Mental Health Exam 2

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The daughter of a severely depressed patient asks the nurse "What do you think about the relationship between depression and physical illness? Since my mother has been grieving over my father's death, she has had colds, shingles, and the flu, and she's usually not one to get sick." The answer that best reflects the current thinking about psychoimmunology is:

"Emotions and stress are believed to interfere with white blood cell production and can increase the likelihood of infectious diseases."

A patient with emphysema who has severe shortness of breath and frequent hospitalizations often depends on her portable oxygen tank when she leaves her home. Rcently she has not been able to go upstairs to her bedroom at night because of shortness of breath and fear of developing severe breathing difficulty if she continues up the stairs. A support group leader suggests the use of guided imagery. What image would the patient be encouraged to visualize?

Walking up the stairs in a steady, relaxed manner, taking regular deep breaths.

A nurse who leads group therapy for a group of depressed patients plans to implement a plan of exercise for each patient. The rationale to use when presenting this plan to the treatment team is that exercise:

Has an antidepressant effect comparable to selective serotonin reuptake inhibitors.

A recent immigrand from Central America is brought to the clinic by her daughter, who has been a U.S. resident for 10 years. The daughter says the stress of immigration has made her mother unwell. For which expression of stress should the nurse be alert during the assessment interview?

Somatic complaints.

A patient reports that financial problems are stressing his marriage. Today he heard rumors about impending cutbacks at work, and he fears he will be laid off. He is wringing his hands, has a pulse rate of 112/minute, respirations are 26/minute, and his blood pressure is 166/88 instead of being his usual 110-120/76-84 range. Which nursing intervention or recommendation should be used first?

Slow and deepen breathing via use of a positive, repeated word.

According to the Life Changing Event Questionaire, which situation would most merit a complete assessment of a person's stress status and coping abilities?

A person returning to college after his employer ceased operations.

A patient newly diagnosed as being HIV positive seeks the nurse's advice on how to reduce the risk of infections. The patient states, "I used to go to church, and it seems like I was in my best health then. Maybe I should start going to church again." The reply that shows the best understanding of psychoimmunology is:

"Studies show that spiritual practices can enhance immune system function."

When the inpatient psychiatric nurse asks the newly admitted patient to describe her social supports, the patient reports that she is newly divorced, has no siblings, her parents died last year, and has little contact with her former in-laws, who subtly blame her for the divorce. She has few friends because most of her peers are not nearly as religiously conservative as she is. Which response related to social supoort would be most therapeutic?

Discuss how divorce support groups could increase coping and social support.

A patient who is experiencing great stress associated with a disturbing new diagnosis asks the nurse, "Do you think saying a prayer would help?" The answer the nurse should give is:

"You may find prayer gives comfort and lowers your stress."

The nurse planning to teach a patient how to use Benson's relaxation techniques to treat hypertension is essentially teaching the patient to:

Switch from the sympathetic mode of the autonomic nervous system of the parasympathetic mode.

A patient tells the nurse, "I'm told that I should reduce the stress in my life, but I have no idea where to start." Which would be the best initial nursing response?

"Let's talk about what is going on in your life and then look at possible options."

A patient tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." Which response would be in keeping with the doctor's recommendations.

Teaching the patient to recognize, reconsider, and reframe irrational thoughts.

A patient who had been complaining of intolerable stress at work has demonstrated the ability to use progressive muscle relaxation and deep breathing techniques. He will return to the clinic for follow- up evaluation in 2 weeks. Which data will best suggest that the patient is successfully using these techniques to cope more effectively with stress?

His systolic blood pressure has gone from the 140s to the 120s

The patient telsl the nurse, "I'll neber be happy until I'm as successful as my older sister." The nurse asks the patient to reassess this statement and reframe it. Which reframed statement is most likely to promote coping?

"I can find contentment in succeding at my own job level."

The patient tells the nurse that one result of his chronic stress is that he has considerable fatigue. He usually sleeps from 11:00 PM to 6:30 AM. He reports he now sets his alarm to give himself an extra 30 minutes of sleep each morning but feels no better and is rushed for work. Which nursing response would best address the patient's concerns?

"Perhaps going to bed a half hour earlier would work better than sleeping later."

A patient reports that he is overwhelmed by stress. Which question would be most important to use in assessing the patient during your first meeting?

"Tell me about the kinds of things you do to reduce or cope with your stess."

MULTIPLE RESPONSE
Which changes reflect the short-term physiological response to stress?

- Cortisol is released, increasing glucogenesis and reducing fluid loss.
- Corticosteroid release increases stamina and impedes digestion.
- Muscular tension, blood pressure, and triglycerides increase.
- Epinephrine is released, increasing heart and respiratory rates.

MULTIPLE RESPONSE
Which nursing interventions are likely to help the patient to cope by addressing the mediators of stress?

- "A divorce, while stressful, can be the beginning of a new, better phase of life."
- "Journaling gives one more awareness of how experiences have affected them."
- "Perhaps a short-term loan from your father will make your layoff less stressful."
- I have found a support group for newly divorced person in your neighborhood."

MULTIPLE RESPONSE
The nurse wishes to use guided imagery to help her patient relax. Which comment would be appropriate to include in the guided imagery script?

- "With each breath, you are feeling calmer, more relaxed, almost as if you are floating...."
- "You are alone on a beach, the sun is warm, and you hear only the sound of the surf..."
- "You have grown calm, your mind is still, there is nothing to disturb your well-being..."

OTHER
A stress-laden patient has elected to learn deep breathing as a means of reducing stress. Rank the order the nurse should give the following information when teaching this technique.

1.) Find a comfortable position. Relas the shoulders and chest; let the body relax.
2.) Take a deep breath through the nose, expanding the abdomen.
3.) Hold the breath for 3 seconds.
4.) Exhale slowly through the nose, telling the body to relax.
5.) With each breath, pay attention to muscular sensations that accompany abdominal expansion.
6.) Focus on your breathing; repeat the exercise for 2 to 5 minutes.

The nurse wishes to teach an alternative coping strategy to a patient who is currently experiencing severe anxiety. The nurse will first need to:

Use measures designed to lower the patient's anxiety.

A patient complains of tension, indigestion, and difficult concentrating; his resting pulse is 110/minute. An appropriate nursing response would be:

"It might help to talk. Tell me about what has been going on today."

A patient is noted to have a high level of non-goal-directed motor activity, running from chair to chair in the solarium. He is wide eyed and seems terror stricken. He cries, "They're coming! They're coming!" He neither follows staff direction nor responds to verbal efforts to calm him. Which nursing response should be the highest priority?

Reduce his fearfulness and running.

A secretary is asked by her boss to take on additional work. She initially agrees but feels resentful. A day later when the boss asks for the completed work, the secretary explains that she has been working on another priority job and hasn't been able to complete it. When asked several hours later, she states someone else was using the files, so she hasn't been able to do the necessary research before typing the report. The secretary's behavior demonstrates.

Rationalization.

A patient reports that nothing is wrong with him except a chest cold he's had for a couple weeks that 'hasn't been able to shake off." His wife is very worried and says he smokes, coughs a lot, has lost 15 pounds, and is easily fatigued. Which of the following statements best describes this situation?

The patient is using denial to cope adaptiviely.

While working with an anxious patient, the nurse begins to feel tense and jittery and notices that she is having difficulty concentrating on what the patient is telling her. How can this be explained? The nurse is experiencing:

Contagious anxiety.

The nurse plans to encourage an anxious patient to talk about his feelings and concerns. The rationale for this intervention is that:

Stating concerns aloud becomes less overwhelming and promotes problem solving.

A college student who usually gets "straigh-A" grades scored a C on a difficult examination. When he received the grade, he began to shake, sweat profusely, and feel sick to his stomach. The best explanation for the student's reaction is that:

Not receiving the expected grade threatened his self-esteem, causing anxiety.

A patient, laid off from his job of 15 years, is pacing rapidly in the waiting room. His behavior is disorganized, he is trembling, and he can be heard admonishing himself that he should have worked harder. He told the triage nurse that he would like to get some medication to calm him down so he can "think straight." Which of the following would constitute a therapeutic rationale for the use of antianxiety medication as his initial treatment?

It would better enable him to participate in treatment.

A patient accompanied her boyfriend to the emergency department after the two had been in a motorcycle accident. The boyfriend was badly hurt, but the patient had only minor cuts and bruises and was discharged. She mentioned to the nurse that since she was driving, she should have been the one to be injured. twenty-four hours later, while visiting her boyfriend, the patient reported that she was unable to move from her chair and unable to walk. Diagnostic workup revealed no physical reason for the problem. The anxiety relief behavior the patient is demonstrating is:

Conversion.

Two staff nurses were considered for promotion. The promotion was announced by a memo on the unit belletin board. When the nurse hwo was not promoted first read the memo and learned that the other nurse had received the promotion, she left the room in tears. This behavior is an example of:

Regression

A patient who asks for and was refused a pass to leave the unit left the nurse's station and went to his room, where he slammed his closet door several times while looking for a sweater. This behavior is an example of ________ use of ______.

Adaptive use of displacement.

A patient who asked for and was refused a pass to leave the unit left the nurse's station and went to his room, where he slammed his closet door several times while looking for a sweater. A nurse came into the room and remarked, "You seem pretty angry." The patient replied that he was not the least bit angry. What defense mechanism is the patient demonstrating?

Denial.

A patient tells the nurse, "My new friend is the most perfect person one could imagine! I can't find a single flaw. He is kind , considerate, handsome -- and he puts me before anyone or anything else." The nurse should hypothesize that htis patient may be demonstrating:

Splitting.

A rather unnattractive woman seems to work diligently to be an excellent mother and a bright, exceptional employee, striving to please her husband and her boss, sometimes to the point that she sacrifices her own needs to assure that their needs are met. This is an example of:

Compensation.

The husband who is sexually inadequate and blames it on his partner, saying that her expectations are unrealistic and that no man could meet them, may be demonstrating:

Rationalization.

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness and a sense of restlessness. The nurse should assess the patient's situation as:

Mild anxiety.

A patient who is a university student states that before taking an examination he feels a heightened sense of awareness, a sense of reslessness, and a mild degree of apprehension. Which nursing intervention is most therapeutic?

Normalize his symptoms as resulting from mild anxiety and calmly discuss how they may actually help his performance.

An anxious patient who receives anxiolytic medication every 6 hours PRN is in the corridor pacing. He grabs the arms of anyone who comes along and asks, "When can I have medication?" His voice is high pitched and shaky. His respiratory rate is rapid. His assigned nurse should intervene by:

Checking when his medication is due and informing him.

A patient with severe anxiety has been pacing the hall and suddenly begins to run, shouting " I'm going to explode!" Over and over. The nurse who has been walking with him should:

quickly gather more staff and state, "We will help you regain control."

A patient is scheduled to undergo a bipsy of a mass in his lung tomorrow morning. He seems to have difficulty grasping the procedure as the nurse explains it to him and repeatedly asks questions such as "What do you mean I'm going to have surgery? What are they going to do?" His voice tremulous. His respirations are 28/minute, and his pulse is 110/minute. Which of the following initial outcome indicators would be most appropriate?

Patient demonstrates understanding of the procedure.

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse, "I know it's probably crazy, but I just can't bring myself to leave my apartment alone. And I can't expect somebody to take me up to work every day." The nurse can make the assessment that the patient is:

Aware that his fear is irrational.

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse: "I feel really stupid, a grown man not being able to leave his house." The most therapeutic reply is:

"You feel stupid because you're afraid to leave home?"

A patient who has been unable to leave his home for more than a month because of symptoms of severe anxiety tells the nurse, "I know it's probably crazy, but I just can't bring myself to leave my apartment alone." An appropriate nursing intervention for the nurse to include in the initial nursing care plan is:

Teach the patient to replace negative self-talk with positive.

A patient is seeking treatment for her fear of cats; even a picture or a though of a cat causes her to weat, tremble, become very apprehensive and uncomfortable, and become sick to her stomach. The nurse has established the nursing diagnosis as Anxiety related to exposure to phobic object (cats). A realistic indicator for the outcome Anxiety self-control would be that within 10 days, the patient will:

Report a decrease in distress when thinking about cats.

A patient with an intense fear of cats reports that after 2 weeks of therapy, she no longer sweats or becomes nauseated when she sees a cat on television but still cannot be in the same room with a cat. The nurse would interpret this change as meaning that the patient:

Is responding to therapy, and the current treatment can continue.

For the patient whose nursing diagnosis is Powerlessness related to an inability to control compulsive cleaning, the nurse must understand that the patient uses the cleaning to:

Exert control over her anxiety.

The nurse caring for a patient who has been diagnosed as having generalized anxiety disorder tells a preceptor, "I find myself feeling uncomfortable and anxious around the patient. When he starts trembling and perspiring and pacing, I find myself with cold, clammy hands, and my pulse races. I start worrying whether I will be able to help him stay in control." In such an interaction, the patient will most likely experience:

Increased anxiety.

A patient who is a recovering alcoholic has been diagnosed as having panic attacks. The psychiatrist mentions plans to treat the patient with daily doses of medication. Of the medications listed below, for which drug should the nurse plan patient teaching?

Paroxetine (Paxil)

A patient with chronic obstructive pulmonary disease is hospitalized for respiratory distress and has improved. She becomes very anxious when experiencing shortness of breath. One evning she is found to be restless and disorganized in her behavior and conversation. Which of the following should be considered first in determining the possible causes of these changes?

The multiple neurocognitive changes may be due to hypoxia.

A patient is hospitalized for acute respiratory distress related to pneumonia and has improved. On admission she had been very anxious because she could not get her breath. On the night shift, she is found to be restless and disorganized in her behavior and conversation. Which of the following nursing interventions should be implemented first?

Check her pule oximetry reading.

A patient who has been pacing rapidly for the past hour cannot immediately be located on the unit. When he is found, he is in the closet, rocking back and forth rapidly and talking rapidly to himself. When staff approach, he only seems to notice them momentarily, then leaves his room and begins running up and down the hallway. Which of the following interventions should be attempted at this point?

In a calm but direct voice say: "Stop running. I will stay with you. Walk with me."

A patient with moderate to severe anxiety associated with generalized anxiety disorder can be assessed as successfully lowering her anxiety level to mild when she:

Concentrates on what the nurse is saying.

A soldier serving in the Middle East was in a convoy when an improvised explosive device (IED) killed three fellow soldiers in the vehicle in front of hers. Five weeks later, she began to report intrusive thoughts of missiles screaming toward her and exploading, and loud sounds began to trigger an involuntary re-experiencing of IED explosion. Three months later, she reported continuing sleep impairment, nightmares, social withdrawal, disrupted relationships, and flashbacks. This soldier's rpesentation most suggests:

posttamatic stress disorder.

A nursing student asks to be excused from a required group presentation. He reveals that he is afraid that he will "mess up" and that others will laugh at him.. He reports significant dread at the thought of any public presentation, accompanied often by nausea and vomiting when such situations occurred in the past. He reports he was unable to go to prom because he cannot dance well and feared he would be teased or become physically ill. This history suggest the presence of a:

Social phobia

A famous general sometimes slowed down his entire army because he felt he must count all the windows in each of the buildings he passed. A patient feels that he must repeat washing his hands three times each time he washes. The nurse recognizes that such behaviors serve the purpose of reducing:

Anxiety.

A man checks that his doors are locked two or more times each time he leaves home. The door is always found to be locked. Which of the following initial interventiosn would most likely be useful to this patient?

Discussing what the patient was thinking and feeling before checking the door.

When a patient asks what causes his panic attacks, the nurse should reply that research gives evidence to support the theory that panic disorders have their etiology in:

Genetic-biological factors.

When interviewing and planning care for a patient with fear of public speaking, the nurse must be aware that social phobias are often treatable with:

Beta-blockers.

A patient tells the nurst that she wants her physician to prescribe diazepam (Valium) for anxiety reduction. The physician has prescribed buspirone (BuSpar). The nruse's reply should be based on the knowledge that buspirone:

Is not habituating or likely to be abused.

An insurance agent who is sitting in his office after returning from a cardiovascular examination in which he was pronounced "in good health" suddenly experiences a feeling of terror. His heart pounds, he feels as though he cannot breathe, and he cannot focus on what is being said to him. Several earlier episodes (for which he was seen in the emergency room, without any findings of cardiovascular disease) and the fear of their repetition had prompted the visit to the doctor for a more thorough evaluation. This experience should be assessed as a possible:

Panic attack.

The care for an engineer with agoraphobia includes increasing self-esteem with cognitive restructuring. When the patient tells the nurse, "I'm not smar enough to get that job," the nurse should say:

"Let's stop and think about what you just said."

The nurse is assisting a patient with obsessive thoughts. The advanced practice nurse suggests using thought-stopping techniques. Which of the following is an example of such a technique?

Teach the patient to snap a rubber band on her wrist whenever an obsessive thought enters her mind.

Two forms of therapy that call for the nurse to plan for an initial rise in patient anxiety level are:

Flooding and response prevention.

A nurse has been counseling a patient with generalized anxiety disorder to increase the patient's anxiety self-control. The patient has identified several stressful situations that cause physical and psychological manifestations of anxiety. Which indicator should the nurse monitor to the Nursing Outcomes Classification outcome of anxiety self-control?

Plans coping strategies for stressful situations.

Which assessment question would be highly appropriate to ask a patient with possible generalized anxiety disorder?

"Do you find yourself worrying so much that it causes problems for you?"

A nurse is counseling a patient with an anxiety disorder by using cognitive therapy strategies. She gives the patient a homework assignment to keep a diary in which he records the symptoms of anxiety he experiences and the events that transpired just before the onset of symptoms. What is the rationale for this strategy?

Link symptoms with precipitating events, which provides a basis for discussion and framing.

A Hispanic woman is recovering from surgery on an inpatient unit when she receives word that her mother has passed away unexpectedly. She begins to shout unintelligibly and then complains of palpitations and a sense of heat in her chest and head. She suddenly begins to tremble and exhibit seizure-like motor behavior. Which of the following would be the most appropriate nursing response?

Provide reassurance and emotional support while continuing to assess the patient.

When working with a patient with posttraumatic stress disorder who has frequent flashbacks as well as persistent symptoms of arousal, effect nursing interventions would include:

Explaining that physical symptoms are related to the psychological state.

MULTIPLE RESPONSE
A patient who has been pacing actively approaches the nurse and blurts out, "You've got to help me! Something terrible is happening. I'm falling apart. I can't think. I can't get my breath; I feel like I'm dying. What's happening to me?!" Which of the following nursing responses would be appropriate?

- "You are having a panic episode; I will stay with you until it passes."
- "Watch me; I'll show you how to calm by slowing your breathing."
- "I'll get you some orange juice, and we'll walk together for awhile."

MULTIPLE RESPONSE
A patient knows that his symptoms suggest that he may have lung cancer but insists that it is just a cold. Which of the following nursing responses would be helpful in this situation?

-"The prospect of a serious health problem can be very frightening for most people."
- "Tell me about what helps you cope, what has helped when life has been difficult."
- "There are some new treatments for lung disease; the outlook is better now."

MULTIPLE RESPONSE
A teenager reports to her therapist that she had been sexually abused by her older brother. She explains that she "went somewhere else" during the assaults and does not remember the details. The patient reports that she often feels numb or "not real" in romantic relationships, especially if sexual activity occurs or is anticipated, and that she generally avoids such relationships. Which of the following disorders should be suspected based on this history?

- Acute stress disorder.
- Posttraumatic stress disorder

MULTIPLE RESPONSE
A patient with a history of resolved substance abuse and who has been pacing, disorganized, mumbling to himself, trembling, and intrusive has just been given 10 mg of PRN intramuscular diazepam (Valium) after responding threateningly to a peer who asked him to lend him money. Important nursing interventions at this point include:

- Monitor the patietn's vital signs and behavior to determine his response to the medication.
- Stay with the patient to probide reassurance and support, and provide for any safety needs that might develop.

MULTIPLE RESPONSE
A 10 year old child, who has been placed in a foster home after being removed from parental contact because of abuse, demonstrates apprehension, tremulousness, and impaired concentration. The foster parent reports the child has an upset stomach, is urinating requently, and does not seem to understand what has happened. She asks the nurse what measures they can use to help the child. The nurse should recommend:

- Using a calm manner and low, comforting voice.
- Conveying empathy and acknowledging the child's distress.
- Explaining and reinforcing reality to avoid distortions.

MULTIPLE RESPONSE
For the patient with ritualistic hand washing and an identified outcome expectation of Use of effective coping patterns, the nurse should:

- Encourage the patient to participate in unit activities.
- Teach relaxation techniques to be used in lieu of rituals.
- Restrict the ritual to demonstrate that anxiety subsides without it.
- Gradually increase the intervals between permitted washing.

MULTIPLE RESPONSE
The nurse interviewing a patient with suspected posttramautic stress disorder should be alert to findings indicating the patient:

- Experiences flashbacks or re-experiences trauma.
- Demonstrates hypervigilance or distrusts.
- Feels detached, estranged, or empty inside.
- Avoids people and places that arouse painful memories.

MULTIPLE RESPONSE
A patient with obsessive compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work, then comes home on the lunch hour and spends more than one hour rechecking faucets, stove burners, appliances, window and door locks, and so forth. The checking continues after work and during the evening. The patient spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent. Which of the following nursing diagnoses should the nurse consider for this patient?

- Ineffective role performance related to time spent in rituals.
- Ineffective coping as evidenced by use of compulsive behavior.
- Social Isolation related to excessive use of time to perform rituals.
- Self-care deficit related to excessive time spent in rituals.

MULTIPLE RESPONSE
A patient with obsessive compulsive disorder spends 2 hours each morning checking and rechecking her home before leaving for work, then comes home on the lunch hour and spends more than one hour rechecking faucets, stove burners, appliances, window and door locks, and so forth. The checking continues after work and during the evening. The patient spends so much time in ritualistic behavior that grooming is poor and social activities are nonexistent. Which indicators for measuring progress would be appropriate for this patient?

- Participates in social activity 30 minutes per day.
- Checks no more than once when leaving home.
- Achieves adequate grooming and hygiene daily.

The medical-surgical nurse working with patients who has a somatoform disorder will find planning is facilitated by the understanding that the patients will probably:

Be resistant to seeking psychiatric help.

A patient has been diagnosed as having blindness related to conversion disorder. She displays indifference regarding the conversion symptom. The nurse states, "I can't understand why the patient doesnt' seem more anxious about her symptoms." Which explanation from the clinical nurse specialist would enable the nurse to understand the patient's behavior?

The blindness is actually helping the patient by reducing her anxiety.

A patient has blindness related to conversion disorder. Which response would be most appropriate for ensuring adequate nutrition?

Explain where the foods and utensils are on the tray so she can self-feed.

A patient with blindness related to conversion disorder tells the nurse, "Lots of doctors and nurses stop by to check on my blindness, and the other patients are really interested in it, too. Too bad people don't think I was interesting before I became blind." Which nursing diagnosis is most suggested by this comment?

Chronic low-self esteem

To best assist a patient with a conversion disorder, which nursing intervention would be most effective?

"Everyone has been focused on your blindness, but I would like to talk about your feelings and what emotions you were experiencing before this began."

A patient who is concerned that she may have a serious heart disease seeks help at the mental health center after her internist examined her and told her that she has no physical illness. She wants staff to tell her internist it's not all in her head. The patient reports she has had tightness in her chest and the sensation of her heart missing a beat. Her concern over her symptoms has caused her to miss much time from work over the past 2 years, and her social life has been severely restricted becasue she believes she must rest each evening. This presentation most suggests"

Hypochodriasis.

The nurse assessing a apatient with somatoform disorder is most likely to note that the patient:

Has alterations in comfort and activities trelated to physical complaints.

To plan effective care for patients with somatoform disorders, the nurse must understand that the patients may have difficulty giving up the symptoms because they:

Provide relief of anxiety.

A patient with somatization has an established nursing diagnosis of interrupted family processes related to patient's symptoms. The patient's spouse and children assume roles and tasks that previously belonged to the patient. Which is an appropriate outcome for the patient? The patient will _____

Demonstrate resumption of former roles and tasks.

A patient who is 5 feet 9 inches tall and weighs 160 pounds believes that her size 9 feet are enormous compared to the rest of her body. She has visited orthopedic surgeons to see if surgery could reduce the length of her feet, and she spends hours trying to buy shoes to make her feet look smaller. In social situations, she sits with her feet concealed under a table or wears long skirts to hide them. The nurse can assess that the patietn's symptoms are consisten with:

Body dysmorphic disorder.

Which assessment data most suggests that the patient is experiencing a fugue state?

After being caught in an affair, a man disappeared only to reappear months later without memory of what had occured while he was missing.

The patient lives with her roommate in a condominium. The roommate has observed her leaving the condo wearing seductive clothing quite different from her usual wardrobe and returning 12-24 hours later, after which she sleeps for 8-12 hours. Episodes have also occurred in which the patient and her roommate have argued about household matters, and the patient has gone to sit on the floor in the corner of the kitchen. While seated there, she has spoken like a young child. The patient's problem can be assessed as being consistent with DSM-IV-TR criteria for:

Dissociative identity disorder.

A patient with somatoform pain disorder reveals to the nurse that he has begun to question why God has made him an invalid who is unable to provide for his family. He states that he believes the burden placed on his spouse and his children may be even greater than the burden he must bear. He blames God for punishing his "innocent family." Which nursing diagnosis should be the priority diagnosis?

Ineffective role performance.

A medical inpatient who is being ocunseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury. He adds that he is unable to adhere to his plan for care, and using pain medication only at bedtime. Which behavior, as charted by staff, would most suggest that he is responding to interventions?

"Patient bathed himself and did not seek analgesics as shift."

A fellow nurse reports a strange experience: She was riding with her carpool partner after working her second double shift in a row when she looked down at her hands on her lap and did not immediately recognize them as her own. They seemed "small and far away" to her. She felt "like I wasn't myself" for several minutes, after which she gradually returned to normal. This happened several weeks ago, and she has never had a similar experience otherwise. She is worried she is losing her mind or suffering from a brain tumor. Which response most accurately reflects what the friend probably experienced?

The long hours of work with little recovery time led her to have a transient episode of depersonalization; these are common, stress-related, and not a sign of major illness.

Establishing a therapeutic relationship with a patient with a dissociative disorder may be more difficult for the nurse than establishing a relationship with a psychotic patient because the patient with dissociative disorder:

Has symptoms that may seem contrived.

The nurse who is counseling a patient with dissociative idenity disorder should understand that the assessment of highest priority is:

Risk for self-harm.

A patient states, "I feel detached and weird all the time. IT's as though I'm looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school." This presentation is most consistent with the DSM-IV-TR criteria for:

Depersonalization disorder.

The nursing assistant remarksto the nurse, "The patient with amnesia looks together, but when I talk to her, she seems rather vague. What should I be doing for her?" The best reply would be:

"Use short, simple sentences and keep her environment calm and protective."

The husband of a patient who has been diagnosed with severe dissociative disorder asks the nurse if he is in any way at fault for his wife's illness. He states their relationship is mutually supportive, and no trauma has recently occurred. Which response would be most therapeutic and best illustrates our current understanding of the etiology of such disorders?

"We think the disorder is caused by trauma or abuse early in life. You seem very concerned about you wife; we could talk about your concerns if you like."

To assess patients effectively, the nurse must understand that the essential difference between somatoform disorders and dissociative disorders is that somatoform disorders:

Involve the expression of anxiety through bodily sensation or function, and dissociative disorders alter conscousness, recall, and awareness of self.

Which assessment data would help the health care team distinguish symptoms of conversion from symptoms of hypochondriasis?

Patient's style of presentation.

A patient with depersonalization disorder tells the nurse, "It's starting again. I feel as though I'm going to float away." Which intervention would be most appropriate at this point?

Engage her in a concrete, here and now activity such as singing.

Which physician orders would be most likely for a patient with chronic pain?

Relaxation techniques and antidepressant medications.

A patient who is being counseled for somatoform pain disorder states he believes his pain is the result of an undiagnosed injury. He adds that he cannot adhere to his plan for care involving performing his own activities of daily living, walking 20 minutes daily, and using pain medication only at bedtime. He states he feels "like a baby" because his wife and children must provide so much care for him. The nurse understands that it is most important to assess:

Secondary gains.

A college senior comes to the mental health clinic with the chief complaint that "My face is so ugly I can't go out in public." Assessment reveals she has no actual disfigurement and is of average attractiveness. SHe tells the nurse that she goes to class wearing a scarf draped across her lower face but is concerned that she will be unable to interview for positions after graduation because of her ugly appearance. The patient's symptoms are consistent with the clinical picture of:

Body Dysmorphic Disorder.

MULTIPLE RESPONSE
You are caring for a child with a history of multiple admissions for recurrent systemic infections, and the child is not improving in the hospital, despite aggressive treatment. A doctor mentions "factitious disorder by proxy." What nursing interventions would be appropriate when this disorder is suspected?

- Stop by the patient's room frequently during visiting hours.
- Encourage family members to visit in groups of two or three.
- Keep careful, detailed records of visitation and untward events.

MULTIPLE RESPONSE
Which presentations suggest the possibility of a factitious disorder?

-Has a history of multiple hospitalizations without findings of physical illness.
-If the desired response is not received, accuses staff of incompetence.
- Has had multiple workups for even multiple exploratory surgeries.

A physical therapist recently convicted of multiple counts of Medicare fraud is brought to the emergency department after taking an overdose of sedatives. He tells the nruse, "Sure I obverbilled. Why not? Eveyrbody takes advantage of the government. They have too many rules. No one can abide by all of them." These statements can be assessed as showing:

Lack of guilt feelings.

Which intervention would be appropriate for a patient with a nursing diagnosis of ineffective coping as evidenced by manipulation of others?

Refer patient requests and questions about care to the primary nurse.

A patient tells a nurse, "The others won't give me my pain meds early, but you are more understanding, you know what it's like to be in pain, and you don't want to see your patients suffer. Could you find a way to get me my pill now? I won't tell anyone." Which response by the nurse would be most therapeutic?

"I understand that you have pain, but giving medicine too soon would not be safe."

Which nursing strategy leads patients to respond more positively to limit setting?

Reflect back to the patient an understanding of the patient's distress.

An appropriate outocme for a patient with a personality disorder and a nursing diagnosis of ineffetive coping as evidenced by use of manipulation would be that the patient will:

Acknowledge manipulative behavior when it is pointed out.

A patient with antisocial personality disorder tells nurse A, "You're a much better nurse than nurse B said you were." The patient tells nurse B, "Nurse A's upset with you for some reason." To Nurse C the patient states, "You'd like to think you're perfect but I've seen three of your mistakes this morning." These comments can best be assessed as:

Manipulative.

A patient with antisocial personality disorder tells nurse A, "You're a much better nurse than nurse B said you were." The patient tells nurse B, "Nurse A's upset with you for some reason." To Nurse C the patient states, "You'd like to think you're perfect but I've seen three of your mistakes this morning." Which nursing intervention would be most helpful for addressing this behavior?

Hold a weekly staff meeting to discuss feelings and conflicts related to such behavior.

The nurse reports to the interdisciplinary team that an antisocial patient lies to other patients, verbally abuses a patient with Alzheimer's disease, flatters his primary nurse, and is detached and superficial during counseling sessions. Which behavior should be the priority focus of limit setting?

Verbally abusing other patients.

A patient with borderline personality disorder has been making steady progress but one day gets a phone call from her boyfriend, who breaks off their relationship. Although she has not self-injured in over 2 months, she makes repeated lacerations on her forearm. Which statement about this and most maladaptive behaviors seen in perosnality disorders is most accurate?

However dysfunctional, most behavior is the person's best effort to cope.

A patient remanded by the court after his wife had him jailed for battery told the judge how sorry he was and suggested he needed psychiatric help. His history reveals acting-out behaviors as an adolescent and severl adult arrests. The nurse interviews him about his relationship with his wife. Which statement by the patient is most consistent with a diagnosis of antisocial personality disorder?

"I hit her because she nags at me. She deserves it when I beat her up."

When a patient with a personality disorder uses manipulation as a way of getting needs met, the staff agree to use limit setting as an intervention. How does limit setting work to reduce manipulation?

External controls provide secruity while internal controls are developing.

The patient tells his primary nurse, "I get into trouble because I have hair-trigger responses. I shoot from the hip. Lots of times that gets me into a mess." Which response would be most therapeutic?

"Let's look at ways to help you slow it down and think before acting."

The nurse who assesses a patient previously diagnosed as having paranoid personality disorder most likely to describe the patient as:

Guarded and distant.

While the nurse at the personality disorders clinic is interviewing a patient, the patient constantly scans the environment and frequently interrupts to ask what the nurse means by certain words for phrases. The nurse notes that the patient is very sensitive to the nruse's nonverbal behavior. His responses are often argumentative, sarcastic, and hostile. He suggests that he is being hospitalized "so they can exploit me." The patient's behaviors are most consistent with the clinical picture of:

Paranoid personality disorder.

In lcinical supervision, the nurse caring for the patient with a paranoid personality disorder tells the advanced practice nurse, "I tied being caring and empathetic, but the patient just kept telling me to stay away." WHich response by the advanced practice nurse would be best?

"Mistrustful people do not bond as others do, so first it's important to be realistic. Second, a neutral yet courteous approach will work better."

To plan effective interventions, the nurse should understand that the underlying reason a patient with paranoid personality disorder is so critical of others probably lies in the patient's:

Profection of blame for his own shortcomings onto others.

A patient with paranoid personality disorder is noted to sit alone in a corner of the unit living room. When anyone approaches, the patient is haughty or simply ignores the other person. When staff invite her to join an activity, she tells them, "I do not care to be with peopel who do not like me." A nursing diagnosis that should be considered is:

Impaired social interaction.

A patient with borderline personality disorder cut her wrists while out on a pass. For future planning, staff should consider that the reason for the self-mutilation is probably related to:

Fear of abandonment associated with relationships or increasing autonomy.

A patient with borderline personality disorder has cut her wrists. The physician orders daily dressing changes for the lacerations. The nruse performing this care should:

Provide care in a matter of fact manner.

The nurse has recently set limits for a patient with boarderline personality disorder. The patient tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see I was mistaken. You're hateful." Which phenomenon is represented by this response?

Splitting.

The characteristic in individuals with personality disorders makes it most necessary for staff to schedule frequent meetings is:

A tendency to evoke countertransference and conflict.

A patient tells the nurse that he is planning to hire a private detective to follow his wife, who he believes is having an extramarital affair. The patient looks behind the door to be sure no one is eavesdropping and asks the nurse what she did with his medical record after he left. The patient's behaviors are most consistent with the diagnosis of:

Personality personality disorder.

A worker is characterized by her co-workers as "painfully shy" and lacking self-confidence. Her co-workers say she stays in her cubicle all day, never coming out for breaks or lunch. One day after falling on the ice in the parking lot, she goes to the nruse's office, where she appologizes for falling and mentions that hse hopes the company will not fire her for being so clumsy. With which diagnosis is the presentation most consistent?

Avoidant.

A worker is characterized by her co-workers as "painfully shy" and lacking self-confidence. Her co-workers say she stays in her cubicle all day, never coming out for breaks or lunch. One day after falling on the ice in the parking lot, she goes to the nruse's office, where she appologizes for falling and mentions that hse hopes the company will not fire her for being so clumsy. Which nursing approach or response would be most therapeutic?

Reassure her that many others have fallen at work and not eve been criticized or fired.

The nurse in the emergency department tells the daughter of a patient that her 86 year old mother has had a stroke. The daughter tearfully asks the nurse, "Who will take care of me now?" When the nurse explores this query, the daughter mentions that her mother alwyas tells her what job to take, what clothes to buy and wear, and what to have for lunch. The daughter The daughter states that she needs someone to direct her and reassure her when she gets anxious. With which personality disorder is this presentation most consistent?

Dependent.

For which behavior(s) would limit setting be most essential?

A young woman urges a suspicious patient to hit anyone who stares at him.

When told that he is scheduled to interview a patient with narcissistic personality disorder, the nurse can anticipate the assessment findings will include the following:

Grandiosity, self importance, and a sense of entitlement.

Which statement by a patient with broderline personality disorder best indicates the treatment plan is helping?

"I feel empty and want to cut myself, so I called you."

A patient with borderline personality disorder has been hospitalized several times after slef injurious behavior and suicide attempts. The patient has entered dialectical behavior therapy on an outpatient basis. During therapy, the advanced practice has been counseling her regarding self harm behabvior management. Today the patient called the nurse and reported "feeling empty and anxious" and wants to cut herself. Which response would best help this situation?

Assist the patient to identify and choose a coping strategy.

A teacher comes to the mental health clinic saying a co-worker recently confronted her about behaviors that are annoying to other co-workers. She is now experienceing moderate to severe levels of anxiety. The co-worker told the patient that others find her very difficult because she is a perfectionist and micromanages the tasks of others on the teaching team, always demanding that things should be done according to her plans. The co-worker mentioned that the patient made everyone feel as though everything they tried was inadequate, and they feel frustrated and angry. The patient states she likes her co-workers and only want to help them be successful. The nurse realizes the patient's behaviors are most consist with:

Obsessive-Compulsive personality disorder.

MULTIPLE RESPONSE
A patient with personality disorder seemed intelligent to the nurse. He said all the right things to please the nurse but often failed to follow through. One evening he was brought back late from a pass, actuely intoxicated. The nurse seemed dismayed and remarked, "I thought he was making such good progress."Which phenomena are likely illustrated in the nurse's response?

- Successful manipulation by the patient.
-Naivete on the part of the nurse herself.
-Failure by the nurse to remain objective.
- Honest disappointment that the patient regressed.

MULTIPLE RESPONSE
A patient with borderline personality disorder hashad 21 admissions to the mental health unit, each precipitated by a suicide attempt usually resulting in superficial cuts on the arm. On this admission, the patient has developed a relationship with a highly supportive nurse. The patient has progressed to having a pass to spend an afternoon in a nearby shopping mall. The nurse is shocked when the emergency department calls to say that the patient has just been brought in with multiple self-inflicted lacerations. The nurse asks a peer, "Why? Everything was going well. How could she do this to me?" Which response(s) by the other nurse reflects objectivity and understanding of the patients personality disorder?

- "I know the patient's behavior seems personal, but it's really not. Patients with borderline personality disorder self-injure to relieve numbing or anxiety."
- She was doing well here, where she was adjusted to the milieu and th epeople, but I suspect leaving here for the pass really increased her anxiety."
- "People do not necessarily improve in a steady, lasting fashion; sometimes there are setbacks. It does not mean she isn't progressing overall."

MULTIPLE RESPONSE
A woman is brought to the hospital after having been badly beaten. She is withdrawn and does not want to talk with anyone. She is thought to have a schizoid personality disorder. Which response(s) would likely be most useful for working with this patient?

- Explain clearly what to expect while assessing, and treat any injuries per routine.
- Anticipate a somewhat detached response to the trauma and responders.

OTHER
Place the steps for limit setting in the most desirable order.

1.) Implement consequences when undesired behaviors present.
2.) Identify undesirable behavior and discuss concerns with patient.
3.) Jointly establish consequences for future inappropriate behavior.
4.) Jointly determine what behaviors would be preferred instead.

MULTIPLE RESPONSE
Which of the following interventions would be appropriate when working with a woman whose nursing diagnosis is ineffective coping related to impaired impulse control as evidenced by impulsive self-injurious behavior?

- Assist the patient to develop a list of effective coping options to carry for future use.
- Guide the patient to examine the advantages and costs of her present coping strategies.
- Help her to practice the desired responses in role plays and later in real-life situations.
- Teach the patient to "cue" herself to stop and think before taking undesired actions.

OTHER
A nurse notices that although it is midsummer, a patient with borderline personality disorder has begun wearing long-sleeve shirts. The nurse investigates and discovers that the patient has cut her wrists. Place the nursing responses in the correct order, leaving out those which are inappropriate:

1.) Assess the severity of the injury.
2.) Remain neutral while providing first aid.
3.) Have the patient journal about the event.
4.) Discuss the patient's feelings.

An 18 year old referred to the mental health center often cooks gourmet meals but eats only tiny portions. The patient wears layers of loose clothing saying, "I like the style." The patient's weight dropped from 130 to 95 pounds. She has amenorrhea. Which diagnosis is most likely?

Anorexia nervosa.

Disturbed body image is the nursing diagnosis for a patient with an eating disorder. Which outcome indicator is most applicable to this diagnosis?

Patient satisfaction with body appearance.

A patient referred to the eating disorders clinic lost 35 pounds over 3 months. To assess eating patterns, the nurse should ask:

"What do you eat in a typical day?"

A history reveals that a patient virtually stopped eating 5 months ago and lost 25% of body weight. The nurse says, "Describe what you think about your present weight and how you look." Which response would be most consistent with anorexia nervosa?

"I'm fat and ugly."

A patient has anorexia nervosa. The history shows the patient virtually stopped eating 5 months ago and lost 25% of body weight. The serum potassium is 2.7 mg/dL. Which nursing diagnosis applies?

Imbalanced nutrition: less than body requirements related to refusal to eat, as evidenced by loss of 25% of body weight and hypokalemia.

A patient with anorexia nervosa is treated as an outpatient. Select the desired outcome related to the nursing diagnosis imbalanced nutrition: less than body requirements. Within 1 week, the patient will:

Gain 1 to 2 pounds.

Therapeutic nutrition begins for a patient with anorexia nervosa who is 70% of ideal body weight. Which nursing intervention is most important to add to the plan of care?

Observe for adverse effects associated with refeeding.

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