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NCLEX style nursing questions for mental health nursing

Ms. T has been diagnosed with agoraphobia. Which behavior would be most characteristic of this disorder?

She stays in her home for fear of being in a place from which she cannot escape.

Which of therapy is the most appropriate for a client with agoraphobia?

Facing his or her fear in gradual step regression.

With implosion therapy, a client with phobic anxiety would be:

Presented with massive exposure to a variety of stimuli associated with the phobic object/situation.

A client with OCD spends many hours each day washing his hands. The most likely reason he washes his hands so much is that:

It relieves his anxiety.

The initial care plan for a client with OCD who washes her hands obsessively would include which nursing intervention?

Sets limitations on the amount of time the client may engage in the ritualistic behavior.

John, a veteran of the war in Iraq, is diagnosed with PTSD. he says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses that John suffers from:

Survivor's guilt.

John, a veteran of the war in Iraq, is diagnosed with PTSD. He experiences a nightmare during his first night in the hospital. He explains to the nurse that he was dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to:

Stay with John and reassure him of his safety.

John, a veteran of the war in Iraq, is diagnosed with PTSD. Which therapy regimen is most appropriate for John?

Paroxetine and group therapy.

What may be influential in the predisposition to PTSD?

Severity of the stressor and availability of support systems.

Three years ago, Anna's dog Lucky, whom she had for 16 years, was run over by a car and killed. Anna's daughter reports that since that time, Anna has lost weight, rarely leaves her home, and just sits and talks about Lucky. Anna's behavior would be considered maladaptive because:
- it has been more than 3 years since Lucky died
-her grief is too intense just over the loss of a dog
-her grief is interfering with her functioning
-people in this culture would not comprehend such behavior

Her grief is interfering with her functioning.

Based on the last question about Anna, Anna's grieving behavior would most likely be considered to be:
-delayed -inhibited
-prolonged -distorted

Distorted.

George is diagnosed with Major Depression. She is most likely fixed in which stage of the grief process?
-denial -depression
-anger -acceptance

Anger

David, who is 72 years old is of the age at which she may have experienced many losses coming close together. What is this called?
-Bereavement overload -isolation
-Normal mourning - cultural relativity

Bereavement overload

Anna, age 72, has been grieving the death of her dog, Lucky, for 3 years. She is not able to take care of her activities of daily living, and wants only to make daily visits to Lucky's grave. Her daughter has likely put off seeking help for Anna because:
-women are less likely to seek help for emotional problems than men are
-relatives often try to "normalize" the behavior, rather than label it mental illness
-she knows that all older people are expected to be a little depressed
-she is afraid that the neighbors "will think her mother is crazy"

Relatives often try to "normalize" the behavior, rather than label it a mental illness

Anna's dog, Lucky got away from her while they were taking a walk. He ran into the street and was hit by a car. Anna cannot remember any of these circumstances of his death. This is an example of what defense mechanism?

-Rationalization -Denial
-Supression -Repession

Repression

Lucky sometimes refused to obey Anna and, indeed, did not come back to her when she called to him on the day he was killed. But Anna continues to insist "he was the very best dog. He always minded me. He did everything I told him to do" This represents the defense mechanism of:

-sublimation -reaction formation
-compensation - undoing

Reaction Formation

Anna has been a widow for 20 years. Her maladaptive grief response to the loss of her dog may be attributed to which of the following? Select all that apply.

-unresolved grief over the loss of her husband
-loss of several relatives and friends over the last few years
-repressed feelings of guilt over the way in which Lucky died
-inability to prepare in advance for the loss

All answers are correct. Unresolved grief over the loss of her husband; loss of several relatives and friends of the last few years; repressed feelings of guilt over the way in which Lucky died; inability to prepare in advance for the loss.

Mr. J is a new client on the psychiatric unit. He is 35 years old. Theoretically, in which level of psychosocial development (according to Erikson) would you place Mr. J?

- Intimacy vs Isolation
- Generativity vs. Self-Absorption
- Trust vs. Mistrust
- Autonomy vs. Shame and Doubt

Generativity vs. Self-Absorption

Mr. J has been diagnosed with Paranoid Schizophrenia. He refuses to eat and told the nurse he knew he was "being poisoned." According to Erikson's theory, in what development stage would you place Mr. J?

- Intimacy vs. Isolation
- Generativity vs. Self-Absorption
-Trust vs. Mistrust
-Autonomy vs. Shame and Doubt

Trust vs. Mistrust

Janet, a psychiatric client diagnosed with Borderline Personality Disorder, has just been hospitalized for threatening suicide. According to Mahler's theory, Janet did not receive the critical "emotional refueling" required during the rapprochement phase of development. That are the consequences of this deficiency?

-she has not yet learned to delay gratification
-she does not feel guilt about wrong doings to others
-she is unable to trust others
-she has internalized rage and fears of abandonment

She has internalized rage and fears of abandonment

John is on the alcohol treatment unit. He walks into the dayroom where other clients are watching a program on TV. He picks up the remote and changes the channel and says, "That's a stupid program! I want to watch something else!" In what stage of development is John fixed according to Sullivan's interpersonal theory?

-Juvenile because he is learning to form satisfactory peer relationships.
-Childhood because he has not learned to delay gratification.
-Early adolescence because he is struggling to form an identity.
-Late adolescence because he is working to develop a lasting relationship.

Childhood because he has not learned to delay gratification.

Which of the following are considered to be the chemical messengers of the brain?
- Neurotransmitters
-Dendrites
-Axons
-Synapses

Neurotransmitters

All of the following are competing biological theories of depression except:
-Dysregulation of limbic system,
-Imbalance of neurotransmitters such as serotonin, dopamine, and norepinephrine
-Thyroid dysfunction
-Excessive amount of inhibitory amino acids such as GABA.

Excessive amount of inhibitory amino acids such as GABA

Most anti-depressants work by blocking ___________ of certain neurotransmitters, like serotonin, after they are released into the synaptic cleft:
-Reuptake
-Regeneration
-Recycling
-Retransmission

Reuptake

A decrease in acetylcholine may play a significant role in which of the following illnesses?
- Alzheimer's disease
- Schizophrenia
-Anxiety Disorder
-Depression

Alzheimer's disease

A decrease in norepinephrine may pay a significant role in:
o Bipolar disorder
o Schizophrenia
o Alzheimer's
o Depression

Depression

An increase in dopamine activity may play a significant role in which of the following illness?
o Schizophrenia
o Anxiety disorders
o Depression
o Alzheimer's

Schizophrenia

The nurse-client therapeutic relationship includes all of the following characteristics except:
-Meeting the social needs of both the nurse and the client
-Ensuring therapeutic termination
-Promoting client insight into problematic behavior
-Collaboration on a set of goals

Meeting the social needs of both the nurse and the client

The most essential task for a nurse to conduct before forming a therapeutic relationship with a client is:
o Clarifying one's attitudes, values, and beliefs
o Ensuring therapeutic termination
o Promoting client insight

Clarifying one's attitudes, values, and beliefs

The phase of the nurse patient relationship that may be the most difficult for the patient because of anxieties may reappear and feelings of past losses are triggered is the:
o Working phase
o Preinteraction
o Orientation
o Termination

Termination

Resistance, although potentially present in all stages, is most often found in the following phase:
o Preinteraction
o Working
o Orientation
o Termination

Working

The client is very hostile toward one of the staff for no apparent reason. The client is probably manifesting:
o Transference
o Splitting
o Countertransference
o Resistance

Transference

When there is congruence between what the nurse is feeling and what is being expressed the nurse is conveying:
o Genuineness
o Respect
o Sympathy
o Rapport

Genuineness

Which therapeutic communication technique is being used in the following example?
Patient: "Every time I get angry, I wind up getting into a fistfight with my wife or I take it out on the kids."
Nurse: "I notice that you are you are smiling as you talking this physical violence."
o Making observations
o Restating
o Formulating a plan of action

Making Observations

Andrea's teenage son recently committed suicide. She discovered her son's body and was subsequently diagnosed with post-traumatic stress disorder. Andrea was then admitted to the inpatient psychiatric unit for evaluation and medication stabilization. She is 47 years old. An example of the therapeutic technique of "placing the event in time or sequence" is:
-"The day you discovered your son's body, you were arriving home from work. What happened then?"
-"Tell me about it"
-"I notice you seem uncomfortable"

The day you discovered your son's body, you were arriving home from work. What happened then?

Which of the following is not part of SOLER acronym for active listening?
-Lean away from client
-Sit squarely facing the client
-Establish eye contact

Lean away from client

Sarah is currently living in a shelter with her four children after escaping her abusive husband. Early in her stay, Sarah attends but does not participate in the support group held for the residents. One day, Sarah speaks up and appropriately confronts another peer who had stolen her hairbrush. The group leader states, "I'm so proud of you being assertive. You are so good!!" Which technique has the leader used, and is it therapeutic?
o Giving approval; no
o Translating words to feelings; yes
o Interpreting; no
o Offering reassurance; yes

Giving approval; no

Sarah has been living in a shelter with her four children after escaping her abusive husband. Sarah's move-out date is getting closer. Sarah states, I'm afraid to leave here. I'm afraid for my safety and the safety of my children." The nurse's best response is:
o This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community.
o It's the policy that clients are here only 30 days
o You've had a month to come up with a plan
o You're husband has probably moved on by now.

This is a difficult and scary transition. Let's work together to summarize what you've learned into a plan to keep you and your family safe in the community.

The nurse asks the patient to identify the date, the time of day and the location of the clinic. The nurse is assessing the patient's:
o Mental status
o Perception
o Orientation
o Thought

Orientation

Laura is a nurse in an inpatient psychiatric unit. Much of her time is spent observing client activity, talking with clients, and striving to maintain a therapeutic environment in collaboration with other health care providers. This specific example of the implementation step of the nursing process is called:
o Health teaching
o Case management
o Milieu therapy
o Self care activities

Milieu therapy

Which of the following best describes the role of the nurse in the therapeutic milieu of a psychiatric unit?
o The treatment team member who is responsible for management of therapeutic milieu.
o The treatment team member who develops the medical diagnosis for all the clients in the unit
o The treatment team member who provides for the spiritual and comfot needs of the client and his or her family.

The treatment team member who is responsible for management of therapeutic milieu.

Which of the following statements is not true about milieu therapy?
o Punishments are used to eliminate negative behaviors
o One to one relationship between the patient and the nurse is a major focus
o The goal is for the client to eliminate negative behaviors

Punishments are used to eliminate negative behaviors

A 18 year old female was sexually assaulted while on her way home from work. She is brought to the ER by her mom. Sexual assault is an example of the following type of crisis:
o Resulting from traumatic stress
o Dispositional
o Developmental crisis
o Reflecting psychopathology

Resulting from traumatic stress

The nurse considers a client's response to crisis intervention successful if the client is at a minimum:
o Returns to his previous level of functioning
o Learns to relate better to others
o Develops insight into the reasons why the crisis occurred.

Returns to his previous level of functioning

A single, pregnant teenager in a parenting class discloses her ambivalence toward the pregnancy and the subsequent guilt that these thoughts generate.
o Universality
o Altruism
o Imparting of information

Universality

When planning group therapy, which configuration should a nurse identify as most optimal for a therapeutic group?
o Circle of chairs, 5-10 people
o Members choose chair placement
o Chairs around a table, 5-10 people

Circle of chairs, 5-10 people

A man diagnosed with alcohol dependence experiences his first relapse. During his AA meeting, another group member states, I relapsed three times, but now have been sober for 15 years. Which of Yalom's curative group factors does this illustrate?
o Instillation of hope
o Catharisis
o Universality

instillation of hope

What should be the priority nursing dx for a client experiencing alcohol withdrawal?
o Disturbed thought process r/t tactile hallucinations
o Ineffective denial e/t continued alcohol despite negative consequence
o Risk for injury r/t CNS stimulation

Risk for injury r/t CNS stimulation

A client has a hx of drinking one pint of bourbon per day for the past 6 months. He is brought to an ER by family who report that his last drink was 1 hour ago. It is now 12 am. When should a nurse expect this client to begin experiencing withdrawal symptoms?
o Shortly after 24 hours
o Between 3am and 11am
o At the beginning of the 3rd day

Between 3am and 11am

A nurse is reviewing that stat labs of a client in the ER. At what minimum blood alcohol level should a nurse expect intoxication to occur?
o 50 mg/dL
o 100 mg/dL
o 250 mg/dL
o 300 mg/dL

100 mg/dL

A nurse evaluates a client PCA pump and notices 100 attempts within a 30 min period. Which is the best rationale for assessing this client for substance dependence?
o Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control
o Narcotic pain medication is contraindicated for all clients with active substance abuse problems
o There is no need to assess the client
o The client is experiencing symptoms of withdrawal, and needs to be accurately assed for lorazepam dosage

Clients who are dependent on alcohol or benzodiazepines may have developed cross tolerance to analgesics and required increased doses to achieve effective pain control

On the 1st day of a clients alcohol detox, which nursing intervention should take priority?
o Administer chloiazepoxide (Librium) in a dosage according to protocol.
o Strongly encourage the client to attend 90 AA meetings in 90 days
o Educate the client about the biopsychosocial consequences of alcohol abuse

Administer chloiazepoxide (Librium) in a dosage according to protocol

Depressed divorcee has been self medicating with cocaine for the past year. What should a nurse use to best describe the individual's situation?
o Physical dependency
o Social dependency
o Psychological dependency
o Substance dependency

Psychological dependency

A despondent client who has just lost her husband of 30 years tearfully states "I'll feel better if I sell my house and move" Which nursing response is appropriate?
o I'm confident you know what's best for you.
o Tell me why you want to make this change
o This may not be the best time for you to make such an important decision

This may not be the best time for you to make such an important decision-crisis situation, requires nurse to be more upfront so no rash decisions are made.

What is the best nursing rationale for holding a debriefing session with client and staff after a take down intervention has taken place on an inpatient unit?
o To reinforce the unit rules with the clients
o To process the feelings and alleviate fears of undeserved seclusion and restraint
o To discuss client problems that led to inappropriate expression of anger

To discuss client problems that led to inappropriate expression of anger

A client is admitted to a psych unit with a dx of catatonic schizophrenia. Which neurotransmitter should the nurse expect to be elevated in the client?
o Dopamine
o Serotonin
o GABA
o Histamine

Dopamine

Which client dx should a nurse associate with a decrease in GABA?
-Depression
-Alzheimer's
-Panic Disorder
-Schizophrenia

Panic disorder

From which of the following symptoms might the nurse identify a chronic cocaine user?
-Clear, constricted pupils
-Red, irritated nostrils
-Muscle aches
-Conjunctival redness

Red, irritated nostrils

A patient with physical dependence of opiates is likely to experience which symptoms of withdrawal?
o Nausea, vomiting, diarrhea, and piloerection
o Tremors, hallucinations, seizures
o Incoordination and unsteady gait

Nausea, vomiting, diarrhea, and piloerection

A client on an inpatient psych unit comes to the nurse to complain about another patient (Peter) not cleaning up after himself in the community restroom. The patient is angry and upset. What is the best response by the nurse?
-Why don't you go discuss that with Peter
-I will go take care of it so Peter does not get upset
-I can see that you are angry. Let's discuss ways to approach Peter with your concerns.

I can see that you are angry. Let's discuss ways to approach Peter with your concerns.

A nurse understands that abnormal secretion of growth hormone may play a role in which illness?
-Schizophrenia
-Anorexia
-Schizophrenia
-Anxiety Disorder

Anorexia

During a therapeutic group, 2 clients engage in an angry verbal exchange. The nurse leader interrupts the exchange and excuses both the clients from the group. Which leadership style has the nurse demonstrated?
-Autocratic
-Democratic
-Bureaucratic

Autocratic

A patient with back pain says "my nurse practitioner told me acupuncture may enhance the effect of the medications and physical therapy prescribed." What type of therapy is being recommended?
-Alternative therapy
-Physiotherapy
-Complementary therapy
-Biophsycosocial therapy

Complementary therapy

The goal of therapeutic touch is to:
o Improve circulation by deep circular massage
o Repattern the body's energy field by using rhythmic hand motions
o Improve breathing by increasing oxygen to the brain and body
o Decrease blood pressure by toxin release

Repattern the body's energy field by using rhythmic hand motions

Correcting subluxation by manipulating vertebra of spinal column is what kind of therapy?
o Allopathic therapy
o Therapeutic touch
o Massage therapy
o Chiropractic therapy

Chiropractic therapy

The nurse is providing tips on using herbal remedies. Which teaching point should the nurse provide?
o Select a reputable brand
o Herbal remedies are subject to FDA approval
o No need to monitor for adverse reactions
o They are natural and completely safe

-Select a reputable brand

The patient says the shopatouliens took my shoes! What is the appropriate charting to describe the patient's actions/statements?
o The client is experiencing command hallucinations
o The client is expressing neologism
o The client is experiencing an erotic delusion
o The client is verbalizing word salad

The client is expressing neologism

Nursing intervention that is most appropriate for caring for an acutely agitated client diagnosed with paranoid schizophrenia?
o Provide neon light and soft music
o Maintain continual eye contact through interventions
o Use therapeutic touch to increase trust and rapport
o Provide personal space to respect client boundaries

Provide personal space to respect client boundaries

A statement made by a client that indicates the client is experiencing a somatic delusion is:
o I see my dead husband everywhere I go
o The IRS may audit my taxes
o I'm not eating my food, it smells like brimstone
o There is an alien growing in my liver

There is an alien growing in my liver.

Flat affect, paranoid delusions, anhedonia, anergia, neologisms, and echolalia. Which of these symptoms are correctly placed as negative/positive symptoms of schizophrenia?
-(+) Paranoid delusions, anhendonia, anergia
-(+) Paranoid delusions, neologisms, echolalia
- (-) Paranoid delusions, anergia, echolalia
- (-) Paranoid delusions, flat affect, anhedonia

Paranoid delusions, neologisms, echolalia

Progressive relaxation exercise therapy focuses on:
-use of instrumentation to become aware of processes in the body
-use of own imagination as frame of reference
- hair-thin, sterile, disposable, stainless steel needles
-tensing and relaxing groups of muscles

-Tensing and relaxing groups of muscles

Reality therapy emphasizes:
- decrease visual and auditory hallucinations
- personal responsibility over choices
- confronting unconscious conflicts
- increasing assertive behavior

tensing and relaxing groups of muscles

A patient is brought to the E.R after being violently raped. Which nursing action is most appropriate?

Remain nonjudgmental and actively listen to the client's description

A client is diagnosed with schizophrenia is slow to respond and appears to be listening to unseen others. Which medication administered addresses this positive symptom?
-Citalopram
-Phenelzine
-Risperidone
-Sertaline

Risperidone

A patient is diagnosed with schizophrenia. The physician orders Haldol 50 MG BID and Benztropine 1 MG PRN. Which behaviors warrants administration of Benztropine?
-Hallucinations
-Tremors and shuffling gait
- Shouting and screaming

Tremors and shuffling gait

A 60 year old client with chronic schizophrenia presents in to ER with uncontrollable tongue movements, stiff neck, and difficulty swallowing. What is happening and how is it resolved?

-Neuroleptic malignant syndrome treated by discontinuing antipsychotic medications
-Angranulocytosis treated by administration of clozapine
-extrapyramidal dyskinesia treated by discontinuing antipsychotic medications
-tardive dyskinesia treated by discontinuing antipsychotic medications

-Tardive dyskinesia treated by discontinuing antipsychotic medications

Which of the following is not a negative symptom of schizophrenia?
-Inappropriate affect
-Emotional Ambivalence
-Delusions
-Waxy Flexibility

-Delusions.
Other negative symptoms include: bland or flat affect, apathy, autism, deteriorated appearance, anergia, posturing, pacing and rocking, anhendonia, regression.

An aging patient with a dx of chronic schizophrenia takes an antipsychotic and beta blocker for HTN. Which statement made by the nurse is the most important?
-Make sure you concentrate on taking slow, deep, cleansing breaths
- Rise slowing after sitting or laying down
-Watch your diet and try to engage in physical activity
-Wear sunscreen when outside

All of these side effects are true for antipsychotic medications. However, with consideration of the beta blocker, rising slowing from a sitting or lying position is most important.

A patient diagnosed with schizophrenia is prescribed Clozapine (Clozaril). Which symptoms present should the nurse intervene immediately?

-Sore throat, fever, malaise
-Akathisia and hypersalivation
-Akinesia and insomnia
-Dry mouth and urinary retention

Sore throat, fever, malaise

A nurse is administering risperidone (Risperdal) to a patient with schizophrenia. Which symptoms should the nurse expect as a therapeutic effect of this medication?
-Dystonia
-Social Isolation
-Glustastory Hallucinations
-Flat affect

Glustastory hallucinations

Nurse discovers clients suicide note that details the time, place and means. What is the priority intervention?

-Placing client on one to one suicide precautions
-Administer lorazepam (Ativan) prn, because the client is angry at the exposure of the plan
-Calling an emergency treatment team meeting, because the client's threat must be addressed
-Establishing room restrictions, because the client's threat is an attempt to manipulate the staff

place client on one to one suicide precautions

In planning care for a suicidal client, which outcome is the first priority?
-The client will not physically harm self
-The client will verbalize feeling on why he wants to commit suicide
- The client's mood and affect will improve over the next 3 days
-The client will work well with others

The client will not physically harm self

Immediately after ECT, which position is best for the client?
-On their side
-In high fowler's
-Trendelenburg's
-Prone position

on side, to prevent aspiration

A patient diagnosis with dysthymic disorder. Which symptom should the nurse classify as an affective symptom of this disorder?
-Gloomy and pessimistic outlook on life
-Low energy level
-Difficulty concentration
-Social isolation with a focus on self

gloomy, pessimistic outlook on life

A nurse assesses a patient with suspected of having major depression disorder. Which symptom would eliminate the diagnosis?

-Maxed out charge cards and exhibits perniscuous behaviors
-refuses to interact with others
-unable to feel any pleasure
0disheveled and malodorous

-maxed out charge cards and exhibits perniscuous behavior.
Depressed mood, loss of interest or pleasure in usual activities and significant weight loss are signs of major depressive disorder.

Phases of Schizophrenia

-Phase I Premorbid Phase- social maladjustment, social withdrawal, irritability, and antagonistic thoughts and behavior
-Phase II Prodromal Phase- certain signs and symptoms that precede the characteristic manifestations of the acute, fully developed illness.
-Phase III Schizophrenia- active phase of the disorder. Two or more of the following present for a significant amount of time during one month: delusions, hallucinations, social/occupational dysfunction, duration, schizoaffective and mood disorder exclusion, substance/general medical condition exclusion, relationship to a pervasive developmental disorder
Phase IV Residual Phase- characterized by periods of remission and exacerbation. A residual phase usually follows an active phase of the illness.

Disorganized Schizophrenia

Onset of symptoms before age 25, behavior is markedly regressive and primitive, contact with reality is extremely poor, affect is flat or grossly inappropriate, often with periods of silliness and incongruous giggling. Facial grimaces and bizarre mannerisms are common, and communication is consistently incoherent. Personal appearance is generally neglected.

Catatonic Schizophrenia

Characterized by marked abnormalities in motor behavior and may be manifested in the form of stupor or excitement.

Paranoid Schizophrenia

Characterized mainly by the presence of delusions of persecution or grandeur and auditory hallucinations related to a single theme. Individual is often tense, suspicious, guarded, and my be argumentative, hostile, and aggressive. Onset of symptoms is usually later, (20-30s) and less regression of mental faculties, emotional response, and behavior is seen than in the other subtypes of schizophrenia.

Undifferentiated Schizophrenia

Do not meet the criteria for any other subtypes, or they may meet the criteria for more than one subtype. Behavior is clearly psychotic-evidence of delusions, hallucinations, incoherence, and bizarre behavior.

Residual Schizophrenia

Individual has a history of at least one previous episode of schizophrenia. Individual who has a chronic form of the disease and is the stage that follows an acute episode. Residual symptoms may include social isolation, eccentric behavior, impairment in personal hygiene and grooming, blunted or inappropriate affect, poverty of or overly elaborate speech, illogical thinking, or apathy.

Schizoaffective Disorder

Manifested by schizophrenic behaviors, with a strong element of symptomatology associated with the mood disorders (depression or mania). Client may appear depressed, with psychomotor retardation and suicidal ideation, or symptoms may include euphoria, grandiosity, and hyperactivity.

Brief Psychotic Disorder

Sudden onset of symptoms that may or may not be preceded by a sever psychological stressor. Symptoms last at least 1 day but less than 1 month. Individual experiences emotional turmoil or overwhelming perplexity or confusion. Evidence of impaired reality testing may include bizarre behavior, and disorientation.

Schizophreniform Disorder

Essential features of this disorder are identical to those of schizophrenia, with the exception that the duration, including prodromal, active, and residual phases, is at least 1 month but less than 6 months. Thought to have good prognosis if the individual's affect not blunted or flat, if there is a rapid onset of psychotic symptoms from the time the unusual behavior is noticed, or if the premorbid social and occupational functioning was satisfactory.

Delusion Disorder Types

Erotomanic- individual believes that someone of higher status is in love with them
Grandiose- irrational ideas regarding the person's worth, talent, knowledge, or power
Jealous- centers on the idea that the person's sexual partner is unfaithful.
Persecutory- most common; they believe they are malevolently treated in some way, frequently they believe they are being conspired against, cheated, spied on, followed, drugged or poisoned.
Somatic- believe they have some physical defect, disorder, or disease

Acetylcholine Functions/Mental Implications

-implicated in sleep, arousal, pain perception, the modulation and coordination of movement, and memory acquisition and retention
-cholinergic mechanisms may have some role in certain disorders of motor behavior and memory, such as Parkinson's, Huntington's, and Alzheimer's disease. Increased levels of acetylcholine have been associated with depression

Norepinephrine Function/Mental Implications

-may have role in the regulation of mood, cognition, perception, and in cardiovascular functioning, and in sleep and arousal.
-implicated in certain mood disorders such as depression and mania, anxiety states, and in schizophrenia. Levels of the neurotransmitter are thought to be decreased in depression and increased in mania, anxiety disorders, and in schizophrenia

Dopamine Function/Mental Implications

-involved in regulation of movements and coordination, emotions, voluntary decision-making ability, and because of its influence on the pituitary gland, it inhibits the release of prolactin
-decreased levels of dopamine have been implicated in the etiology of Parkinson's disease and depression. Increased levels of dopamine are associated with mania and schizophrenia.

Serotonin Function/Mental Implications

-play a role in sleep and arousal, libido, appetite, mood, aggression, and pain perception
-increased levels of serotonin have been implicated in schizophrenia and anxiety states. Decreased levels of the neurotransmitter have been associated with depression

Histamine Function/Mental Implications

-exact processes mediated by histamine within CNS are unclear
-some data suggest that histamine may play a role in depressive illnesses

Gamma Aminobutyric Acid (GABA) Function/Mental Implications

- GABA interrupts the progression of the electrical impulse at the synaptic junction, producing a significant slowdown of body activity.
-decreased levels of GABA have been implicated in the etiology of anxiety disorders, movement disorders such as Huntington's Disease, and various forms of epilepsy.

Glyceine Function/Mental Implications

-appears to be involved in recurrent inhibition of motor neurons within the spinal cord and is possibly involved in the regulation of spinal and brainstem reflexes.
-decreased levels of glycine have been implicated in the pathogenesis of certain types of spastic disorders. Toxic accumulation of the neurotransmitter in the brain and cerebrospinal fluid can result in "glycine encephalopathy"

Glutamate Function/Mental Implications

-functions in the relay of sensory information an in the regulation of carious motor and spinal reflexes.
-increased receptor activity has been implicated in the etiology of certain neurodegenerative disorders such as Parkinson's disease. Decreased receptor activity can induce psychotic behavior.

Endorphins and Enkephalins Functions/Mental Implications

-natural morphine like properties, they are thought to have a role in pain modulation
-modulation of dopamine activity by opioid peptides may indicate some link to the symptoms of schizophrenia

SSRI
-action on neurotransmitter/receptor
-physiological effect
-side effect

-inhibit reuptake of serotonin
-reduces depression, controls anxiety, controls obsessions
-nausea, agitation, headache, sexual dysfunction

Tricyclic Antidepressants
-action on neurotransmitter/receptor
-physiological effect
-side effect

-inhibit reuptake of serotonin, norepinephrine, block NE receptor, ACh receptor, histamine receptor
-reduces depression, relief of severe pain, prevent panic attacks
-sexual dysfunction, sedation, weight gain, dry mouth, constipation, blurred vision, urinary retention, postural hypotension, and tachycardia

MAO Inhibitors
-action on neurotransmitter/receptor
-physiological effect
-side effect

-increase NE and 5-HT by inhibiting the enzyme that degrades them
-reduces depression and anxiety
-sedation, dizziness, sexual dysfunction, hypertensive crisis

SSNRIs: venlafaxine, desvenlafaxine, and duloxetine
-action on neurotransmitter/receptor
-physiological effect
-side effect

-potent inhibitor of serotonin and norepinephrine reuptake. Weak inhibitor of dopamine reuptake.
-Reduces depression, relieves pain of neuropathy, relieves anxiety
-nausea, increase sweating, insomnia, tremors, sexual dysfunction

Trazodone and Nefazodone
-action on neurotransmitter/receptor
-physiological effect
-side effect

-5-HT reuptake block, 5-HT2 receptor antagonism, adrenergic receptor blockade
-reduces depression and anxiety
-nausea, sedation, orthostasis, priapism

Bupropion
-action on neurotransmitter/receptor
-physiological effect
-side effect

-inhibits reuptake of NE and dopamine
-reduces depression, aid in smoking cessation, decrease in symptoms of ADHD
-insomnia, dry mouth, tremor, seizures

Antipsychotics: phenthiazines and haloperidol
-action on neurotransmitter/receptor
-physiological effect
-side effect

-strong D2 receptor blockade, weaker blockade of ACh, H1, alpha-adrenergic and 5-HT2 receptors
-relief of psychosis, relief of anxiety, some provide relief from nausea and vomiting and intractable hiccoughs

Antipsychotics: Novel: clozapine, olanzepine, aripiprazole, quetiapine, risperdone, ziprasidone, paliperidone, iloperidone, and asenapine
-action on neurotransmitter/receptor
-physiological effect
-side effect

-receptor antagonism of 5-HT1 and 5-HT2, D1-D5, H1, alpha-adrenergic, muscarinic
-relief of psychosis, relief of anxiety, and acute mania
-potential with some of the drugs for mild EPS, sedation, weight gain, orthrostasis and dizziness, blurred vision, dry mouth, sweating, constipation, urinary retention, tachycardia

Antianxiety: Benzodiazepines
-action on neurotransmitter/receptor
-physiological effect
-side effect

-binds to BZ receptor sites on the GABA-A receptor complex, increases receptor affinity for GABA
-relief of anxiety, sedation
-dependence, confusion, memory impairment, motor incoordination

Antianxiety: Buspirone
-action on neurotransmitter/receptor
-physiological effect
-side effect

-5-HT1A agonist, D2 agonist, D2 antagonist
-relief of anxiety
-nausea, headache, dizziness, restlessness

Which of the following part of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the "emotional brain"?
-frontal lobe
-thalamus
-hypothalamus
-limbic system

Limbic system

Which of the following parts of the brain is concerned with visual reception and interpretation?
-frontal lobe
-parietal lobe
-temporal lobe
-occipital lobe

Occipital Lobe

Which of the following parts of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling?
-frontal lobe
-parietal lobe
-temporal lobe
-occipital lobe

Frontal Lobe

Which of the following parts of the brain integrates all sensory input (except smell) on the way to the cortex?
-temporal lobe
-thalamus
-limbic system
-hypothalamus

Thalamus

Which of the following parts of the brain deals with sensory perception and interpretation?
-hypothalamus
-cerebellum
-parietal lobe
-hippocampus

Parietal Lobe

Which of the following parts of the brain is concerned with hearing, short term memory, and sense of smell?
-temporal lobe
-parietal lobe
-cerebellum
-hypothalamus

Temporal Lobe

Which of the following parts of the brain has control over the pituitary gland and autonomic nervous system? It also regulates appetite and temperature.
-temporal lobe
-parietal lobe
-cerebellum
-hypothalamus

Hypothalamus

At a synapse, the determination of further impulse transmission is accomplished by means of which of the following?
-potassium ions
-interneurons
-neurotransmitters
-the myelin sheath

Neurotransmitters

A decrease in which of the following neurotransmitters has been implicated in depression?
-GABA, acetylcholine, and aspartate
-Norepinephrine, serotonin, and dopamine
-Somatostatin, substance P, and glycine
-Glutamate, histamine, and opioid peptides

Norepinephrine, serotonin, and dopamine

Which of the following hormones has been implicated in the etiology of mood disorder with seasonal pattern?
-increased levels of melatonin
-decreased levels of oxytocin
-decreased levels of prolactin
-increased levels of thyrotropin

Increased levels of melatonin

Psychotropic medications that block the reuptake of serotonin may result in which of the following side effects?
-dry mouth
-constipation
-blurred vision
-sexual dysfunction

Sexual dysfunction

Psychotropic medications that block the acetylcholine receptor may result in which of the following side effects?
-dry mouth
-sexual dysfunction
-nausea
-priapism

dry mouth

Psychotropic medications that are strong blockers of the D2 receptor are more likely to result in which of the following side effects?
-sedation
-urinary retention
-extrapyramidal symptoms
-hypertensive crisis

Extrapyramidal symptoms

Nurse Mary has been providing care for Tom during his hospital stay. On Tom's day of discharge, his wife brings a bouquet of flowers and box of chocolates to his room. He presents these gifts to Nurse Mary, saying "Thank you for taking care of me." What is a correct response by the nurse?
- I don't accept gifts from patients
-Thank you so much! It is so nice to be appreciated.
-Thank you. I will share these with the rest of the staff.
-Hospital Policy forbids me to accept gifts from patients.

Thank you, I will share these with the rest of the staff

Nancy says to the nurse "I worked as a secretary to put my husband through college, and as soon as he graduated, he left me. I hate him! I hate all men!" Which is an empathetic response by the nurse?
-You are angry now. This is a normal response to your loss.
-I know what you mean. Men can be very insensitive.
-I understand completely. My husband divorced me too.
-You are depressed now, but you will feel better in time.

You are angry now, this is a normal response to your loss.

Which of the following behaviors suggest a possible breach of professional boundaries? Select all that apply.
-The nurse repeatedly requests to be assigned to a specific client
-The nurse shares the details of her divorce with the client
-The nurse makes arrangements to meet the client outside of the therapeutic environment
-The nurse shares how she dealt with a similar difficult situation

the nurse repeatedly requests to be assigned to a specific client, the nurse shares details of her divorce with the client, the nurse makes arrangements to meet the client outside the therapeutic environment

A client states: "I refuse to shower in this room. I must be very cautious. The FBI placed a camera in here to monitor my every move." Which of the following is the therapeutic response?
-That's not true
-I have a hard time believing that's true
-Surely you don't believe that
-I will help you search this room so that you can see there is no camera

I have a hard time believing that's true

Nancy, a depressed client who has been unkempt and untidy for weeks, today comes to group therapy wearing makeup and a clean dress and having washed and combed her hair. Which of the following responses by the nurse is most appropriate?
-Nancy, I see you have put on a clean dress and combed your hair
-Nancy, you look wonderful today!
-Nancy, I'm sure everyone will appreciate that you have cleaned up for the group today
-Now that you see how important it is, I hope you will do this everyday

Nancy, I see you have put on a clean dress and comber your hair

Dorothy was involved in an automobile accident while under the influence of alcohol. she swerved her car into a tree and narrowly missed hitting a child on a bicycle. She is in the hospital with multiple abrasions and contusions. She is talking about the accident with the nurse. Which of the following statements by the nurse is most appropriate?
-Now that you know what can happen when you drink and drive, I'm sure you won't let it happen again
-You know that was a terrible thing you did. That child could have been killed
-I'm sure everything is going to be okay now that you understand the possible consequences of such behavior
-How are you feeling about what happened?

How are you feeling about what happened?

Judy has been in the hospital for 3 weeks. she has used Valium "to settle my nerves" for the past 15 years. She was admitted by her psychiatrist for safe withdrawal from the drug. She has passed the physical symptoms of withdrawal at this time, but states to the nurse "I don't know if I will make it without Valium after I go home. I'm already starting to feel nervous. I have so many personal problems." Which of the following is the most appropriate response by the nurse?
-Why do you think you have to have drugs to deal with your problems?
-Everybody has problems, but not everybody uses drugs to deal with them. You'll just have to do the best that you can.
-We will just have to think about some things that you can do to decrease your anxiety without resorting to drugs
-Just hang in there. I'm sure everything is going to be okay.

We will just have to think about some things you can do to decrease your anxiety without resorting to drugs

Mrs. S asks the nurse, "Do you think I should tell my husband about my affair with my boss?" Which is the most appropriate response by the nurse?
-What do you think would be best for you to do?
-Of course you should. Marriage has to be based on truth.
-Of course not. That would only make things worse.
-I can't tell you what to do. You have to decide for yourself?

What do you think would be best for you to do?

Carol, an adolescent, just returned from group therapy and is crying. She says to the nurse, "All the other kids laughed at me! I try to fit in, but I always seem to say the wrong thing. I've never had a close friend. I guess I never will." Which is the most appropriate response by the nurse?
-What makes you think you will never have any friends?
-You're feeling pretty down on yourself right now
-I'm sure they didn't mean to hurt your feelings
-Why do you feel this way about yourself?

You're feeling pretty down on yourself right now

Which of the following tasks are associated with the orientation phase of relationship development? Select all that apply?
-Promoting the client's insight and perception of reality
-Creating an environment for the establishment of trust and rapport
-Using the problem solving model toward goal fulfillment
-Obtaining available information about the client from various sources
-Formulating nursing diagnoses and setting goals

Creating an environment for the establishment of trust and rapport, and formulating nursing diagnoses and setting goals

Define Rapport

implies special feeli8ngs on the part of both the client and the nurse based on acceptance, warmth, friendliness, common interest, a sense of trust, and a nonjudgmental attitude.

Providing food when the client is hungry, providing a blanket when the client is cold, being consistent in adhering to unit guidelines, and ensuring confidentiality are all ways to enhance __________ with a client.

-Trust
-Respect
-Genuineness

Trust

Promoting an atmosphere of privacy during therapeutic interactions, always being open and honest, striving to understand motivation behind the client's behavior and calling the client by name all demonstrate what?

-Trust
-Respect
-Genuineness

Respect

Define Genuineness

Refers to the nurse's ability to be open, honest, and "real" in interactions with the client.

Define Empathy

A process wherein an individual is able to see beyond outward behavior and sense accurately another's inner experience at a given point in time.

Therapeutic Relationships, The Preinteraction Phase

-involves preparation for the 1st encounter
-obtain available info about the client. Initial assessment
-Examine one's own feelings, fears, and anxieties about working with particular client

Therapeutic Relationships, The Orientation (Introductory) Phase

-create environment for the establishment of trust and rapport
-contract for intervention that details expectations/responsibilities
- gathering assessment data to build strong client database.
-identify strengths/weakness of client
-formulating nursing dx
-set goals that are mutually agreeable
-develop a plan of action that is realistic for meeting the established goals
-explore feelings of both the client and nurse

Therapeutic Relationships, The Working Phase

-maintain trust/rapport
-promote client's insight and perception of reality
-problem solving using the model
-overcoming resistance behaviors on the part of the client as the level of anxiety rises in response to discussion of painful issues
-continuously evaluating progress toward the goal

Therapeutic Relationships, The Termination Phase

-progress has been made toward attainment of mutually set goals
-a plan for continuing care or assistance during stressful life situations
-feelings about termination of the relationship are recognized and explored.

Define Transference:

-occurs when the client unconsciously attributes to the nurse feelings and behavioral predispositions formed toward a person from his or her past.

Define Countertransference:

-refers to the nurse's behavioral and emotional response to the client. These responses may be related to unresolved feelings toward significant others form the nurse's past, or they may be generated in response to transference feelings on the part of the client.

Functions of a therapeutic group include all of the following except:
-support
-comaraderie
-informational
-governance
-hope

hope

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