NSG 526 Exam 1 | Questions and Answers (Complete Solutions)

NSG 526 Exam 1 | Questions and Answers (Complete Solutions) A syndrome characterized by clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental functioning they are associated with significant distress, disability in social occupational, or other important activities mental disorder/psychiatric illness criteria that are offered as guidelines for making diagnoses Diagnostic Criteria when the symptom presentation does not meet full criteria for any disorder and the symptom cause clinically significant distress/impairment what categories should be used in the diagnosis "other specified" "unspecified" when the symptom presentation does not meet full criteria and "other specified" and "unspecified" categories are used in the diagnosis, what should the main diagnosis be corresponding to? main diagnosis should correspond to the most predominant symptoms. ex: Bipolar disorder, unspecified the coding system that is used in the U.S. for diagnosing and documenting psychiatric disorders ICD-10-CM (international classification of disease-10th revision-clinical modification) true or false: the diagnosis of a mental disorder is not equivalent to a need for treatment TRUE - clinicians should treat based on symptom severity, clinical presentation, etc. A nurse is assessing a client who is experiencing occasional feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors? 1. The client's behaviors demonstrate mental illness in the form of depression. 2. The client's behaviors are extensive, which indicates the presence of mental illness. 3. The client's behaviors are not congruent with cultural norms. 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness. At what point should the nurse determine that a client is at risk for developing a mental illness? 1. When thoughts, feelings, and behaviors are not reflective of the DSM-5 criteria. 2. When maladaptive responses to stress are coupled with interference in daily functioning. 3. When a client communicates significant distress. 4. When a client uses defense mechanisms as ego protection. During an intake assessment, a nurse asks both physiological and psychosocial questions. The client angrily responds, "I'm here for my heart, not my head problems." Which is the nurse's best response? 1. "It is just a routine part of our assessment. All clients are asked these same questions." 2. "Why are you concerned about these types of questions?" 3. "Psychological factors, like excessive stress, have been found to affect medical conditions." 4. "We can skip these questions, if you like. It isn't imperative that we complete this section." A fourth-grade boy teases and makes jokes about a cute girl in his class. This behavior should be identified by a nurse as indicative of which defense mechanism? 1. Displacement 2. Projection 3. Reaction formation 4. Sublimation Reaction formation is the attempt to prevent undesirable thoughts from being expressed by expressing opposite thoughts or behaviors. When under stress, a client routinely uses alcohol to excess. Finding her drunk, her husband yells at the client about her chronic alcohol abuse. Which action alerts the nurse to the client's use of the defense mechanism of denial? 1. The client hides liquor bottles in a closet. 2. The client yells at her son for slouching in his chair. 3. The client burns dinner on purpose. 4. The client says to the spouse, "I don't drink too much!" Which nursing statement regarding the concept of psychosis is most accurate? 1. Individuals experiencing psychoses are aware that their behaviors are maladaptive. 2. Individuals experiencing psychoses experience little distress. 3. Individuals experiencing psychoses are aware of experiencing psychological problems. 4. Individuals experiencing psychoses are based in reality. The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. They are unaware of their psychological problems How would a nurse best complete the new DSM-5 definition of a mental disorder? "A health condition characterized by significant dysfunction in an individual's cognitions, or behaviors that reflect a disturbance in ..." which of the following? 1. Psychosocial, biological, or developmental process underlying mental functioning 2. Psychological, cognitive, or developmental process underlying mental functioning 3. Psychological, biological, or developmental process underlying mental functioning 4. Psychological, biological, or psychosocial process underlying mental functioning A nurse is assessing a client who appears to be experiencing some anxiety during questioning. Which symptoms might the client demonstrate that would indicate anxiety? (Select all that apply.) 1. Fidgeting 2. Laughing inappropriately 3. Palpitations 4. Nail biting 5. Limited attention span Which documentation of a patient's behavior best demonstrates a psychiatric advanced practice nurse's professional observations regarding the patient's psychotic symptoms? A) Isolates self from others. Frequently fell asleep during group. Vital signs stable. B) Calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking. C) Appeared to hallucinate. Frequently increased volume on television, causing conflict with others. D) Wore four layers of clothing. States, "I need protection from evil bacteria trying to pierce my skin. In using the communication technique of reflection, the psychiatric advanced practice nurse: A) Interprets the difference between a patient's thoughts and his or her behaviors. B) Repeats something that the patient has said to encourage the patient to give more information. C) Provides prompts such as "tell me more." D) Seeks more information in order to have a more clear understanding. Which one of the following is not true regarding the mental status examination? A) Racing thoughts are considered part of the thought process B) Blunted is a term used to describe affect C) Hallucinations are part of thought content D) Delusions are part of thought content **** Delusions are a part of thought content ** suicidal thoughts, homicidal thoughts, and thoughts of self-harm are all covered in thought content -- think - it is the CONTENT of your thoughts!!! *** The thought process is the WAY in which a client thinks. - often evidenced by their speech ***illusions and hallucinations are covered under perceptual disturbances The PMHNP has a new patient in the clinic. While looking at the materials the patient filled out in the waiting area, the PMHNP ascertains the patient has a substance abuse history. The PMHNP immediately says, "stupid drug addicts, they're so annoying. There such a waste of time. They never want to get better. "This is an example of: A) Projection B) Transference C) Countertransference D) ResistanceFsaf Which comment(s) by an elderly person best indicates successful completion of developmental tasks? Select all that apply. A) "I am proud of my children's successes in life." B) "I should have given to charities more often." C) "My relationship with my father made life more difficult for me." D) "I often wonder what would have happened if I had chosen a different career." The purposes of the psychiatric interview include all except: A) Gaining an understanding of the patient's illness. B) Obtaining information efficiently. C) Providing education about psychiatric disorders. D) Establishing a therapeutic alliance. operates to the pleasure principle. Seeking please and avoiding pain. It drives wishes, desires and fantasies. No real perception of reality. It uses primary process... Seeks to satisfy its needs. ID ID has 2 major instincts, what are they? EROS - focus on pleasure-seeking tendencies such as sexual urges. THANATOS - motivates people to use aggressive urges to destroy. aware of reality and understands that behaviors have consequences. It uses secondary processes... perception, recognition, judgement, memory, reasoning, problem-solving, impulse control and formation of relationships EGO contains morals and values and is developed from our parents through childhood and society. Contains the rules of right and wrong. SUPER EGO What reason does the nurse give the patient for the emphasis and attention being paid to the recovery phase of their treatment plan? a. Recovery care, even when intensive, is less expensive than acute psychiatric care. b. Effective recovery care is likely to result in fewer relapses and subsequent hospitalizations. c. Planning for recovery care is time consuming and involves dealing with many complicated details. d. Recovery care is usually done on an outpatient basis and so is generally better accepted by patients. Which activity shows that a therapeutic alliance has been established between the nurse and patient? a. The nurse respects the patients right to privacy when visitors are spending time with the patient. b. The patient is eagerly attending all group sessions and working independently on identifying their personal stressors. c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse. d. The nurse dutifully administers the patients medications on time and with appropriate knowledge of the potential side effects. When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ED) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by: a. Reviewing the ED chart b. Contacting the admitting physician c. Directing the questions to the family members d. Establishing a line of communication with the patient When engaging in outcomes identification, the nurse: a. Interviews and collects patient-focused data b. Re-assesses the patients physical and emotional status evaluation c. Reviews the patients existing problems and projects the results of the nursing care d. Considers the patients presenting symptoms and identifies nursing-related problems If a client makes a threat to harm a specific individual, the PMH-APRN must notify that individual per the _________ law. Tarasoff Law Individuals can be involuntarily committed for a psychiatric evaluation for only three reasons. what are they? 1. They are a danger to themselves due to a mental illness. 2. They are a danger to others due to a mental illness. 3. They are gravely disabled due to a mental illness. true or false: Multiple diagnoses must be presented in a hierarchy from the condition of most significance to that of least concern true The main diagnoses is considered the principle diagnosis. I will be documented as: Patient Y meets the criteria for two DSM-5 diagnoses: (F41.1) Generalized Anxiety Disorder (Principal Diagnosis), (F43.21) Adjustment Disorder with Depressed Mood Example of Patient with a Mental Health Disorder and a Primary Medical Condition: Patient X meets the criteria for the following DSM-5 and ICD-10 diagnoses: (250) Diabetes Mellitus (Primary Diagnosis), (F43.12) Post Traumatic Stress Disorder, Chronic. what are the four lobes of the brain 1. frontal 2. temporal 3. occipital 4. Parietal dense collections of nerve cells with common specific functions nuclei This lobe is generally involved in self-awareness (introspection, physical and emotional sensation) and executive functions (focusing, planning, judgment, decision making, and social functioning). This lobe regulates the expression of emotion and of motor behavior. Frontal Lobe This LOBE is noted to be involved in clinical psychiatric syndromes such as schizophrenia, disorders of attention (i.e., ADD), obsessive compulsive disorder, and mood disorders. Frontal lobe This lobe is generally associated with the coordination of sensation and motor behavior (such as the coordination of language functions), spatial orientation (knowing where your body is, in a physical sense), and recognition of people and objects. Parietal This lobe is intimately involved in memory formation: language, and learning. Temporal Lobe euphoria, auditory hallucinations, and delusions are usually associated with impaired function of the dominant (usually left) _______ lobe, temporal lobe dysphoria, depression, irritability, and inappropriate affect are associated with abnormalities of the non-dominant (usually right) ___________ lobe. Temporal lobe lobes associated with vision and visual memory. occipital lobes this tract allows each hemisphere of the brain to receive and send information to the other hemisphere, so that functions can be coordinated between the left and right sides of the brain. Corpus Collosum True or false: the Cingulum has been implicated as abnormal in schizophrenia and ADHD FALSE the Corpus Callosum has been implicated as abnormal in schizophrenia and ADHD As a body (corpus) of nerve fibers of colossal proportions, this tract allows each hemisphere of the brain to receive and send information to the other hemisphere, so that functions can be coordinated between the left and right sides of the brain. It has been implicated as abnormal in schizophrenia and attention deficit hyperactivity disorder (ADHD). Corpus Callosum On the same level as the corpus callosum is the main information highway of emotion, the __________. This central highway seems to be involved with the summation and integration of emotion and thinking in preparation for final input to the hypothalamus, a central integrating station. the _______ facilitates an integration from higher (thinking and emotion) to lower (the hypothalamic nuclei) brain regions. Cingulum ** this is larger in women REWARD tract The various tracts (mesocortical and mesolimbic tracts) involved in the processing of pleasurable experience and reward come together in a pathway called the _____________________ This bundle of reward fibers interconnects areas of the brain involved in the mediation of emotion, learning, arousal, memory, and hormonal control. It runs between the hypothalamus and the septal region. *****This tract has clinical importance in depression, mania, and schizophrenia. Researchers have postulated that there is a fundamental imbalance of activity between the median forebrain bundle reward system and the inhibitory (punishment) center of the brain. In mania, the pleasure centers are hypothesized to be overactive and/or the inhibitory centers, underactive. In depression, the reverse would be so. median forebrain bundle. PUNISHMENT tract This tract follows a path around (peri) the fluid-filled spaces within the interior parts of the brain (the ventricles), connecting the emotional, thinking, and hormonal functions of the brain. This is the primary inhibitory or punishment pathway in the brain; activation of this pathway seems to initiate avoidance behaviors. This tract is in balance with the reward tract, mentioned above. Together they modulate varying degrees of excitation and inhibition of behavior in various areas of the brain involved in learning, emotion, arousal, and hormonal activation. The Periventricular System reinforcement These two pathways carry information between a part of the brain stem called the mid (meso) brain and the limbic system and frontal lobes of the brain, respectively. The pathways that appear most involved in reinforcement are the mesolimbic and mesocortical pathways. These two pathways join to pass through the median forebrain bundle. Abnormal function of nerve cells in these two tracts has been implicated in the positive symptoms of schizophrenia, such as hallucinations (mesolimbic tract), and the deficit symptoms, such as flat affect (mesocortical). Mesolimbic and Mesocortical Tracts kernel-like aggregates of nerve cells, which are the hub of specialized functions The brain has numerous ___________, all of which are involved in a complex network of communication. Certain nuclei have been identified as having a clear role in specific clinical states. Nuclei The purpose of the _____________ is to gather information necessary to understand, diagnose, and treat the client. psychiatric interview echopraxia (a mimicking of the interviewer's behavior), catatonia (statue-like immobility), and waxy flexibility (when limbs can be moved by the interviewer into positions that the client maintains) this would be documented under what section of the mental status examination Behavior and general appearance Observe for evidence of dysarthria (physical difficulty in vocalizing), echolalia (the repetition of the interviewer's words), perseveration (the repetition of the same words or themes), aphasia (difficulties in understanding or producing speech), and other disorders or oddities of speech. this would be documented under what section of the mental status examination Speech We ask the patient about DELUSIONS in what section of the mental status examination Thought content intrusive thoughts or ideas that the client recognizes as "crazy" but act in accordance with anyway obsessions delusions involving death or destruction nihilistic delusions delusions involving bodily concerns somatic delusions believing that benign environmental occurrences relate to or have special meaning for the client referential delusions true or false The validity of delusions should not be questioned by the interviewer; such questioning is ineffective in changing the client's beliefs and often causes alienation and anger true evaluation of suicidal and homicidal thoughts are under what section of the MSE thought content what scale can be used to evaluate suicide risk SADPERSONS S sex male A age 19 or 45 D depression P previous attempt E ethanol R rational thinking loss S social supports lacking O organised plan N no partner S sickness **Score one point for each factor Use calculated score to help determine outcome 0-2 home with appropriate follow up 3-6 admit or discharge with appropriate follow up 7-10 admit to hospital illogical , difficult to follow shifting of ideas loose associations when client wanders from the subject at hand to a related one and is unable to come back to the original topic Tangential thinking Tangential thinking is noted under which section of MSE? THOUGHT PROCESS completely nonsensical combination of words word salad made up words neoglisms loose associations, tangential thinking, word salad, and neoglisms often indicate what???? Schizophrenic disorders. demonstrated by clients who get lost in details but eventually return to the relevant thought Circumstantial thought occurs when thinking process stops altogether and the mind goes "blank" thought blocking involves pressures speech with rapid topic changes, the topics may be associated but in a strange way flight of ideas often seen in mania fabrication of information to fill in our memory gaps confabulation - often indicated dementia. A client with a ________thought process as opposed to an abstract thought process is only able to understand conversations literally. concrete A client's ability to think abstractly may be ascertained by assessing the client's interpretation of a proverb such as "people in glass houses should not throw stones" Concrete thought is common in clients with schizophrenic disorders. A concrete thought process is not pathological when exhibited by children, however, who developmentally may not have the capacity for abstract thought until early adolescence are misinterpretations of true stimuli. An example is when a curtain in a dark room is mistaken for a person illusions common in delirium illusions and hallucinations are documented/assessed under what section of the MSE perceptual disturbances defined as sensations experienced by the client without real external stimuli hallucinations documented under perceptual disturbances what are the most common type of hallucination auditory the more unusual hallucinations such as visual, gustatory, olfactory, and tactile hallucinations may indicate what?? medical illness or substance intoxication or withdrawal false sensory perceptions that occur while falling asleep hypnagogic hallucinations false perceptions that occur while waking from sleep hypnopompic hallucinations is a perceptual difficulty in which the client feels unreal, dead, or mechanical depersonalization he sensation that the outside world is unreal derealization True or False: Hypnagogic and hypnopompic hallucinations, derealization, and depersonalization are considered within the normal range of experience and are not considered pathologic unless they cause undue distress or problems with daily functioning. True. the ability to delay, modulate, or inhibit the expression of behaviors and feelings impulse control clues to the client's ability to control their impulses are found in the _______ and ______ of the general interview thought content and process A client who describes a recent history of binge drinking and indiscriminate sexual contacts has ______ impulse control poor impulse control accessing the client's ability to control impulses is an integral part of determining potential for acting on _______ and ______ thoughts suicidal and violent thoughts level of consciousness , orientation, concentration and memory are assessed under what section of the MSE? Cognition and Sensorium