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NSG 526 Clin Modal. EXAM 1 Questions
and Answers.
A syndrome characterized by clinically significant disturbance in an individual's cognition, emotion, regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental process underlying mental funcioning They are associated with significant distress, disability in social occupational, or other important activities - correct answer mental disorder/psychiatric illness Criteria that are offered as guidelines for making diagnoses - correct answer diagnostic criteria When the symptom presentation does not meet full criteria for any disorder and the symptom cause clinically significant distress/impairment what categories should be used in the diagnosis - correct answer "other specified" "unspecified" When the symptom presentation does not meet full criteria and "other specified" and "unspecified" categories are used in the diagnosis, what should the main diagnosis be corresponding to? - correct answer main diagnosis should correspond to the most predominant symptoms. Ex: bipolar disorder, unspecified The coding system that is used in the u.s. for diagnosing and documenting psychiatric disorders - correct answer icd-10-cm (international classification of disease-10th revision-clinical modification)
True or false: the diagnosis of a mental disorder is not equivalent to a need for treatment - correct answer true - clinicians should treat based on symptom severity, clinical presentation, etc.
- A nurse is assessing a client who is experiencing occasional Feelings of sadness because of the recent death of a beloved pet. The client's appetite, sleep patterns, and daily routine have not changed. How should the nurse interpret the client's behaviors?
- The client's behaviors demonstrate Mental illness in the form of Depression.
- The client's behaviors are extensive, Which indicates the presence of mental Illness.
- The client's behaviors are not congruent With cultural norms.
- The client's behaviors demonstrate no Functional impairment, indicating no Mental illness. - correct answer 4. The client's behaviors demonstrate no functional impairment, indicating no mental illness.
- At what point should the nurse determine that a client is at risk For developing a mental illness?
- When thoughts, feelings, and behaviors Are not reflective of the dsm-5 criteria.
- When maladaptive responses to stress Are coupled with interference in daily Functioning.
- When a client communicates Significant distress.
- When a client uses defense mechanisms As ego protection. - correct answer 2. When maladaptive responses to stress are coupled with interference in daily functioning.
Which action alerts the nurse to the client's use of the defense mechanism of denial?
- The client hides liquor bottles in a closet.
- The client yells at her son for slouching in His chair.
- The client burns dinner on purpose.
- The client says to the spouse, "i don't Drink too much!" - correct answer 4. The client says to the spouse, "i don't drink too much!"
- Which nursing statement regarding the concept of psychosis is most Accurate?
- Individuals experiencing psychoses are Aware that their behaviors are maladaptive.
- Individuals experiencing psychoses Experience little distress.
- Individuals experiencing psychoses are Aware of experiencing psychological Problems.
- Individuals experiencing psychoses are Based in reality. - correct answer 2. Individuals experiencing psychoses experience little distress The nurse should understand that the client with psychosis experiences little distress owing to his or her lack of awareness of reality. They are unaware of their psychological problems
- How would a nurse best complete the new dsm-5 definition of a mental disorder? "a health condition characterized by significant dysfunction in an individual's Cognitions, or Behaviors that reflect a disturbance in ..." which of the following?
- Psychosocial, biological, or
Developmental process underlying Mental functioning
- Psychological, cognitive, or Developmental process underlying Mental functioning
- Psychological, biological, or Developmental process underlying mental Functioning
- Psychological, biological, or Psychosocial process underlying Mental functioning - correct answer 3. Psychological, biological, or developmental process underlying mental functioning.
- A nurse is assessing a client who appears to be experiencing some anxiety during Questioning. Which symptoms might the client demonstrate that would indicate Anxiety? (select all that apply.)
- Fidgeting
- Laughing inappropriately
- Palpitations
- Nail biting
- Limited attention span - correct answer 1. Fidgeting
- Laughing inappropriately
- Nail biting Which documentation of a patient's behavior best demonstrates a psychiatric advanced practice nurse's professional observations regarding the patient's psychotic symptoms? A) isolates self from others. Frequently fell asleep during group. Vital signs stable. B) calmer; more cooperative. Participated actively in group. No evidence of psychotic thinking.
**** delusions are a part of thought content ** suicidal thoughts, homicidal thoughts, and thoughts of self- harm are all covered in thought content -- think - it is the content of your thoughts!!! *** the thought process is the way in which a client thinks. - often evidenced by their speech ***illusions and hallucinations are covered under perceptual disturbances The pmhnp has a new patient in the clinic. While looking at the materials the patient filled out in the waiting area, the pmhnp ascertains the patient has a substance abuse history. The pmhnp immediately says, "stupid drug addicts, they're so annoying. There such a waste of time. They never want to get better. "this is an example of: A) projection B) transference C) countertransference D) resistancefsaf - correct answer c. Countertransference Which comment(s) by an elderly person best indicates successful completion of developmental tasks? Select all that apply. A) "i am proud of my children's successes in life." B) "i should have given to charities more often." C) "my relationship with my father made life more difficult for me."
D) "i often wonder what would have happened if i had chosen a different career." - correct answer a. I am proud of my children's success in life The purposes of the psychiatric interview include all except: A) gaining an understanding of the patient's illness. B) obtaining information efficiently. C) providing education about psychiatric disorders. D) establishing a therapeutic alliance. - correct answer c. Providing education about psychiatric disorders Operates to the pleasure principle. Seeking please and avoiding pain. It drives wishes, desires and fantasies. No real perception of reality. It uses primary process... Seeks to Satisfy its needs. - correct answer id Id has 2 major instincts, what are they? - correct answer eros - focus on pleasure-seeking tendencies Such as sexual urges. Thanatos - motivates people to use aggressive urges to destroy. Aware of reality and understands that behaviors have consequences. It uses Secondary processes... Perception, recognition, judgement, memory, reasoning, Problem-solving, impulse control and formation of relationships - correct answer ego Contains morals and values and is developed from our parents through
- correct answer c. The patient is freely describing their feelings related to the physical and emotional trauma they experienced as a child with the nurse.
- When preparing to conduct a nursing history and assessment on a patient transferred from the emergency department (ed) whose family believes the patient to be a questionable historian due to cognitive impairment, the nurse initially begins the interview by: A. Reviewing the ed chart B. Contacting the admitting physician C. Directing the questions to the family members D. Establishing a line of communication with the patient - correct answer d. Establishing a line of communication with the patient
- When engaging in outcomes identification, the nurse: A. Interviews and collects patient-focused data B. Re-assesses the patients physical and emotional status evaluation C. Reviews the patients existing problems and projects the results of the nursing care D. Considers the patients presenting symptoms and identifies nursing-related problems - correct answer c. Reviews the patients existing problems and projects the results of the nursing care If a client makes a threat to harm a specific individual, the pmh- aprn must notify that individual per the _________ law. - correct answer tarasoff law
Individuals can be involuntarily committed for a psychiatric evaluation for only three reasons. What are they? - correct answer 1. They are a danger to themselves due to a mental illness.
- They are a danger to others due to a mental illness.
- They are gravely disabled due to a mental illness. True or false: Multiple diagnoses must be presented in a hierarchy from the condition of most significance to that of least concern - correct answer true The main diagnoses is considered the principle diagnosis. I will be documented as: Patient y meets the criteria for two dsm-5 diagnoses: (f41.1) generalized anxiety disorder (principal diagnosis), (f43.21) adjustment disorder with depressed mood Example of patient with a mental health disorder and a primary medical condition: Patient x meets the criteria for the following dsm-5 and icd- diagnoses: (250) diabetes mellitus (primary diagnosis), (f43.12) post traumatic stress disorder, chronic. What are the four lobes of the brain - correct answer 1. Frontal
- Temporal
- Occipital
- Parietal Dense collections of nerve cells with common specific functions - correct answer nuclei
be coordinated between the left and right sides of the brain. - correct answer corpus collosum True or false: The cingulum has been implicated as abnormal in schizophrenia and adhd - correct answer false The corpus callosum has been implicated as abnormal in schizophrenia and adhd As a body (corpus) of nerve fibers of colossal proportions, this tract allows each hemisphere of the brain to receive and send information to the other hemisphere, so that functions can be coordinated between the left and right sides of the brain. It has been implicated as abnormal in schizophrenia and attention deficit hyperactivity disorder (adhd). - correct answer corpus callosum On the same level as the corpus callosum is the main information highway of emotion, the __________. This central highway seems to be involved with the summation and integration of emotion and thinking in preparation for final input to the hypothalamus, a central integrating station. The _______ facilitates an integration from higher (thinking and emotion) to lower (the hypothalamic nuclei) brain regions. - correct answer cingulum ** this is larger in women Reward tract
The various tracts (mesocortical and mesolimbic tracts) involved in the processing of pleasurable experience and reward come together in a pathway called the _____________________ This bundle of reward fibers interconnects areas of the brain involved in the mediation of emotion, learning, arousal, memory, and hormonal control. It runs between the hypothalamus and the septal region. *****this tract has clinical importance in depression, mania, and schizophrenia. Researchers have postulated that there is a fundamental imbalance of activity between the median forebrain bundle reward system and the inhibitory (punishment) center of the brain. In mania, the pleasure centers are hypothesized to be overactive and/or the inhibitory centers, underactive. In depression, the reverse would be so. - correct answer median forebrain bundle. Punishment tract This tract follows a path around (peri) the fluid-filled spaces within the interior parts of the brain (the ventricles), connecting the emotional, thinking, and hormonal functions of the brain. This is the primary inhibitory or punishment pathway in the brain; activation of this pathway seems to initiate avoidance behaviors. This tract is in balance with the reward tract, mentioned above. Together they modulate varying degrees of excitation and inhibition of behavior in various areas of the brain involved in learning, emotion, arousal, and hormonal activation. - correct answer the periventricular system Reinforcement
Observe for evidence of dysarthria (physical difficulty in vocalizing), echolalia (the repetition of the interviewer's words), perseveration (the repetition of the same words or themes), aphasia (difficulties in understanding or producing speech), and other disorders or oddities of speech. This would be documented under what section of the mental status examination - correct answer speech We ask the patient about delusions in what section of the mental status examination - correct answer thought content Intrusive thoughts or ideas that the client recognizes as "crazy" but act in accordance with anyway - correct answer obsessions Delusions involving death or destruction - correct answer nihilistic delusions Delusions involving bodily concerns - correct answer somatic delusions Believing that benign environmental occurrences relate to or have special meaning for the client - correct answer referential delusions True or false The validity of delusions should not be questioned by the interviewer; such questioning is ineffective in changing the client's beliefs and often causes alienation and anger - correct answer true Evaluation of suicidal and homicidal thoughts are under what section of the mse - correct answer thought content
What scale can be used to evaluate suicide risk - correct answer sadpersons S sex male A age <19 or >45 d depression P previous attempt E ethanol R rational thinking loss S social supports lacking O organised plan n no partner S sickness **score one point for each factor use calculated score to help determine outcome 0-2 home with appropriate follow up 3-6 admit or discharge with appropriate follow up 7-10 admit to hospital Illogical , difficult to follow shifting of ideas - correct answer loose associations When client wanders from the subject at hand to a related one and is unable to come back to the original topic - correct answer tangential thinking Tangential thinking is noted under which section of mse? - correct answer thought process Completely nonsensical combination of words - correct answer word salad Made up words - correct answer neoglisms
Are misinterpretations of true stimuli. An example is when a curtain in a dark room is mistaken for a person - correct answer illusions Common in delirium Illusions and hallucinations are documented/assessed under what section of the mse - correct answer perceptual disturbances Defined as sensations experienced by the client without real external stimuli - correct answer hallucinations Documented under perceptual disturbances What are the most common type of hallucination - correct answer auditory The more unusual hallucinations such as visual, gustatory, olfactory, and tactile hallucinations may indicate what?? - correct answer medical illness or substance intoxication or withdrawal False sensory perceptions that occur while falling asleep - correct answer hypnagogic hallucinations False perceptions that occur while waking from sleep - correct answer hypnopompic hallucinations Is a perceptual difficulty in which the client feels unreal, dead, or mechanical - correct answer depersonalizaiton He sensation that the outside world is unreal - correct answer derealization True or false:
Hypnagogic and hypnopompic hallucinations, derealization, and depersonalization are considered within the normal range of experience and are not considered pathologic unless they cause undue distress or problems with daily functioning. - correct answer true. The ability to delay, modulate, or inhibit the expression of behaviors and feelings - correct answer impulse control Clues to the client's ability to control their impulses are found in the _______ and ______ of the general interview - correct answer thought content and process A client who describes a recent history of binge drinking and indiscriminate sexual contacts has ______ impulse control - correct answer poor impulse control Accessing the client's ability to control impulses is an integral part of determining potential for acting on _______ and ______ thoughts - correct answer suicidal and violent thoughts Level of consciousness , orientation, concentration and memory are assessed under what section of the mse? - correct answer cognition and sensorium The capacity to identify possible course of action, anticipate their consequences, and choose the appropriate behavior - correct answer judgement Evaluate judgment with the "stamped envelope" scenario. The extent of the client's awareness of illness and maladaptive behaviors. - correct answer insight
