Mental Health Exam 2 Study guide

1. You are caring for Maggie, a 78-year-old with Alzheimer's disease and Stage III breast cancer who can no longer communicate verbally. What is the appropriate way to assess Maggie's pain? a. The Wong-Baker FACES Pain Rating Scale b. The McGill Pain Questionnaire c. Direct questioning with the use of a Likert 1-10 pain rating scale d. The Pain Assessment in Advanced Dementia scale d. The Pain Assessment in Advanced Dementia scale 1. Joshua, a 17-year-old outpatient, has been diagnosed with intermittent explosive disorder. As you care for Joshua, you anticipate that the psychiatric care provider may prescribe which of the following? a. A benzodiazepine b. An anticonvulsant c. A psychostimulant d. An anticholinesterase inhibitor b. An anticonvulsant 3. Blake is a 15-year-old patient admitted for emergency observation after stealing a car and being pulled over by the police for reckless driving. He also has a history of pyromania. Which of the following is the priority assessment? a. Illegal behaviors in the past six months b. Assessment of childhood development and family interactions c. Suicide risk d. Feelings of remorse c. Suicide risk 4. ________________ disorder is one of the most frequently diagnosed disorders in children and adolescents and is a problem in the adult population as well, with adults experiencing the same type of symptoms. It is characterized by disregard of the rights of others and disdain for societal rules. Answer: Conduct 5. When working on an inpatient adolescent mental health unit, staff may be able to maintain safety and a calm environment when they interact with patients using: a. High expressed emotion—"You must stop that immediately!"—using a stern tone. b. Strict rule adherence—"There are no snacks after 10 pm. No exceptions!"—using a authoritarian tone. c. Suppressed emotion—"Hey, let's just talk about something else that doesn't upset you!"—using a light, friendly tone. d. Low expressed emotion—"Please go to your room for quiet time now"—using a neutral, calm tone. d. Low expressed emotion—"Please go to your room for quiet time now"—using a neutral, calm tone. 4. 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? a. Symptoms of intoxication include dilation of the pupils, dryness of the oronasal cavity, and excessive motor activity. b. Medical management focuses on removing the drugs from the body. c. Withdrawal is simple and rarely complicated. d. Postwithdrawal symptoms include fatigue and depression. d. Postwithdrawal symptoms include fatigue and depression. 5. 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: a. Alcohol and CNS depressants. b. CNS stimulants and hallucinogens. c. Narcotic antagonists and caffeine. d. Opiates and inhalants. a. Alcohol and CNS depressants. CH 21: Which of the following statements are true regarding childhood-onset conduct disorder? (select all that apply): -It is more commonly diagnosed in males -It is characterized by feelings of remorse and regret. -It is usually diagnosed in late teen years. -It is characterized by disregard for the rights of others. -Those with conduct disorder rationalize their aggressive behaviors. -It is usually outgrown by early adulthood. Answer: -It is more commonly diagnosed in males. -It is characterized by disregard for the rights of others. -Those with conduct disorder rationalize their aggressive behaviors Childhood-onset conduct disorder is more common in male patients and is seen before the age of 10 years. Hallmarks include disregard for the rights of others, physical aggression, poor peer relationships, and lack of feelings of guilt or remorse. The other options are the opposite of what is correct. Eli is a 17-year-old patient admitted to the psychiatric unit with conduct disorder after threatening his mother during an argument. Which of the following would be an appropriate short-term outcome for Eli? Engages in appropriate coping skills to manage stressors Expresses feelings Maintains self-control during hospitalization Mother will improve communication skills to interact with Eli Expresses feelings Expressing feelings is an appropriate short-term outcome and would be a good start to working with the patient to establish rapport, develop coping skills, and set goals. Engaging in appropriate coping skills and maintaining self-control are desired outcomes. Outcomes for the patient are being discussed, not outcomes for the patient's mother. CH22 Which of the following is true regarding substance addiction and medical comorbidity? Most substance abusers do not have medical comorbidities. There has been little research done regarding substance addiction disorders and medical comorbidity. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. Comorbid conditions are thought to positively affect those with substance addiction in that these patients seek help for symptoms earlier. Conditions such as hepatitis C, diabetes, and HIV infection are common comorbidities. The more common co-occurring medical conditions are hepatitis C, diabetes, cardiovascular disease, HIV infection, and pulmonary disorders. The high comorbidity appears to be the result of shared risk factors, high symptom burden, physiological response to licit and illicit drugs, and the complications from the route of administration of substances. Most substance abusers do have medical comorbidities. There is research such as the National Comorbidity Survey Replication (NCS-R) showing the correlation between medical comorbidities and psychiatric disorders. It is more likely that medical comorbidities negatively affect substance addiction in that they cause added symptoms, stress, and burden. 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: intoxication. tolerance. withdrawal. addiction. Answer: tolerance. Tolerance is described as needing increasing greater amounts of a substance to receive the desired result to become intoxicated or finding that using the same amount over time results in a much-diminished effect. Intoxication is the effect of the drug. Withdrawal is a set of symptoms patients experience when they stop taking the drug. Addiction is loss of behavioral control with craving and inability to abstain, loss of emotional regulation, and loss of the ability to identify problematic behaviors and relationships. CH23 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: apraxia. agnosia. aphasia. agraphia. Answer: agnosia. Agnosia is the loss of sensory ability to recognize objects. Apraxia is the loss of purposeful movement in the absence of motor or sensory impairment. Aphasia is the loss of language ability. Agraphia is the loss of the ability to read or write. 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): hallucination. delusion. illusion. confabulation. Answer: illusion. Illusions are errors in perception of sensory stimuli. The stimulus is a real object in the environment; however, it is misinterpreted and often becomes the object of the patient's projected fear. Hallucinations are false sensory stimuli. For example, individuals experiencing delirium may become terrified when they "see" giant spiders crawling over the bedclothes or "feel" bugs crawling on or under their bodies. A delusion is described as thinking or believing something that is not true and is seen more often in schizophrenia. For example, a patient may firmly believe that government agencies can read and are monitoring his or her thoughts or that neighbors can see him or her through walls. Confabulation is the creation of stories or answers in place of actual memories to maintain self-esteem. CH28 Nurses working in emergency departments and walk-in clinics should be aware that some victims of violence may present: with vague physical complaints such as insomnia or pain. with extreme anger and unpredictable behavior. with many family members there to support them. with psychosis and/or mania as a result of long-term abuse. Answer: with vague physical complaints such as insomnia or pain. Patients may present with symptoms that may be vague and can include chronic pain, insomnia, hyperventilation, or gynecological problems. Attention to the interview process and setting is important to facilitate accurate assessment of physical and behavioral indicators of family violence. Presenting with extreme anger is possible but not as common as presenting with vague physical complaints. Having many family members there is unlikely as many victims keep their history of being battered a secret. It is not known that psychosis or mania is a result of physical violence, and this would not be a usual presenting complaint. CH30 Which of the following are more often seen in mental illness in late life? Depression and alcohol abuse Bipolar disorder with a predisposition to mania Schizophrenia, undifferentiated type Dissociative disorders Answer: Depression and alcohol abuse Depression, risk for suicide, alcohol abuse, and anxiety are all disorders seen in mental illnesses in late life. Although it may be possible to suffer from these disorders in older age, they are not usually first diagnosed in this age group; patients diagnosed with these disorders earlier in life may in fact have some symptom remission as they age. 2. A 15-year-old ran away from home six times and was arrested for shoplifting. The parents told the court, "We can't manage our teenager." The adolescent is physically abusive to the mother and defiant with the father. Which diagnosis is supported by this adolescent's behavior? a. Attention deficit hyperactivity disorder (ADHD) b.Posttraumatic stress disorder (PTSD) c.Intermittent explosive disorder d.Conduct disorder ANS: D similar question but based on the teen boy beating up another kid. Conduct disorders are manifested by a persistent pattern of behavior in which the rights of others and age-appropriate societal norms are violated. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. Criteria for ADHD and PTSD are not met in the scenario. 6. A 12-year-old has engaged in bullying for several years. The parents say, "We can't believe anything our child says." Recently this child shot a dog with a pellet gun and set fire to a neighbor's trash bin. The child's behaviors support the diagnosis of: tion deficit hyperactivity disorder. mittent explosive disorder. nce of authority. ct disorder. ct disorder. ANS: D The behaviors mentioned are most consistent with criteria for conduct disorder, for example, aggression against people and animals; destruction of property; deceitfulness; rule violations; and impairment in social, academic, or occupational functioning. Intermittent explosive disorder is a pattern of behavioral outbursts characterized by an inability to control aggressive impulses in adults 18 years and older. The behaviors are not consistent with attention deficit and are more pervasive than defiance of authority. See related audience response question. 7. An 11-year-old diagnosed with oppositional defiant disorder becomes angry over the rules at a residential treatment program and begins cursing at the nurse. Select the best method for the nurse to defuse the situation. a.Ignore the child's behavior. b.Send the child to time-out. c.Accompany the child to the gym and shoot baskets. d.Role-play a more appropriate behavior with the child. c.Accompany the child to the gym and shoot baskets. ANS: C The child's behavior warrants an active response. Redirecting the expression of feelings into nondestructive age-appropriate behaviors, such as a physical activity, helps defuse the situation here and now. This response helps the child learn how to modulate the expression of feelings and exert self-control. This is the least restrictive alternative and should be tried before resorting to a more restrictive measure. Role-playing is appropriate after the child's anger is defused. 13. Parents of an adolescent diagnosed with a conduct disorder say, "We don't know how to respond when our child breaks the rules in our house. Is there any treatment that might help us?" Which therapy is likely to be helpful for these parents? a.Parent-child interaction therapy (PCIT) b.Behavior modification therapy c.Multi-systemic therapy (MST) d.Pharmacotherapy a.Parent-child interaction therapy (PCIT) ANS: A In parent-child interaction therapy (PCIT), the therapist sits behind one-way mirrors and coaches parents through an ear audio device while they interact with their children. The therapist can suggest strategies that reinforce positive behavior in the adolescent. The goal is to improve parenting strategies and thereby reduce problematic behavior. Behavior modification therapy may help the adolescent, but the parents are seeking help for themselves. Multi-systemic therapy is much broader and does not target the parents' need. 14. An adolescent diagnosed with an impulse control disorder said, "I just want to die. I spend all my time getting even with people who have done wrong to me." When asked about a suicide plan, the adolescent replied, "I'll jump from the bridge near my home. My father threw kittens off that bridge, and they died because they couldn't swim." Rate the suicide risk. a.Absent c.Moderate b.Low d.High d.High ANS: D The suicide risk is high. The child is experiencing feelings of hopelessness and helplessness. The method described is lethal, and the means to carry out the plan are available. 16. An adolescent was recently diagnosed with oppositional defiant disorder. The parents say to the nurse, "Isn't there some medication that will help with this problem?" Select the nurse's best response. a."There are no medications to treat this problem. This diagnosis is behavioral in nature." b."It's a common misconception that there is a medication available to treat every health problem." c."Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use." d."There are many medications that will help your child manage aggression and destructiveness. The health care provider will discuss them with you." c."Medication is usually not prescribed for this problem. Let's discuss some behavioral strategies you can use." 3. A nurse cares for a patient diagnosed with an opioid overdose. Which focused assessment has the highest priority? a.Cardiovascular b.Respiratory c.Neurologic d.Hepatic b.Respiratory ANS: B Opioid overdose causes respiratory depression. Respiratory depression is the primary cause of death among opioid abusers. The assessment of the other body systems is relevant but not the priority. See relationship to audience response question.