Psychiatric Assessment for Psychiatric-Mental Health
Nurse Practitioner
Exam 4,5,6 Covered Weeks 3-4
1. A nurse on a mental health unit is caring for a client. Nurse's
Notes
1300:
Client openly participated in group therapy and provided validating feedback to peers.
Described a longstanding pattern of frequent changes in their life: changes in hobbies,
employment, and in their friends. Reports a history of giving their best friends numerou
gifts and constantly calling them every day, only to suddenly ignore and belittle them,
followed by regret for doing so. Client also shared that they frequently feel "super
nervous" and are restless for no known reason. Client reports that this anxiety makes
,sleeping and focusing on tasks difficult.
1530:
The client approached the nurse's station and attempted to interrupt a staff member
who was talking on the phone. After noticing the staff member has a hearing impairment
the client loudly yelled, "Are you deaf or something?" and walked to their room. A couple
of minutes later, th: When generating solutions while planning care for this client, the
nurse should
determine if the client is having thoughts of harming themselves or others. Clients who
have borderline personality disorder often exhibit self-injurious behaviors, such as cutting
or scratching. They also often experience suicidal ideation, even chroni- cally, and have a
higher risk for death by suicide. Feelings of hostility and anger are also common with this
disorder, increasing the risk for violence toward others.
The nurse should
encourage the client to verbalize their feelings to diffuse frustration and other emo- tions.
Clients who have borderline personality disorder experience emotional lability; therefore,
verbalization of these emotions can decrease the impulsive behaviors often exhibited by
clients who have this disorder.
The nurse should
,establish consequences for unacceptable behavior such as manipulation and im-
pulsivity, which are manifestations of this disorder. Clearly communicate expected
behaviors and the subsequent consequences when unacceptable behavior occurs.
The nurse should also
provide clear boundaries for behaviors toward peers as clients who have this disorder can
exhibit aggression and manipulation of others for their own benefit.
The nurse should
instruct the client on coping mechanisms and relaxation techniques. Clients who have
borderline personality disorder also often have another mental illness, such as depression
or anxiety disorder. The client verbalized feeling anxious and restless and that these
feelings are disrupting their sleep and ability to focus.
,Therefore, identifying and practicing coping mechanisms and relaxation techniques are
interventions that can decrease the client's anxiety.
2. A nurse is caring for a client who is experiencing manifestations of anxiety. The nurse
should recognize which of the following statements about the neurophysiologic
manifestations of anxiety as correct?
The amygdala-centered (ACC) circuit of the brain is associated with feelings of panic.
The amygdala-centered (ACC) circuit of the brain is associated with feelings of
apprehension.
The cortico-striato-thalamo-cortical circuit (CSTC) of the brain is associated with
phobias.
The cortico-striato-thalamo-cortical circuit (CSTC) of the brain is associated with
feelings of fear.: The amygdala-centered (ACC) circuit of the brain is associ- ated with
feelings of panic.
The ACC is associated with manifestations such as fear, panic, and phobia.
3. A nurse has successfully completed a drug treatment program and is return- ing to work
,3 months later. Which of the following best describes a program designed for a nurse
returning to work after treatment?
An Alternative-to-Discipline (ATD) program A
drug recovery support group
An early-release incarceration program
An involuntary long-term residential treatment program: An Alternative-to-Dis- cipline
(ATD) program
An alternative-to-discipline (ATD) program is one in which the nurse who has had a
substance use disorder will not practice nursing for a designated time while being involved
in a recovery program or undergoing treatment.
4. A nurse is reviewing their state board of nursing's information about sub- stance use
rehabilitation programs for nurses. Which of the following is a reason to enroll a nurse
into an Alternative-to-Discipline program?
A character flaw A
crime
, A mistake
A treatable disease: A treatable disease
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