Misc
The nurse is taking care of a patient newly diagnosed with an anxiety disorder. Which process is most important in providing care to patients with anxiety disorders?
1. Review of the health care professional's orders for the patient
2. Acquisition of information from the patient's high school counselor
3. Assessment of the patient's response during the initial phase of treatment
4. Awareness of the nurse's own anxiety and how it may affect the patient's treatment
Answer: 4
Explanation: 4. Because nurses encounter anxiety in patients, families, staff, and themselves on a daily basis, it is important that nurses be aware of their own anxiety and how it affects others. It is important to acquire information about the patient's condition through review of orders, assessment, and peers/family, however, becoming comfortable with how anxiety affects the nurse is important in learning what it represents for patients in order to promote healing and alleviate suffering.
The nurse taking care of an older adult patient recently diagnosed with anxiety disorder. The patient asks why the primary care provider is reluctant to prescribe an antianxiety medication. The nurse educates that patient about which possible adverse effect of antianxiety medications commonly seen in older adults?
1. Dizziness
2. Decreased libido
3. Gastrointestinal distress
4. Paradoxical reaction
Answer: 4
Explanation: 4. Special considerations should be given when administering antianxiety medication to older adults due to the slower rate of clearance secondary to a slow metabolism rate, increased accumulation, and/or greater sensitivity to central nervous system depressants. Older adults may exhibit a paradoxical effect in which the medication gives an opposite effect than the expected outcome. Dizziness, decreased libido, and gastrointestinal side effects may also be seen, but these are not side effects specific to older adults.
A 16-year-old patient is brought into the emergency department (ED) after being attacked in an alley. The patient states that she "can't see," but that she is otherwise "okay." The initial assessment reveals no physiological reason for the blindness, but several bruises, cuts, and abrasions are noted. After a thorough assessment, the patient is diagnosed with posttraumatic stress disorder (PTSD). The nurse knows that the patient is employing which defense mechanisms? Select all that apply.
1. Denial
2. Projection
3. Conversion
4. Suppression
5. Displacement
Answer: 1, 3, 4
Explanation: 1. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person.
3. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person.
4. The patient is using conversion, denial, and suppression as defense mechanisms. Conversion transfers mental conflict or trauma into a physical symptom. Denial is avoiding, ignoring, or rejecting a situation and the feelings associated with it. Suppression is the conscious denial of a disturbing situation or feeling. Displacement transfers emotions from one person, or object to another less threatening or more neutral person or object. Projection attributes thoughts or impulses to another person.
A patient has had what appeared to be an epileptic seizure; however, the patient's MRI and EEG results that do not show seizure activity. After a thorough assessment and appropriate tests by the patient's health care professional, the nurse begins to suspect which psychological disorder?
1. Factitious disorder
2. Conversion disorder
3. Illness anxiety disorder
4. Somatic symptom disorder
Answer: 2
Explanation: 2. Patients who have symptoms of conversion disorder experience one or more changes in voluntary motor or sensory function, changes that are not recognized as neurologic or medical in origin. Some patients may experience symptoms that mimic seizure. Factitious disorder is characterized by patients falsifying an illness. Somatic symptom disorder refers to emotional distress that exhibits through somatic or physiological symptoms. Illness anxiety disorder refers to patients who experience preoccupation with having an illness, though there are typically no physical symptoms.
When assessing patients with dissociative disorders, the nurse knows that which assessments are most important?
1. Pain, bowel sounds, behaviors
2. Anxiety, B12 level, heart sounds
3. LOC, patient safety, and level of anxiety
4. Facial expression, body image, pupillary reactivity
Answer: 3
Explanation: 3. When assessing patients with dissociative symptom disorders, it is important to assess patient safety, level of consciousness, and anxiety level. The other choices are more appropriate for assessing the patient with a somatic symptom or related disorder.
A patient in the clinic is diagnosed with General Adaptation Syndrome (GAS). Which physiological symptoms would indicate that the patient is in the last stage of this syndrome if the patient is unable to find resolution of the stressor?
1. Infection, migraines, stroke
2. Increased cortisol, stroke, high cholesterol levels
3. Hallucinations, fatigue, decreased immune response
4. Decreased albumin, increased adrenaline, decreased blood pressure
Answer: 1
Explanation: 1. The stage of exhaustion is the last stage of General Adaptation Syndrome. Physical and psychological manifestations of this stage include migraines, delusions, and/or hallucinations. The body is unable to compensate and begins to fail, and the patient exhibits symptoms such as elevated blood pressure, infection, stroke, cardiac arrest, and renal failure. Without resolution death may occur. The other answer choices do not reflect the last stage of General Adaptation Syndrome.
The mental health nurse is speaking with primary care providers about treatment options for anxiety disorders, including pharmacologic options. Why are selective serotonin-reuptake inhibitors (SSRIs) the choice class of medications for treating anxiety disorders?
1. They have a short half-life.
2. They are metabolized by the liver.
3. They are adrenergic blocking agents.
4. They have fewer side effects than other anti-anxiety medications.
Answer: 4
Explanation: 4. Because SSRIs have fewer side effects than other anti-anxiety medications, this makes them the medications of choice. SSRIs are not adrenergic blocking agents and are not metabolized in the liver. SSRIs do not have a short half-life.
The nurse taking care of a patient recently diagnosed with somatic symptom disorder knows that which biological symptoms are related to this disorder? Select all that apply.
1. Pain
2. Anxiety
3. Gastrointestinal distress
4. Paralysis
5. Blindness
Answer: 1, 3, 4, 5
Explanation: 1. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
3. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
4. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
5. Patients with somatic symptom disorder have symptoms that are physical in nature and cause significant distress and inability to function in activities of daily living. These may include pain, gastrointestinal distress, paralysis, or blindness. Psychological symptoms of somatic symptom disorder include persistent anxiety about symptoms and disproportionate and persistent thoughts about symptoms that result in disruption of daily living.
The nurse is caring for a patient who has been diagnosed with a dissociative disorder after being missing for two weeks and returning home, not knowing any time had passed. The nurse recognizes the patient is experiencing which condition associated with dissociative disorders?
1. Fugue
2. Amnesia
3. Alexithymia
4. Derealization
Answer: 1
Explanation: 1. Individuals with dissociative fugue wander, usually far from home and for days, perhaps even weeks or months, at a time. During this period, patients completely forget their past life and associations, but unlike people with amnesia, they are unaware of having forgotten anything. Individuals do not recall the fugue period when they return to consciousness. Alexithymia is the inability to label feelings with words. Derealization is the experience of unreality or detachment from the individual's surroundings.
The nurse is caring for a patient with dissociative identity disorder who has been admitted to the hospital for dehydration. Which question is the priority for including in the assessment?
1. "Do you remember what you were doing today?"
2. "Do you look in the mirror and not recognize yourself?"
3. "Do you ever think about harming yourself?"
4. "Do you find new things among your belongings that you don't recall obtaining?"
Answer: 3
Explanation: 3. Patients with dissociative disorders have a high risk for suicide. It is important to ask these patients direct questions about risk for suicide and self-harm. The other questions may be appropriate, but they are not the priority. Assessing for safety always takes priority.
The nurse taking care of a patient with panic disorder understands that which nursing interventions are important at this anxiety level?
1. Speak in a low voice and help patient identify triggers.
2. Encourage the patient to explore alternative coping strategies.
3. Remain calm and assist patient with problem-solving techniques.
4. Administer medications as prescribed and respect the need for personal space without leaving the patient unattended.
Answer: 4
Explanation: 4. When taking care of a patient at the panic level of anxiety nursing interventions will include: remaining calm; staying with the patient; using clear, simple, and direct communication; helping the patient regain a sense of control; ensuring the safety of the patient and others; respecting the need for personal space, but not leaving the patient unattended; administering medications as prescribed; reinforcing reality; and getting assistance as needed.
A new nurse has just taken his state board exams and passed, but he has not yet found a job. He also married the month after graduation, and his new wife just announced that she is pregnant. He has recently been experiencing sleep disturbances, difficulty concentrating, and irritability. The nurse at the clinic suspects which disorder?
1. Obsessive-compulsive disorder
2. Generalized anxiety disorder
3. Adjustment disorder
4. Reactive attachment disorder
Answer: 3
Explanation: 3. The new nurse is likely experiencing adjustment disorder in response to the stressful events in his life. Symptoms occur within 3 months of onset of the disorder and will continue for no more than 6 months after the termination of the stressor.
The nurse suspects that the patient who was brought to the emergency department (ED) because of what the family describes as "a sudden case of Alzheimer disease" may have general amnesia. Which characteristics make the nurse suspect general amnesia? Select all that apply.
1. The patient cannot remember any personal information.
2. The patient has been wandering away from home.
3. The patient describes a "detachment" from her mind.
4. The patient feelings of "disconnection" with her home.
5. The patient has developed an alternate personality.
Answer: 1, 2
Explanation: 1. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual's life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person's surroundings. Multiple personality states do not emerge with general amnesia.
2. General amnesia typically occurs rapidly and causes disorientation and wandering. It results in a complete loss of memory of the individual's life history. Localized amnesia is when an individual cannot recall specific events, selective amnesia is when the individual can recall some, but not all events during a specified period of time. Depersonalization is the experience of unreality or detachment from mind, self, and/or physical body. Derealization is the experience of unreality or detachment from the person's surroundings. Multiple personality states do not emerge with general amnesia.
The nurse is taking care of patient admitted with a diagnosis of dissociative identity disorder. The nurse knows that which symptoms differentiate dissociative disorders from somatic symptom disorder? Select all that apply.
1. Flashbacks
2. Self-mutilation
3. Dissociation
4. Struggling with faith
5. Lack of connectedness
Answer: 1, 2
Explanation: 1. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.
2. Individuals with dissociative disorders exhibit symptoms of alterations in sensory or motor functioning; alterations in memory; changes in consciousness; inability to recall autobiographical information; self-mutilation; flashbacks; and functional neurologic symptoms. These symptoms are not seen in somatic symptom disorder. Dissociation, struggling with faith, and lack of connectedness may be seen in individuals suffering from either disorder.
The nurse caring for a patient admitted with somatic symptom disorder questions the health care provider about which orders? Select all that apply.
1. Morphine 4 mg PO prn pain
2. Alprazolam 2 mg PO prn anxiety
3. Teach patient breathing techniques
4. Psychotherapy with family involvement
5. Walk 15-30 minutes per day in neighborhood
Answer: 1, 2
Explanation: 1. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.
2. Medication is not advised for individuals with somatic symptom and related disorders. The most effective ways of treating this disorder are cognitive-behavioral therapy and complementary/alternative therapies.
What is the most important action for the nurse to take when caring for a patient with obsessive-compulsive disorder (OCD) who is performing a ritual?
1. Don't interrupt the ritual.
2. Teach stress reduction strategies.
3. Interrupt the ritual.
4. Teach patient about the disorder.
Answer: 1
Explanation: 1. The nurse should not interrupt the ritual because that may cause the patient to start from the beginning. Patient teaching is not the priority for a patient who is performing a ritual.
The nurse taking care of a patient recently diagnosed with anxiety disorder knows that the patient's symptoms of hyperventilation, insomnia, and nausea are at which level according to Peplau?
1. Severe +3
2. Panic +4
3. Mild +1
4. Moderate +2
Answer: 1
Explanation: 1. Peplau identified four levels of anxiety: mild, moderate, severe, and panic. The patient experiencing the severe level of anxiety may present with dizziness, diarrhea, feelings of dread, headaches, hyperventilation, insomnia, nausea, palpitations, trembling, urinary frequency, and total focus of self.
The nurse understands that the patient with somatic symptom disorder may have an increased sensitivity to pain. This explanation of the patient's symptoms is based in which domain?
1. Genetic domain
2. Biologic domain
3. Humanistic domain
4. Psychological domain
Answer: 2
Explanation: 2. Holistically, in nursing, there are five domains of wellness: biological, psychological, sociological, cultural, and spiritual. Research has shown that patients with somatic symptom disorder and its related disorders express symptoms such as pain and other somatic experiences through their body. This heightened sense of pain and other normal body sensations occurs in the biological domain.
A patient diagnosed with dissociative identity disorder is in the emergency department after attempting suicide. After a thorough assessment the nurse determines the attempted suicide was in response to which event?
1. Drug abuse and living homeless on streets
2. Childhood sexual abuse by biological father
3. Unidentified continuous abdominal and neck pain
4. Multiple somatic and psychological issues over the past 6 months
Answer: 2
Explanation: 2. Patients with dissociative identity disorder have sustained horrific physical and psychological abuse over time. These events lead to the patient experiencing multiple ego states that help the patient survive the trauma. Suicidal ideation is common among patients with this disorder. The other answer choices are not indicative of dissociative identity disorder.
Which information related to the physiology of circadian rhythms would be most significant in the assessment of a patient suspected of having bipolar disorder?
1. Personality patterns
2. Psychiatric diagnosis
3. Negative thought patterns
4. Sleep and appetite patterns
Answer: 4
Explanation: 4. Sleep and appetite patterns are part of the physiologic circadian rhythms, and a disruption of these patterns may explain many bipolar disorder symptoms. Personality patterns, psychiatric diagnoses, and negative thought patterns are not related to physiology.
What is the priority action by the nurse for a patient having a severe panic attack?
1. Explaining about anxiety
2. Teaching about ways to decrease anxiety
3. Reassuring and protecting until the episode subsides
4. Providing a physical activity to redirect patient focus
Answer: 3
Explanation: 3. Offering firm reassurance and protection until the episode subsides provides safety for the patient. Teaching about anxiety and ways to decrease anxiety are not appropriate because a patient who is having a severe panic attack cannot learn at this level of anxiety. The patient is unable to focus on a physical activity at this level of anxiety.
An ICU nurse diagnosed with acute anxiety is scheduled to take the CCRN exam for the second time in 2 weeks after being unsuccessful the first time. The nurse knows that which medication may be prescribed to help him with his anxiety?
1. Buspirone (Buspar)
2. Citalopram (Celexa)
3. Alprazolam (Xanax)
4. Propranolol (Inderal)
Answer: 4
Explanation: 4. The nurse is experiencing Peplau's moderate level of anxiety or situational anxiety. Benzodiazepines such as alprazolam (Xanax) are effective for anxiety at low doses and insomnia at higher doses. SSRIs such as citalopram (Celexa) take at least 2-4 weeks to become fully effective. Buspirone, a nonbenzodiazepine anxiolytic, can take up to 4 weeks to achieve effect. The beta-blocker propranolol (Inderal) can prevent physical symptoms of anxiety and may be prescribed to control symptoms of performance anxiety only.
The nurse is caring for a 40-year-old patient suspected of having a somatic symptom or related disorder. Which symptoms within the psychological domain would suggest that the patient does not have a somatic symptom or related disorder? Select all that apply.
1. Hallucinations
2. Compulsions
3. Flashbacks
4. Irritability
5. Withdrawal
Answer: 2, 3
Explanation: 2. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).
3. Individuals with somatic symptom and related disorders may exhibit the following psychological symptoms: dissociation; hallucinations; crying; decreased interest; decreased productivity; depression; difficulty concentrating; feelings of apprehension, helplessness, worthlessness; focusing on the past; hypercritical; irritability; persistent worrying preoccupation with negatives; and withdrawal. Flashbacks are associated with dissociative disorders and posttraumatic stress disorder (PTSD). Compulsions are associated with obsessive-compulsive disorder (OCD).
The nurse is caring for a patient diagnosed with dissociative identity disorder (DID). Which statements by the patient best describes the manifestations of this disorder? Select all that apply.
1. "I feel like my body is here but my mind is not."
2. "I have chronic pain, not a psychological problem."
3. "I can't really find any words to describe my feelings."
4. "I sometimes feel like I am floating in the air looking down at myself."
5. "I cannot recall the events that happened during certain periods of time."
Answer: 1, 4, 5
Explanation: 1. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
4. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
5. Dissociative disorders are characterized by a combination of fragmented memories (which may result in fragmented personalities), difficulties with memory recall, and dissociative behavior patterns. Depersonalization, a manifestation of dissociative disorders, is the experience of unreality or detachment from the individual's mind, sense of self, and/or physical body. Dissociations are unwelcome intrusions that occur with losses of continuity of time, changes in ability to relate to others, and amnesia, or the inability to recall what the person was doing during the dissociation. The client stating physical pain, not psychological suffering, is manifesting a somatic symptom. Difficulty describing or discussing feelings is seen in somatic symptom and related disorders.
The nurse is working with a patient who was diagnosed two days ago with severe depression. Reflecting on the diathesis-stress model, the nurse recognizes that which event is most likely to be a factor in the development of depression?
1. Losing his job last week
2. His mother's suicide when he was ten years old
3. Breaking up with his girlfriend the week before his diagnosis
4. The death of his 12-year-old dog three years ago
Answer: 2
Explanation: 2. The diathesis-stress model states that certain individuals inherit tendencies to express certain traits or behaviors when exposed to the right conditions or stressors. A patient's diathesis, or hereditary predisposition, must interact with life events in order to trigger depression. A life trauma, especially during the formative years of childhood, may predispose vulnerable individuals to alteration in brain neurochemistry that initiates the process for future mood disorders.