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

  • Ms. T. has frequent panic attacks and often feels like she is going to die.
  • Ms. T. stays in her home for fear of being in a place from which she cannot escape. (correct)
  • Ms. T. has an intense fear of dogs and will avoid any place where she might encounter a dog.
  • Ms. T. is afraid of heights and avoids going to the top of buildings.

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

Facing her fear in gradual step progression

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 her hands. The most likely reason she washes her hands so much is that it:

<p>Relieves her anxiety</p> Signup and view all the answers

The initial care plan for a client with OCD who washes her hands obsessively would include which of the following nursing interventions?

<p>Structure the client's schedule so that she has plenty of time for washing her hands.</p> Signup and view all the answers

A client with OCD says to the nurse, "I've been here 4 days now, and I'm feeling better. I feel comfortable on this unit, and I'm not ill-at-ease with the staff or other patients anymore." In light of this change, which nursing intervention is most appropriate?

<p>Set limits on the amount of time Sandy may engage in the ritualistic behavior.</p> Signup and view all the answers

Annie has trichotillomania. She is receiving treatment at the mental health clinic with habit-reversal therapy. Which of the following elements would be included in this therapy? (Select all that apply.)

<p>Social support (A), Competing response training (C), Awareness training (D)</p> Signup and view all the answers

A new client at the mental health clinic is diagnosed with body dysmorphic disorder. Which of the following nursing interventions is a priority?

<p>Encourage the client to describe reasons for seeking treatment.</p> Signup and view all the answers

A client who is experiencing a panic attack has just arrived at the emergency department. Which is the priority nursing intervention for this client?

<p>Stay with the client and reassure of safety.</p> Signup and view all the answers

Janet has a diagnosis of generalized anxiety disorder. Her physician has prescribed buspirone 15 mg daily. Janet says to the nurse, "Why do I have to take this every day? My friend's doctor ordered Xanax for her, and she only takes it when she is feeling anxious." Which of the following would be an appropriate response by the nurse?

<p>&quot;Buspirone must be taken daily in order to be effective.&quot;</p> Signup and view all the answers

Joanie is a new patient at the mental health clinic. She has been diagnosed with body dysmorphic disorder. Which of the following medications is the psychiatric nurse practitioner most likely to prescribe for Joanie?

<p>Fluoxetine (Prozac)</p> Signup and view all the answers

A client, who is a veteran of the war in Iraq, is diagnosed with PTSD. The client says to the nurse, "I can't figure out why God took my buddy instead of me." From this statement, the nurse assesses which of the following in the client?

<p>Survivor's guilt</p> Signup and view all the answers

Which of the following treatment regimens would most appropriately be ordered for a client with PTSD?

<p>Paroxetine and group therapy</p> Signup and view all the answers

Which of the following may be influential in the predisposition to PTSD?

<p>Severity of the stressor and availability of support systems</p> Signup and view all the answers

Which of the following is true regarding the diagnosis of adjustment disorder?

<p>Symptoms will likely remit once the client has accepted the changes that precipitated the difficulties with adjustment.</p> Signup and view all the answers

The physician orders sertraline (Zoloft) for a client who is hospitalized with adjustment disorder with depressed mood. This medication is intended to:

<p>Increase energy and elevate mood.</p> Signup and view all the answers

Trauma-informed care is a philosophical approach that includes which of the following principles? (Select all that apply.)

<p>Nurses need to be aware of the potential for trauma in any client and provide care that minimizes the risk of revictimization or retraumatization. (A), Trauma-informed care highlights the importance of providing care that protects the physical, psychological, and emotional safety of the client. (B)</p> Signup and view all the answers

A client experiences a nightmare during their first night in the hospital and explains to the nurse that they were dreaming about gunfire all around and people being killed. The nurse's most appropriate initial intervention is to:

<p>Stay with the client and reassure them of their safety.</p> Signup and view all the answers

A client who recently divorced after 10 years of marriage is admitted to the hospital with a diagnosis of adjustment disorder with depressed mood. The client acknowledges difficulty adjusting to an independent lifestyle and having thoughts of taking an overdose of acetaminophen. Which is the priority nursing diagnosis for this client?

<p>Risk for suicidal behavior</p> Signup and view all the answers

A client, who is depressed following the breakup of a very stormy marriage, says to the nurse, "I feel so bad. I thought I would feel better once I left, but I feel worse!" Which is the best response by the nurse?

<p>&quot;You are grieving the loss of your marriage. It's natural for you to feel bad.&quot;</p> Signup and view all the answers

A client, age 16, has recently been diagnosed with diabetes mellitus. The client must watch their diet and take an oral hypoglycemic medication daily. The client has become very depressed, and the client's mother reports that they refuse to change their diet and often skips their medication. The client has been hospitalized for stabilization of their blood glucose level. The psychiatric nurse practitioner has been called in as a consultant. Which nursing diagnosis by the psychiatric nurse would be a priority for the client at this time?

<p>Risk-prone health behavior related to denial of the seriousness of their illness, evidenced by refusal to follow diet and take medication</p> Signup and view all the answers

Some individuals with obesity take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with the use of amphetamines that makes this practice undesirable?

<p>Tolerance</p> Signup and view all the answers

The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts?

<p>The patient's family should be actively involved in each phase of treatment.</p> Signup and view all the answers

A client has sought help for their concern that they are binge eating and feels like it has "gotten out of control." The client asks the nurse what can be done to help them. Which of the following is the most accurate response?

<p>&quot;Some medications and psychological treatments have demonstrated effectiveness in reducing binge-eating behaviors.&quot;</p> Signup and view all the answers

Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa?

<p>Bradycardia, hypotension, hypothermia</p> Signup and view all the answers

Which medication has been used with some success in clients with bulimia nervosa?

<p>Fluoxetine (Prozac)</p> Signup and view all the answers

A client is hospitalized on the psychiatric unit with a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with this client's diagnosis?

<p>Frequent episodes of vomiting, dental problems, dehydration, electrolyte imbalances (A), Binging, purging, normal weight, hypokalemia (D)</p> Signup and view all the answers

A 14-year-old client has just been admitted to the psychiatric unit for anorexia nervosa. The individual is emaciated and refusing to eat. What is the priority nursing diagnosis for this client?

<p>Imbalanced nutrition: Less than body requirements.</p> Signup and view all the answers

The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse?

<p>&quot;If you continue to refuse to take food orally, you will be fed through a nasogastric tube.&quot;</p> Signup and view all the answers

A hospitalized client with bulimia nervosa is discussing their need to vomit and tells the nurse they are afraid they will gain weight. Which is the most appropriate response by the nurse?

<p>&quot;I understand that you are concerned about your weight, and we will talk about the importance of good nutrition, but for now I want you to tell me about your recent invitation to join the National Honor Society. That's quite an accomplishment.&quot;</p> Signup and view all the answers

A client presents in the emergency department with complaints of suicidal ideation. The following information is collected by the nurse. Which of these assessment findings suggests that bulimia nervosa might be a health problem? (Select all that apply.)

<p>Client's weight is within the expected range. (A), Client reports a history of binge-eating and self-induced vomiting. (B), Teeth have a &quot;moth-eaten&quot; pattern of tooth decay. (C), Parotid glands appear enlarged. (D), Client reports taking laxatives daily. (E)</p> Signup and view all the answers

A client diagnosed with borderline personality disorder manipulates the staff in an effort to fulfill their own desires. All of the following may be examples of manipulative behaviors in the borderline patient except:

<p>Refusal to stay in a room alone, stating, &quot;It's so lonely.&quot;</p> Signup and view all the answers

A client on the psychiatric unit has a diagnosis of antisocial personality disorder. Which of the following characteristics is consistent with this diagnosis?

<p>Lack of guilt for wrongdoing</p> Signup and view all the answers

A nurse on the psychiatric unit documents that the client was attempting to use "splitting" behaviors with staff. This should be interpreted to mean that the client is exhibiting what behavior?

<p>Characterizing staff members as either all good or all bad</p> Signup and view all the answers

According to researchers, which of the following is a common theme in the health history of the client with borderline personality disorder?

<p>Early childhood trauma</p> Signup and view all the answers

Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder?

<p>Overly self-centered and exploitative of others</p> Signup and view all the answers

Which of the following behavioral patterns is characteristic of individuals with schizoid personality disorder?

<p>A lifelong pattern of social withdrawal</p> Signup and view all the answers

A client with a diagnosis of borderline personality disorder exhibits alternating clinging and distancing behaviors with the nurse who has been assigned to their care. Which is the most appropriate nursing intervention for the client with this type of behavior?

<p>Rotate staff members who work with the client so that the client will learn to relate to more than one person.</p> Signup and view all the answers

A client diagnosed with antisocial personality disorder approaches the nurse and says, "You're so cute, are you married?" Which of these is the most appropriate response by the nurse?

<p>&quot;Our relationship is strictly professional. It is not appropriate for us to have that kind of discussion.&quot;</p> Signup and view all the answers

A client with borderline personality disorder reports to the nurse that she is having abdominal pain and is requesting pain medication. Which action by the nurse is a priority?

<p>Assess the client's pain in more detail</p> Signup and view all the answers

A male client with antisocial personality disorder was found on the bed in a female patient's room. When instructed to leave the room, the client states, "I'm sick of you telling me what I can or can't do. If I want to carry on a relationship with one of these ladies, it's my right. I'll do exactly as I please!" Which of these actions by the nurse is a priority at this point?

<p>Reinforce the rules of the treatment program that all clients are expected to follow.</p> Signup and view all the answers

Flashcards

Agoraphobia

A disorder characterized by excessive fear of situations where escape might be difficult or help unavailable, leading to avoidance of such situations.

Gradual Exposure Therapy

A therapy for agoraphobia involves gradually exposing the client to feared situations, starting with less anxiety-provoking situations and progressing to more difficult ones.

Implosion Therapy

A technique of treating phobias by flooding the client with a massive amount of stimuli related to the phobic object or situation.

Repetitive handwashing in OCD

The primary reason for repetitive handwashing in OCD is that it provides temporary relief from the anxiety associated with obsessive thoughts.

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Initial care plan for handwashing OCD

Providing a structured schedule that allows ample time for handwashing rituals initially, but gradually reducing the time as the client progresses in therapy.

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Limiting ritualistic behaviors in OCD

Setting limits on the time allowed for ritualistic behaviors as the client feels more comfortable and reports reduced anxiety.

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Habit-Reversal Therapy for Trichotillomania

A therapy for trichotillomania that involves three primary components: increasing awareness of hair pulling, practicing competing responses to replace the urge, and utilizing social support for accountability and encouragement.

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Priority nursing intervention for Body Dysmorphic Disorder

The priority nursing intervention for a client with body dysmorphic disorder involves encouraging them to articulate their reasons for seeking treatment, fostering a sense of understanding and validation.

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Priority nursing intervention during a panic attack

The primary nursing intervention during a panic attack involves providing immediate reassurance and safety, ensuring the client feels safe and supported.

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Importance of daily buspirone dosage

Buspirone, unlike Xanax, needs to be taken daily to achieve its full therapeutic effect. It is a non-benzodiazepine anxiolytic that works gradually over time.

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Medication for Body Dysmorphic Disorder

Fluoxetine (Prozac) is a selective serotonin reuptake inhibitor (SSRI) commonly prescribed for body dysmorphic disorder.

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Survivor's Guilt

A common experience among individuals with PTSD, survivor's guilt occurs when they feel guilty for surviving a traumatic event while others did not.

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Standard treatment for PTSD

A combination of medication like Paroxetine (an SSRI) and group therapy is considered a standard treatment regimen for PTSD.

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Factors predisposing to PTSD

Factors such as the severity of the traumatic experience and the availability of supportive relationships can increase a person's susceptibility to PTSD.

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Diagnosis of Adjustment Disorder

Adjustment disorder signifies difficulties adjusting to significant life changes, and symptoms typically resolve once the individual has accepted the changes.

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Sertraline for Adjustment Disorder

Sertraline (Zoloft), an SSRI medication, is often prescribed to alleviate depressed mood by enhancing energy levels and elevating mood in individuals with adjustment disorder.

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Trauma-informed care

This approach emphasizes recognizing the potential for trauma in all clients and providing care that minimizes the risk of retraumatization. It prioritizes the client's safety and well-being.

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Intervention for a client experiencing a nightmare during hospitalization

The nurse's most appropriate action is to stay with the client, providing reassurance and a sense of safety during the nightmare.

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Priority nursing diagnosis for a client with adjustment disorder and suicidal thoughts

The priority nursing diagnosis is 'Risk for suicidal behavior' due to the client's expressed suicidal ideation.

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Response to a client grieving the loss of their marriage

The nurse acknowledges the client's grief and validates their feelings, normalizing the sadness associated with divorce.

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Priority nursing diagnosis for a diabetic adolescent refusing treatment

The priority nursing diagnosis is 'Risk-prone health behavior' as the client's refusal to follow a diabetic regimen indicates potential for complications.

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Tolerance to Amphetamines

Tolerance, a common adverse effect of amphetamines, occurs when increasing doses are needed to achieve the same effect, making long-term use undesirable.

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Maudsley Approach to Anorexia Nervosa

A key principle of the Maudsley approach involves active family involvement throughout all phases of treatment for adolescents with anorexia nervosa.

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Treatment options for Binge Eating Disorder

Binge eating disorder can be effectively managed through a combination of medications and various psychological therapies.

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Physical Manifestations of Anorexia Nervosa

Physical signs of anorexia nervosa include bradycardia, hypotension (low blood pressure), and hypothermia (low body temperature).

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Medication for Bulimia Nervosa

Fluoxetine (Prozac) is often prescribed for bulimia nervosa, as it can help regulate mood and reduce impulsive behaviors.

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Symptoms of Bulimia Nervosa

Symptoms congruent with bulimia nervosa include binge eating, purging behaviors, normal weight despite the eating disorder, and hypokalemia (low potassium levels).

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Priority nursing diagnosis for Anorexia Nervosa

The priority nursing diagnosis for a severely malnourished client with anorexia nervosa is 'Imbalanced nutrition: Less than body requirements,' emphasizing the critical need for nutritional support.

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Response to a client refusing to eat with Anorexia Nervosa

The nurse establishes clear boundaries and consequences for refusing to eat, emphasizing the importance of nutritional support in the client's recovery.

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Response to a client with bulimia nervosa expressing fear of weight gain

The nurse acknowledges the client's concerns about weight gain but shifts the focus to a different topic, demonstrating a non-judgmental and validating approach.

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Assessment findings suggestive of bulimia nervosa

Parotid gland enlargement, tooth decay, daily laxative use, and normal weight despite binge-purge cycles are all findings suggestive of bulimia nervosa.

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Manipulative behaviors in BPD

While various manipulative behaviors are commonly observed in borderline personality disorder, refusing to stay alone out of loneliness is not typically considered a manipulative tactic.

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Antisocial Personality Disorder Characteristic

A core characteristic of antisocial personality disorder involves a lack of remorse or guilt for their actions, even when they harm others.

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Splitting in BPD

Splitting, a common defense mechanism in BPD, refers to the client's tendency to view people as either entirely good or entirely bad, often shifting back and forth.

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Early childhood trauma and BPD

Early childhood trauma is often found in the history of individuals with borderline personality disorder, suggesting a possible link to the development of this disorder.

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Narcissistic Personality Disorder Characteristics

Narcissistic personality disorder is characterized by an inflated sense of self-importance, a need for admiration, and a lack of empathy for others, often leading to exploitative behavior.

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Schizoid Personality Disorder Characteristics

Schizoid personality disorder is defined by a lifelong pattern of social withdrawal, emotional detachment, and a limited range of emotional expression.

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Intervention for clients with BPD exhibiting clinging behaviors

Rotating staff members allows clients with BPD to learn to relate to multiple individuals, reducing their reliance on one specific person and fostering healthy boundaries.

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Response to a client with antisocial personality disorder making inappropriate comments

The nurse maintains professionalism, setting clear boundaries by acknowledging the inappropriate nature of the client's comment, and redirecting the interaction towards a professional relationship.

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Prioritizing assessment of pain in a client with BPD

Assessment of the client's pain involves gathering detailed information about the pain's location, intensity, duration, and any possible underlying causes.

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Response to a client with antisocial personality disorder breaking rules

Reiterating the treatment program's rules and expectations reinforces the client's accountability and promotes a sense of structure and fairness.

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Study Notes

Agoraphobia

  • Agoraphobia is characterized by avoiding places from which escape might be difficult or embarrassing.
  • Gradual exposure therapy is the preferred treatment.
  • Implosion therapy involves intense exposure to phobic stimuli.

Obsessive-Compulsive Disorder (OCD)

  • OCD is driven by anxiety and relieved by compulsive behaviors.
  • Initial care for a client with OCD includes structuring time for compulsive behaviors.
  • Setting limits on compulsive behaviors is essential for treatment progress.

Trichotillomania

  • Trichotillomania involves the urge to pull out one's hair.
  • Habit-reversal therapy for trichotillomania includes awareness and competing response training.
  • Social support is also crucial in habit reversal therapy.

Body Dysmorphic Disorder (BDD)

  • BDD involves preoccupation with perceived flaws in appearance.
  • Encouraging the client to explain their reasons for seeking treatment is a priority.

Panic Attacks

  • Staying with the client and reassuring them is the initial priority in a panic attack.
  • Nurses must help patients feel safe during the attack

Generalized Anxiety Disorder (GAD)

  • GAD necessitates daily medication like buspirone for sustained effects, unlike occasional needs of other medications.

PTSD

  • PTSD symptoms often include survivor's guilt, where individuals feel responsible for the deaths of others.
  • Treatment for PTSD might include paroxetine and group therapy.
  • Predisposition to PTSD is influenced by stressor severity and support systems.

Adjustment Disorder

  • Symptoms of adjustment disorder often resolve once the individual adjusts to changes.
  • Medication like sertraline helps boost mood and energy.

Trauma-Informed Care

  • Nurses must recognize trauma's potential impact on clients.
  • Protecting clients' physical, emotional, and psychological safety is crucial.

Suicidal Thoughts

  • Risk for suicidal behavior is a priority nursing diagnosis for a client struggling with adjustment disorder and suicidal ideation.
  • Acknowledging the client's grief for the loss of a relationship is an essential step in providing care.

Medical Illness and Depression

  • A priority nursing diagnosis for clients dealing with diabetes and depression involves intervening to address risk-prone health behaviors causing difficulty managing the illness.

Substance Use and Effects

  • Tolerance is a potential adverse effect if amphetamines are used to suppress appetite.

Eating Disorders

  • Anorexia Nervosa: Low body weight, bradycardia, hypotension, hypothermia are physical signs.
  • Bulimia Nervosa: Binging, purging, normal weight, and hypokalemia may be symptoms.
  • Treatment for anorexia involves restoring nutritional status, and a primary nursing diagnosis is imbalanced nutrition.
  • Bulimia treatment might involve addressing purging behaviors and nutritional needs.

Personality Disorders

  • Borderline Personality Disorder:
    • Characterized by shifting behaviors between clinging and distancing.
    • Early trauma is often a component of their history.
    • Manipulative behaviours may include splitting (characterizing people as all good or all bad, or alternating).
    • Treatment might involve rotating staff to help clients relate to multiple individuals.
  • Antisocial Personality Disorder:
    • Characterized by a lack of guilt.
  • Narcissistic Personality Disorder: Characterized by excessive self-centeredness and exploitation of others.
  • Schizoid Personality Disorder: Characterized by lifelong social withdrawal.

Additional Notes

  • Nurses should reinforce treatment program rules when clients exhibit inappropriate behavior.
  • Assessing pain is the priority when a client with a borderline personality disorder complains of pain.

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Description

Morgan, K. I., & Townsend, M. C. (2024). Davis advantage for Townsend's psychiatric mental health nursing (11th ed.). F.A. Davis.

  • Chapter 27: Anxiety, Obsessive-Compulsive, and Related Disorders
  • Chapter 28: Trauma- and Stressor-Related Disorders
  • Chapter 30: Eating Disorders
  • Chapter 31: Personality Disorders

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