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Questions and Answers

What do you plan to do?

The nurse identifies the client's risk for suicide as which of the following?

Unable to be determined

Low risk

Imminent risk

High risk (correct)

Which of the following interventions are most appropriate for Theresa? (Select all that apply)

Do not allow Theresa to participate in any unit activities while she is on suicide precautions.

Ask Theresa specific questions about her thoughts, plans, and intentions related to suicide. (correct)

Restrict access to any item that might be harmful by placing the client in a seclusion room.

Obtain an order from the physician to give Theresa a sedative to calm her and reduce suicidal ideas.

Check on Theresa every 15 minutes at irregular intervals, or assign a staff person to stay with her on a one-to-one basis. (correct)

Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply)

Reassess the intensity of suicidal thoughts and urges on a regular basis. Signup and view all the answers

Success of long-term psychotherapy with Theresa could be measured by which of the following behaviors?

Theresa has an increased sense of self-worth. Signup and view all the answers

A positive reinforcer:

Increases the probability that a behavior will recur. Signup and view all the answers

A negative reinforcer:

Increases the probability that a behavior will recur. Signup and view all the answers

An aversive stimulus or punisher:

Decreases the probability that a behavior will recur. Signup and view all the answers

In using the Premack principle, which does the nurse suggest to Sally's parents?

Explain that she may watch TV only after she has practiced the piano for 1 hour. Signup and view all the answers

List the steps in order for Jill to overcome her fear of dogs:

F = Look at a picture of a dog. B = Look at a stuffed toy dog. D = Pet a real dog. A = Look at a real dog. E = Walk past a real dog. C = Pet the stuffed toy dog. Signup and view all the answers

Janet thinks, 'I'll never be a nurse.' What automatic thought does this represent?

Catastrophic thinking Signup and view all the answers

When Jack thinks, 'I'm so stupid. No law school will ever accept me.' What does this represent?

Overgeneralization Signup and view all the answers

Nancy thinks, 'I must be a lousy cook.' What automatic thought does this statement represent?

Personalization Signup and view all the answers

Barbara thinks, 'I'm a totally incompetent person.' What automatic thought does this represent?

Magnification Signup and view all the answers

Opal, who feels worthless, is asked by the therapist about the problems suicide would solve. What technique is the therapist using?

Problem-solving Signup and view all the answers

The thought recording cognitive therapy techniques help clients to:

Identify automatic thoughts. Signup and view all the answers

The daily record of dysfunctional thoughts (DRDT) helps clients to:

All of the above. Signup and view all the answers

The therapist asks a client about her responsibilities in her husband's leaving. What cognitive therapy technique is being used?

Reattribution Signup and view all the answers

The therapist teaches a client to whistle when feelings of worthlessness arise. What technique is being used?

Distraction Signup and view all the answers

An example of a treatable form of NCD is one caused by which of the following? (Select all that apply)

Electrolyte imbalance Signup and view all the answers

The cause of NCD due to Alzheimer's disease is which of the following?

Unknown Signup and view all the answers

The primary nursing intervention when working with a patient with NCD due to Alzheimer's is which of the following?

Ensuring that the environment is safe to prevent injury. Signup and view all the answers

Which medications are indicated for improvement in cognitive functioning in mild to moderate Alzheimer's disease? (Select all that apply)

Donepezil (Aricept) Signup and view all the answers

Mrs. G. with NCD due to Alzheimer's believes she has a date on Christmas. What is the appropriate response?

Today is Tuesday, October 21, Mrs. G. We will have supper soon, and then your daughter will come to visit. Signup and view all the answers

In addition to disturbances in cognition, individuals with Alzheimer's may show changes in which of the following? (Select all that apply)

Speech Signup and view all the answers

Which nursing actions would best promote sleep in Mrs. G., who has NCD due to Alzheimer's and trouble sleeping?

Ensure Mrs. G. gets regular physical exercise during the day. Signup and view all the answers

How might the nurse assess the statement, 'I was an evil person in my youth, and now I must pay'?

Some African Americans believe illness is God's punishment for their sins. Signup and view all the answers

How must the nurse interpret Frank's behavior of arriving late for his appointment?

Frank is a member of a cultural group that is present-time oriented. Signup and view all the answers

What cultural norm explains Frank's refusal to remove his clothing for a physical examination?

Frank is modest and embarrassed to remove his clothes. Signup and view all the answers

How should the nurse handle the situation when Maria's room is filled with relatives after her miscarriage?

Allow the family to remain and continue their activity as described, as long as they do not disturb other clients. Signup and view all the answers

With which spiritual need is Joe struggling?

Forgiveness Signup and view all the answers

What nursing diagnosis might the nurse apply to Joe's situation, based on his expressed feelings?

Spiritual distress Signup and view all the answers

Which of the following is the most therapeutic response to a client stating they refuse to shower due to believing the FBI has placed a camera in the room?

I have a hard time believing that is true. Signup and view all the answers

Which response by the nurse is most appropriate when Simone comes to group therapy looking tidy for the first time?

Simone, I see you have put on a clean dress and combed your hair. Signup and view all the answers

What is the most appropriate statement by the nurse to Dorothy, who discusses her alcohol-related accident?

How are you feeling about what happened? Signup and view all the answers

What is the most appropriate response by the nurse to Judy, regarding her Valium withdrawal concerns?

Let's explore some things you can do to decrease your anxiety without resorting to drugs. Signup and view all the answers

What is the most appropriate response by the nurse when Mrs. S asks about confessing her affair to her husband?

What do you think would be best for you to do? Signup and view all the answers

What is the most appropriate response to Abby, who feels rejected after group therapy?

You're feeling pretty down on yourself right now. Signup and view all the answers

What nontherapeutic technique is exhibited when the nurse says, 'He has been a doctor for many years and has helped many people' in response to Walter's criticism of his psychiatrist?

Defending Signup and view all the answers

What therapeutic technique is demonstrated when the nurse reflects Walter's fear of failing in a new job by stating, 'You're afraid you may fail in the new position'?

Restating Signup and view all the answers

Which aspects of the environment influence communication? (Select all that apply)

Density Signup and view all the answers

What communication technique does the nurse use when asking a client, 'Why did you stop taking your medication?'

Requesting an explanation Signup and view all the answers

What are appropriate outcome objectives for John, diagnosed with Risk for other-directed violence? (Select all that apply)

The client will verbalize anger rather than hit others. Signup and view all the answers

What is the nurse's best response to John, who claims he is in control and does not need medication?

John has the right to refuse the medication provided there is no immediate danger to self or others. Signup and view all the answers

What is the priority intervention for the nurse observing John yelling and exhibiting signs of agitation?

Call for assistance. Signup and view all the answers

Which of the following interventions for a client in restraints should be included? (Select all that apply)

Provide ongoing assessment and observation. Signup and view all the answers

What is the correct procedure to follow when a client no longer requires restraints?

With assistance, the nurse removes one restraint. Signup and view all the answers

What procedures are important immediately following an episode of violence on the unit? (Select all that apply)

Discuss what occurred with other clients who witnessed the incident. Signup and view all the answers

What is the nurse's best response to a client saying, 'I hope I didn't hurt anyone' after being restrained?

It is fortunate that no one was hurt. You will not be placed in restraints as long as you can control your behavior. Signup and view all the answers

Which behavior by John indicates he is learning to adaptively problem-solve his frustrations after an argument with his girlfriend?

When his girlfriend leaves, John goes to the exercise room and punches on the punching bag. Signup and view all the answers

What assessment data should the nurse consider as risk factors for possible violence in a client? (Select all that apply)

Substance intoxication Signup and view all the answers

Which of the following statements is true about aggression? (Select all that apply)

It is goal directed. Signup and view all the answers

Who is at the highest risk for a suicide attempt?

John, who reports he is in deep emotional pain, feels hopeless, and says 'No one is there for me.' Signup and view all the answers

What considerations are important to good suicide risk assessment? (Select all that apply)

Identifying whether the patient has thought about a plan for trying to kill himself Signup and view all the answers

What is the best response by the nurse to Theresa, who is feeling heartbroken after her boyfriend broke up with her?

You must be feeling very sad about your loss. Signup and view all the answers

What is the most appropriate outcome criterion for Theresa's nursing diagnosis of Risk for suicide?

The client has experienced no physical harm to herself. Signup and view all the answers

Freudian psychoanalytic theory would explain Theresa's suicide attempt because:

She is angry at her boyfriend for breaking up with her and has turned the anger inward on herself. Signup and view all the answers

What is the best response by the nurse to Theresa expressing intentions to retry a suicide attempt after hospitalization?

What exactly do you plan to do? Signup and view all the answers

What is the most likely reason that Sondra experiences no anxiety after hearing about the tornado in Texas?

She appraises the event as irrelevant to her own situation. Signup and view all the answers

Which of the following is most likely a predisposing factor to Cindy's maladaptive response of nausea and vomiting in stressful situations?

When Cindy was a child, her mother pampered her and kept her home from school when she was ill. Signup and view all the answers

When an individual's stress response is sustained over a long period, the endocrine system involvement results in which of the following?

Decreased resistance to disease Signup and view all the answers

Why is stress management extremely important in today's society?

The stressors of today tend to be ongoing, resulting in a sustained response. Signup and view all the answers

Elena's primary appraisal of her job promotion, despite her anxiety, is most likely that she views the situation as which of the following?

Challenging Signup and view all the answers

According to the transactional model of stress and adaptation, which factors are important to consider when assessing John’s complaints?

Existing social supports Signup and view all the answers

According to Maslow's hierarchy of needs, which level of need is not being met for Anna after losing her friend Lucky?

Love and belonging needs Signup and view all the answers

What does Anna experience when she hears someone telling her she was a horrible caretaker for Lucky?

Psychosis Signup and view all the answers

Why is Anna's behavior after losing her dog Lucky considered maladaptive?

Her grief is interfering with her functioning. Signup and view all the answers

At what age might Anna experience bereavement overload due to several losses?

Bereavement overload Signup and view all the answers

What is most likely the reason Anna's daughter has put off seeking help for Anna?

Relatives often try to normalize behavior rather than label it mental illness. Signup and view all the answers

Lucky's inability to remember the circumstances of his death is an example of which defense mechanism?

Repression Signup and view all the answers

Anna insists that Lucky was always obedient, despite evidence to the contrary. Which defense mechanism is she exhibiting?

Reaction formation Signup and view all the answers

Which factors may contribute to Anna's maladaptive grief response?

Unresolved grief over the loss of her husband Signup and view all the answers

For what reason would Anna's illness be considered a neurosis rather than a psychosis?

She experiences no loss of contact with reality. Signup and view all the answers

Which statement by Anna might suggest that she is achieving resolution of her grief over Lucky's death?

'It's true. Lucky didn't always mind me. Sometimes he ignored my commands.' Signup and view all the answers

Which part of the brain is associated with multiple feelings and behaviors and is sometimes referred to as the 'emotional brain'?

Limbic system Signup and view all the answers

Which part of the brain is concerned with visual reception and interpretation?

Occipital lobe Signup and view all the answers

Which part of the brain is associated with voluntary body movement, thinking and judgment, and expression of feeling?

Frontal lobe Signup and view all the answers

Which part of the brain integrates all sensory input (except smell) on the way to the cortex?

Thalamus Signup and view all the answers

Which part of the brain deals with sensory perception and interpretation?

Parietal lobe Signup and view all the answers

Which part of the brain is concerned with hearing, short-term memory, and sense of smell?

Temporal lobe Signup and view all the answers

Which part of the brain has control over the pituitary gland and autonomic nervous system, as well as regulation of appetite and temperature?

Hypothalamus Signup and view all the answers

At a synapse, the determination of further impulse transmission is accomplished by means of which of the following?

Neurotransmitters Signup and view all the answers

A decrease in which neurotransmitters has been implicated in depression?

Norepinephrine, serotonin, and dopamine Signup and view all the answers

Which hormone has been implicated in the etiology of mood disorder with seasonal pattern?

Increased levels of melatonin Signup and view all the answers

Psychotropic medications may act at the neural synapse to accomplish which of the following?

Inhibit catabolic enzymes, promoting more availability of a neurotransmitter Signup and view all the answers

Psychoneuroimmunology is a branch of science that involves which of the following?

The relationships between the immune system, the nervous system, and psychological processes including mental illness Signup and view all the answers

How do antianxiety medications, such as benzodiazepines, produce a calming effect?

Depressing the CNS Signup and view all the answers

Why did Dr. S order alprazolam for Tam instead of buspirone?

Buspirone has delayed onset of action and cannot be used on a prn basis. Signup and view all the answers

Education for the client who is taking MAOIs should include which of the following?

Tyramine-restricted diet, prohibitive concurrent use of over-the-counter medications without physician notification Signup and view all the answers

Symptoms of lithium toxicity are likely to appear if the serum levels exceed which of the following?

1.5 mEq/L Signup and view all the answers

Initial symptoms of lithium toxicity include which of the following?

Vomiting, diarrhea Signup and view all the answers

Antipsychotic medications are thought to decrease psychotic symptoms by:

Blocking the action of dopamine in the brain Signup and view all the answers

Which of the following are examples of extrapyramidal symptoms?

Muscular weakness, rigidity, tremors, facial spasms Signup and view all the answers

If extrapyramidal symptoms occur, which of the following would be a priority nursing intervention?

Administer prn trihexyphenidyl (Artane). Signup and view all the answers

A concern with children on long-term therapy with CNS stimulants for ADHD is:

Addiction Signup and view all the answers

Doses of bupropion should be administered at least 4 to 6 hours apart and never doubled when a dose is missed to prevent:

Seizures Signup and view all the answers

What cultural belief is likely associated with Miss Lee's request for hot ginger root for her headache?

She subscribes to the restoration of health through the balance of yin and yang. Signup and view all the answers

Miss Lee fears no family members will visit her. What belief does this statement reflect?

Many Asian Americans view psychiatric problems as bringing shame to the family. Signup and view all the answers

How should the nurse handle Joe's insistence on involving the shaman in his emergency treatment?

Contact the shaman and have him meet them at the ED to consult with the attending physician. Signup and view all the answers

The shaman's behavior of lightly touching the physician's hand and moving away is likely explained by which cultural norm?

The shaman does not feel comfortable with touch. Signup and view all the answers

Study Notes

Stress and Appraisal

Sondra feels no anxiety about a tornado incident as she appraises it as irrelevant to her situation.
Cindy’s nausea in stressful situations likely stems from childhood pampering and avoidance of consequences.
Prolonged stress leads to a sustained endocrine response that decreases disease resistance.

Importance of Stress Management

Modern stressors are often ongoing, making stress management vital in today's society.
Positive appraisal of situations, like Elena’s promotion, can be viewed as challenging rather than threatening.

Grief Response and Needs

Anna’s constant grief for her dog Lucky indicates unmet love and belonging needs according to Maslow's hierarchy.
Psychotic experiences may arise in Anna, reflecting intense self-criticism post-bereavement.
Maladaptive grief responses, such as excessive talking about a deceased pet, interfere with daily functioning.

Aging and Loss

Bereavement overload can occur in older adults experiencing multiple recent losses.
Family members may delay seeking help for the elderly due to normalization of maladaptive behavior.

Defense Mechanisms

Repression is indicated when Anna exhibits an inability to recall the circumstances of Lucky’s death.
Reaction formation is observed in Anna’s insistence that Lucky always obeyed her.

Neuroanatomy and Emotions

The limbic system is often referred to as the "emotional brain" due to its role in emotions and behaviors.
The occipital lobe is responsible for visual reception and interpretation, while the frontal lobe governs voluntary movement and decision-making.
The thalamus integrates sensory input (excluding smell) to the cortex, and the hypothalamus controls pituitary functions and autonomic nervous system responses.

Neurotransmitters and Mood Disorders

Norepinephrine, serotonin, and dopamine are crucial neurotransmitters implicated in depression.
MAOIs require a strict tyramine-restricted diet to prevent severe interactions.

Psychopharmacology

Lithium toxicity occurs at serum levels exceeding 1.5 mEq/L, with nausea and diarrhea as initial symptoms.
Antipsychotic medications work by blocking dopamine action to alleviate symptoms of psychosis.
Extrapyramidal symptoms like tremors and rigidity may arise from antipsychotic use, warranting prompt intervention with medications like trihexyphenidyl (Artane).

Cultural Perspectives in Mental Health

The belief in maintaining health through the balance of yin and yang reflects traditional Asian American practices.
Many Asian Americans may associate psychiatric issues with familial shame, influencing their willingness to seek treatment.
Latino cultural norms often emphasize present-time orientation, affecting perceptions of punctuality and authority in healthcare settings.

Family Involvement and Emotional Processes

Family dynamics play a crucial role in grieving processes, as seen in Maria’s environment filled with relatives during her hospital stay.
Nurses must navigate cultural sensitivities while addressing the emotional and physical needs of patients from diverse backgrounds.### Family Dynamics and Grief Management
Families should be allowed to participate in their activities in supportive settings, provided they don’t interfere with others.
It is crucial to manage discussions around loss sensitively, particularly for individuals like Maria, who may struggle with triggers causing distress.
Engaging the family priest may facilitate healthier coping mechanisms and support for the grieving family.

Client's Spiritual Needs and Nursing Diagnoses

Joe's situation highlights a struggle with forgiveness due to a history of abusive behavior from his father, currently on his deathbed.
His feelings of frustration and anger towards God indicate a state of spiritual distress during this challenging time.

Therapeutic Communication Techniques

Responding with skepticism to delusional beliefs requires a supportive yet cautious approach by expressing doubt about the client's perceptions.
Acknowledging positive changes in clients, such as Simone's self-care efforts, reinforces their progress and builds self-esteem.
When discussing traumatic events, asking clients how they feel allows for emotional processing rather than judgment.

Managing Substance Withdrawal and Personal Challenges

Exploring alternatives for anxiety management after drug withdrawal encourages clients like Judy to develop healthier coping strategies.
Ethical dilemmas in personal relationships, such as infidelity, require guidance from nurses in assisting clients to reflect on their values and decisions.

Recognizing and Responding to Violence Risk

Identifying risk factors for violent behavior involves recognizing mental health diagnoses, substance use, and past aggression.
Understanding aggression encompasses its intent and purpose, emphasizing the importance of mobilizing for self-defense and harm.

Assessing and Managing Suicide Risk

Clients expressing deep emotional pain and hopelessness represent a high risk for suicide, requiring immediate attention and assessment.
Suicide risk assessment strategies include open communication, establishing trust, and understanding the client’s intentions and plans.
For clients on suicide precautions, interventions include removing harmful objects, regular reassessments, and monitoring suicidal ideation.

Behavioral Interventions and Reinforcement Principles

Positive reinforcement techniques are utilized to increase desired behaviors, while negative reinforcers also promote behavior recurrence but without positive emotional feedback.
Aversive stimuli decrease undesirable behaviors, aligning with various behavioral modification strategies.

Engaging Clients in Healthy Practices

Utilizing the Premack principle encourages clients, such as Sally, to commit to preferred activities contingent upon completing less desirable tasks, like practicing piano.### Cognitive Behavioral Therapy Techniques
Systematic desensitization involves gradual exposure to anxiety-inducing stimuli, helping clients manage fears effectively.
Automatic thoughts reflect distorted thinking patterns, such as catastrophic thinking, overgeneralization, personalization, and magnification.
Cognitive therapy techniques include examining evidence, reattribution, distraction, and thought recording.
Daily records of dysfunctional thoughts assist in identifying and modifying automatic thoughts, offering rational alternatives.

Cognitive Distortions

Catastrophic thinking: Assuming the worst outcome, exemplified by Janet's belief that failing one test means she will never be a nurse.
Overgeneralization: Drawing broad conclusions from a single event, as Jack believes he is "stupid" after being denied entry to law school.
Personalization: Attributing external events personally, like Nancy thinking she is a lousy cook after a small comment from her mother-in-law.
Magnification: Exaggerating negative self-perceptions, shown by Barbara's view of herself as incompetent due to a cooking mistake.

Mental Health Cases

Opal's deep feelings of worthlessness and suicidal ideation prompt therapeutic intervention focused on problem-solving.
Reattribution technique encourages clients to consider shared responsibilities in relationship failures, promoting healthier perspectives.

Alzheimer's Disease Management

NCD due to Alzheimer's has an unknown origin and is managed through ensuring a safe environment to prevent injuries.
Treatable causes of Neurocognitive Disorder (NCD) include electrolyte imbalances and folate deficiency.
Cognitive medications such as Donepezil, Rivastigmine, and Galantamine enhance cognitive function in mild to moderate Alzheimer's cases.
Changes in personality, speech, and mobility are common in individuals with Alzheimer’s, alongside cognitive disturbances.

Nursing Interventions

For patients with NCD, maintaining a safe environment is prioritized over other considerations to prevent accidents.
Promoting regular physical activity is vital for improving sleep quality, especially in individuals experiencing sleep disturbances associated with Alzheimer’s.

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