1) A patient with schizophrenia begins to talks about "volmers" hiding in the warehouse at work. The term "volmers" should be documented as: a. neologism RATIONALE: A neologism is a newly coined word having special meaning to the patient. "Volmer" is not a known common noun. 2) A patient with suicidal impulses is placed on the highest level of suicide precautions. Which measures should be incorporated into the plan of care by the nurse caring for the patient? a. Maintain arm's-length, one-on-one nursing observation around the clock. b. Allow no glass or metal on meal trays. f. Remove all potentially harmful objects from the patient's possession. RATIONALE: One-on-one observation is necessary for anyone who has limited control over suicidal impulses - Plastic dishes on trays and the removal of potentially harmful objects from the patient's possession are measures included in any-level suicide precautions. 3) A patient diagnosed with schizophrenia anxiously says, "I can see the left side of my body merging with the wall, then my face appears and disappears in the mirror." While listening, the nurse should d. maintain a normal social interaction distance from the patient. RATIONALE : The patient is describing phenomena that indicate personal boundary difficulties. The nurse should maintain an appropriate social distance and not touch the patient, because the patient is anxious about the inability to maintain ego boundaries and merging with or being swallowed by the environment. Physical closeness or touch could precipitate panic. 4) Which statement indicates a patient with major depression is most likely outlook on life during the acute phase of the illness? During an acute phase of major depression, the client may feel worthless and deserve bad things to happen personally. 5) A patient diagnosed with bipolar disorder is in the maintenance phase of treatment. The patient asks, "Do I have to keep taking this lithium even though my mood is stable now?" Select the nurse's appropriate response. b. "Taking the medication every day helps reduce the risk of a relapse." RATIONALE: Patients diagnosed with bipolar disorder may be maintained on lithium indefinitely to prevent recurrences. Helping the patient understand this need will promote medication compliance. 6) A person has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today the person shouts, "They're all plotting to destroy me. Isn't that true?" Select the nurse's most therapeutic response. b. "Feeling that people want to destroy you must be very frightening." RATIONALE: Resist focusing on content; instead, focus on the feelings the patient is expressing. This strategy prevents arguing about the reality of delusional beliefs. Such arguments increase patient anxiety and the tenacity with which the patient holds to the delusion. The other options focus on content and provide opportunity for argument. 7) A patient is undergoing a series of diagnostic tests. The patient says, "Nothing is wrong with me except a stubborn chest cold." The spouse reports the patient smokes and coughs a lot, has lost 15 pounds, and is easily fatigued. Which defense mechanism is the patient using? c. Denial RATIONALE : Denial is an unconscious blocking of threatening or painful information or feelings. Regression involves using behaviors appropriate at an earlier stage of psychosexual development. Displacement shifts feelings to a more neutral person or object. Projection attributes one's own unacceptable thoughts or feelings to another 8) A cab driver, stuck in traffic, becomes lightheaded, tremulous, diaphoretic, tachycardia and dyspneic. A workup in an emergency department reveals no pathology. Which medical diagnosis should a nurse suspect, and what nursing diagnosis should be the nurse's first priority? 1. Generalized anxiety disorder and a nursing diagnosis of fear 2. Altered sensory perception and a nursing diagnosis of panic disorder 3. Pain disorder and a nursing diagnosis of altered role performance 4. Panic disorder and a nursing diagnosis of anxiety ANS: D RATIONALE: The nurse should suspect that the client has exhibited signs/symptoms of a panic disorder. The priority nursing diagnosis should be anxiety. Panic disorder is characterized by recurrent, sudden onset panic attacks in which the person feels intense fear, apprehension, or terror. 9) The nurse is providing health teaching for a patient who has been prescribed Phenelzine (Nardil) for depression and provides a written list of foods that should not be eaten while taking this medication. What is the potential problem if the patient is not compliant with these dietary restrictions? Hypertensive crisis Foods with Tyramine in it Aged meats or aged cheeses, protein extracts, sour cream, alcohol, anchovies, liver, sausages, overripe figs, bananas, avocados, chocolate, soy sauce, bean curd, natural yogurt, fava beans— tyramine-containing foods—may precipitate hypertensive crisis. Avoid chocolate or caffeine. Herbal: Ginseng, ephedra, ma huang, St. John's wort may cause hypertensive crisis. For depression that is refractory to TCAs. Avoid certain foods such as cheese, sour cream, wine, beer, figs, anchovies, shrimp, bananas, and chocolate, and avoid drugs (e.g., TCAs). Risk for hypertensive crisis: Avoid self-medication. WHY? OTC preparations containing dextromethorphan, sympathomimetic agents, or antihistamines (e.g., cough, cold, and hay fever remedies, appetite suppressants) can precipitate severe hypertensive reactions if taken during therapy or within 2-3 wk after discontinuation of an MAO inhibitor. 10) Which piece of subjective data obtained during the nurse's psychosocial assessment of a client experiencing severe anxiety would indicate the possibility of obsessive-compulsive disorder? a. "I have to keep checking to see where my car keys are." b. "My legs feel weak most of the time." c. "I'm afraid to go out in public." d. "I keep reliving the rape." ANS: A RATIONALE: Recurring doubt (obsessive thinking) and the need to check (compulsive behavior) suggest obsessive-compulsive disorder. The repetitive behavior is designed to decrease anxiety but fails and must be repeated. Option B is more in keeping with a somatoform disorder. Option C is associated with agoraphobia and option D with posttraumatic stress disorder. 11) The nurse is evaluating the effectiveness of psychotropic medication on negative symptoms of psychosis. The nurse looks for a decrease in which of the following? A: Affective flattening. B: Bizarre behavior. C: Illogicality. D: Somatic delusions. A: Affective flattening. Reason: Negative symptoms of psychosis involve a diminution or loss of normal functioning. They include affective flattening, alogia (restricted thought and speech), avolution/apathy (lack of behavior initiation), and anhedonia/asociality (inability to experience pleasure or maintain social contacts). Positive symptoms of psychosis involve an excess or distortion of normal functioning. These include psychotic disorders of thinking (delusions) and disorganization of speech (illogicality) and behavior. 11) The nurse is evaluating the effectiveness of an antipsychotic on negative symptoms of psychosis. Which of the following symptoms would be classified as negative symptoms of psychosis? Blunted affect Poverty of thought Loss of motivation Inability to experience pleasure or joy 12) A 39-year-old woman is recently divorced and is learning to cope with additional stressors. Which of the following best demonstrate(s) that she is utilizing positive coping strategies to manage her stress? (Select all that apply). 1. Alter her general lifestyle by moving to another area