. "St. John's Wort isn't very effective for depression, but we can increase your Zoloft dose." - Correct Answers 2. The effectiveness of St. John's Wort with depression is unconfirmed. The critical issue is that the combination of St. John's Wort and Zoloft (an SSRI antidepressant) can produce Serotonin Syndrome which can be fatal. The client should not take the St. John's Wort while taking Zoloft. A client diagnosed with obsessive-compulsive disorder arrives late for an appointment with the nurse at the outpatient clinic. During the interview, he fidgets restlessly, has trouble remembering what topic is being discussed, and says he thinks he is going crazy. Which of the following statements by the nurse best deals with the client's feelings of "going crazy?"
9. "What do you mean when you say you think you're going crazy?"
10. "Most people feel that way occasionally."
11. "I don't know you well enough to judge your mental state."
12. "You sound perfectly sane to me." - Correct Answers 1. When the client says he thinks he is "going crazy," it is best for the nurse to ask him what "crazy" means to him. The nurse must have a clear idea of what the client means by his words and actions. Using an open-ended question facilitates client description to help the nurse assess his meaning.

The other statements minimize and dismiss the client's concern and do not give him the opportunity to openly discuss his feelings, possibly leading to increased anxiety. A client with obsessive-compulsive disorder reveals that he was late for his appointment "because of my dumb habit. I have to take off my socks and put them back on 41 times! I can't stop until I do it just right." The nurse interprets the client's behavior as most likely representing an effort to obtain which of the following?

1. Relief from anxiety.
2. Control of his thoughts.
3. Attention from others.
4. Safe expression of hostility. - Correct Answers 1. A client who is exhibiting compulsive behavior is attempting to control his anxiety. The compulsive behavior is performed to relieve discomfort and to bind or neutralize anxiety. The client must perform the ritual to avoid an extreme increase in tension or anxiety even though the client is aware that the actions are absurd. The repetitive behavior is not an attempt to control thoughts; the obsession or thinking component cannot be controlled. It is not an attention-seeking mechanism or an attempt to express hostility. A client with obsessive-compulsive disorder, who was admitted early yesterday morning, must make his bed 22 times before he can have breakfast. Because of his behavior, the client missed having breakfast yesterday with the other clients. Which of the following actions should the nurse institute to help the client be on time for breakfast?
5. Tell the client to make his bed one time only.
6. Wake the client an hour earlier to perform his ritual.
7. Insist that the client stop his activity when it's time for breakfast.
8. Advise the client to have breakfast first before making his bed. - Correct Answers 2. The nurse should wake the client an hour earlier to perform his ritual so that he can be on time for breakfast with the other clients. The nurse provides the client with time needed to perform rituals because the client needs to keep his anxiety in check. The nurse should never take away a ritual, because panic will ensue. The nurse should work with the client later to slowly set limits on the frequency of the action.

The nurse notices that a client diagnosed with Major Depression and Social Phobia must get up and move to another area when someone sits next to her. Which of the following actions by the nurse is appropriate?

1. Ignore the client's behavior.
2. Question the client about her avoidance of others.
3. Convey awareness of the client's anxiety about being around others.
4. Tell the other clients to follow the client when she moves away. - Correct Answers 3. The nurse conveys empathy and awareness of the client's need to reduce anxiety by showing acceptance and understanding to the client, thereby promoting trust. Ignoring the behavior, questioning the client about her avoidance of others, or telling other clients to follow her when she moves are not therapeutic or appropriate. The nurse is developing a long term care plan for an outpatient client diagnosed with Dissociative Identity Disorder. Which of the following should be included in this plan? Select all that apply.
5. Learning how to manage feelings, especially anger and rage.
6. Joining several outpatient support groups that are process-oriented.
7. Identifying resources to call when there is a risk of suicide or self- mutilation.
8. Selecting a method for alter personalities to communicate with each other, such as journaling.
9. Trying different medicines to find one that eliminates the dissociative process.
10. Helping each alter accept the goal of sharing and integrating all their memories. - Correct Answers 1, 3, 4, 6. Managing suicidal thought, urges to self-mutilate and the intense anger are critical safety issues. Then the focus can switch to communication methods for each alter and the integration issues. Process groups can be overwhelming when too much is revealed or when child alters are unable to understand the group content. There are no known medicines to stop the process of dissociating. A co-manager of a convenience store was taking the daily receipts to the bank when she was robbed at gun point. She did not report the robbery and could not be found for 2 days. In a city 100 miles away, a hotel manager called the police because the woman gave a false name and address. After learning that the robbery was confirmed by the bank cameras, she was admitted to the hospital with a diagnosis of Dissociative