Psych Flashcards
(515 cards)
1
Q
What can Advanced Practice Nurses do that RNs cannot?
A
Prescribe meds and do psychotherapy
2
Q
When is it most important that a psych nurse advocate for her client?
A
To improve care in hospitals with legislations
3
Q
What are the signs and symptoms of depression?
A
Anhedonia, fatigue, sleep disturbances, appetite changes, hopelessness, thoughts of death or suicide, inability to concentrate, change in physical activity, and psychomotor retardation
4
Q
What is psychomotor retardation
A
An extreme slowing of movement not associated with normal aging
5
Q
Who uses the DSM 5?
A
Medical professionals diagnosing a patient
6
Q
Who uses the ICD 9 CM?
A
Insurances companies like Medicare
7
Q
What stage would Freud consider a 26 month old?
A
Anal; ability to delay gratification and control over impulse
8
Q
What stage would Freud consider a 4 year old?
A
Phallic; obsessed with genitals and parent of the same sex
9
Q
How does Maslow’s Hierarchy of Needs work?
A
Have to fulfill the basic bottom ones in order to find self happiness
10
Q
What are the basic needs according to Maslow?
A
Food, oxygen, water, sleep, sex and body temperature
11
Q
What is aversion therapy?
A
A form of punishment when all else fails that causes adverse affects to stimuli
12
Q
Name an example of aversion therapy?
A
Antabuse for alcoholics
13
Q
The source of all drives, reflexes, needs, instincts, genetic inheritance, and capacity to respond as well as all the wishes that motivate us
A
Id
14
Q
What is transference?
A
Feelings a patient has towards healthcare workers that were initially meant for another person in their life
15
Q
What is counter transference?
A
The unconscious feelings a healthcare worker has towards their patient
16
Q
How are phobias treated?
A
Systematic desensitization
17
Q
What is cognitive distortion?
A
Rapid, unthinking responses based on schemas
18
Q
An extreme form of magnification in which the very worst of is assumed to be a probable outcome
A
Catastrophizing
19
Q
Using a bad outcome as evidence that nothing will ever go right again
A
Overgeneralization
20
Q
Maintaining a negative view by rejecting information that supports the positive view as being irrelevant, inaccurate, or accidental
A
Disqualifying the positive
21
Q
Assuming responsibility for an external event or situation that was likely outside personal control
A
Personalization
22
Q
Problem solver and reality tester
A
Ego
23
Q
The moral component of personality
A
Super Ego
24
Q
What are neurotransmitters?
A
Chemicals releases across neural synapses that deliver messages throughout the nervous system
25
What are the functions of neurotransmitters?
They either stimulate or inhibit impulses
26
What can the Id not tolerate?
Frustration or delayed satisfaction
27
What is the difference between a CT and PET scan?
CT shows structure while PET scans should activity
28
What does the Id lack?
The ability to problem solve
29
What medication promotes GABA receptors in the brain?
Benzodiazapam
30
What does Benzodiazapam do?
Calms and sedates in high doses
31
What changes occurs in a schizophrenic's frontal lobe?
Reduced volume, increased thickness
32
What changes occur in a schizophrenic's hippocampus?
Reduced volume
33
What changes occurs in a schizophrenic's cerebellum?
Enlargement of the lateral cerebral ventricles
34
What are the pharmacological interventions for anxiety?
Anti-anxiety meds, anti-depressants, and others
35
What are the main SSRIs?
Prozac, citalopram (celexa), zoloft, paxil, luvox, and lexapro
36
What do SSRIs do?
Block the reuptake and degradation of serotonin, thus increasing serotonin levels
37
What medication is used for bipolar disorder?
Lithium
38
What are the therapeutic levels of lithium?
0.8-1.4 mEq/L
39
What does lithium do?
Mood stabilizer
40
What are the toxic levels of lithium?
Anything above 1.5 mEq/L
41
What happens to patients with lithium toxicity?
Possible kidney damage and dialysis
42
According to Freud, what are the three parts of personality?
Id, Ego, and Super Ego
43
What are anti-cholenergic side effects caused by?
First generation anti-psychotics
44
What are anti-cholenergic side effects?
Dry mouth, constipation, and urinary retention
45
What do patients on SSRIs need to avoid?
Sunlight
46
What are the side effects of clozapine?
Metabolic syndrome, suppresses bone marrow, convulsions
47
Life threatening response to antipsychotics with temperature over 103, muscle rigidity, urinary retention, increased blood pressure and flushed appearance
Neuroleptic Malignant Syndrome
48
How do you treat Neuroleptic Malignant Syndrome?
Parlodel and stop giving med
49
A decrease in white blood cell count caused by antipsychotics
Agranulocytosis
50
What foods need to be avoided for patients on MAOIs?
Aged, cured, fermented, pickled, tyramine, alcohol
51
What medication given for Bipolar disorder causes fluid and electrolyte imbalance?
Lithium
52
What are the symptoms of schizophrenia?
Auditory and tactile hallucinations, positive and negative symptoms
53
What are nursing interventions for schizophrenic voices?
Assess for safety, redirect and distract, talk, maintain eye contact, present reality, do not challenge
54
What is the number one nursing intervention for schizophrenia?
Safety
55
In order to be diagnosed with depression, how many symptoms need to be demonstrated?
5
56
What are the major side effects of first generation antipsychotics?
Tardive dyskinesia, dystonia, occulogyric crisis, akathisia, and pseudoparkinsonianism
57
Head and neck muscles in constant, painful contraction
Dystonia
58
What is akathisia?
Restlessness
59
Eyeballs locked into place
Occulogyric Crisis
60
When assessing a patient with schizophrenia, how do you respond to voices in their head?
Ask what voices are saying and react accordingly
61
What are the signs and symptoms of mania?
Manipulative, demanding, splitting, flight of ideas, clang associations, and grandiosity
62
What are the nursing diagnoses associated with mania?
Risk for injury, ineffective coping
63
What do anticonvulsants do?
Alter electrical conductivity of the membrane
64
Name the anticonvulsants.
Neurotin, depakote, carbamazepine, topamax
65
What are the theories on the development of bipolar?
Genetic, neurotransmitters, hypothyroidism, or psych/environmental factors
66
What are the principles of cognitive therapy?
Individuals and environment, thoughts come before feelings and actions, and our thoughts are our own unique perspective of the the world and our place in it
67
What would you do for an out of control schizophrenic?
Verbal intervention
68
What teaching needs to accompany SSRIs?
Take with food
69
Who can't have anti-convulsants?
Pregnant women
70
What are the side effects of SSRIs?
Sexual dysfunction and brown spots in the sun
71
What are the defense mechanisms?
Displacement, regression, denial and projection
72
Why are defense mechanisms used?
Used to keep anxiety at manageable levels
73
Escaping the unpleasant, anxiety-cauing thoughts, feelings, wishes or needs by ignoring their existence
Denial
74
The transference of emotions associated with a particular person, object or situation to another nonthreatening person, object or situation
Displacement
75
The unconscious rejection of emotionally unacceptable features and attributing them to others
Projection
76
Reverting to an earlier, more primitive and childlike pattern of behavior that may or may not have been previously exhibited?
Regression
77
What disease are defense mechanisms associated with?
Anxiety
78
Who says defense mechanisms are used to reduce anxiety?
Freud
79
What are the severe anxiety medications?
Percocet or prozac, valium, Ativan
80
If a patient has anxiety before surgery, how do you teach them?
Reduce their anxiety, calm, quiet environment, clear, simple directions, low/slow talk, and remove source if possible
81
Justifying illogical/unreasonable ideas, actions, or feelings by developing acceptable explanations that satisfy teller as well as listener
Rationalization
82
What is the highest priority with opium overdose?
Airway clearance
83
What are the most important substance abuse medications?
Thiamin, folate, Ativan, maltrexone, valium, benzo, methadone
84
What would a heroin or opioid overdose look like?
Bradycardia, hypotension, hypothermia, sedation, constricted pupils, hypokinesis, slurred speech, head nodding, euphoria, analgesia, calmness
85
Patient can't find words
Aphasia
86
Loss of purposeful movement
Apraxia
87
Can't recognize objects
Agnosia
88
Can't feel pleasure
Anhedonia
89
What are the nursing interventions for patients with dementia?
General assessment, personal centered care approach, speak in soft tones, self care, teach and promote, safety, treat symptoms with low doses of antipsychotics
90
How is borderline personality disorder treated?
Set limits and treat symptoms
91
What can result from drug interaction, especially in the elderly?
Delirium
92
What are the interventions for borderline personality disorder?
Maintain safety, set realistic goals and options, set limits, conduct therapy
93
What are the signs of antisocial personality disorder?
Deceitful, manipulaiton, callousness, aggression, splitting, exploitation, threats to staff
94
What are the interventions for antisocial personality disorder?
Teamwork, maintain safety
95
Evidence based therapy developed to successfully treat chronically suicidal persons with borderline personality disorder by focusing on impulse control
Dialectical Behavioral Therapy
96
If a patient is receiving dialectical behavioral therapy and threatening suicide, what would you do?
Commit the client, call the police, and work with the client to bring about the situation they want
97
A person has a high level of resilience. Which other characteristic would the nurse expect this person to have?
Optimism
98
Which mental health problem has the highest annual prevalence in the US?
Major Depressive Disorder
99
According to Freud, which aspect of the personality motivates an individual to seek perfection?
Super Ego
100
Which theorist most influenced the professional practice of psychiatric nursing?
Hildegard Peplau
101
Schemata, anatomic thoughts and cognitive distortion are terms that relate to...
Cognitive Behavioral Therapy
102
A patient with schizophrenia says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding?
Positive Symptom
103
What do loose association in a person with schizophrenia indicate?
Poorly organized thinking
104
Which assessment finding represents a negative symptom of schizophrenia?
Apathy
105
Which anticonvulsant medication might be prescribed for a patient with bipolar disorder?
Depakote
106
Which question would be a priority when assessing for symptoms of major depression?
You look really sad. Have you ever thought of harming yourself?
107
A patient with major depression walks and moves slowly. Which term should the nurse use to document this finding?
Psychomotor retardation
108
Which assessment fining is a patient with major depression represents a vegetative sign?
Hypersomnia
109
A parent is shopping with a 5-year-old child in a large, busy mall. The parent suddenly realizes the child is missing. Which level of anxiety would likely result?
Panic
110
An adolescent female is brought to the school nurse after fainting during gym class. She is grossly underweight, wears baggy clothes, and has dry skin. She complains of feeling cold despite wearing two sweaters. To further assess for an eating disorder, what should the nurse ask?
When was your last menstrual period?
111
Hypoalbuminemia in a patient with an eating disorder would produce which assessment finding?
Peripheral Edema
112
A nurse is assigned the care of four patients who are detoxing from alcohol. The patient with which symptoms would be the nurse's highest priority?
Hallucinations and delusions
113
The spouse of an alcoholic pours all the alcohol in the home down the sink. What type of behavior is evident?
Codependence
114
A person has recently abused morphine. The person's pupils would most likely be....
Constricted
115
Acute onset of disordered thinking is most associated with....
Delirium
116
A patient with dementia attempts to brush his teeth with a spoon. Which problem is evident?
Apraxia
117
Which behavior indicates that a patient diagnosed with borderline personality disorder is improving?
The patient informs a staff member that she feels unsafe and is having thoughts of harming herself
118
Use of splitting is most associated with which personality disorder?
Borderline
119
Perfectionism is a trait likely to be evident in a person with personality disorder?
Obsessive compulsive
120
Antisocial, obsessive compulsive, and schizotypal personality disorders occur most frequently in who?
Men
121
A patient is hospitalize with major depression and suicidal ideation. He has a history of several suicide attempts. For the first two days of hospitalization, the patient eats 20% of meal and stays in his room between groups. By the fourth day, the nurse observes that the patient is more sociable, is eating meals, and has a bright affect. Which factor should the nurse consider?
The patient may have decided to commit suicide; the nurse should reassess suicidality
122
A person with which psychiatric problem is most likely to complete suicide?
Major Depression
123
Which method of suicide has the highest lethality?
Self-inflicted gunshot wound
124
If a person has decreased circulating levels of GABA, which health problem would be expected?
Anxiety disorders
125
Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function?
CT
126
Which age group is at the highest priority for suicide?
Anyone 10-64 (4th for 10-14, 3rd for 15-24, 4th for25-44, 8th for 45-64)
127
What statements would make you think a patient is a danger to himself or others?
Overt statements with intent and a plausible plan
128
What biochemical chemical changes occur in clients who are suicidal?
Changes in serotonin, norepinephrine and dopamine levels
129
What symptoms would a narcissistic patient display?
Need for constant admiration, lack of empathy, antagonism, grandiosity and attention seeking behaviors, exploitations of others, and feelings of intense shame and fears of abandonment
130
How is narcissistic personality disorder treated?
Family group therapy, no drugs
131
What are the nursing diagnoses for a patient with borderline personality disorder who has been self mutilating?
Set limits, treat symptoms, maintain safety, stay consistent
132
When a suicide threat is made, what needs to be assessed?
Assess how lethal the threat and if the patient has the means to carry out the plan
133
What are the nursing diagnoses for personality disorders?
Risk for injury, risk for violence, disturbed self image and inability to cope
134
What are the interventions for personality disorders?
Create a structured and safe environment in which to control and limit client's behaviors, therapy, possible meds to treat symptoms
135
What are the positive symptoms of schizophrenia?
Alterations in thinking, alterations in speech, alterations in thought, alterations in perception, and alterations in behavior
136
What are the negative symptoms of schizophrenia?
Changes in affect and difficulty with attention, memory and information processing
137
What does opioid withdrawal look like?
Tachycardia, hypertension, insomnia, diaphoretic, goosebumps, yawning, runny nose, cramps, nausea, vomiting, diarrhea, anxiety and increased respiratory rate
138
What does alcohol withdrawal look like?
Restlessness, irritability, anorexia, tremors, insomnia, impaired cognitive functions, sweating, increased pulse and blood pressure, nausea, hypersensitivity, hallucinations, fever and grand mal seizures
139
In order for anorexics to be on a SSRI, what percentage of body weight must they be at?
90%
140
Why are anorexics and bulimics likely to have cardiac arrhythmias?
They have imbalanced fluids and electrolytes
141
Restore electrolyte imbalances, correct dysrhythmias and observe bathroom privileges and eating for patients with eating disorders
Re-feeding Syndrome
142
According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by......
Cultural and ethnic factors
142
One characteristic of mental health that allows people to adapt to tragedies, trauma and loss is...
Resilience
142
One characteristic of mental health that allows people to adapt to tragedies, trauma and loss is...
Resilience
143
You are caring for Kiley, a 29-year-old female patient who is being admitted following a suicide attempt. Saying what illustrates the concept of patient advocacy?
Dr. Raye, I notice you ordered Prozac for Kiley. She has stated to me that she does not want to take Prozac because she had adverse effects when it was previously prescribed.
143
You have graduated with your BSN degree and have taken your first job on a psychiatric unit after becoming a RN. You are providing teaching to Mason, a newly admitted patient on the psych unit, regarding his daily schedule. What is an inappropriate teaching statement?
You will attend a psychotherapy group that I lead
143
Lucas states, "I will always be alone because nobody could love me." This is most likely an example of:
Schema
143
You are caring for Vanessa, a 38-year-old patient with major depression. She states to you, "my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?" Your best response is?
Neurotransmitters are chemical messengers in the brain that help regulate specific functions.
143
Vanessa's provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?
Serotonin/Norepinephrine
143
Which neurotransmitter is messed up in patients with anxiety disorders?
GABA
143
The term pharmacodynamics refers to the effect for eh drug on the body, while pharmacokinetics refers to:
The effect of the person on the drug
143
A nurse who is active in local consumer mental health groups and in local state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by:
Reducing the stigma of mental illness and advocating for equality in treatments
143
You are caring for Alyssa, a 28-year-old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which of the following symptoms needs to be the first priority in caring for this patient?
Lack of sleep
143
You and Jack are two of the nurses working on the psych unit. Jack mentions to you that the biological model for mental illness is the one he embraces and states, "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model?
In believing only the biological model, other incidences on mental health including cultural, environmental, social, and spiritual influences are not taken into account
143
Sullivan's term "security operations" and Freud's term "defense mechanisms" both reflect actions that serve to:
Reduce anxiety
143
The term pharmacodynamics refers to the effect for eh drug on the body, while pharmacokinetics refers to:
The effect of the person on the drug
144
Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?
Shelly, who is taking lithium
144
Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone. Which of the following nursing assessments is the priority assessment with Julie?
Monitoring for abnormal involuntary movements
144
Which statement best describes the DSM-5?
It is a medical psychiatric assessment system
144
Current information suggests that the most disabling mental disorders are the result of:
Biological influences
144
A nurse's identification badge includes the term "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering:
"We have the specialized skills needed to care for those with mental illnesses."
144
The quantitative study of the distribution of mental disorders in human populations is called...
Epidemiology
144
A nurse's identification badge includes the term "Psychiatric Mental Health Nurse." A client with a history of paranoia asks, "What does that title mean?" The nurse responds best by answering:
"We have the specialized skills needed to care for those with mental illnesses."
145
Which statement about diagnosis of a mental disorder is true?
Culture may cause variations in symptoms for each clinical disorder
145
These severe mental illness are recognized across cultures:
Schizophrenia and bipolar disorder
145
Which branch of epidemiology is the nurse involved in when seeking outcomes for patients whose depression was treated with ECT?
Clinical
145
A client tells the mental health nurse "I am terribly frightened! I hear whispering that someone is going to kill me." Which criterion of mental health can the nurse assess as lacking?
Appraisal of reality
145
A 14-year-old belongs to a neighborhood gang, engages in sexually promiscuous behaviors, and has a history of school truancy but reports that her parents are just old-fashioned and don't understand her. The assessment data supports that the client...
Is displaying deviant behavior
145
The nurse planning care for a mentally ill client bases interventions on the concept that the client...
Has areas of strength on which to build
145
In order to best differentiate whether an Asian client is demonstrating a mental illness when attempting suicide is to...
Identify his culture's view regarding suicide
145
An individual is found to consistently wear only a bathrobe and neglect the cleanliness of his apartment. When neighbors ask him to stop his frequent outbursts of operatic arias, he acts outraged and tells them he must sing daily and will not promise to be quieter. This behavior supports that he is....
No demonstrating any definitive signs of mental illness
145
A nursing diagnosis for a client with a psychiatric disorder serves the purpose of...
Providing a framework for selecting appropriate interventions
145
Which of the following best demonstrates parity related to mental health care?
A client's mental health coverage is equal to his medical/surgical coverage
145
The mental health status of a particular client can best be assessed by considering...
Placement on a continuum for health to illness
145
Which statement about mental illness is true?
Mental illness changes with culture, time in history, political systems, and the groups defining it
145
Epidemiological studies contribute to improvements in care for individuals with mental disorders by:
Identifying who in the general population will develop a specific disorder
145
Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis?
The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems
145
The intervention that can be practice by an advanced practice RN in psych by cannot be practiced by a basic level RN is:
Psychotherapy
145
An important difference between the developmental theories of Freud and Erikson is...
Erikson viewed individual growth in terms of social setting
145
Maslow's theory of humanistic psychology has provided nursing with a framework for...
Holistic assessment
145
The premise underlying behavioral therapy is...
Behavior is learned and can be modified
145
The prevalence rate over a 12-month period for major depressive disorder is...
Greater than the prevalence rate fro generalized anxiety
145
A nursing student new to psych mental health nursing asks a peer what resources he can use to figure out which symptoms are present in a specific disorder. The best answer would be...
DSM-5
145
The premise underlying behavioral therapy is...
Behavior is learned and can be modified
146
Sullivan viewed anxiety as...
Any painful feeling or emotion arising from social insecurity
146
Which statement best clarifies the difference between the art and the science of nursing?
The art is the care, compassion, and advocacy component, and the science is the applied knowledge base
146
Which client problem would be most suited to the use of interpersonal therapy?
Dysfunctional grieving
146
A cognitive therapist would help a client restructure the thought "I am stupid!" to...
"What I did was stupid."
146
The nurse providing anticipatory guidance to the mother of a toddler should advise that childhood temper tantrums are best handled by...
Ignoring the tantrum and giving attention when the child acts appropriately
146
Freud believed that individuals cope with anxiety by using...
Defense mechanisms
146
Which contribution to modern psychiatric mental health nursing practice was made by Freud?
The theory of personality struct and levels of awareness
146
The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist?
Sullivan
146
The concepts at the heart of Sullivan's theory of personality are:
Needs and anxiety
146
The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:
Cognitive-behavioral therapy
146
One implication of Freud's theory of the unconscious on psychotic mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand...
The root causes of client suffering
146
According to Freud, the nurse recognizes that a client experiencing dysfunction of the conscious as part of the mind with have problems with...
All material that the person is aware of at any one time
146
A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention wit sarcasm. When asking for advice, the nurse manager's most helpful response is...
Remember that sarcasm represents the oral-stage fixation of development
146
The nurse planning care for a 14-year-old needs to take into account that the developmental task of adolescent is to....
Achieve identity
146
Providing a safe environment for patients with impaired cognition, planning unit actives to stimulate thinking, and including patients and staff in unit meet ins are all part of:
Milieu Therapy
146
When asked, the nurse explains that a client's id is...
The source of his instincts to save himself from hurting himself
146
As a result of Harry Stack Sullivan's work, the mental health nurse is involved in providing clients with...
A psychotherapeutic environment
146
The nurse is working with a client experiencing both a postpartum depression and a very low self-esteem. The client is distrustful of unit staff and "just wants to go home." Initially the nurse's priority is to...
Establish trust with the client
146
Using Maslow's model of needs, the nurse providing care for an anxious client identifies the priority intervention to be...
Assessing the client for her strengths upon which a nurse-client relationship can be based
146
A suspicious client who smokes several packs of cigarettes daily and drinks large quantities of coffee and soda as he is able to afford reacts to every nursing intervention wit sarcasm. When asking for advice, the nurse manager's most helpful response is...
Remember that sarcasm represents the oral-stage fixation of development
147
A client with a history of three failed engagements is concerned about being "too possessive." This concern supports a need for which type of therapy?
Interpersonal
147
The basic functional unit of the nervous system is called a...
Neuron
147
Treatment of mental illnesses with psychotropic drugs is directed at...
Altering brain neurochemistry
147
Homeostasis is promoted by interaction between the brain and internal organs mediated by...
The autonomic nervous system
147
Cells that respond to stimuli, conduct electrical impulse and release neurotransmitters are called...
Neurons
147
When a tumor of the cerebellum is present, the nurse should expect that the client would initially demonstrate...
Disequilibrium
147
Which organs secrete hormones that are a normal component of the body's general response to stress?
Brain, pituitary gland, and adrenal glands
147
Role-playing is associated with which type of therapy?
Modeling
147
Which of the following is considered a primary behavioral theorist?
Skinner
147
The incoherent thought and speech patterns of the client with schizophrenia are related to the brain's inability to...
Regulate conscious mental activity
147
Which imaging technique can provide information about brain functioning?
PET scan
147
Which organs secrete hormones that are a normal component of the body's general response to stress?
Brain, pituitary gland, and adrenal glands
148
The behavior of an individual who seems unable to learn right from wrong and who repeatedly violates laws and lies demonstrates problems related to the brains's inability to...
Regulate social behavior
148
The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving...
Lithium
148
Which drug group calls for nursing assessment for development of abnormal movement disorders about individuals who take therapeutic dosages?
Antipsychotics
148
A client's communication is marked by loose associates and word salad. Dysfunction of which portion of the brain is responsible for these symptoms?
Cerebrum
148
A nursing assistant shares with the nurse that a client with schizophrenia is as difficult to communicate with as "someone with Alzheimer's." The nurse offers the following advice:
"His meds target his disturbed thought and speech patterns. To maximize improvement he will need positive interactions and support."
148
The nurse acing for a client taking risperidone observes the client carefully for...
Napping during the day, a weight gain, and reports of dizziness
148
The nurse responsible for the care of a client prescribed clonazepam would evaluate treatment as being successful when the client demonstrates...
Less anxiety
148
The medication prescribed for a client acts by blocking reuptake of both serotonin and norepinephrine. The nurse evaluates the treatment as successful when observing...
Laughing at a joke
148
The physician tells a client suspected of experiencing OCD that "We want to do an imaging study that will tell us which parts of your brain are particularly active." From this explanation, the nurse can determine that the MD will order a...
PET scan
148
A client is admitted to the hospital experiencing severe depression. The nurse recognizes the possibility that depression may be related to a stress-induced hormonal imbalance associated with...
Cortisol
148
Schizophrenia is best characterized as...
Deteriorating personality
148
Which of the following would be assessed as a negative symptoms of schizophrenia?
Anhedonia
148
Which symptoms would NOT be assessed as a positive symptom of schizophrenia?
Affective flattening
148
When a client diagnosed with schizophrenia hears voices saying that he is a horrible human being, the nurse can correctly assume that the hallucination...
Is a projection of the client's own feelings
148
Which side effect of antipsychotic medication is generally nonreversible?
Tardive dyskinesia
148
Tony, a 45-year-old patient with schizophrenia, sometimes moves his lips silently or murmurs to himself when he does not realize others are watching. Sometimes when talking to others, he suddenly stops, appears distracted for a moment, and then resumes. Based on these observations, Tony most likely is experiencing:
Auditory hallucinations
148
A nurse administering a benzodiazepine should understand that the therapeutic effect of benzos result from potentiating the neurotransmitter...
GABA
148
Venlafaxine exerts its antidepressant effect by selectively blocking the reuptake of...
Serotonin and Norepinephrine
148
Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in...
Amenorrhea
148
A client being medicated for both hallucinations and delusions reposes being drowsy. The nurse will correctly interpret this symptom as related to the drug's effect on the brain's ability to regulate...
Sleep
148
On the basis of the current understanding of NTs, the nurse can view a client's symptoms of profound depression as likely related in part to...
Decreased serotonin levels
148
The nurse caring for a client prescribed an antipsychotic medication that produces anticholinergic side effects will assess for...
Blurred vision, dry mouth, and constipation
148
The type of altered perception most commonly experienced by clients with schizophrenia is...
Auditory hallucinations
148
The most common course of schizophrenia is an initial episode followed by...
Recurrent acute exacerbations and deterioration
148
The causation of schizophrenia is currently understood to be...
A combination of inherited and non-genetic factors
148
Mark, a 32-year old patient with schizophrenia, is found in a closet with an empty 2-liter bottle of cola taken from the staff refrigerator. The bottle had been full. The patient has also been drinking for from the hallway water cooler and taking drinks from his peers' dinner trays. Recently, staff has noticed an increase in auditory hallucinations and the onset of confusion. Which response is most appropriate?
Restrict is access to fluids, and evaluate for water intoxication via daily weights
148
Jordan is a 21-year-old who was recently diagnosed wit schizophrenia. He has had to drop out of college as the probative symptoms of his disease have made it impossible for him to pursue his dream of being an architect. He presents to the ED with flat affect, depressed mood, and having auditory hallucinations tell him he is "no good to anyone anymore." Which of the following statements is true regarding depression and schizophrenia?
Assessing for depression and suicidal ideation in patients with schizophrenia is important since almost half of people with schizophrenia will attempt suicide
214
Which of the following is classified as a circadian rhythm?
Sleep cycle
245
Julia, a 28-year-old diagnosed with schizophrenia, is encouraged to attend groups but stays in her room instead. Staff and peers encourage her participation, but without success. Her hygiene is poor despite encouragement to shower and brush her teeth. She does not seem concerned that others wish she would behave differently. Which is the most likely explanation for Julia’s failure to respond to others’ efforts to help her behave in a more adaptive fashion?
She is displaying avolition, anergia, and is apathetic
246
Kyle, a 23-year-old patient with schizophrenia, has been admitted to the psychiatric unit for one week. He has begun to take the first- generation antipsychotic haloperidol (Haldol). One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to turn towards you or to respond verbally. You obtain vital signs, which are as follows: BP 170/100, P 110, T 103. What are the priority nursing interventions?
Begin to wipe him with a washcloth wet with cold water or alcohol and hold his medication, and contact his provider stat
247
A client diagnosed with residual schizophrenia is uninterested in community activities. He lacks initiative, demonstrates both poverty of content of speech and poverty of speech, and seems unable to follow the schedule for taking his antipsychotic medication. The case manager continues to direct his care with the knowledge that his behavior is most likely prompted by...
Neural dysfunction
248
A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. A therapeutic response for the nurse would be...
"I understand that the voices are very real to you, but I do not hear them."
249
A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nurse...
Giving multistep directions
250
A nursing intervention designed to help a schizophrenic client manage relapse is to...
Teach the client and family about behaviors associated with relapse
251
A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as...
A neologism
252
When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," an appropriate response for the nurse would be...
"It must be frightening to think something is going to harm you."
253
A desired outcome for a client diagnosed with schizophrenia who has a nursing diagnosis of Disturbed sensory perception: auditory hallucinations related to neurobiological dysfunction would be that the client will...
Ask for validation of reality.
254
A client has reached the stable plateau phase of schizophrenia. An appropriate clinical focus for planning would be...
Social, vocational, and self-care skills.
255
A client, who has been receiving antipsychotic medication for 6 weeks, tells the nurse that the hallucinations are nearly gone and that concentration has improved. When the client reports flulike symptoms including a fever and a very sore throat, the nurse should...
Arrange for the client to have blood drawn for a white blood cell count.
256
The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of...
Tardive Dyskinesia
257
Nico, a 22-year-old patient, is diagnosed with schizophrenia. Which of the following symptoms would alert a provider to a possible diagnosis of schizophrenia?
Hearing voices telling him to hurt his roommate
258
Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years and Tara at 31 years. Based on your knowledge of early and late onset of schizophrenia, which of the following is true?
Tara has a better chance for positive outcomes because of later onset.
259
Which of the following is true regarding schizophrenia treatment and outcomes?
Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.
260
Declan is a 26-year-old patient with schizophrenia. He states to you, "My, oh my. My mother is brother. Anytime now it can happen to my mother." Your best response would be:
"I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"
261
Declan is being discharged from the psychiatric unit on risperidone (Risperdal). You are providing medication teaching to Declan and his mother, who is his primary caregiver. Which of the following statements is the appropriate response to Declan's mother's question regarding the risk for extrapyramidal side effects (EPSs) while taking risperidone?
Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics.
262
The first-line drug used to treat mania is...
lithium carbonate (Lithium).
263
A person who has numerous hypomanic and dysthymic episodes can be assessed as demonstrating characteristics of...
Cyclothymia
264
A bipolar client tells the nurse, "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying...
Grandiosity
265
Which behavior would be most characteristic of a client during a manic episode?
Going rapidly from one activity to another
266
The nurse can expect a client demonstrating typical manic behavior to be attired in clothing that is...
Colorful and outlandish
267
An outcome for a manic client during the acute phase that would indicate that the treatment plan was successful would be that the client...
Is free of injury
268
When a client experiences four or more mood episodes in a 12-month period, the client is said to be...
Rapid cycling
269
Which room placement would be best for a client experiencing a manic episode?
A single room near the nurse's station
270
When a hyperactive manic client expresses the intent to strike another client, the initial nursing intervention would be to...
Set verbal limits
271
When a client reports that lithium causes an upset stomach, the nurse suggests taking the medication:
With meals
272
A major principle the nurse should observe when communicating with a patient experiencing elated mood is to:
Use a calm, firm approach
273
Nadia has been diagnosed with bipolar disorder. Which is an outcome for Nadia in the continuation of treatment phase of bipolar disorder?
Patient will adhere to medication regimen
274
A medication teaching plan for a patient receiving lithium should include:
Periodic monitoring of renal and thyroid function.
275
Which symptom related to communication is likely to be present in a patient experiencing mania?
Verbosity
276
For assessment purposes, the nurse should identify the body system most at risk for decompensation during a severe manic episode as:
Cardiac
277
The priority nursing diagnosis for a hyperactive manic client during the acute phase is...
Risk for injury
278
An acute phase nursing intervention aimed at reducing hyperactivity is redirecting the client to...
Write in a diary
279
A bipolar client whose continuing phase treatment consists of lithium therapy and cognitive-behavioral therapy may become noncompliant with medication. Which factor would be of least concern to the nurse developing a psychoeducation plan to foster compliance?
The voices tell the client to stop taking it.
280
A manic client tells a nurse "Bud. Crud. Dud. I'm a real stud! You'd like what I have to offer. Let's go to my room." The best approach for the nurse to use would be
"It's time to work on your art project."
281
A desired outcome for the maintenance phase of treatment for a manic client would be that the client will...
Adhere to follow-up medical appointments
282
What action should the nurse take on learning that a manic client's serum lithium level is 1.8 mEq/L?
Withhold medication and notify the physician.
283
To plan care for a manic client the nurse must consider that lithium cannot be started until...
The physical examination and laboratory tests are analyzed
284
A desirable short-term goal for the nursing diagnosis "defensive coping related to biochemical changes as evidenced by aggressive verbal and physical behaviors" would be...
Making no attempts at self-harm within 12 hours of admission
285
Which side effects of lithium can be expected at therapeutic levels?
Fine hand tremor and polyuria
286
When the wife of a manic client asks about genetic transmission of bipolar disorder, the nurse's answer should be predicated on the knowledge that
The rate of bipolar disorder is higher in relatives of people with bipolar disorder
287
Which of the following is true of the relationship between bipolar disorder and suicide?
Suicide is a serious risk because nearly 20% of those diagnosed with bipolar disorder commit suicide.
288
Tyler is a 31-year-old patient admitted with acute mania. He tells the staff and the other patients that he is on a secret mission given to him by the President of the United States to monitor citizens for terrorist activity. He states, "I am the only one he trusts, because I am the best!" For documentation purposes you know that this behavior is referred to as:
Grandiosity
289
Tyler is being discharged home to his family. Which of the following is important teaching to include for the patient and the family to recognize possible signs of impending mania?
Decreased sleep
290
Which of the following describe the symptoms of the manic phase of bipolar disorder?
Excessive energy, pressured speech, purposeless movements, racing thoughts and distractibility
291
A new psychiatric technician mentions to the nurse, "Depression seems to be a disease of old people. All the depressed clients on the unit are older than 60 years." The reply by the nurse that clarifies the prevalence of this disease is...
"Depression is seen in people of all ages, from childhood to old age."
292
What statement about the comorbidity of depression is accurate?
Depression is commonly seen in individuals with medical disorders.
293
Beck's cognitive theory suggests that the etiology of depression is related to...
Negative processing of information
294
When the clinician mentions that a client has anhedonia, the nurse can expect that the client...
Obtains no pleasure from previously enjoyed activities
295
Assessment of the thought processes of a client diagnosed with depression is most likely to reveal...
Self-deprecatory ideation
296
A client who has been assessed by the nurse as moderately depressed is given a prescription for daily doses of a selective serotonin reuptake inhibitor. The client mentions that she will take the medication along with the St. John's wort she uses daily. The nurse should...
Explain the high possibility of an adverse reaction
297
The nursing diagnosis "Imbalanced nutrition: less than body requirements" has been identified for a client diagnosed with severe depression. The most reliable evaluation of outcomes will be based on the client's...
Weekly weights
298
It is likely that a client diagnosed with seasonal affective disorder will begin to experience fewer symptoms in the...
Spring
299
A depressed client is noted to pace most of the time, pull at her clothes, and wring her hands. These behaviors are consistent with...
Psychomotor agitation
300
Dysthymia cannot be diagnosed unless it has existed for...
At least 2 years
301
The nurse is caring for a patient who exhibits disorganized thinking and delusions. The patient repeatedly states, “I hear voices of aliens trying to contact me.” The nurse should recognize this presentation as which type of major depressive disorder (major depression)?
Psychotic
302
A nurse is educating a patient about the causes of depression. Which statement lets the nurse know the patient understands the neurobiological theory of depression?
“If I take these medications as prescribed, I should start to think clearly and feel energized.”
303
The nurse is planning care for a patient with depression who will be discharged to home soon. What aspect of teaching should be the priority on the nurse’s discharge plan of care?
Awareness of symptoms that increase depression
304
The nurse is reviewing orders given for a patient with depression. Which order should the nurse question?
An SSRI given initially with an MAOI
305
A female patient tells the nurse that she would like to begin taking St. John’s wort for depression. What teaching should the nurse provide?
"St. John’s wort has generally been shown to be effective in treating depression.”
306
Which nursing diagnosis would be least useful for a depressed client who shows psychomotor retardation?
Death anxiety
307
When the nurse remarks to a depressed client, "I see you are trying not to cry. Tell me what is happening." The nurse should be prepared to...
Wait quietly for the client to reply
308
An statement that would show acceptance of a depressed, mute client would be...
"I would like to sit with you for 15 minutes now and again this afternoon."
309
Select the nursing diagnosis least likely to be chosen after analysis of data pertinent to a client with post-partum depression.
Health-seeking behaviors
310
A depressed client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can identify this cognitive distortion as an example of...
Learned helplessness
311
A depressed, socially withdrawn client tells the nurse, "There is no sense in trying. I am never able to do anything right!" The nurse can best begin to attack this cognitive distortion by...
Suggesting, "Let's look at what you just said, that you can 'never do anything right'"
312
A depressed client tells the nurse he is in the "acute phase" of his treatment for depression. The nurse recognizes that the client has been in treatment...
To reduce depressive symptoms
313
A client prescribed a monamine oxidase inhibitor (MOA) has a pass to go out to lunch. Given a choice of the following entrees, the client can safely eat...
Fruit and cottage cheese plate
314
The nurse has developed a plan for a client with a severe sleep pattern disturbance to spend 20 minutes in the gym exercising each afternoon. Which intervention should be scheduled for upon returning to the unit?
Rest
315
Which statement about antidepressant medications, in general, can serve as a basis for client and family teaching?
Onset of action is from 1 to 6 weeks
316
The major reason for hospitalization for depressed patients is:
Suicidal ideation
317
Sasha is a 38-year-old patient admitted with major depression. Which of the following statements Sasha makes alerts you to a common accompaniment to depression?
"I still feel bad about my sister dying of cancer. I should have done more for her!"
318
Sasha has been having angry outbursts with staff and peers on the unit. You are talking with Sasha on her third day of admission. You ask whether she is having any thoughts of suicide. Sasha becomes angry and defensive, shouting, "I'm sick of you people! Are you ever do is ask me the same question over and over. Get out of here!" Your response is based on the knowledge that:
Sasha may be at high risk for self-harm.
319
Sasha is started on fluoxetine. Which statement by Sasha indicates that she understands the medication teaching you have provided?
"I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away."
320
Sasha's roommate Kate was admitted with major depression and suicidal ideation with a plan to overdose. Kate is preparing for discharge and asks you, "Why did Dr. Travis give me a prescription for only 7 days of amitriptyline?" Your response is based on the knowledge that:
Amitriptyline (Elavil) is lethal in overdose.
321
The major distinction between fear and anxiety is that fear...
Is a response to a specific danger; anxiety is a response to an unknown danger
322
The initial nursing action for a newly admitted anxious client is to...
Assess the client's level of anxiety
323
Selective inattention is first noted when experiencing anxiety that is...
Moderate
324
Delusionary thinking is a characteristic of...
Panic level anxiety
325
Generally, ego defense mechanisms...
Often involve some degree of self-deception
326
A 20-year-old was sexually molested at age 10, but he can no longer remember the incident. The ego defense mechanism in use is...
Repression
327
The defense mechanisms that can only be used in healthy ways include...
Altruism and sublimation
328
Which behavior would be characteristic of an individual who is displacing anger?
Procrastinating
329
A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, and "burns" money that could be better spent to feed the poor is demonstrating...
Reaction formation
330
A man continues to speak of his wife as though she were still alive, 3 years after her death. This behavior suggests the use of...
Denial
331
It can be said that the onset of most anxiety disorders occurs...
Before 40
332
What can be said about the comorbidity of anxiety disorders?
A second anxiety disorder may coexist with the first.
333
Studies of clients diagnosed with posttraumatic stress disorder suggest that the stress response of which of the following is considered abnormal?
Hypothalamus-pituitary-adrenal system
334
An obsession is defined as...
A recurrent, persistent thought or impulse
335
A symptom commonly associated with panic attacks is...
Fear of impending doom
336
Working to help the client view an occurrence in a more positive light is called...
Cognitive restructuring
337
The primary purpose of performing a physical examination before beginning treatment for any anxiety disorder is to...
Determine whether the anxiety is primary or secondary in origin
338
An important question to ask during the assessment of a client diagnosed with anxiety disorder is...
Have you ever considered suicide?
339
A possible outcome criterion for a client diagnosed with anxiety disorder is...
Client demonstrates effective coping strategies
340
Inability to leave one's home because of avoidance of severe anxiety suggests the anxiety disorder of...
Panic attacks with agoraphobia
341
Which of the following statements are correct regarding obsessive-compulsive disorder (OCD)?
Obsessions are repetitive thoughts, whereas compulsions are ritualistic behaviors; OCD symptoms can start as early as 3 years of age; OCD patients often have difficulty sleeping; there is a tool (scale) to measure compulsive behaviors
342
Since learning that he will have a trial pass to a new group home tomorrow, Luke’s usual behavior has changed. He has started to pace, has become distracted, and is breathing rapidly. He has trouble focusing on anything other than the group home issue and complains that he suddenly feels nauseated. Which initial nursing response is most appropriate for Luke’s level of anxiety?
“Luke, slow down. Listen to me. You are safe. Take a deep breath, and let’s go to a quieter place.”
343
Michael seems to be angry when his family fails to visit him in the hospital as promised. However, he tells you that he is fine and that the visit wasn’t important to him. When you suggest that perhaps he might be disappointed or even a little angry that the family has again let him down, the patient responds that it is his family that is angry, not him, or else they would have visited. What defense mechanism(s) is this patient using to deal with his feelings?
Rationalization, projection, and denial
344
A variety of medications are used in the treatment of severe anxiety disorders. Which class of medication used to treat anxiety is potentially addictive?
Benzodiazepines
345
A disorder in which one experiences fear of being in places or situations from which escape might be difficult or embarrassing or in which help might not be available if a panic attack occurs is called ____________________.
Agoraphobia
346
A teenager changes study habits to earn better grades after initially failing a test. This behavioral change is likely a result of...
Normal anxiety
347
A client frantically reports to the nurse that "You have got to help me! Something terrible is happening. I can't think. My heart is pounding, and my head is throbbing." The nurse should assess the client's level of anxiety as...
Severe
348
A client is displaying symptomatology reflective of a panic attack. In order to help the client regain control, the nurse responds...
"Can you tell me what you were feeling just before your attack?"
349
A client who is demonstrating a moderate level of anxiety tells the nurse, "I am so anxious, and I do not know what to do." A helpful response for the nurse to make would be...
"What things have you done in the past that helped you feel more comfortable?"
350
A client is running from chair to chair in the solarium. He is wide-eyed and keeps repeating, "They are coming! They are coming!" He neither follows staff direction nor responds to verbal efforts to calm him. The level of anxiety can be assessed as...
Panic
351
A cultural characteristic that may be observed in a teenage, female Hispanic client in times of stress is to...
Suddenly tremble severely
352
The nurse anticipates that the nursing history of a client diagnosed with obsessive compulsive disorder (OCD) will reveal...
A sibling with the disorder
353
A client is diagnosed with generalized anxiety disorder (GAD). The nursing assessment supports this diagnosis when the client reports...
Being so worried he hasn't been able to work for the last 12 months
354
If a client's record mentions that the client habitually relies on rationalization, the nurse might expect the client to...
Justify illogical ideas and feelings
355
Panic attacks in Latin American individuals often involve...
Fear of dying
356
The plan of care for a client who has elaborate washing rituals specifies that response prevention is to be used. Which scenario is an example of response prevention?
Not allowing the client to wash hands after touching a "dirty" object
357
A client is experiencing a panic attack. The nurse can be most therapeutic by...
Telling the client to take slow, deep breaths
358
The nurse caring for a client experiencing a panic attack anticipates that the psychiatrist would order a stat dose of...
A short-acting benzodiazepine medication
359
A Gulf War veteran is entering treatment for post-traumatic stress disorder. An important facet of assessment is to...
Determine use of chemical substances for anxiety relief
360
When prescribed lorazepam (Ativan) 1 mg po qid for 1 week for generalized anxiety disorder, the nurse should...
Teach the client to limit caffeine intake
361
Which nursing diagnosis would be most useful for clients with anxiety disorders?
Ineffective role performance
362
Which nursing intervention would be helpful when caring for a client diagnosed with an anxiety disorder?
Reinforce use of positive self-talk to change negative assumptions.
363
A potential problem for a client diagnosed with severe obsessive-compulsive disorder is...
Sleep disturbance
364
Which therapeutic intervention can the nurse implement personally to help a client diagnosed with a mild anxiety disorder regain control?
Modeling
365
You are providing teaching to Lana, a preoperative patient just before surgery. She is becoming more and more anxious as you talk. She begins to complain of dizziness and heart pounding, and she is trembling. She seems confused. Your best response is to:
Not attempt any teaching at this time
366
Lana is out of surgery and on the medical-surgical unit for recovery. You visit her the day after her surgical procedure. While you are in the room, Lana becomes visibly anxious and short of breath, and she states, "I feel so anxious! Something is wrong!" Your best action is to:
Call for help and assess Lana's vital signs
367
Stella brings her mother, Dorothy, to the mental health outpatient clinic. Dorothy has a history of anxiety. Stella and Dorothy both give information for the assessment interview. Stella states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." You suspect:
Adult separation anxiety disorder
368
Which medication is FDA approved for treatment of anxiety in children?
None
369
Jerry is a 72-year-old patient with Parkinson's disease and anxiety. He is living by himself and has had several falls lately. His provider orders lorazepam, 1 mg PO bid, for anxiety. You question this order because:
Jerry is at risk for falls
370
The client with bulimia differs from the client with anorexia nervosa by...
Maintaining a normal weight
371
A subjective symptom the nurse would expect to note during assessment of a client with anorexia nervosa is...
Fear of gaining weight
372
During assessment of a client with anorexia nervosa, it is not likely that the nurse would note indications of...
High-self esteem
373
Biological theorists suggest that the cause of eating disorders may be...
Serotonin imbalance
374
A client who is 16 years old, 5 foot, 3 inches tall, and weighs 80 pounds eats one tiny meal daily and engages in a rigorous exercise program. The nursing diagnosis for this client would be...
Imbalanced nutrition: less than body requirements
375
A coping mechanism used excessively by clients with anorexia nervosa is...
Denial
376
A client reveals that she induces vomiting as often as a dozen times a day. The nurse would expect assessment findings to reveal...
Hypokalemia
377
A client with bulimia nervosa uses enemas and laxatives to purge to maintain her weight. The imbalance for which the nurse should assess is a(n)...
Disruption of the fluid and electrolyte balance
378
A client has been hospitalized with anorexia nervosa. The client's weight is 65% of normal. For this client, a realistic short-term goal for the first week of hospitalization would be: By the end of week 1, the client will...
Gain a maximum of 3 lb
379
Bupropion (Wellbutrin), although seemingly effective, is contraindicated in patients who purge because of...
An increased risk of seizures
380
While on an inpatient unit, you are caring for newly admitted Alyssa, a 16-year-old diagnosed with anorexia nervosa. List the following nursing interventions in order of priority:
Initiate a therapeutic relationship; Assess for suicidal ideation; Promote caloric consumption; Explore feelings of underlying anxiety and low self-esteem; Review accomplishments made during treatment
381
Brittany is caring for a patient with bulimia. She recognizes which of the following nursing interventions as being most appropriate?
Monitor the patient on bathroom trips after eating
382
The nurse is admitting a patient who weighs 100 pounds, is 66 inches tall, and is below ideal body weight. The patient’s blood pressure is 130/80 mm Hg, pulse is 72 beats per minute, potassium is 2.5 mmol/L, and ECG is abnormal. Her teeth enamel is eroded, her hands are shaking, and her parotid gland is enlarged. The patient states, “I am really nervous about coming to this unit.” What is the priority nursing diagnosis?
Imbalanced nutrition: Less than body requirements
383
The nurse is planning care for a patient with a binge eating disorder. What outcomes are appropriate?
The patient will identify stressors that lead to binge eating; the patient will identify four alternate coping skills
384
Which of the following are true regarding feeding disorders in children?
Feeding disorders are often manifested in children with developmental delays; in many cases, toddler mealtime difficulties spontaneously resolve with no intervention; behavior modification has been found to be effective in treating feeding disorders
385
In contrast to the client diagnosed with anorexia nervosa, the client diagnosed with bulimia usually...
Fits more easily into the family
386
A focus for the acute phase of treatment for anorexia nervosa would be...
Weight restoration
387
The nurse can determine that inpatient treatment for a client diagnosed with an eating disorder would be warranted when the client...
Has systolic blood pressure less than 70 mm Hg
388
Which assessment question should be asked of a client suspected of demonstrating characteristics of anorexia nervosa?
"How would you describe your body?"
389
Which statement is least likely to be made by a client diagnosed with bulimia nervosa during the assessment interview?
"I eat three meals each day and purge every evening."
390
Assessment of a client suspected of experiencing bulimia nervosa calls for the nurse to perform...
Inspection of the oral cavity
391
Which diagnosis from the list below would be given priority for a client diagnosed with bulimia nervosa ?
Risk for injury: electrolyte imbalance
392
Which intervention would be least useful for accurate assessment of the weight of a client diagnosed with anorexia nervosa?
Weigh fully clothed before breakfast.
393
Which intervention would be removed from the plan of care for a client diagnosed with bulimia nervosa?
Support importance of avoiding forbidden foods.
394
The nurse working with clients diagnosed with eating disorders can help families develop effective coping mechanisms by...
Teaching the family about the disorder and the client's behaviors
395
Which of the following statements is true of bulimia?
Patients with bulimia often appear at a normal weight.
396
According to current theory, eating disorders:
Are possibly influenced by sociocultural factors
397
Your patient, Erin, is a 16-year-old patient newly diagnosed with anorexia. Her provider is starting her on medication to reduce compulsive behaviors regarding food and resistance to weight gain. You prepare teaching on which class of medication that may help these specific symptoms in eating disorders?
Atypical antipsychotics
398
When you are educating Erin and her mother about the medication dosage and side effects, Erin becomes upset and tearful, stating, "No! I will not take that medication!" Which of the following is the most likely reason for Erin's feelings?
Erin is upset about the possible side effect of weight gain.
399
Ali is a 17-year-old patient with bulimia coming to the outpatient mental health clinic for counseling. Which of the following statements by Ali indicates that an appropriate outcome for treatment has been met?
"I am a hard worker and I am very compassionate toward others."
400
A syndrome that occurs after stopping the long-term use of a drug is called...
Withdrawal
401
The only class of commonly abused drugs that has a specific antidote is the...
Opiates
402
The term tolerance, as it relates to substance abuse, refers to...
The need to take larger amounts of a substance to achieve the same effects
403
Benzodiazepines are useful for treating alcohol withdrawal because they...
Exert a calming effect
404
A person who covertly supports the substance-abusing behavior of another is called a(n)...
Enabler
405
A client who is dependent on alcohol tells the nurse, "Alcohol is no problem for me. I can quit anytime I want to." The nurse can assess this statement as indicating...
Denial
406
What is the ethical obligation of the nurse who sees a peer divert a narcotic, compared with the ethical obligation when the nurse observes a peer who is under the influence of alcohol?
Supervisory staff should be informed as soon as possible in both cases.
407
A young woman reports that although she has no memory of the event, she believes that she was raped. This raises suspicion that she unknowingly ingested...
GHB
408
In helping an addicted individual plan for ongoing treatment, which intervention is the first priority for a safe recovery?
The client must strive to maintain abstinence.
409
Symptoms that would signal opioid withdrawal include...
Lacrimation, rhinorrhea, dilated pupils, and muscle aches
410
When intervening with a patient who is intoxicated from alcohol, it is useful to first:
Ask what drugs other than alcohol the patient has recently used.
411
You are caring for Mick, a 32-year-old patient with chemical addiction who will soon be preparing for discharge. A principle of counseling interventions that should be observed when caring for a patient with chemical addiction is to:
Communicate that relapses are always possible.
412
As you evaluate a patient’s progress, which treatment outcome would indicate a poor general prognosis for long-term recovery from substance abuse?
Patient demonstrates positive expectations for ongoing drug use
413
You are caring for Leah, a 26-year-old patient who has been abusing CNS stimulants. Which statement provides a basis for planning care for a patient who abuses CNS stimulants?
Postwithdrawal symptoms include fatigue and depression.
414
The provision of optimal care for patients withdrawing from substances of abuse is facilitated by the nurse's understanding that severe morbidity and mortality are often associated with withdrawal from:
Alcohol and CNS depressants
415
Which of the drugs used by a polysubstance abuser is most likely to be responsible for withdrawal symptoms requiring both medical intervention and nursing support?
Barbituates
416
Nursing assessment of an alcohol-dependent client 6 to 12 hours after the last drink would most likely reveal the presence of...
Tremors
417
A client has been using cocaine intranasally for 4 years. When brought to the hospital in an unconscious state, nursing measures should include...
Observation for hyperpyrexia and seizures
418
Which assessment data would be most consistent with a severe opiate overdose?
Blood pressure, 80/40 mm Hg; pulse, 120 beats/min; respirations, 10 breaths/min
419
Cocaine exerts which of the following effects on a client?
Stimulation and anesthetic effects
420
An appropriate long-term goal/outcome for a recovering substance abuser would be that the client will...
Abstain from the use of mood-altering substances
421
A client was in an automobile accident and while there is the odor of alcohol on his breath, his speech is clear, and he is alert and answers questions posed to him. His blood alcohol level is determined to be 0.30 mg%. What conclusion can be drawn?
The client has a high tolerance to alcohol.
422
A client brought to the emergency department after phenylcyclohexylpiperidine (PCP) ingestion is both verbally and physically abusive, and the staff is having difficulty keeping him and themselves safe. The nursing intervention that would be most therapeutic is...
Obtaining an order for seclusion and close observation
423
A teaching need is revealed when a client taking disulfiram (Antabuse) states,...
"Most over-the-counter cough syrups are safe for me to use."
424
The most helpful message to transmit about relapse to the recovering alcoholic client is that lapses...
Result from lack of good situational support
425
Erik is a 26-year-old patient who abuses heroin. He states to you, "I've been using more heroin lately. I told my provider about it and she said I need more and more heroin to feel the effect I want." You know this describes:
Tolerance
426
Which of the following is true regarding substance addiction and medical comorbidity?
Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities.
427
Cody is a 19-year-old college sophomore who has been using cocaine and alcohol heavily for 5 months. He is admitted for observation after admitting to suicidal ideation with a plan to the college counselor. What would be an appropriate priority outcome for Cody's treatment plan while in the hospital?
Cody will be medically stabilized while in the hospital.
428
The treatment team meets to discuss Cody's plan of care. Which of the following factors will be priorities when planning interventions?
Readiness to change and support system
429
Cody is preparing for discharge. He tells you, "Dr. Jacobson is putting me on some medication called naltrexone. How will that help me?" Which response is appropriate teaching regarding naltrexone?
"It helps prevent relapse by reducing drug cravings."
430
Which problem is NOT considered a causative agent in delirium?
Antibiotic therapy
431
The term "perceptual disturbance" refers to difficulty...
Processing information about one's internal and external environment
432
Which event would a client with early stage 4 Alzheimer's disease have greatest difficulty remembering?
What he or she ate for breakfast
433
When a delirious client insists that a vacuum hose is a large, poisonous snake, the nurse recognizes that this client is...
Experiencing an illusion
434
A client with delirium strikes out at a staff member. The nurse can most correctly hypothesize that this behavior is related to...
Fear
435
Which type of dementia has a clear genetic link?
Alzheimer's disease
436
What is the usual progression of Alzheimer's disease?
Progressive deterioration
437
A client diagnosed with Alzheimer's disease looks confused when the phone rings and cannot recall many common household objects by name, such as a pencil or glass. The nurse can document this loss of function as...
Agnosia
438
The family of a client diagnosed with Alzheimer's disease mentions to the nurse that seeing his loss of function has been very difficult. A nursing diagnosis that might be considered for such a family would be...
Anticipatory Grieving
439
A nursing diagnosis appropriate for a client with Alzheimer's disease, regardless of the stage, would be...
Risk for injury
440
Evelyn, a 73-year-old woman with pneumonia becomes agitated after being admitted to the intensive care unit through the emergency department. Her vital signs are erratic, and her thinking seems disorganized. During her first 24 hours in ICU, the patient varies from somnolent to agitated and from laughing to angry shouting. Her daughter reports that the patient “was never like this at home.” What is the most likely explanation for the situation?
The patient is experiencing delirium secondary to the pneumonia.
441
Intervention(s) appropriate for Evelyn and other hospitalized patients experiencing delirium include which of the following?
Ensuring that a clock and a sign indicating the day and date are displayed where the patient can see them easily; being prepared for possible hostile responses to efforts to take vital signs or provide direct physical care; speaking with the patient frequently for short periods for reassurance, assisting the patient in remaining oriented, and ensuring the patient’s safety; anticipating that the patient may try to leave if agitated and providing for continuous direct observation to prevent wandering
442
3. Mrs. Smith dies at the age of 82. In the 2 months following her death, her husband, aged 84 and in good health, has begun to pay less attention to his hygiene and seems less alert to his surroundings. He complains of difficulty concentrating and sleeping and reports that he lacks energy. His family sometimes has to remind and encourage him to shower, take his medications, and eat, all of which he then does. Which response is most appropriate?
Arrange for an appointment with a therapist for evaluation and treatment of suspected depression
443
You are preparing Genevieve, an 86-year-old patient diagnosed with Alzheimer’s disease, for discharge and giving discharge education to Genevieve’s family, who will be caring for her. Which of the following intervention(s) would be beneficial to teach Genevieve’s family?
Recommend switching to hospital-type gowns to facilitate bathing, dressing, and other physical care of the patient; discourage wandering by installing complex locks or locks placed at the tops of doors where the patient cannot readily reach them; for situations in which the patient becomes upset, teach loved ones to listen briefly, provide support, and then change the topic; encourage caregivers to care for themselves, as well as the patient, via use of support resources such as adult day care or respite care.
444
Which statement about dementia is accurate?
Hypertension, diminished activity levels, and head injury increase the risk of dementia.
445
The physician mentions to the nurse that a client who is about to be admitted has "sundowning." The nurse can expect to assess nightly...
Agitation
446
The nurse caring for a client with Alzheimer's disease can anticipate that the family will need information about therapy with...
Acetylcholinesterase inhibitors.
447
A family member reports that the client had been oriented and able to carry on a logical conversation last evening, but this morning she is confused and disoriented. The nurse can suspect that the client is displaying symptoms associated with...
Delirium
448
When preparing educational materials for the family of a client diagnosed with progressive dementia, the nurse will include information related to local...
Family support groups
449
A client is brought to the hospital by her daughter, who visited this morning and found her mother to be confused and disoriented. When the client is admitted, the daughter states, "I'll take her glasses and hearing aid home, so they don't get lost." The best reply for the nurse would be...
"I would like to have your mother wear them. It will help her to be less confused."
450
The nurse is expected to perform an assessment of a client suspected to be in the earliest stage of Alzheimer's disease. What finding would be out of character if the client truly has stage 2 Alzheimer's disease?
Willingness to respond directly to questions posed by nurse; Confabulation to compensate for forgotten information
451
A client diagnosed with Alzheimer's disease has become more forgetful and has difficulty performing familiar tasks like bathing and dressing. The nurse would assess the client as being in the stage of Alzheimer's disease labeled...
Stage 3, Moderate-Severe
452
An initial intervention the nurse might suggest to the family members of a client diagnosed with Alzheimer's disease who has begun incontinence would be to...
Label the bathroom door with a picture
453
Dementia in an older adult is often a misdiagnosis for...
Depression
454
The family members of a client with stage 1 Alzheimer's disease have jobs and cannot provide adequate supervision for the client. A reasonable alternative for the nurse to explore with them would be...
Day care
455
Elaine is a 62-year-old patient who is recovering from a urinary tract infection during which she was hospitalized with delirium. She is following up with her primary care provider 4 weeks after being discharged. Based on research regarding possible postdelirium complications, what are important areas for the provider to assess at this time?
Depression and level of cognition
456
Trudy is a 72-year-old patient hospitalized with pneumonia and experiencing delirium. She points to her IV pole and screams, "Get him out of here! He's going to hurt me!" You recognize that what Trudy is experiencing is a(n):
Illusion
457
Based on current research, which of the following patients is most likely to develop dementia?
Milo, who is a former boxer and is now a trainer
458
Rosa, a 78-year-old patient with Alzheimer's disease, picks up her glasses from the bedside table but does not recognize what they are or their purpose. She is experiencing:
Agnosia
459
Claire is a student nurse working with Carl, an 82-year-old patient with dementia. She finds herself frustrated at times by not knowing how best to care for or communicate with Carl. Which of the following statements she could make to Carl illustrates best care practice?
Positive regard: "Carl, I am glad to be here caring for you today. Let's talk about your plans for the day."
460
A nurse caring for a client who has been diagnosed with a personality disorder should expect that the client will exhibit...
Inflexible and maladaptive responses to stress
461
Which statement is descriptive of clients with a personality disorder?
They are resistant to behavioral change.
462
Research has indicated that the antisocial personality may be characterized by...
Lack of remorse
463
The primary goal of milieu therapy for clients diagnosed with personality disorders is...
To manage the effect the behavior has on the entire group
464
Characteristic behaviors the nurse will assess in the narcissistic client are...
Grandiose, exploitive, and rage-filled behavior
465
The client diagnosed with a personality disorder who is most likely to be admitted to a psychiatric unit is one who has...
Borderline personality disorder and is impulsive
466
Characteristics the nurse will assess in the client diagnosed with antisocial personality disorder are...
Deceitfulness, impulsiveness, and lack of empathy
467
Playing one staff member against another is an example of...
Splitting
468
Splitting is a process in which the client...
Sees things as divided into "all good" or "all bad"
469
A client arrested for an assault in which he savagely beat a classmate states, "The guy deserved everything he got." The behaviors described are most consistent with the clinical picture of...
Antisocial personality disorder
470
Josie, a 27-year-old patient, complains that most of the staff do not like her or care what happens to her, but you are special and she can tell that you are a caring person. She talks with you about being unsure of what she wants to do with her life and her “mixed-up feelings” about relationships. When you tell her that you will be on vacation next week, she becomes very angry. Two hours later, she is found using a curling iron to burn her underarms and explains that it “makes the numbness stop.” Given this presentation, which personality disorder would you suspect?
Borderline
471
Which statement about persons with personality disorders is accurate?
They tend not to perceive themselves as having a problem but instead believe their problems are caused by how others behave toward them.
472
Lacey, a 19-year-old patient, shows you multiple fresh, serious (but non-life-threatening) self-inflicted cuts on her forearm. Which response would be most therapeutic?
“After I care for your wounds, I’d like you to write down what you were thinking and feeling before you cut yourself; then we will discuss it.”
473
Alicia, a 31-year-old patient, is flirting with a peer. She is overheard asking him to convince staff to give her privileges to leave the inpatient mental health unit. Later she offers you a backrub in exchange for receiving her 10:00 p.m. Xanax an hour early. Which response(s) to such behaviors would be most therapeutic?
Label the behavior as undesirable, and explore with Alicia more effective ways to meet her needs; by role-playing, demonstrate other approaches Alicia could use to meet her needs; explain that such behavior is unacceptable, and give Alicia specific examples of consequences that will be enacted if the behavior continues
474
A patient becomes frustrated and angry when trying to get his MP3 player and headset to function properly and angrily throws it across the room, nearly hitting a peer with it. Which intervention(s) would be the most therapeutic?
Place the patient in seclusion for 1 hour to allow him to de-escalate; explore with the patient how he was feeling as he worked with the music player; point out the consequences of such behavior and note that it cannot be tolerated; encourage the patient to recognize signs of mounting tension and seek assistance
475
Which behavior would be inconsistent with defining characteristics for the nursing diagnosis of ineffective coping?
Interdependence
476
When providing care for a client diagnosed with borderline personality disorder, the nurse will need to consider strategies for dealing with the client's...
Mood shifts, impulsivity, and splitting
477
A newly admitted client has an axis II diagnosis of schizoid personality disorder. The nursing intervention of highest priority will be to...
Respect need for social isolation
478
A client diagnosed with obsessive-compulsive personality disorder takes the nurse aside and mentions, "I've observed you interacting with that new patient. You are not approaching him properly. You should be more forceful with him." The best response for the nurse would be...
"I will be continuing to follow the care plan for the patient."
479
The priority nursing intervention for a client diagnosed with borderline personality disorder is to...
Assess for suicidal and self-mutilating behaviors
480
A nurse who is idealized by a client is at risk for...
Becoming overinvolved and being protective and indulgent
481
Clients demonstrating characteristics of personality disorders have various self-defeating behaviors and interpersonal problems despite having near-normal ego functioning and intact reality testing. A nursing diagnosis that addresses this sort of interpersonal dysfunction is...
Impaired social interactions
482
Mary Alice is a 37-year-old patient referred to the mental health clinic with a suspected personality disorder. She is withdrawn and suspicious and states she has always preferred to be alone. She describes herself as having "special powers" and states that she is thinking of opening a business where she gives "readings" to people about their future. She states, "I believe we can all read each other's thoughts at times." Based on this presentation, you suspect:
Schizotypal personality disorder (STPD)
483
Belinda is a 24-year-old patient with borderline personality disorder (BPD). She is admitted to the inpatient psychiatric unit following a suicide attempt. You are caring for Belinda. Which of the following statements by Belinda illustrates a primary coping style of persons with BPD?
"Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here."
484
Which is true of pharmacological therapies for treatment of personality disorders?
Although there are no FDA-approved drugs specific to the treatment of personality disorders, patients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident.
485
Which of the following are true of antisocial personality disorder (APD)?
Persons with APD are concerned with personal pleasure and power; It is characterized by deceitfulness, disregard for others, and manipulation; Frontal lobe dysfunction is a brain change identified in APD
486
Which is the greatest protective factor against the risk of suicide?
A sense of responsibility to family, including spouse and children
487
An assessment tool that is useful to nurses in rating suicide risk is the...
Sad Persons scale
488
Which statement is a fact about suicide?
A client with schizophrenia is at great risk for attempting suicide.
489
A suicidal individual calls a suicide hot line. This represents the level of intervention classified as...
Secondary
490
Which neurotransmitter has been implicated as playing a part in the decision to commit suicide?
Serotonin
491
When working with a client who may have made a covert reference to suicide, the nurse should...
Ask the client directly if he or she is thinking of attempting suicide
492
Nurses should assess the lethality of the client's plan for suicide. What factor would be irrelevant to that assessment?
How long the client has been suicidal
493
The suicide intervention that has the greatest impact on a client's safety is...
One-on-one observation by the staff
494
Some of the most important characteristics of staff members who work with suicidal clients are...
Warmth and consistency when interacting
495
The nurse proposes that a suicidal client enter into a no-suicide contract. Such a contract would contain a provision that the client promises...
Not to attempt suicide in the next 24 hours
496
Griffin is a 19-year-old student who volunteers for a depression screening at his college. He identifies himself as gay. Which of the following is true based on current knowledge of the gay, lesbian, and bisexual community and suicide risk?
Griffin has a higher suicide risk than his heterosexual peers.
497
You are admitting Joel, a 39-year-old patient with depression. Which assessment statement(s) would be appropriate to ask Joel to assess suicide risk?
Do you ever think about suicide; are you thinking of hurting yourself; do you sometimes wish you were dead; has it ever seemed as if life is not worth living; if you were to kill yourself, how would you do it; does it seem as if others might be better off if you were dead?
498
Which person is at the highest risk for suicide?
A young, single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.
499
Which intervention(s) maximize the safety of a patient who is actively suicidal on an inpatient mental health unit?
Place the patient on every-15-minute checks; place the patient in a room near the nurses’ station; install breakaway curtain rods, coat hooks, and shower rods
500
Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara?
Assess the patient thoroughly, and reassess the patient at regular intervals as levels of risk fluctuate; meet regularly with the patient to provide opportunities for the patient to express and explore feelings; administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group; help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic
501
A client tells the nurse that he believes his situation is intolerable. The nurse assesses that the client is isolating socially. A nursing diagnosis that should be considered is...
Hopelessness
502
The nursing diagnosis "risk for self-directed violence" has been added to the care plan of a suicidal client. The most appropriate short-term goal would be that while hospitalized, the client will...
Seek help when feeling self-destructive
503
An identical twin recently committed suicide. The parent tells the nurse, "Thank heavens suicide does not run in families. I won't have to worry about my other son." The nurse's response will be based on the understanding that this optimism is...
Not based on accurate knowledge because twin studies suggest the presence of genetic factors in suicide
504
A client with a history of repeated suicidal attempts refuses to participate in a no-suicide contract. What intensity of nursing observation should be instituted?
Constant 24-hour, one-to-one observation at arm's length
505
The nurse observes the meal tray about to serve a suicidal client. Which item should be removed from the tray?
Metal utensils
506
A client on one-to-one supervision at arm's length indicates a need to go to the bathroom but reports, "I cannot 'go' with you standing there." The nurse should...
Say "For your safety I can be no more than an arm's length away."
507
Unit practice requires inspection of all items being brought onto the unit by visitors. This can be most effectively done by...
Having a staff member sit at the door and check packages as visitors enter
508
The morning after he was admitted, a suicidal client wishes to use the cordless electric razor the staff took from his suitcase the night before. The nurse should...
Allow him to use the razor under staff supervision
509
If a suicidal client is to be treated outside the hospital, which intervention would be of high priority?
Have the client identify three people to call if he is overwhelmed by hopelessness.
510
When a colleague committed suicide, the nurse stated "I do not understand why she would take her own life." This is an expression of...
Denial
511
Which of the following statements is true regarding culture and protective factors against suicide?
Religion and the importance of family are protective factors for Hispanic Americans.
512
You are working with Ava, another student nurse on the psychiatric unit. She tells you she doesn't want to ask her patient about suicidal ideation because "It might put ideas in her head about suicide." Your best response would be:
"Actually, it's a myth that asking about suicide puts ideas into someone's head."
513
You are talking with Jennifer, a patient admitted with depression. Which statement by the patient indicates the need for further assessment?
"I think things will be better soon."
514
Jermaine attempted suicide while intoxicated by using a gun, although the bullet missed when he staggered. Jermaine's method of using a gun to attempt suicide is considered:
High risk, or a hard method
515
Jermaine scores a 7 on the SAD PERSONS scale. What action needs to be taken?
Hospitalize or commit
