ATI CMS Proctored Exam Retake.

NR326 CMS Proctored Exam 2022 Retake. Which of the following is a correct assumption regarding the concept of crisis? - Crises occurs when an individual: Amanda's mobile home was destroyed by a tornado. Amanda re ...

NR326 CMS Proctored Exam 2022 Retake. Which of the following is a correct assumption regarding the concept of crisis? - Crises occurs when an individual: Amanda's mobile home was destroyed by a tornado. Amanda received only minor injuries, but is experiencing disabling anxiety in the aftermath of the event. This type of crisis is called: - - The most appropriate crisis intervention with Amanda (#3) would be to: A nurse is conducting chart reviews of multiple clients at a community mental health facility. Which of the following events is an example of a client experiencing a maturational crisis? A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (select all that apply) A nurse is conducting a group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive-communication? A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the pre-assaultive stage of violence? (Select all that apply) A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? Andrew, a NYC Firefighter and his entire unit responded to the terrorist attacks at the World Trade Center. He and his friend, Carlo, entered the area together. Carlo was killed when the building collapsed. Andrew was injured, but survived. Andrew has been having nightmares and anxiety/panic attacks. He says to his nurse at the clinic, "I don't know why Carlo didn't make it and I did!" This statement by Andrew suggest that he is experiencing: - Survivor's guilt Intervention with Andrew (12) would include: Jenny reports to the high school nurse that her mom drinks too much. She is drunk every afternoon when Jenny comes home from school and her mom yells at Jenny and blames her for everything wrong. Jenny is afraid to invite her friends over because of her mother's behavior. Nursing interventions would include: You are asked to serve on a committee on which you do not wish to serve. Which of the following is an example of your nonassertive response? A nurse on a crisis hotline is speaking to a client who states, "I just took an entire bottle of Xanax." Which of the following is the priority nursing response? A nurse observes a client hitting another client. Which of the following statements is the best response by the nurse? A nurse is monitoring a client in restraints. Which of the following findings should indicate to the nurse that the client is ready to reintegrate into the unit? A client during a therapeutic group session led by the nurse suddenly jumps up, screams, and runs out of the room. What is the nurse's priority of action? A nurse plans to develop a therapeutic relationship with a client. Which of the following should be included in the care plan? Which of the following is true about clients admitted for involuntary admission? (SATA) - A mandatory educational session is conducted on an inpatient mental health unit for all nurses about seclusion and restraints. Seclusion is contraindicated in which of the following clients? A nurse is reviewing the protocol for restraints and seclusion (r/s). Included in the protocol are which of the following? (SATA) A client is extremely suspicious of the nursing staff and other clients. Which of the following nursing approaches is appropriate to include in the plan of care when establishing a therapeutic relationship with this client? A nurse is caring for a client who has delusional behavior and states, "I can't go to group therapy today. The mayor is coming any time now to visit me!" The nurse responds, "I understand, but it is time for group therapy and we expect everyone to attend. Let's walk over together." For which of the following reasons is the nurse's response considered therapeutic? A nurse is caring for an adolescent client with a history of violent behavior. The client asked the nurse to keep information confidential about the desire to kill several classmates and a school teacher. Which statement by the nurse is the best response? - A nurse on a behavioral health unit is monitoring a client who was placed in 4 point restraints. Nursing care for the client in restraint includes which of the following? (SATA). The nurse initiating therapeutic relationship with clients knows which of the following defense mechanisms are always adaptive and never maladaptive? A client tells a nurse that the nurse is the only one who cares about them, yet the following day, the client refuses to talk to that nurse. This is an example of which of the following defense mechanisms? A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary information to the client? (SATA) Which of the following should the nurse include in the nursing assessment of a client's ability to cope during a crisis? A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? Nursing considerations when giving a benzodiazepine medication to a client exhibiting severe to panic anxiety include which of the following? A charge nurse is discussing mental status examinations with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.) A nurse is planning care for a client who has a mental health disorder. Which of the following actions should the nurse include as a psychobiological intervention? A nurse in an outpatient mental health clinic is preparing to conduct an initial client interview. When conducting the interview, which of the following actions should the nurse identify as the priority? A nurse is planning a peer group discussion about the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM 5). Which of the following information is appropriate to include in the discussion? (Select all that apply.) A nurse in an emergency mental health facility is caring for a group of clients. The nurse should identify that which of the following clients requires a temporary emergency admission? A nurse decides to put a client who has a psychotic disorder in seclusion overnight because the unit is very short staffed, and the client frequently fights with other clients. The nurse's actions are an example of which of the following torts? A client tells a nurse, "Don't tell anyone, but I hid a sharp knife under my mattress in order to protect myself from my roommate, who is always threatening me." Which of the following actions should the nurse take? A nurse is caring for a client who is in mechanical restraints. Which of the following statements should the nurse include in the documentation? (Select all that apply.) - - A nurse hears a newly licensed nurse discussing a client's hallucinations in the hallway with another nurse. Which of the following actions should the nurse take first? - A charge nurse is conducting a class on therapeutic communication with a group of newly licensed nurses. Which of the following aspects of communication should the nurse identify as a component of verbal communication? A nurse in an acute mental health facility is communicating with a client. The client states, "I can't sleep. I stay up all night." The nurse responds, "You are having difficulty sleeping?" Which of the following therapeutic communication techniques is the nurse demonstrating? A nurse is communicating with a client who was admitted for treatment of a substance use disorder. Which of the following communication techniques should the nurse identify as a barrier to therapeutic communication? A nurse caring for a client who has anorexia nervosa. Which of the following examples demonstrates the nurse's use of interpersonal communication? A nurse is talking with the caregiver of a child who has demonstrated recent changes in behavior and mood. When the caregiver of the child asks the nurse for reassurance about their child's condition, which of the following responses should the nurse make? - A nurse is caring for a client who smokes and has lung cancer. The client reports, "I'm coughing because I have that cold that everyone has been getting." The nurse should identify that the client is using which of the following defense mechanisms? A nurse is providing preoperative teaching for a client who was informed of the need for emergency surgery. The client has a respiratory rate 30/min, and says, "This is difficult to comprehend. I feel shaky and nervous." The nurse should identify that the client is experiencing which of the following levels of anxiety? A nurse is caring for a client who is experiencing moderate anxiety. Which of the following actions should the nurse take when trying to give necessary information to the client? (Select all that apply.) A nurse is talking with a client who is at risk for suicide following their partner's death. Which of the following statements should the nurse make? A charge nurse is discussing the characteristics of a nurse client relationship with a newly licensed nurse. Which of the following characteristics should the nurse include in the discussion? (Select all that apply.) A nurse is in the working phase of a therapeutic relationship with a client who has methamphetamine use disorder. Which of the following actions indicates transference behavior? A nurse is planning care for the termination phase of a nurse client relationship. Which of the following actions should the nurse include in the plan of care? A nurse is orienting a new client to a mental health unit. When explaining the unit's community meetings, which of the following statements should the nurse make? A nurse is preparing an educational seminar on stress for other nursing staff. Which of the following information should the nurse include in the discussion? A nurse is discussing acute vs. prolonged stress with a client. Which of the following effects should the nurse identify as an acute stress response? (Select all that apply.) - - A nurse is teaching a client about stress reduction techniques. Which of the following client statements indicates understanding of the teaching? A nurse is talking with a client who reports experiencing increased stress because a new partner is "pressuring me and my kids to go live with him. I love him, but I'm not ready to do that." Which of the following recommendations should the nurse make to promote a change in the client's situation? A nurse is caring for a client who states, "I'm so stressed at work because of my coworker. I am expected to finish others' work because of their laziness!" When discussing effective communication, which of the following statements by the client to the coworker indicates client understanding? A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply.) A nurse is caring for a client who takes paroxetine to treat post traumatic stress disorder. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply.) A nurse is reviewing the medical records of multiple clients at a community mental health facility. Which of the following events is an example of client experiencing a maturational crisis? A nurse is caring for a client who is experiencing a crisis. Which of the following medications might the provider prescribe? (Select all that apply.) A nurse is conducting group therapy with a group of clients. Which of the following statements made by a client is an example of aggressive communication? A nurse is caring for a client who is speaking in a loud voice with clenched fists. Which of the following actions should the nurse take? A nurse is assessing a client in an inpatient mental health unit. Which of the following findings should the nurse expect if the client is in the preassaultive stage of violence? (Select all that apply.) A nurse is caring for a client in an inpatient mental health facility who gets up from a chair and throws it across the day room. Which of the following is the priority nursing action? A nurse is caring for a client who is screaming at staff members and other clients. Which of the following is a therapeutic response by the nurse to the client? A charge nurse is leading a peer group discussion about family and community violence. Which of the following statements by a member of the group indicates an understanding of teaching? A nurse is preparing to assess an infant. Which of the following is an expected finding of shaken baby syndrome? (Select all that apply.) A nurse working in an emergency department is assessing a preschool age child who reports abdominal pain. Which of the following findings should alert the nurse to possible abuse? (Select all that apply.) A nurse is preparing a community education seminar about family violence. When discussing types of violence, the nurse should include which of the following? - A nurse is caring for an adult client who has injuries resulting from spousal violence. The client does not wish to report the violence to law enforcement authorities. Which of the following nursing actions is the highest priority? A nurse is assessing a client who experienced sexual assault. Which of the following findings indicate the client is experiencing an emotional reaction of rape trauma syndrome? (Select all that apply.) A nurse is discussing the care of a client following a sexual assault with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of teaching? A nurse is caring for a client who was recently sexually assaulted. The client states, "I never should have been out on the street alone at night." Which of the following responses should the nurse make? A community health nurse is leading a discussion about rape with a neighborhood task force. Which of the following statements by a neighborhood citizen indicates an understanding of the teaching? A client tells a nurse, "I would be better off dead." What is the nurse's priority response? The following interventions are the focus of nursing during a crisis intervention: (SATA) - A client is in crisis. Which of the following medications will more than likely be ordered for the nurse to administer? What is necessary for an involuntary hospital admission? A client just slammed the telephone down, yelling, displaying hostility. Which of the following is the nurse's priority? Which is a nurse's priority during an admission assessment of a client who received treatment after a situational crisis A client cannot recall any of the circumstances from a recent assault experience. Which defense mechanism is this? A staff nurse who is abusing alcohol will more than likely use which of the following defense mechanisms when confronted A client working at a busy law firm drinks heavily, complaining he has not yet received recognition. Defense mechanism: Client refuses group therapy complains of nausea and headaches. Nursing assessment indicates no medical reason. Defense Mechanism: Client is in the ER, disheveled, talking to self, complains of hearing voices. Nursing priority response: Client gives candy to a roommate after telling the nurse they dislike them and needs another room. Defense Mechanism: Nursing priority in a client who ran out of his prescription of Alprazolam Crisis intervention is focused on: (SATA) Which of the following is considered a benzodiazepine that can be given for a client who exhibits a panic attack? (SATA) - Clonazepam Which of the following is true about Critical Incident Stress Debriefing? According to Robert's Seven Stage Crisis Intervention what happens during the first 2 stages? A client in a busy dining room suddenly becomes angry and throws a chair on the wall? The nurse's priority action is A client starts to become agitated and angry. Which is the best therapeutic response? - A nurse hears a client accusing their teacher and college for wanting them to fail. Defense mechanism: Which of the following should be included in the plan of care for clients with history of anger and aggression? (SATA) A charge nurse is discussing TMS with a new RN graduate. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? - A charge nurse is reviewing Kubler Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? (SATA.) A major difference between normal and maladaptive grieving has been identified to which of the following? A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Mark all that apply): A nurse is assessing a client who has illness anxiety disorder. Which of the following findings should the nurse expect? (SATA). - When the client is obsessing about an illness and fears an illness - Illness anxiety disorder A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy? A nurse is caring for a client who is prescribed disulfiram (Antabuse) for the treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting if he drinks alcohol. Which of the following types of treatment is this method an example? A nurse is caring for a client who lost his mother to cancer a month ago. The client states, "I would still have my daughter if the doctor would have diagnosed her sooner." Which response is the best one for the nurse to choose? A nurse is conducting a family therapy session. The younger child tells the nurse about plans to make the older sibling look bad, believing this will earn more freedom and privileges. The nurse should identify this dysfunctional behavior as which of the following? A nurse is counseling a client who has factitious disorder imposed on another. Which of the following client statements should the nurse expect? A nurse is developing a plan of care for a client who has conversion disorder. Which of the following actions should the nurse include? A nurse is discussing risk factors for somatic disorder to a new RN grad. Which of the following risk factors should the nurse include? A nurse is going to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse prepare to include in the plan of care? Mark all that apply: A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A nurse is planning a group therapy session for clients dealing with bereavement. The following activities should be included in the initial phase (Mark all that apply): - A nurse is planning care following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (SATA) A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of her depressive disorder. Which of the following client statements indicate understanding of the teaching? A nurse is reviewing the medical record of a client who has conversion disorder. Which of the following findings should the nurse identify as placing the client at risk for conversion disorder? A nurse on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members conspire together to exclude the rest of the group. This is an example of which of the following concepts? Engel identifies which of the following as successful resolution of the grief process? - Gloria, a recent widow, states, "I'm going to have to learn to pay all the bills. Hank always did this. I don't know if I can handle all of that." This is an example of which of the tasks described by Worden? Identify the order in which your client, experiencing the death of her spouse, will experience, according to Engel's five stages of grief (write down the order here - use all 5 stages listed): a. Developing awareness b. Restitution c. Shock and disbelief d. Recovery e. Resolution of the loss When Frank's wife of 34 years dies, he is very stoic, handles all of the funeral arrangements, doesn't cry or appear sad, and comforts all of the other family members in their grief. Two years later, when Frank's best friend dies, Frank has sleep disturbances, difficulty concentrating, loss of weight, and difficulty performing on his job. This is an example of which of the following maladaptive responses to loss? Which grief reaction can the nurse anticipate in a 10 year old child? Which of the following is a correct statement when attempting to distinguish normal grief from clinical depression? - In clinical depression, anhedonia is prevalent Which of the following is not true regarding grieving by an adolescent? Which of the following is thought to facilitate the grief process? A nurse is teaching a client who has an anxiety disorder and is scheduled to begin classical psychoanalysis. Which of the following client statements indicates an understanding of this form of therapy? A nurse is discussing free association as a therapeutic tool with a client who has major depressive disorder. Which of the following client statements indicates understanding of this technique? A nurse is preparing to implement cognitive reframing techniques for a client who has an anxiety disorder. Which of the following techniques should the nurse include in the plan of care? (Select all that apply.) A nurse is caring for a client who has a new prescription for disulfiram for treatment of alcohol use disorder. The nurse informs the client that this medication can cause nausea and vomiting when alcohol is consumed. Which of the following types of treatment is this method an example? A nurse is assisting with systematic desensitization for a client who has an extreme fear of elevators. Which of the following actions should the nurse implement with this form of therapy? A nurse wants to use democratic leadership with a group whose purpose is to learn appropriate conflict resolution techniques. The nurse is correct in implementing this form of group leadership when demonstrating which of the following actions? A nurse is planning group therapy for clients dealing with bereavement. Which of the following activities should the nurse include in the initial phase? (Select all that apply.) - A nurse on an acute mental health unit forms a group to focus on self-management of medications. At each of the meetings, two of the members conspire together to exclude the rest of the group. This is an example of which of the following concepts? A nurse is conducting a family therapy session. The younger child tells the nurse about plans to make the older sibling look bad, believing this will earn more freedom and privileges. The nurse should identify this dysfunctional behavior as which of the following? A nurse is working with an established group and identifies various member roles. Which of the following should the nurse identify as an individual role? A nurse is providing teaching for a client who is scheduled to receive ECT for the treatment of major depressive disorder. Which of the following client statements indicates understanding of the teaching? A charge nurse is discussing TMS with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A nurse is assessing a client immediately following an ECT procedure. Which of the following findings should the nurse expect? (Select all that apply.) A nurse is leading a peer group discussion about the indications for ECT. Which of the following indications should the nurse include in the discussion? A nurse is planning care for a client following surgical implantation of a VNS device. The nurse should plan to monitor for which of the following adverse effects? (Select all that apply.) A nurse observes a client who has OCD repeatedly applying, removing, and then reapplying makeup. The nurse identifies that repetitive behavior in a client who has OCD is due to which of the following underlying reasons? A nurse is caring for a client who is experiencing a panic attack. Which of the following actions should the nurse take? A nurse is assessing a client who has generalized anxiety disorder. Which of the following findings should the nurse expect? (Select all that apply.) A nurse is planning care for a client who has body dysmorphic disorder. Which of the following actions should the nurse plan to take first? A nurse is caring for a client who has generalized anxiety disorder and is experiencing severe anxiety. Which of the following statements actions should the nurse make? - A nurse working on an acute mental health unit is caring for a client who has posttraumatic stress disorder (PTSD). Which of the following findings should the nurse expect? (Select all that apply.) A nurse is involved in a serious and prolonged mass casualty incident in the emergency department. Which of the following strategies should the nurse use to help prevent developing a trauma-related disorder? (Select all that apply) - A nurse is collecting an admission history for a client who has acute stress disorder (ASD). Which of the following client behaviors should the nurse expect? A nurse is caring for a client who has derealization disorder. Which of the following findings should the nurse identify as an indication of derealization? A nurse in an acute mental health facility is planning care for a client who has dissociative fugue. Which of the following interventions should the nurse add to the plan of care? A nurse is caring for a client who has major depressive disorder. Which of the following should the nurse identify as a risk factor for depression? (Select all that apply.) - - A nurse working on an acute mental health unit is admitting a client who has major depressive disorder and comorbid anxiety disorder. Which of the following actions is the nurse's priority? A nurse is teaching a client who has a new diagnosis of premenstrual dysphoric disorder (PMDD). Which of the following statements by the client indicates understanding of the teaching? A charge nurse is discussing the care of a client who has major depressive disorder (MDD) with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A nurse is interviewing a client who has a new diagnosis of persistent depressive disorder. Which of the following findings should the nurse expect? A nurse is planning care for a client who has bipolar disorder and is experiencing a manic episode. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) - A nurse is teaching a newly licensed nurse about the use of electroconvulsive therapy (ECT) for the treatment of bipolar disorder. Which of the following statements by the newly licensed nurse indicates understanding? A nurse is caring for a client who has bipolar disorder. Which of the following is the priority nursing action? A nurse is caring for a client who has bipolar disorder. The client states, "I am very rich, and I feel I must give my money to you." Which of the following responses should the nurse make? A nurse is discussing relapse prevention with a client who has bipolar disorder. Which of the following information should the nurse include in the teaching? (Select all that apply.) - - A nurse is caring for a client following the loss of a partner due to a terminal illness. Identify the sequence of Engel's five stages of grief that the nurse should expect the client to experience. (Select the stages of grief in order of occurrence. All steps must be used.) A. Developing awareness B. Restitution C. Shock and disbelief D. Recovery E. Resolution of the loss A charge nurse is reviewing Kübler-Ross: Five Stages of Grief with a group of newly licensed nurses. Which of the following stages should the charge nurse include in the teaching? (Select all that apply.) - Kubler Ross: Five Stages of Grief question A nurse is working with a client who has recently lost a guardian. The nurse recognizes that which of the following factors influence a client's grief and coping ability? (Select all that apply.) A nurse is discussing normal grief with a client who recently lost a child. Which of the following statements made by the client indicates understanding? (Select all that apply.) A nurse is caring for a client who lost a guardian to cancer last month. The client states, "I'd still have my guardian if the doctor would have made a diagnosis sooner." Which of the following responses should the nurse make? In determining degree of suicidal risk with a client, the nurse assesses the following behavioral manifestations: severely depressed, withdrawn, statements of worthlessness, difficulty accomplishing activities of daily living, no close support systems. The nurse identifies the client's risk for suicide as which of the following? - Which of the following interventions are appropriate for a client on suicide precautions? (Select all that apply.) The goal of cognitive therapy with depressed clients is to: Education for the client who is taking MAOIs should include which of the following? - - A client expresses interest in alternative treatments for depression with seasonal variations and asks the nurse about light therapy. Which of the following are evidence-based teaching points that the nurse may share with the client? (Select all that apply.) - A client has just been admitted to the psychiatric unit with a diagnosis of major depressive disorder. Which of the following behavioral manifestations might the nurse expect to assess? (Select all that apply.) A client with depression asks the nurse, "Why would they be checking my thyroid function when I clearly have depression and I'm not overweight?" Which of these is an accurate response? A client whose husband died 6 months ago is diagnosed with major depressive disorder. She says to the nurse, "I start feeling angry that Harold died and left me all alone; he should have stopped smoking years ago! But then I start feeling guilty for feeling that way." What is an appropriate response by the nurse? An acutely depressed client isolates herself in her room and just sits and stares into space. Which of these is the best example of an active communication approach with this client? Sally is admitted to the hospital with major depressive disorder and repeatedly makes negative statements about herself. Which of the following interventions are identified as Margaret, age 68, is diagnosed with bipolar I disorder, current episode manic. She is extremely hyperactive and has lost weight. One way to promote adequate nutritional intake for Margaret is to: The physician orders lithium carbonate 600 mg tid for a newly diagnosed client with bipolar I disorder. There is a narrow margin between the therapeutic and toxic levels of lithium. Therapeutic range for acute mania is: Although historically lithium has been the medication of choice for mania, several others have been used with good results. Which of the following are used in the treatment of bipolar disorder? (Select all that apply.) Margaret, a 68-year-old widow experiencing a manic episode, is admitted to the psychiatric unit after being brought to the emergency department by her sister-in-law. Margaret yells, "My sister-in-law is just jealous of me! She's trying to make it look like I'm insane!" This behavior is an example of: What is the most common comorbid condition in children with bipolar disorder? - A nurse is educating a client about his lithium therapy and explaining signs and symptoms of lithium toxicity. Which of the following would she instruct the client to be on the alert for? A client experiencing a manic episode enters the milieu area dressed in a provocative and physically revealing outfit. Which of the following is the most appropriate intervention by the nurse? The nurse is prioritizing nursing diagnoses in the plan of care for a client experiencing a manic episode. Number the diagnoses in order of the appropriate priority. __3__ a. Disturbed sleep pattern evidenced by sleeping only 4 to 5 hours per night __1__b. Risk for injury related to manic hyperactivity __4__c. Impaired social interaction evidenced by manipulation of others __2__d. Imbalanced nutrition: Less than body requirements evidenced by loss of weight and poor skin turgor A child with bipolar disorder also has attention-deficit/hyperactivity disorder (ADHD). How would these comorbid conditions most likely be treated? A nurse is teaching a client who has a new prescription for alprazolam for generalized anxiety disorder. Which of the following information should the nurse provide? A nurse working in an emergency department is caring for a client who has benzodiazepine toxicity. Which of the following actions is the nurse's priority? A nurse is caring for a client who is to begin taking fluoxetine for treatment of panic disorder. Which of the following statements indicates the client understands the use of this medication? A nurse is assessing a client 4 hr after receiving an initial dose of fluoxetine. Which of the following findings should the nurse report to the provider as indications of serotonin syndrome? (Select all that apply.) - A nurse is caring for a client who takes paroxetine to treat post-traumatic stress disorder. The client states, "I grind my teeth during the night, which causes pain in my mouth." The nurse should identify which of the following interventions as possible measures to manage the client's bruxism? (Select all that apply.) - A nurse is providing teaching to a client who has a new prescription for amitriptyline. Which of the following statements by the client indicates an understanding of the teaching? A nurse is caring for a client who is taking phenelzine. For which of the following manifestations should the nurse monitor as an adverse effect of this medication? (Select all that apply.) - A nurse is reviewing the medical record of a client who has a new prescription for bupropion for depression. Which of the following findings is the priority for the nurse to report to the provider? A nurse is teaching a client who has a new prescription for imipramine how to minimize anticholinergic effects. Which of the following instructions should the nurse include in the teaching? (Select all that apply.) A charge nurse is discussing mirtazapine with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates understanding? A nurse is caring for a client who is prescribed lithium therapy. The client tells of the plan to take ibuprofen for osteoarthritis pain relief. Which of the following statements should the nurse make? A nurse is discussing early indications of toxicity with a client who has a new prescription for lithium carbonate for bipolar disorder. The nurse should include which of the following manifestations in the teaching? (Select all that apply.) A nurse is discussing routine follow-up needs with a client who has a new prescription for valproate. The nurse should inform the client of the need for routine monitoring of which of the following? A nurse is caring for a client who is experiencing extreme mania due to bipolar disorder. Prior to administration of lithium carbonate, the client's lithium blood level is 1.2mEq/L. Which of the following actions should the nurse take? A nurse is admitting a client who has a new diagnosis of bipolar disorder and is scheduled to begin lithium therapy. When collecting a medical history from the client's caregiver, which of the following statements is the priority to report to the provider? - A nurse is interviewing a client who is demonstrating speech that takes a circuitous route before reaching its goal. Extra unnecessary and sometimes tedious details are added. The client often needs to be interrupted and redirected. Nursing actions includes which of the following? A nurse is assessing lethality and suicide risk during an admission assessment. Which of the following situations demonstrates the most risk for suicide? Client demanding to see the Psychiatrist pounds fist on table at 0300 am. Best nursing response: "I feel like superman, I can do anything!" Which of the following thought process findings is this patient demonstrating? A client diagnosed Bipolar Disorder shows a nurse her fresh, self-inflicted wound. Which is nursing priority of action? The nurse caring for a Bipolar patient in mania realizes which of the following medications reduces symptoms of mania? Which is an appropriate intervention for a client in mania, running around the unit organizing competitive games? Which of the following client actions will the nurse interpret as displaying manic behavior? (SATA): - The following comments from a client with bipolar disorder in group therapy indicates adaptive coping (SATA): A nurse assessing a client's suicide risk potential asks which of the following important questions? Which of the following risk factors will the nurse include in the nursing assessment of a recently admitted client? (SATA) The nurse conducts a family therapy group and identifies which of the following as attributes of healthy families? A nurse is working with a client who presents with Dissociative Fugue. Which of the following are nursing interventions? The nurse identifies which the following as indications for Derealization Disorder? - A client presents with Dissociative Identity Disorder (DID). The nurse includes which of the following in the care plan? A client with a diagnosis of Major Depressive Disorder states to the nurse, "I should have died. I've always been a failure." Which of the following is a therapeutic response by the nurse? Nursing care for a client diagnosed with Major Depressive Disorder includes which of the following? The nurse is conducting medication teaching for a client with Major Depressive Disorder. Which of the following will the nurse include in the medication teaching? - The nurse knows that a diagnosis of Major Depressive Disorder recognized by the DSM-5 includes which of the following criteria occurring almost every day for at least 2 weeks, and last most of the day. - The nurse is assessing the severity of depression symptoms of a client by asking questions from the PH-Q 9 screening tool. Which of the following questions will the nurse ask the client? (Select all that apply) The nurse gets ready to assess a client after an ECT procedure. Which of the following includes care and monitoring? Which of the following actions should the nurse take prior to a client's scheduled ECT treatment? (SATA) Nursing evaluation of medication effectiveness of mood stabilizers include which of the following? A nurse is taking care of a client that presents with serotonin syndrome. Nursing priority of action includes which of the following? Which of the following statements by the client indicates an understanding of the medication, amitriptyline (antidepressant)? A nurse is preparing the first dose of Amitriptyline to give to a client. Which of the following are contraindications and precautions? (SATA) Which of the following is a nursing priority of action to report for a client on Bupropion (antidepressant and smoking cessation aid)? The nurse is administering Bupropion to a client with Major Depressive Disorder. Contraindications includes which of the following? The nurse caring for a Bipolar patient in mania realizes which of the following medications reduces symptoms of mania? Client teaching for a patient who is prescribed Fluoxetine (SSRI-treats depression, panic disorder, etc.): Fluoxetine hydrochloride is prescribed for a client with MDD. The nurse provides instructions for the client regarding administration of the medication. Which statement by the client indicates an understanding about administration of the medication? Client with Bipolar Disorder is on long term treatment with Lithium (mood stabilizer-treats bipolar [reduces mania] and MDD). Which lab will be monitored? Which of the following client education should be included for lithium therapy?. Which will put a client on Lithium in danger of toxicity? Which of the following manifestations is an early indication of toxicity in a client taking Lithium? Which is a side effect of Olanzapine (antipsychotic-treats bipolar and schizo)? A nurse caring for a client with Major Depressive Disorder is giving the client his ordered dose of a Tricyclic Antidepressant. Which of the following are important nursing considerations? (SATA) Client on Valproate should receive which of the following discharge teaching education? A nurse is caring for a client who has substance-induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (Select all that apply.) A nurse is completing an admission assessment for a client who has schizophrenia. Which of the following findings should the nurse document as positive symptoms? (Select all that apply.) A nurse is caring for a client who has schizoaffective disorder. Which of the following statements indicates the client is experiencing depersonalization? A nurse is caring for a client on an acute mental health unit. The client reports hearing voices that are stating, "kill your doctor." Which of the following actions should the nurse take first? A nurse is speaking with a client who has schizophrenia when the client suddenly seems to stop focusing on the nurse's questions and begins looking at the ceiling and talking to themselves. Which of the following actions should the nurse take? A nurse manager is discussing the care of a client who has a personality disorder with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? A nurse is caring for a client who has avoidant personality disorder. Which of the following statements is expected from a client who has this type of personality disorder? A nurse is caring for a client who has borderline personality disorder. The client says, "The nurse on the evening shift is always nice! You are the meanest nurse ever!" The nurse should recognize the client's statement as an example of which of the following defense mechanisms? A nurse is assisting with a court-ordered evaluation of a client who has antisocial personality disorder. Which of the following findings should the nurse expect? (Select all that apply.) A charge nurse is preparing a staff education session on personality disorders. Which of the following personality characteristics associated with all of the personality disorders should the charge nurse include in the teaching? (Select all that apply.) - A nurse is caring for a client who has early stage Alzheimer's disease and a new prescription for donepezil. The nurse should include which of the following statements when teaching the client about the medication? A nurse in a long-term care facility is caring for a client who has major neurocognitive disorder and attempts to wander out of the building. The client states, "I have to get home." Which of the following statements should the nurse make? A home health nurse is making a visit to a client who has Alzheimer's disease to assess the home for safety. Which of the following suggestions should the nurse make to decrease the client's risk for injury? A nurse is making a home visit to a client who is in the late stage of Alzheimer's disease. The client's partner, who is the primary caregiver, wishes to discuss concerns about the client's nutrition and the stress of providing care. Which of the following actions should the nurse take? A nurse is performing an admission assessment for a client who has delirium related to an acute urinary tract infection. Which of the following findings should the nurse expect? (Select all that apply.) A nurse is planning a staff education program on substance use in older adults. Which of the following information should the nurse to include in the presentation? A nurse is assessing a client who has alcohol use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect? (Select all that apply.) - A nurse is planning care for a client who is experiencing benzodiazepine withdrawal. Which of the following interventions should the nurse identify as the priority? - A nurse is caring for a client who has alcohol use disorder. The client is no longer experiencing withdrawal manifestations. Which of the following medications should the nurse anticipate administering to assist the client with maintaining abstinence from alcohol? A nurse is providing teaching to the family of a client who has a substance use disorder. Which of the following statements by a family member indicates an understanding of the teaching? (Select all that apply.) - A nurse is obtaining a nursing history from a client who has a new diagnosis of anorexia nervosa. Which of the following questions should the nurse include in the assessment? (Select all that apply.) - A nurse is caring for an adolescent client who has anorexia nervosa with recent rapid weight loss and a current weight of 90 lb. Which of the following statements indicates the client is experiencing the cognitive distortion of catastrophizing? A nurse is performing an admission assessment of a client who has bulimia nervosa with purging behavior. Which of the following is an expected finding? (Select all that apply.) - A nurse is planning care for a client who has anorexia nervosa with binge-eating and purging behavior. Which of the following actions should the nurse include in the client's plan of care? A nurse is caring for a client who has bulimia nervosa and has stopped purging behavior. The client tells the nurse about fears of gaining weight. Which of the following responses should the nurse make? A nurse is caring for a client who has schizophrenia and exhibits a lack of grooming and a flat affect. The nurse should expect a prescription for which of the following medications? A nurse is caring for a client who takes ziprasidone. The client reports difficulty swallowing the oral medication and becomes extremely agitated with injectable administration. The nurse should contact the provider to discuss a change to which of the following medications? (Select all that apply.) A charge nurse is discussing manifestations of schizophrenia with a newly licensed nurse. Which of the following manifestations should the charge nurse identify as being effectively treated by first-generation antipsychotics? (Select all that apply.) A nurse is assessing a client who is currently taking perphenazine. Which of the following findings should the nurse identify as an extrapyramidal symptom (EPS)? (Select all that apply.) - A nurse is providing discharge teaching for a client who has schizophrenia and a new prescription for iloperidone. Which of the following client statements indicates understanding of the teaching? A nurse is providing teaching to a client who has alcohol use disorder and a new prescription for carbamazepine. Which of the following information should the nurse include in the teaching? A nurse is assisting in the discharge planning for a client following alcohol detoxification. The nurse should expect prescriptions for which of the following medications to promote long-term abstinence from alcohol? (Select all that apply.) - - Disulfiram - Naltrexone - Acamprosate A nurse is evaluating a client's understanding of a new prescription for clonidine for the treatment of opioid use disorder. Which of the following statements by the client indicates an understanding of the teaching? A nurse is teaching a client who has tobacco use disorder about the use of nicotine gum. Which of the following information should the nurse include in the teaching? - A nurse is discussing the use of methadone with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching? (Select all that apply.) - A nurse is assessing a client who has major depressive disorder. The nurse should identify which of the following client statements as an overt comment about suicide? (Select all that apply.) - A nurse is caring for a client who states, "I plan to commit suicide." Which of the following assessments should the nurse identify as the priority? A nurse is assisting with the development of protocols to address the increasing number of suicide attempts in the community. Which of the following interventions should the nurse include as a primary intervention? (Select all that apply.) - A nurse is caring for a client who is on suicide precautions. Which of the following interventions should the nurse include in the plan of care? A nurse is conducting a class for a group of newly licensed nurses on caring for clients who are at risk for suicide. Which of the following information should the nurse include in the teaching? Josh, age 21, has been diagnosed with schizophrenia. He has been socially isolated and hearing voices telling him to kill his parents. He has been admitted to the psychiatric unit from the emergency department. The initial nursing intervention for Josh is to: The primary goal in working with an actively psychotic, suspicious client would be to: - The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Why is chlorpromazine ordered? The nurse is caring for a client with schizophrenia. Orders from the physician include 100 mg chlorpromazine IM STAT and then 50 mg PO bid; 2 mg benztropine PO bid prn. Because benztropine was ordered on a prn basis, which of the following assessments by the nurse would convey a need for this medication? Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. The most appropriate response by the nurse is: Brandon, a client on the psychiatric unit, has been diagnosed with schizophrenia. He begins to tell the nurse about how the CIA is looking for him and will kill him if they find him. Brandon's belief is an example of a: The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes from these signs that the client is likely experiencing: The nurse is interviewing a client on the psychiatric unit. The client tilts his head to the side, stops talking in midsentence, and listens intently. The nurse recognizes these behaviors as a symptom of the client's illness. The most appropriate nursing intervention for this symptom is to: When a client suddenly becomes aggressive and violent on the unit, which of the following approaches would be best for the nurse to use first? The primary focus of family therapy for clients with schizophrenia and their families is: - A client recently admitted to the hospital reports to the nurse, "I don't understand why I was brought here. I was simply hanging out in my apartment and the police said I had to come with them." This is an example of what symptom of schizophrenia? Recent research on the RAISE approach to treatment of schizophrenia incorporates which of the following elements as important to improving outcomes? (Select all that apply.) - An example of a treatable (reversible) form of NCD (neurocognitive disorder) is one that is caused by which of the following? (Select all that apply.) - Mrs. G. has been diagnosed with NCD (neurocognitive disorder) due to Alzheimer's disease. The cause of this disorder is which of the following? Mrs. G. has been diagnosed with NCD (neurocognitive disorder) due to Alzheimer's disease. The primary nursing intervention in working with Mrs. G. is which of the following? Which of the following medications have been indicated for improvement in cognitive functioning in mild to moderate Alzheimer's disease? (Select all that apply.) - - Mrs. G., who has NCD (neurocognitive disorder) due to Alzheimer's disease, says to the nurse, "I have a date tonight. I always have a date on Christmas." Which of the following is the most appropriate response? In addition to disturbances in cognition and orientation, individuals with Alzheimer's disease may also show changes in which of the following? (Select all that apply.) - - Mrs. G., who has NCD (neurocognitive disorder) due to Alzheimer's disease, has trouble sleeping and wanders around at night. Which of the following nursing actions would be best to promote sleep in Mrs. G.? - The night nurse finds Mrs. G., a client with Alzheimer's disease, wandering the hallway at 4 a.m. and trying to open the door to the side yard. Which statement by the nurse probably reflects the most accurate assessment of the situation? Which of the following factors is not associated with increased incidence of NCD (neurocognitive disorder) due to Alzheimer's disease? Mr. Stone is a client in the hospital with a diagnosis of vascular NCD (neurocognitive disorder). In explaining this disorder to Mr. Stone's family, which of the following statements by the nurse is correct? Which of the following interventions is most appropriate in helping a client with Alzheimer's disease with her ADLs? (Select all that apply.) Mr. White is admitted to the hospital after an extended period of binge alcohol drinking. His wife reports that he has been a heavy drinker for a number of years. Laboratory reports reveal he has a blood alcohol level of 250 mg/dL. He is placed on the chemical addiction unit for detoxification. When would the first signs of alcohol withdrawal symptoms be expected to occur? Symptoms of alcohol withdrawal include: Which of the following medications is the physician most likely to order for a client experiencing alcohol withdrawal syndrome? Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." What is the nurse's best response? Dan, who has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job, states to the nurse, "I don't have a problem with alcohol. I can handle my booze better than anyone I know. My boss is a jerk! I haven't missed any more days than my coworkers." Which defense mechanism is Dan using? Dan has been admitted to the alcohol rehabilitation unit after being fired for drinking on the job. Dan's drinking buddies come for a visit, and when they leave, the nurse smells alcohol on Dan's breath. Which of the following would be the best intervention with Dan at this time? Dan begins attendance at AA meetings. Which of the statements by Dan reflects the purpose of this organization? From which of the following symptoms might the nurse identify in a chronic cocaine user? - An individual who is addicted to heroin is likely to experience which of the following symptoms of withdrawal? A polysubstance abuser makes the statement, "The green and whites do me good after speed." How might the nurse interpret the statement? A client admitted to the emergency department smells strongly of alcohol, and his wife reports he has been a heavy drinker for the last 25 years. Which of the following assessment findings are consistent with long-term chronic alcohol abuse? (Select all that apply.) - Some obese individuals take amphetamines to suppress appetite and help them lose weight. Which of the following is an adverse effect associated with use of amphetamines that makes this practice undesirable? The Maudsley approach to treatment of adolescents with anorexia nervosa advances which of the following fundamental concepts? John has sought help for his concern that he is binge eating and feels like it has "gotten out of control." He asks the nurse what can be done to help him. Which of these is the most accurate response? Emma, age 14, has just been admitted to the psychiatric unit for anorexia nervosa. She is emaciated and refusing to eat. What is the primary nursing diagnosis for Emma? - Which of the following physical manifestations would you expect to assess in a client suffering from anorexia nervosa? - The nurse is caring for a client who has been hospitalized with anorexia nervosa and is severely malnourished. The client continues to refuse to eat. What is the most appropriate response by the nurse? Marissa is hospitalized on the psychiatric unit. She has a history and current diagnosis of bulimia nervosa. Which of the following symptoms would be congruent with Marissa's diagnosis? A hospitalized client with bulimia nervosa has stopped vomiting in the hospital and tells the nurse she is afraid she is going to gain weight. Which is the most appropriate response by the nurse? Mandy presents in the emergency department with complaints of suicidal ideation. The following data is collected by the nurse. Which of these assessment findings suggests that bulimia nervosa might be a health problem? (Select all that apply.) Kim has a diagnosis of borderline personality disorder. She often exhibits alternating clinging and distancing behaviors. The most appropriate nursing intervention with this type of behavior would be to: Kim, a client diagnosed with borderline personality disorder, manipulates the staff in an effort to fulfill her own desires. All of the following may be examples of manipulative behaviors in the borderline client except: "Splitting" by the client with BPD (borderline personality disorder) denotes: - According to Margaret Mahler, predisposition to BPD (borderline personality disorder) occurs when developmental tasks go unfulfilled in which of the following phases? - Jack is a new client on the psychiatric unit with a diagnosis of antisocial personality disorder. Which of the following characteristics would you expect to assess in Jack? - Milieu therapy is a good choice for clients with antisocial personality disorder because it: In evaluating the progress of Jack, a client diagnosed with antisocial personality disorder, which of the following behaviors would be considered the most significant indication of positive change? Which of the following behavioral patterns is characteristic of individuals with narcissistic personality disorder? Jessica is a nurse who was floated to the psychiatric unit to cover for a staff nurse who called out sick. She encounters a patient diagnosed with BPD (borderline personality disorder), and the patient states, "Thank goodness they sent you to the unit. No one else here has taken the time to listen to my concerns." This may be an example of which symptom common in BPD (borderline personality disorder)? Which of the following behavioral patterns is characteristic of individuals with schizotypal personality disorder? Which of the following findings should the nurse document as positive symptoms of schizophrenia? (SATA) A patient with psychosis stares at the ceiling, mumbling. What is the nurse's priority action? A client has difficulty swallowing, increasing agitation w/injectable ziprasidone. Other alternative meds (SATA): The nurse knows that which of the following are true about the therapeutic use of Aripiprazole? (SATA) - Nursing considerations for Risperidone include which of the following? (SATA) - - Nursing actions for Risperidone administration (SATA) Tardive dyskinesia includes which of the following nursing considerations? (SATA) - - Nursing considerations for Haldol include which of the following? (SATA) - The nurse will monitor signs and symptoms of serotonin syndrome which includes which of the following? The nurse will monitor for neuroleptic malignant syndrome observing for which of the following signs and symptoms Nursing action for neuroleptic malignant syndrome (NMS) includes which of the following? A nurse is assessing a client 4 hrs after receiving an initial dose of fluoxetine -Nursing action includes assessing for (SATA): Expected findings for a client with Delirium related to an acute urinary tract infection includes (SATA): - Nursing action in the treatment of acute dystonia in EPS includes which of the following? A nurse is caring for a client diagnosis with Alzheimer's Disease with script for donepezil. Med teaching includes: Home Health RN assessed a client with Alzheimer's Disease. Nursing interventions to decrease injury includes which of the following? (SATA) A positive CAM-ICU finding for Delirium includes which of the following? Expected findings for a client with NCD (neurocognitive disorder) include which of the following? Which are expected findings of bulimia nervosa with purging behavior. (SATA) - - Which following nursing care is best for a client with a diagnosis of anorexia nervosa with binge eating and purging behavior? Clonidine for the treatment of opioid use: Which shows client understanding? CIWA is a screening tool for which condition and what score would indicate medical intervention? Which of the following are best interventions for a patient with cognitive decline/Alzheimer's Disease? (SATA) - Nursing care for patient diagnosed with an eating disorder include which of the following? (SATA) - COMMON LABORATORY ABNORMALITIES ASSOCIATED WITH ANOREXIA AND BULIMIA (SATA): Clients with co-occurring personality disorders often have which of the following risk factors? (SATA) - Which of these personality disorders may include a history of conduct disorder before the age of 15? Borderline Personality Disorder is characterized by which of the following? (SATA) - - Negative symptoms of Schizophrenia include which of the following? Patients diagnosed with co-occurring histrionic disorder require nurses to be consistent with which of the following? A nurse in an acute mental health facility is creating a plan of care for a new client who has a co-occurring histrionic personality disorder. Which of the following is the priority intervention for the nurse to make? A nurse is reviewing the history and physical of an adolescent client who has conduct disorder. Which of the following is an expected finding ? A nurse is planning discharge for a client who has a co-occurring borderline personality disorder. Which of the following interventions should be included for this client? - A nurse is planning care for a client who has dependent personality disorder. Which of the following actions should the nurse plan to take? A nurse is reviewing the medical record of a client who performs self-injury. Which of the following information should the nurse identify as placing the client at risk for self-harm behaviors? A nurse is caring for a client who has schizophrenia and tells the nurse, "They lie about me all the time and they are trying to poison my food." Which of the following statements should the nurse make? A nurse is conducting a group therapy session for several clients. The group is laughing at a joke one of the clients told, when a client, admitted for schizophrenia, jumps up and runs out of the room yelling, "You are all making fun of me!" The nurse should identify this behavior as which of the following characteristics of schizophrenia? A nurse is providing teaching for a client who has schizophrenia and a new prescription for Fluphenazine. Which of the following information should the nurse provide? - A nurse in a mental health clinic is conducting a staff education session on schizophrenia. Which of the following manifestations should the nurse include in the teaching plan as negative symptoms? (Select all that apply.) - A nurse is caring for a client who has substance induced psychotic disorder and is experiencing auditory hallucinations. The client states, "The voices won't leave me alone!" Which of the following statements should the nurse make? (Select all that apply.) A nurse is assisting a client who has schizophrenia prepare a relapse plan. Which of the following statements should the nurse verbalize during the session? A nurse in an acute care mental health facility is sitting with a client who has schizophrenia. The client whispers to the nurse, "I'm being kept in this prison against my will. Please try to get me out." Which of the following responses should the nurse make? A nurse is caring for a client who has schizophrenia and is having difficulty with performing ADLs. The nurse should consult with which of the following members of the interdisciplinary team to assist the client? A client presents with psychosis. The nurse is preparing to administer Clozapine. Which of the following nursing actions is the highest priority with monitoring complications of Clozapine? The nurse planning on discharge of the client with Neurocognitive Disorder who was admitted for an acute exacerbation will include which of the following caregiver education? A nurse is caring for a client who has early stage Alzheimer's disease with a new prescription for Donepezil. The nurse should include which of the following statements when teaching the client about this medication? Nursing care of clients who have potential for complications of Delirium include which of the following A nurse is caring for a client diagnosed with an eating disorder. Which of the following medications are contraindicated in clients with an eating disorder? A nurse is caring for a client admitted for complications related to an eating disorder. Which of the following nursing actions need to be included during complications such as re-feeding syndrome when caring for a client with an eating disorder? A nurse is caring for an older adult client who is recovering from total hip surgery. The client has a history of Depression and Dementia. Which of the following symptom manifestation is the highest priority for nursing action? A nurse is assessing a client's withdrawal symptoms using the clinical institute withdrawal assessment of alcohol scale (CIWA). Which of the following scores would indicate a mild to moderate level of withdrawal? A nurse is discharging a client with bipolar personality disorder. Plan includes: You're a nurse caring for a client with histrionic personality disorder, your priority intervention is: Depersonalization experience that the client with Schizophrenia can experience when they feel overwhelmed/stressed - Haloperidol decanoate to a client who has schizophrenia. Client teaching with Chlorpromazine: Olanzapine 10 mg IM to a client who has schizophrenia. Example nursing actions: - Aripiprazole. Nursing consideration Chlorpromazine. Nursing considerations Schizophrenia client taking risperidone. Nursing considerations/monitoring Ex: Haloperidol Nursing considerations - Example: Clozapine for the treatment of Schizophrenia. Contraindication to clozapine: Schizophrenia - Thioridazine Nursing considerations/Example: A nurse is caring for an adolescent female who has an eating disorder. Nursing Considerations: Comorbidities associated with eating disorders Positive Symptoms of Schizophrenia Negative Symptoms of Schizophrenia - A nurse in an acute mental health facility is creating a plan of care for a new client who has a co-occurring histrionic personality disorder. Which of the following is the priority intervention for the nurse to make? Heroin overdose withdrawal - Stimulant withdrawal - Opioid withdrawal - - Alcohol withdrawal - Clang associations - Associative looseness Schizophrenia Cognitive Behavioral Therapy (CBT) Validation therapy for a pt who is cognitively impaired First gen antipsychotics "I have it all figured out. Everything is going to be okay now." - Electroconvulsive therapy (ECT) Antisocial personality disorder: lack empathy and connection with others; disregards rules or respect for authority - - Methylphenidate: ADHD tx - Quetiapine fumarate - Adjustment disorder: post traumatic - Vegetative signs of depression: altered sleep - Memantine - Paroxetine: SSRI - Remote memory - Chlorpromazine - Dementia - Codependence - Valproic acid - - Bipolar disorder w/rapid cycling - Tension-building phase of violence - Abrupt cessation of amphetamines for ADHD tx - Buspirone - Phenelzine: MAOI - Impulsive behaviors - Splitting behaviors Light therapy for SAD Lithium Borderline PD - - ADHD Assess pts ability to concentrate - Active listening vs therapeutic techniques Transcranial magnetic stimulation (TMS) Alzheimer's Disease Major Depressive Disorder (MDD) Tricyclic Antidepressants (TCA) meds: notify provider immediately of - - -amine Varenicline: smoking cessation - Generalized Anxiety Disorder (GAD) - Eye movement desensitization and reprocessing (EMDR) Rape-trauma syndrome - Adaptive response only - Involuntary Commitment/Admission/Hospitalization - A nurse is caring for a client who reports acute anxiety. Which of the following is the priority nursing action? Alcohol withdrawal Anorexia Nervosa Aripiprazole Bupropion Chlorpromazine CIWA mild to moderate withdrawal Client who performs self-injury Clozapine Command hallucinations Conduct disorder adolescent Confabulation - Dependent Personality Disorder - Dialectical Behavioral Therapy - Disulfiram bad response (vomit) - Donepezil - Eating disorders - Haloperidol Ideas of reference Neurocognitive Disorder-Caregiver Education Neuroleptic Malignant Syndrome Occupational Therapist Older adult who is recovering from total hip surgery...history of Depression and Dementia...highest priority for nursing action Priority = Assess suicide risk Risperidone = Don't give to dementia pt Risperidone Schizophrenia Positive Sx behavior, delusions Schizophrenia Negative Sx Serotonin Syndrome Tardive Dyskinesia