Nurse Renalyn discovers that a male client with obsessivecompulsive disorder (OCD) is attempting to resist the compulsion.

Based on this finding, the nurse should assess the client for:

c. Telling the client to lie down and rest d. Talking continually to the client by explaining what is happening

a. Feelings of failure b. Depression c. Excessive fear d. Increased anxiety

An obsessive-compulsive client who attempts to resist the compulsion must be evaluated for increased anxiety. A compulsion is a repetitive, intentional behavior that the client performs in response to a certain obsession; it's aimed at neutralizing or decreasing anxiety. Resisting the compulsion may increase the client's anxiety. Although a client with OCD may have feelings of failure, depression, and excessive fear, these aren't responses to resisting the compulsion. 2. A female client comes to the emergency department while experiencing a panic attack. Nurse Jonathan can best respond to a client having a panic attack by:

The nurse should remain with the client until the attack subsides. If the client is left alone he may become more anxious. Giving false reassurance is inappropriate in this situation. The client should be allowed to move around and pace to help expend energy. The client may be so overwhelmed that he can't follow lengthy explanations or instructions, so the nurse should use short phrases and slowly give one direction at a time. 3. Nurse Krishna notices that a female client with obsessivecompulsive disorder dresses and undresses numerous times each day. Which comment by the nurse would be most therapeutic?

a. Staying with the client until the attack subsides b. Telling the client everything is under control

a. "I saw you change clothes several times today. That must be very tiring." b. "Try to dress only once per day so you won't be so tired." c. "It bothers me to see you always so busy." d. "It's foolish to change clothes so many times in one day."

Option A focuses on the client's feelings in an empathetic way, helping to reduce the intensity of the ritualistic behavior and promoting trust and rapport. Implying that the client's behavior is tiring, bothersome, or foolish would convey disapproval, impede trust and rapport, promote dysfunctional behavior, and worsen anxiety. 4. Nurse Luz is formulating a short-term goal for a client suffering from a severe obsessivecompulsive disorder (OCD). An appropriately stated short-term goal is that after 1 week, the client will:

reasons for rituals takes time and isn't a realistic goal after 1 week. Most clients with OCD are aware that the ritual is irrational but can't stop it, making option D inappropriate as well. 5. Because antianxiety agents such as chlordiazepoxide (Librium) can potentiate the effects of other drugs, nurse Raquel should incorporate which of the following instructions in her teaching plan?

a. Demonstrate decreased anxiety. b. Participate in a daily exercise group. c. Identify the underlying reasons for rituals. d. State that the rituals are irrational.

a. Avoid mixing antianxiety agents with alcohol or other central nervous system (CNS) depressants b. Avoid taking antianxiety drugs at bedtime c. Avoid taking antianxiety drugs on an empty stomach d. Avoid consuming aged cheese when taking antianxiety agents

Participating in a daily exercise group refocuses the client's time toward adaptive activities and may reduce anxiety. Option A isn't stated specifically enough to allow for evaluation; for this goal to be measurable, specific objectives must be stated such as, "The client will verbalize feeling less anxious." Option C is incorrect because identifying the underlying

Potentiating effect refers to a drug's ability to increase the potency of another drug if taken together. Therefore, the client should be instructed to avoid alcohol while taking Librium because it potentiates the drug's CNS depressant effect. Taken at bedtime, this drug will induce sleep. Librium comes in capsule form and usually can be taken with water. Aged cheese is restricted

with monoamine oxidase inhibitors, not Librium. 6. Danilo, arrives on the psychiatric unit exhibiting extreme excitement, disorientation, incoherent speech, agitation, frantic and aimless physical activity, and grandiose delusion. Which nursing diagnosis takes highest priority for the client at this time?

psychiatric unit where she is diagnosed with conversion disorder. The client asks nurse Rose, "Why has this happened to me?" What is the nurse's best response?

a. Ineffective individual coping b. Hopelessness c. Risk for injury d. Disturbed identity

This client is at increased risk for injury because of severe hyperactivity, disorientation, and agitation. Although the other options also are appropriate, the client's safety takes highest priority. The nurse should take immediate action to protect the client from injury. 7. Gina, age 18, is highly dependent on her parents and fears leaving home to go away to college. Shortly before the fall semester starts, she complains that her legs are paralyzed and is rushed to the emergency department. When physical examination rules out a physical cause for her paralysis, the physician admits her to the

a. "You've developed this paralysis so you can stay with your parents. You must deal with this conflict if you want to walk again." b. "It must be awful not to be able to move your legs. You may feel better if you realize the problem is psychological, not physical." c. "Your problem is real but there is no physical basis for it. We'll work on what is going on in your life to find out why it's happened." d. "It isn't uncommon for someone with your personality to develop a conversion disorder during times of stress."

The nurse must be honest with the client by telling her that the paralysis has no physiologic cause while also conveying empathy and acknowledging that her symptoms are real. The client will benefit from psychiatric treatment, which will help her understand the underlying cause of her symptoms. After the psychological conflict is

resolved, her symptoms will disappear. Saying that it must be awful not to be able to move her legs wouldn't answer the client's question; knowing that the cause is psychological wouldn't necessarily make her feel better. Telling her that she has developed paralysis to avoid leaving her parents or that her personality caused her disorder wouldn't help her understand and resolve the underlying conflict. 8. Dr. Luistro orders a new medication for a client with generalized anxiety disorder. During medication teaching, which statement or question by the nurse Kesselyn would be most appropriate?

right to refuse the medication. Instead of simply ordering the client to take it, as in option A, the nurse should provide the information the client needs to make an informed decision. Attempting to make the client feel guilty, as in option C, or threatening the client, as in option D, would increase anxiety. 9. After seeking help at an outpatient mental health clinic, a client who was raped while walking her dog is diagnosed with posttraumatic stress disorder (PTSD). Three months later, the client returns to the clinic, complaining of fear, loss of control, and helpless feelings. Which nursing intervention is most appropriate for this client?

a. "Take this medication. It will reduce your anxiety." b. "Do you have any concerns about taking the medication?" c. "Trust us. This medication has helped many people. We wouldn't have you take it if it were dangerous." d. "How can we help you if you won't cooperate?"

a. Exploring the meaning of the traumatic event with the client b. Allowing the client time to heal c. Giving sleep medication, as prescribed, to restore a normal sleep-wake cycle d. Recommending a highprotein, low-fat diet

Providing an opportunity for the client to express concerns about a new medication and to make a choice about taking it can help the client regain a sense of control over his life. The client has the

The client with PTSD needs encouragement to examine and understand the meaning of the traumatic event and consequent losses. Otherwise, symptoms may worsen and the client may become

depressed or engage in selfdestructive behavior such as substance abuse. The client must explore the meaning of the event and won't heal without this, no matter how much time passes. Behavioral techniques, such as relaxation therapy, may help decrease the client's anxiety and induce sleep. The physician may prescribe antianxiety agents or antidepressants cautiously to avoid dependence; sleep medication is rarely appropriate. A special diet isn't indicated unless the client also has an eating disorder or a nutritional problem. 10. Jane is admitted to an inpatient psychiatric unit for treatment of obsessive-compulsive symptoms. Obsessive-compulsive disorder (OCD) is associated with:

no physiologic cause typify somatoform disorder. Apprehension and inability to concentrate characterize anxiety disorders. 11. A client with obsessivecompulsive disorder and ritualistic behavior must brush the hair back from his forehead 15 times before carrying out any activity. Nurse Leo notices that the client's hair is thinning and the skin on the forehead is irritated possible effects of this ritual. When planning the client's care, the nurse should assign highest priority to:

a. Physical signs and symptoms with no physiologic cause b. Apprehension c. Inability to concentrate d. Repetitive thoughts and recurring, irresistible impulses

a. Helping the client identify how the ritualistic behavior interferes with daily activities b. Exploring the purpose of the ritualistic behavior c. Setting consistent limits on the ritualistic behavior if it harms the client or others d. Using problem solving to help the client manage anxiety more effectively

OCD is characterized by repetitive thoughts that the client can't control or exclude from consciousness, along with recurring, irresistible impulses to perform a particular action. Physical signs and symptoms with

Client safety is the paramount concern and must be maintained. Therefore, setting consistent limits on potentially harmful ritualistic behavior takes highest priority. Although the other options are important, they take lower priority. For instance, helping the client identify how the ritualistic

behavior interferes with daily activities increases the client's motivation for using more effective coping behavior. Exploring the purpose of the ritualistic behavior helps the client see this behavior as an attempt to control anxiety. As the client learns new ways to manage anxiety, the ritualistic behavior is likely to decrease. 12. During alprazolam (Xanax) therapy, nurse Rachel should be alert for which dose-related adverse reaction?

13. A client is admitted to the psychiatric unit with a diagnosis of conversion disorder. Since witnessing the beating of his wife at gunpoint, he has been unable to move his arms, complaining that they are paralyzed. When planning the client's care, nurse Jay should focus on:

a. Ataxia b. Hepatomegaly c. Urticaria d. Rash

Dose-related adverse reactions to alprazolam include drowsiness, confusion, ataxia, weakness, dizziness, nystagmus, vertigo, syncope, dysarthria, headache, tremor, and a glassy-eyed appearance. These dose-related reactions diminish as therapy continues. Although hepatomegaly may occur with benzodiazepine use, this adverse reaction is rare and isn't dose-related. Idiosyncratic reactions to benzodiazepines may include a rash and acute hypersensitivity reactions; however, they aren't dose-related.

a. Helping the client identify and verbalize feelings about the incident b. Convincing the client that his arms aren't paralyzed c. Developing rehabilitation strategies to help the client learn to live with the disability d. Talking about topics other than the beating to avoid causing anxiety

In conversion disorder, the client represses and converts emotional conflicts into motor, sensory, or visceral symptoms with no physiologic cause. Interventions should focus on helping the client identify the underlying emotional problem. A client with conversion disorder can't be convinced that the physical problem isn't real; attempts to convince him may lead him to seek other health care providers who may accept the reality of his symptoms. Treating the physical symptoms as longterm or permanent may encourage the client to maintain them.

Ignoring the cause of the symptoms would prevent the client from dealing with his feelings about his wife's beating. 14. A male client with borderline personality disorder tells nurse Valerie, "You're the only nurse who really understands me. The others are mean." The client then asks the nurse for an extra dose of antianxiety medication because of increased anxiety. How should the nurse respond?

and "bad guys" to meet their needs; staff members must maintain consistency and a united front at all times. The nurse shouldn't take the client's statements personally because this would interfere with the ability to maintain a therapeutic relationship. 15. Angel, is admitted to the unit visibly anxious. When assessing her, the nurse would expect to see which of the following cardiovascular effects produced by the sympathetic nervous system?

a. "I'll talk to the physician right away. I don't think they give you enough medicine." b. "I'll have to discuss your request with the team. Can we talk about how you're feeling right now?" c. "I don't want to hear you say negative things about the other nurses." d. "You know you can't have extra medication. Why do you keep asking?"

a. Syncope b. Decreased blood pressure c. Increased heart rate d. Decreased pulse rate

Sympathetic cardiovascular responses to stress include increased heart rate, cardiac contractility, and cardiac output; increased blood pressure; and peripheral vasoconstriction. Syncope is a response to parasympathetic stimulation. 16. A male client with Alzheimer's disease has a nursing diagnosis of Risk for injury related to memory loss, wandering, and disorientation. Which nursing intervention should appear in this client's plan of care to prevent injury?

This response appropriately focuses on the emotional content of the client's message and helps the client identify feelings. Focusing on the request for extra medication would allow the client to ignore the underlying emotional issues. Clients with borderline personality disorder commonly divide the staff into "good guys"

a. Provide the client with detailed instructions b. Keep the client sedated whenever possible c. Remove hazards from the environment d. Use restraints at all times

By removing environmental hazards, such as bottles of hydrogen peroxide and benzoin, the nurse can help prevent injury to the client. For a client with Alzheimer's disease, the nurse should provide single, simple instructions, rather than many detailed instructions. The nurse should administer medication as prescribed and as needed not to keep the client sedated. The nurse should use restraints only when required to prevent self-harm by the client. 17. Rudy was found wandering in a local park is unable to state who or where he is or where he lives. He is brought to the emergency department, where his identification is eventually discovered. The client's wife states that he was diagnosed with Alzheimer's disease 3 years ago and has had increasing memory loss. She tells nurseAngelie she is worried about how she'll continue to care for him. Which response by the nurse would be most helpful?

a. "Because of the nature of your husband's disease, you should start looking into nursing homes for him." b. "What aspect of caring for your husband is causing you the greatest concern?" c. "You may benefit from a support group called Mates of Alzheimer's Disease Clients." d. "Do you have any children or friends who could give you a break from his care every now and then?"

The nurse should determine the specific concerns of the client's wife. Jumping to conclusions regarding the client's need for a nursing home or other care placement options would be inappropriate. The nurse must tailor care to the client and family, focusing on their needs. Although support groups, children, and friends may prove helpful to the client's wife, the nurse must establish a plan for continued care that addresses her specific concerns. 18. Nurse Agnes is aware that nursing action most appropriate when trying to diffuse a male client's impending violent behavior?

a. Helping the client identify and express feelings of anxiety and anger b. Involving the client in a quiet activity to divert attention c. Leaving the client alone until he can talk about his feelings d. Placing the client in seclusion

mouth daily, for 1 week. Now the client reports wanting to stop taking the medication because he still feels depressed. At this time, what is the best response of nurse Charlyn?

In many instances, the nurse can diffuse impending violence by helping the client identify and express feelings of anger and anxiety. Such statements as "What happened to get you this angry?" may help the client verbalize feelings rather than act on them. Close interaction with the client in a quiet activity may place the nurse at risk for injury should the client suddenly become violent. An agitated and potentially violent client shouldn't be left alone or unsupervised because the danger of the client's acting out is too great. The client should be placed in seclusion only if other interventions fail or the client requests this. Unlocked seclusion can be helpful for some clients because it reduces environmental stimulation and provides a feeling of security. 19. A male client has been taking imipramine (Tofranil), 125 mg by

a. "Imipramine may not be the most effective medication for you. You should call your physician for further evaluation." b. "Because imipramine must build to a therapeutic level, it may take 2 to 3 weeks to reduce depression." c. "The physician may need to increase the dosage for you to get the medication's maximum benefit." d. "Don't stop taking the medication abruptly because you may develop serious adverse effects."

Antidepressant agents, such as imipramine, don't produce antidepressant effects until they reach a therapeutic level in the blood, usually about 2 to 3 weeks after the initial dose. Therefore, the nurse should encourage the client to continue therapy at least until the drug reaches that level. After this time, if the client's depression doesn't abate, the nurse may use the other responses.

20. A male client with Alzheimer's disease mumbles incoherently and rambles in a confused manner. To help redirect the client's attention, nurse Mark should encourage the client to:

a. Fold towels and pillowcases b. Play cards with another client c. Participate in a game of charades d. Perform an aerobic exercise

Folding towels and pillowcases is a simple activity that redirects the client's attention. Also, because this activity is familiar, the client is likely to perform it successfully. Cards, charades, and aerobic exercise are too complicated for a confused client. 21. Nurse Francis is aware that the nursing preparations for a client undergoing electroconvulsive therapy (ECT) resemble those used for:

nothing by mouth for 8 hours before ECT to reduce the risk of vomiting and aspiration. Also, the nurse should have the client void before treatment to decrease the risk of involuntary voiding during the procedure; remove any full dentures, glasses, or jewelry to prevent breakage or loss; and make sure the client is wearing a hospital gown or loose-fitting clothing to allow unrestricted movement. Usually, these preparations aren't indicated for a client undergoing physical therapy, neurologic examination, or cardiac stress testing. 22. Nurse Hershey must administer activated charcoal before administering certain other drugs to a client who's taken an overdose. Which drug is rendered inactive when administered concomitantly with activated charcoal?

a. Physical therapy b. Neurologic examination c. General anesthesia d. Cardiac stress testing

a. Warfarin sodium (Coumadin) b. Ipecac syrup c. Simethicone (Phazyme) d. Famotidine (Pepcid)

The nurse should prepare a client for ECT in a manner similar to that for general anesthesia. For example, the client should receive

Ipecac syrup is rendered inactive when administered concomitantly with activated charcoal. 23. Dr. Tan orders electroconvulsive therapy (ECT) for a severely depressed client who

fails to respond to drug therapy. When teaching the client and family about this treatment, nurse Bernadeth should include which most important point about ECT?

the adolescent is brought to the community mental health agency for evaluation. This adolescent is at risk for:

a. An anesthesiologist will administer ECT b. ECT can cure depression c. ECT will induce a seizure d. The client will remember the shock of ECT but not the pain

a. Suicide b. Anorexia nervosa c. School phobia d. Psychotic break

Reserved for clients with acute depression who don't respond to pharmacologic or psychiatric measures, ECT is the passage of an electrical current through the brain to induce a brief seizure. According to ECT proponents, the seizure causes desirable changes in neurotransmitters and receptor sites similar to those caused by antidepressant drugs. ECT is administered by a physician or an anesthesiologist. Although ECT may reduce the severity of depression, it doesn't necessarily cure it. Before ECT, the client receives a medication that provides short-term amnesia of the entire event. 24. Julius, an adolescent becomes increasingly withdrawn, is irritable with family members, and has been getting lower grades in school. After giving away a stereo and some favorite clothes,

Changes in academic performance and familial communications, social withdrawal, and giving away of treasured possessions suggest that this adolescent is contemplating suicide. Anorexia nervosa would cause weight loss and other related symptoms. This adolescent's signs and symptoms don't suggest fear of school and typify depression, not psychosis. 25. Nurse Bea is aware the when preparing a client for electroconvulsive therapy (ECT), she should make sure that:

a. The client sees family members immediately before the procedure b. The client is scheduled for a brain scan immediately after the procedure c. The client has undergone a thorough medical evaluation d. The client has received lithium carbonate (Lithonate)

Before an ECT treatment, the nurse should ensure that the client has had a medical evaluation that includes an ECG, a chest X-ray, neurologic and laboratory tests, and spinal X-rays, if indicated. Although making sure that the client sees family members immediately before the procedure would be appropriate, it's unnecessary (unless the client requests this). A brain scan isn't required after ECT because it can't evaluate the therapeutic effects of this treatment. Lithium must be discontinued before ECT because it prolongs the effects of succinylcholine chloride (Anectine), a muscle relaxant given just before the shock is delivered