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In evaluating a client for insomnia, which of the following is most consistent with a presentation of transient insomnia? (p305) - ✔✔Usually caused by stress, jet lag, or physical environmental concerns. Insomnia is a common finding in clients with psychiatric disorder and is most commonly found in clients diagnosed with (p305) - ✔✔Mood disorders Insomnia in children is most often caused by (p305) - ✔✔Family stress A PMHNP is working with a woman whom she suspects is in a violent domestic relationship. The client denies this and refuses to discuss her home life. The continues to present at the clinic for treatment of minor injuries and always is brought by her boyfriend. The client refuses to discuss abuse as a cause of her injuries, simply stating "I am clumsy." The best initial intervention for the PMHNP to take is (p305) - ✔✔Spend a long time with the client building a trusting relationship. A brief period of insomnia is usually associated with - ✔✔Anxiety, anticipation or consequences of a stressful experience, or jet leg. (p337) Although insomnia can occur as a consequence of many psychiatric disorders, research has found that patients with mood disorders are most apt to have - ✔✔Insomnia (p337) Stress within the family is the most common cause of insomnia - ✔✔Childhood (p337) Spending time to build rapport and a trusting relationship with an abused patient - ✔✔Helps the patient feel safer and more comfortable talking about the abuse (p337)
A diagnosis of MR is made when a person has significant below-average intelligence accompanied by impaired adaptive functioning. The IQ range for consideration of MR is an (p287) - ✔✔IQ below 70 Most of the stimulants commonly used to treat ADHD are classified as Schedule II controlled substances. The exception is (p287) - ✔✔Strattera A child presents with a behavioral pattern of negative, defiant, disobedient and hostile behavior, especially towards adults in authority roles. The most likely diagnosis for this child is (p288) - ✔✔Oppositional Defiant Disorder Which of the following is not required to make a diagnosis of Conduct Disorder? (p288) - ✔✔Poor interpersonal relationships with limited peer supports Strattera - ✔✔First non-stimulant medication FDA approved for ADHD Although poor interpersonal relationships can be a consequence of the conduct disorders - ✔✔It is not a required diagnostic criteria. Impulsivity is a common behavioral manifestation of personality disorders. The PMHNP working with a client with high impulsivity should consider what pharmacological interventions? (p259) - ✔✔USE of SSRI The affective instability common in some personality disorders ban be clinically managed with what medications? (p259) - ✔✔Antipsychotic agents The cluster of personality disorders that manifest with dramatic, overly affective behavior is (p260) - ✔✔Cluster B Etiological models that attempt to explain the development of personality disorders include which of the following? (p260) - ✔✔Object relations theory
Substance withdrawal - ✔✔The development of a substance specific syndrome (p245) Knowing the action of a substance (how a person feels when they take it) - ✔✔Allows the PMHNP to infer that withdrawal symptoms will be the opposite of the effects of the agent. (p245) Why is it important to treat the physical withdrawal symptoms of a substance? - ✔✔They can lead to autonomic instability, seizures and death. Risk factors for the development of delirium include (p223) - ✔✔Multisystem illness, age older than 50, substance abuse. The most significant finding that should alert you to the possible diagnosis of delirium (p223) - ✔✔Rapid onset of symptoms different from baseline functioning Prevention and screening actions are essential in the identification of dementia because (p223) - ✔✔Early detection can prevent some of the deterioration of the illness The medication most commonly used to treat moderate cognitive deficits seen in dementia is (p223) - ✔✔Exelon (rivastigmine) The neurotransmitter deregulation theory of the etiology of psychotic disorders such as schizophrenia supports that psychosis is caused, in part, by (p206) - ✔✔An excess of dopamine The positive-negative model of classifying the symptoms of schizophrenia describes positive symptoms as (p206) - ✔✔Symptoms that positively respond to antipsychotic medications Mrs. Jay suffers from schizophrenia and is taking Navane 15 mg/day. During her appointment, she complains of feelings of inner restlessness, tremors, drooling, and stiff muscles. The best explanation for these is (p206) - ✔✔Extrapyramidal side effects of Navane
As part of treatment planning, you place a note on Mrs. Jay's chart about seizure precautions. She notices the note and states that she doesn't understand and that she has no history of seizures. You explain that (p206) - ✔✔Typical antipsychotic medications can lower the seizure threshold. Mrs. Anders. Delusional Disorder. Takes Haldol 5 mg po BID, Tylenol 2 tabls po PRN, Cogentin 1 mg PO prn, and Ativan 2 mg PRN. She is complaining of a sudden painful stiff neck and jaw muscles that started a few hours after she took her medications. these symptoms are most likely related to (p207) - ✔✔Dystonia The most appropriate PMHNP action to help relieve Mrs. Ander's pain and stiff muscles it (p207) - ✔✔Increase the cogentin dose. The psychodynamic theory of anxiety states that the tiology of anxiety is (p176) - ✔✔conflict between the id and superego The interpersonal theory of anxiety states that the etiology of anxiety is (p176) - ✔✔Perceived disapproval from significant others Mr. Zimms is admitted to the hospital with a diagnosis of OCD. He exhibits high use of defense mechanisms; has automatic behavior, physical discomfort, and feelings of dread and horror; and is trembling and ritualistically washing his hands. You would assess his level of anxiety as (p176) - ✔✔Severe Which of the following levels of anxiety is considered normal and useful in motivating a person to action? - ✔✔Mild Severe symptoms of anxiety - ✔✔Autonomic nervous system triggered, flight-or-flight response, dilated pupils, increase in VS, diaphoresis, rigid muscles, decreased hearing, increased pain threshold, urinary frequency and diarrhea. In psychodynamic theory of anxiety, Freud postulated that anxiety resulted from - ✔✔Psychic conflict between the unconscious sexual or aggressive wishes and the corresponding threats from the superego.
When treating elderly people, you should keep in mind that they are more sensitive to issues of drug toxicity because of - ✔✔Decreased protein binding. What happens with decreased protein binding in the elderly population? - ✔✔Many psychotropic medications are highly protein bound. It is the unbound (free) concentration of the drug that is active; the bound concentration of the drug is inert. Thus with decreased protein available for binding, there exists more free (active) drug, which then predisposes elderly people to toxicity. Which known teratogenic effects can be caused by lithium? - ✔✔Epstein anomaly Which known teratogenic effects can be caused by Depakote? - ✔✔Spina bifida (neural tube defects) The study of what the body does to drugs is called - ✔✔Pharmacokinetics The concept of target symptom indentification is best explained as - ✔✔Identification of specific, precise, and individualized symptoms reasonably expected to improve with medications. Mr. Johnson is a newly admitted client to an inpatient psychiatric hospital. The PMHNP on call at the facility plans to perform the initial intake assessment and diagnostic process. Mr. Johnson asks to please talk in his room because, he says, "People make me nervous." His room at the end of the ahllway and is the farthest away from the nursing station. The PMHNPs action should be based on awareness that the best location to do the assessment is - ✔✔In a quiet place but public enough to get assistance with patient care should it be required during the assessment. In assessing a client, you ask him the meaning of the proverb "People who live in glass houses shouldn't throw stones." He replies, "Because it will break the windows." The correct interpretation of this finding is - ✔✔Unable to interpret as age of patient is not known The PMHNP is planning to work with a client using a individual therapy model of care. During the first session, the client makes the following statement: "This is the third time my son has run away. I've grounded him, taken away his bike, even tried cutting off his allowance and locking him in his room. What should I do now?" The most therapeutic response for the PMHNP to make is - ✔✔"Maybe that depends on what you are trying to accomplish." (This statement allows the client to be in partnership with the NP and an active participant in his/her own treatment)
Mrs. Shea has come to the mental health center seeking treatment for depression. She has a history of a suicide attempt by overdose one month ago. she was started on imipramine (TCA) after that event but stopped taking the med one week later because it "did no good." The PMHNP meets with Mrs. Shea to plan care with her. What is the most appropriate initial action? - ✔✔Asking Mrs. Shea how to help her. The role of neurogransmitters in the central nervous system is to function as - ✔✔A communication medium Serotonin is produced in which of the following locations? - ✔✔Raphi nuclei A client presents with c/o changes in appetite, feeling fatigued, problems with sleep-rest cycle, and changes in libido. The neuroanatomical area of the brain responsible for the normal regulation of these functions is the - ✔✔Hypothalamus Hypothalamus - ✔✔Brain's alarm system and plays a key role in regulatory functions such as thirst, hunger, water balance, circadian rhythms, etc. In considering whether or not to order an MRI for a client with suspected psychiatric disorders, which of the following would be contraindication to this diagnostic test? - ✔✔Pacemaker The DSM-IV-TR is the most common classification system used to identify and diagnose mental illness. The one aspect of an illness not discussed in the DSM-IV-TR is - ✔✔Etiology of common disorders Mrs. French has been in individual therapy for 3 months. She has shown much growth and improvement in her functioning and insight and is to discontinue services within the next few weeks. In the next session, after you discuss service termination, she suddenly begins to demonstrate the original symptoms that had brought her to treatment initially. She is now hesitant to discharge, wants to continue services and is displaying an increase in regressive defense mechanisms. The best explanation of Mrs. French's behaviors is - ✔✔A sign of normal resistance seen in the termination phase of the nurse-client relationship. An example of a mature health defense mechanisms is - ✔✔Suppression - this channels conflicting energies into growth-promoting activities
