Shared Flashcard Set

Details

Psychiatric Nurs
Test 2 N350
150
Nursing
04/05/2011

Additional Nursing Flashcards

 


 

Cards

Term
A college student was taken by the police to the hospital after becoming increasingly suspicious and isolated over the past few months. Upon admission to the psychiatric unit, the psychiatrist assigns a diagnosis of paranoid schizophrenia. The client tells the nurse “My roommate was plotting to have others kills me.” Which is the appropriate nursing response?
Definition
"I find that hard to believe"
This response presents reality in a non-argumentative manner. This technique is called “voicing doubt,” and is therapeutic with clients experiencing delusions.
Term
A client on the unit has not received what he expected for lunch, and experiences an angry verbal outburst directed at the nurse. The nurse recognizes what characteristic about this display of emotion?
Definition
Anger can make the client feel powerful.

Anger can instill feelings of power and generate a sense of preparedness.
Term
A newly admitted client on the unit is acting out and requires immediate behavior therapy intervention. The nurse recognizes that which person(s) should provide this type of intervention? (Select all that apply.)
Definition
Nurse
Nurse's assistant

Nurses can implement behavior therapy techniques to help clients modify maladaptive behavior patterns. Untrained individuals should not be called upon to provide this type of intervention.
Term
A client is diagnosed as having paranoid delusions and remarks to the nurse that the FBI and AT&T are plotting against her. In documenting the statement, the nurse interprets this as which type of delusion?
Definition
Persecution

Delusion of persecution is the feeling of being threatened and belief that others intend harm or persecution toward him or her. The client feels that the FBI and AT&T intend to harm or persecute her by “plotting against” her.
Term
Which expected outcome should the nurse define in relation to rehabilitative care?
Definition
Encourage continued participation in outpatient support systems.

This is the expected outcome during rehabilitative care, as it demonstrates the importance of the client continuing to follow up on an outpatient basis to continue and maintain recovery.
Term
A client was experiencing extrapyramidal symptoms secondary to neuroleptic drug therapy. The physician ordered biperiden (Akineton) 2 mg tid IV. Using a 5 mg/mL vial, how many milliliters did the nurse administer? (Fill in the blank.)
Answer:
Definition
0.4 ml
Term
The physician ordered amitriptyline (Elavil) 50 mg HS to a nursing home resident for major depression. On hand were 25-mg tablets. The nurse instructed the client to take how many tablets? (Fill in the blank.)
Answer:
Definition
2 Tablets
Term
An athlete has been recently diagnosed with diabetes. He denies that he has a physical problem. The nurse observes that his speech is monotone, and he states that he is ready to commit suicide. Which one of the following would be an expected outcome of crisis intervention? The client: (Select all that apply.)
Definition
Expresses optimism and hope for the future

Verbalizes feelings of despair

The suicidal client views life as hopeless. Discussing suicidal feelings and conveying a message to the client that he is a worthwhile person will provide a sense of security and optimism. After crisis intervention is complete, long-term therapy may be initiated to help the client learn improved interpersonal skills, a sense of belonging, and adaptive coping skills. New and functional coping skills, not dysfunctional coping skills, should be an outcome of crisis intervention. If the client verbalizes feelings of despair, then crisis intervention has been less than successful. Assist the client to select alternative coping strategies that will help alleviate future crisis situations.
Term
A client was rushed to the emergency room complaining of restlessness, drooling, and tremors. The client's daughter informed the nurse that the client was taking chlorpromazine (Thorazine). The nurse concluded the behaviors to be extrapyramidal symptoms (EPS). The drug of choice used to alleviate these symptoms is:
Definition
Benztropine (Cogentin)
Term
A nurse prepares to teach the client to use decatastrophizing to modify automatic thoughts and schemas. Which is the appropriate client teaching?
Definition
“Decide if this thought is grounded in reality, then decide how to cope better with it.”

Decatastrophizing assists the client to examine the validity of a negative automatic thought. Even if some validity exists, the client is then encouraged to review ways to cope adaptively, moving beyond the current crisis situation.
Term
An alcohol-addicted client complains of feeling tremulous. The BP is now 170/110, P 116, R 30, T 97°F. The nurse anticipates which of the following drugs would most likely give the client the most immediate relief from the withdrawal symptoms and effectively reduce the vital signs?
Definition
Lorazepam (Ativan) 1 mg IM

Ativan would give the client the quickest relief because of the parenteral route of administration. It is a benzodiazepine but has a longer half-life than Serax, therefore, it would be more effective because it will be in the body longer than Serax.
Term
A client with alcoholism has recently started disulfiram (Antabuse). She is now hospitalized with nausea, vomiting, palpitations, and a headache after drinking while taking disulfiram (Antabuse). The nurse recognizes which form of behavioral modification?
Definition
Overt sensitization

Overt sensitization is a type of aversion therapy that produces unpleasant consequences for undesirable behavior. Instead of the euphoric feeling normally experienced from the alcohol (the positive reinforcement for drinking), the individual receives a severe punishment that is intended to extinguish the unacceptable behavior (drinking alcohol).
Term
A client was referred to the crisis intervention center during a state of acute crisis. During the assessment, the client states to the nurse, “I don't need to be here because all of my problems have been solved.” The nurse ascertains that the client is using which defense mechanism?
Definition
Denial

The client denies the reality of the situation and rejects the available support resources.
Term
The nurse has been using a token economy while working with an adolescent client. Which nursing intervention would be included in this approach?
Definition
Allowing the client to earn points for desired behavior that can be redeemed later.

This intervention represents a token economy.
Term
The physician prescribes methylphenidate (Ritalin) for the client. The nurse understands that the mechanism of action for methylphenidate is which of the following?
Definition
Increases levels of neurotransmitters thus increasing motor activity.

Methylphenidate (Ritalin) increases the level of neurotransmitters producing central nervous system and respiratory stimulation, dilated pupils, and increased motor activity.
Term
The nurse is planning care for a client who will undergo cognitive therapy. Which should be included as a goal? (Select all that apply.)
Definition
Recognize the connections between cognition, affect, and behavior.

Examine the evidence for and against distorted automatic thoughts.

Substitute more realistic interpretations for these biased cognitions.

The client should monitor his or her feelings, recognize connections, examine evidence, and substitute realistic interpretations. However, the client should not ignore dysfunctional beliefs, but rather learn to identify and alter the dysfunctional beliefs that predispose him or her to distort experiences.

Term
The nurse recognizes that cognitive therapy is appropriate for which clients on the unit? (Select all that apply.)
Definition
Male with bipolar disorder


Male with social phobias

Female with somatoform disorder

Male with schizophrenia

Cognitive therapy may be used with the following clinical conditions: depression, panic disorder, generalized anxiety disorder, social phobias, obsessive–compulsive disorder, posttraumatic stress disorder, eating disorders, substance abuse, personality disorders, schizophrenia, couples' problems, bipolar disorder, hypochondriasis, and somatoform disorder.
Term
The nurse is working with a client who is fearful of flying. The nurse presents the client with many pictures of airplanes, discusses the mechanics of flying, and has the client hold a model airplane, all within a condensed period of time. Which technique for behavior therapy does the nurse document for this encounter?
Definition
Flooding

Flooding, sometimes called implosive therapy, is also used to desensitize individuals to phobic stimuli. It differs from systematic desensitization in that, instead of working up a hierarchy of anxiety-producing stimuli, the individual is “flooded” with a continuous presentation (through mental imagery) of the phobic stimulus until it no longer elicits anxiety.
Term
A college student is accompanied to the student health center by a roommate. The roommate explains to the nurse that for 3 days the student has been unable to attend classes, has cried constantly, and has become panicky whenever the roommate leaves to go to classes and meals. Before that time, the roommate states that the student was “fine” and did not behave in this manner. The nurse performs an assessment and finds that the student does not know the date and has difficulty with short-term memory. What crucial information is missing that will best enable the nurse to begin planning interventions that will be helpful for the student?
Definition
The precipitating stressor

The data indicate that something happened in the past 3 days that caused the student to become increasingly dysfunctional. However, it is not clear from what is presented what event triggered this crisis. This information is necessary to plan care, as interventions could vary based on the precipitating circumstance.
Term
The nurse overhears two clients talking with each other. They disagree on what activity they will undertake. One client says to another, “Why don't we pick an alternate activity together.” The nurse recognizes which form of communication?
Definition
Assertive

Assertive communication promotes a sense of self-esteem, without diminishing the self-esteem of others. Picking an alternate activity allowed the clients to effectively reach an agreeable compromise, without negating either person's self-esteem.
Term
A client has been admitted to the inpatient psychiatric unit with a diagnosis of catatonic schizophrenia, and appears weak and pale. The nurse would expect to observe which behaviors in this client?
Definition
Stuporous withdrawal, hallucinations, and delusions

Stuporous withdrawal, hallucinations, and delusions are characteristics of catatonic schizophrenia.
Term
In planning care for the medically unstable alcoholic client, which of the following would the nurse consider to be the priority intervention?
Definition
Initiating pharmacological therapy

Benzodiazepines are administered to prevent the more severe forms of withdrawal. Withdrawal can present many safety concerns for a client undergoing detoxification. Providing pharmacological interventions can ensure safety in the client's environment, according to Maslow's hierarchy of needs. Other interventions to meet other needs can be implemented once safety is ensured.
Term
A 20-year-old client has experienced the loss of a twin sibling 2 years ago. Today, this client is still very angry that her sister “left her,” and cannot control the feelings of rage she has over her sister's untimely death. Which nursing diagnosis would the nurse assign?
Definition
Complicated Grieving related to sibling death

The client is experiencing complicated grieving. After two years, she is unable to reconcile this loss, and continues to feel anger and rage over her sister's untimely death.
Term
A client is being treated in the inpatient psychiatric setting for cocaine abuse. After initial detoxification, the client participates eagerly in therapy and becomes charming and ingratiating to the primary nurse. The client's primary diagnosis is cocaine dependence; the secondary diagnosis is antisocial personality disorder. The nurse expects these behaviors to be:
Definition
Characteristics of clients with the diagnosis of antisocial personality disorder

This response is correct because charming and ingratiating behaviors are characteristic traits of the antisocial personality-disordered individual.
Term
The nurse determines which one of the following is most essential when planning care for a client who is experiencing a crisis?
Definition
Explore previous coping strategies.

Inquiring about previous coping strategies will provide insight as to the relationship to the current crisis situation. The nurse can then plan care based on this knowledge of the client's functioning.
Term
A chronic alcoholic tells the substance abuse clinic nurse that he has not had anything to drink in the past 48 hours. The nurse teaches the client that which of the following is the most serious withdrawal syndrome?
Definition
Alcohol withdrawal delirium

Delirium tremens, or alcohol withdrawal delirium, is the most serious form of the withdrawal syndrome. It is potentially fatal, so therefore the nurse must be most concerned about this symptom.
Term
A client has been diagnosed with major depression. The psychiatrist prescribes imipramine (Tofranil). What client teaching specific to this class of antidepressants should the nurse include?
Definition
The medication may cause photosensitivity.

Dry mouth, nausea, and discontinuation syndrome can occur with all antidepressants. Photosensitivity most commonly occurs with tricyclics, such as imipramine.
Term
Which nursing action is within the scope of a Sexual Assault Nurse Examiner (SANE)?
Definition
Collect physical evidence
Term
The nurse is caring for a client who always must be first. The client wants food served to him first, to be called upon first in the group setting, and to get first choice of what activity to pursue. Which statement(s) would be important in a contingency contract? (Select all that apply.)
Definition
The client will not always be first in given situations.

The client will accept not always being first.

The client will lose one group activity privilege for each time he violates the contract.

The client will get one “first choice” daily if he complies with the contract.

The client will have receive an additional “first choice” daily, if he defers to another client to do something first.

All of these statements are important to the contingency contract. The client must know exactly what is expected of him, and what reinforcers will be present if he complies, or does not comply, with the contract. There also needs to be a degree of flexibility built into the contract, as evidenced by choice 5.

Term
An adolescent recently lost his father in a plane crash. He has begun to question his belief in God. He cries out, “No God would have let my father die like that! I'm so angry I could scream!” The nurse's best response provided to him is:
Definition
“You're feeling so angry. I'm here for you. I'm listening.”

The nurse is using the therapeutic techniques of making observations and offering self. This will help build trust and establish the foundation for a working relationship, while recognizing and accepting the client's anger in a nonjudgmental capacity.
Term
A nurse is admitted to an inpatient substance abuse treatment facility. Legally, what action must this nurse take?
Definition
None, as civil rights are ensured.

Although some variations occur from state to state, currently, psychiatric clients basically maintain all of their civil rights.
Term
The nurse is caring for four clients. Which client should not participate in physical exercise at this time?
Definition
44-year-old man with bronchospasm exacerbation

Bronchospasm exacerbation would limit a client's ability to perform physical exercise at this time. Therefore, this client should not be involved in this form of relaxation therapy presently.
Term
A grossly intoxicated client was admitted to the emergency department. The nurse has been monitoring him for withdrawal symptoms and medicating him with prn medications. Four days after admission, he appears much more comfortable and less tremulous. Which nursing action is most appropriate at this time?
Definition
Remain vigilant for withdrawal complications and continue to administer medications on an as-needed basis.

The client should be completing detoxification but monitoring for withdrawal symptoms and continued tapering of medications as needed are recommended until the detox process is complete.

Term
The nurse is providing care to a client experiencing an acute phase of catatonic schizophrenia. A primary nursing goal is to decrease the client's isolated behavior. Which of the following nursing actions would best contribute to that goal?
Definition
Speak in concise, simple terms to prevent sensory overload.

As part of the plan to decrease the catatonic client's withdrawn behavior, the nurse should speak in simple, concise terms to avoid sensory overload of the client.
Term
A nurse working with four clients would identify which person in greatest need of relaxation therapy?
Definition
30-year-old man taking shallow, fast breaths

A client taking shallow, fast breaths may be experiencing anxiety, which could be an indication for relaxation therapy.
Term
A client tells the nurse that she recently failed a class at college, and now she knows she will never pass another college class again in her life. The nurse recognizes which type of automatic thought?
Definition
Overgeneralization

Overgeneralization involves a type of “all or nothing” kind of thinking. The client has stated she will never pass another class, which clearly represents all or nothing mentality.
Term
During the initial interview with a client in crisis, the mental health professional should first anticipate which of the following?
Definition
Evaluate the potential for self-harm.

The essential component of the initial interview is to assess the lethality potential and provide for client safety.
Term
The nurse should utilize which of the following techniques in crisis intervention? (Select all that apply.)
Definition
Supportive therapy

Problem-solving

Mobilizing resources

Supportive therapy, problem-solving, and the mobilization of resources can be used in crisis intervention. Lengthy psychological interpretations are not used in crisis intervention, since crisis intervention is a focused, short-term type of therapy. Guided imagery is used for stress reduction, not for crisis intervention. Crisis intervention requires more immediate techniques.
Term
The nurse conducting an activity asks a group participant to help him distribute the materials. The client responds, “Just get off my back, I'm sick of handing stuff out because I always do it.” To shift from content to process, which response should the nurse provide?
Definition
“Let's talk about what is really bothering you.”

This response accurately reflecting shifting from content to process by changing the focus of the communication from discussing the topic at hand to analyzing what is actually going on in the interaction.
Term
The physician has ordered lithium carbonate for a bipolar client. The nurse administering the drug determines that the most likely rationale for this drug is to do which of the following?
Definition
Decrease hyperactivity

Lithium carbonate enhances reuptake of norepinephrine and serotonin, resulting in decreased hyperactivity.
Term
A client is discussing meditation with the nurse. Which client statement indicates a need for further teaching by the nurse?
Definition
“Meditation is only used by people who believe in God.”

Although historically, meditation has been associated with seeking a higher power, it is not exclusively used by people who believe in God. The nurse would need to provide further client education.
Term
The nurse notices that a client has injuries consistent with contact with shattered glass. How would the nurse document these injuries?
Definition
Dicing injuries

Dicing injuries are multiple, minute cuts and abrasions caused by contact with shattered glass (e.g., often occur in motor vehicle accidents)
Term
To deal with a client's hallucinations therapeutically, which intervention should the nurse plan to implement?
Definition
Distract the client's attention by providing a competing stimulus that is stronger than the hallucination.

Distracting the client to reality-based activities is helpful in reducing hallucinations.
Term
A long-term alcoholic client says to the nurse, “I'm tired of using and I want to stop. The doctor mentioned a medication that can help me maintain sobriety. What is this medicine?” Which medication would the nurse provide information about?
Definition
Disulfiram (Antabuse)

Disulfiram provides a measure of control for the individual who desires to avoid impulse drinking. It is important to educate the client that this medication should not be used with any alcohol intake whatsoever.
Term
A client is admitted for treatment of alcoholism and depression. During the initial assessment the client admits to “lifelong” depression but does not mention a drinking problem. When questioned about alcoholism, the client admits only to socially drinking. Which defense mechanism does the nurse identify that the client is using?
Definition
Denial

Denial is used to protect the ego from a disturbing reality. The client was admitted for alcoholism, but has only admitted to socially drinking, which indicates that the client is not fully acknowledging the problem.
Term
A client has recently been diagnosed with paranoid schizophrenia and has been started on haloperidol (Haldol), which has decreased the hallucinations. The client has begun to attend an art group for brief periods each day. In planning care to reinforce reality, which intervention should the nurse include?
Definition
Reinforce perceptions and thinking that are in touch with reality.

The plan should focus on reinforcing perceptions and thinking that is in touch with reality.
Term
The emergency room nurse assesses a client suffering from chronic alcoholism and observes confabulation. The client reports feeling nervous and lethargic, and has some memory loss. Which disorder would the nurse suspect?
Definition
Korsakoff's psychosis

The symptoms described are those associated with Korsakoff's psychosis, which is caused by a deficiency in thiamine. Thiamine deficiency is commonly seen in clients with alcoholism, since alcoholics tend to replace food with their drink(s) of choice, and the body does not absorb nutrients as it did prior to the alcoholic state.
Term
The client presents to the emergency department after a rape. Which is the most important nursing communication to provide initially to the client?
Definition
You are safe here.

Although each of these pieces of communication is important, the most critical information to initially give to the client is that she is safe in this environment.
Term
The patient hears the word “match.” The patient replies, “A match. I like matches. They are the light of the world. God will light the world. Let your light so shine.” Which technique does the nurse identify?
Definition
Loose association

Loose association is characterized by speech in which ideas shift from one unrelated idea to another. This scenario clearly represents the client moving from one idea to another after hearing an initial word.
Term
A client is being treated with sertraline (Zoloft) for a major depressive episode. One week after medication initiation, the client tells the nurse, “I've only been taking this drug for a week but I'm sleeping better and my appetite has improved.” The nurse concludes that:
Definition
The rapid onset of Zoloft can improve insomnias and appetite disturbances as early as 1 week after initiation.

Zoloft is known to improve middle and terminal insomnia, appetite disturbances, and anxiety as early as 1 week after drug initiation.
Term
A paranoid schizophrenic is an only child. His parents often speak of his “depression,” as they call it, in a quiet voice. His belief that the voice of God told him to jump from his second floor bedroom window precipitated this hospitalization. His parents visit every day. The nurse concludes that which of the following best explains his parents' behavior? (Select all that apply)
Definition
They may still be in denial about the painful reality that their son has a chronic and serious mental illness.

They may be grieving about the loss of their expectations and hopes for their child.

They may not understand the extent or seriousness of the diagnosis of schizophrenia.

They want to show support of their son.

By speaking in a quiet voice about “depression,” the client's parents are denying his true diagnosis and attempting to rationalize it as a problem that is less serious. They may also be grieving about their loss of expectations, which can occur when a child is physically or mentally different than what the parents expected. A knowledge deficit may be present, and the parents truly may not understand the implications of schizophrenia. Visiting every day is a sign of support for their son. This interest could be considered an appropriate foundation for the nurse to begin educating the parents about their son's condition. The chronic nature of schizophrenia makes it a hard diagnosis to accept. Some people cannot initially appreciate the seriousness of the illness. The parents in this scenario speak of “depression” in a soft voice, which indicates that they do not completely understand the diagnosis and its implications.
Term
In which practice settings might a forensic nurse be found? (Select all that apply.)
Definition
Emergency or trauma nursing

Correctional facilities

Public health

Social services (e.g., community health centers)

Outpatient care facilities

Forensic nurses may be found in all of these practices of health care.

Term
Which client and family teaching is most important regarding the cause of substance abuse?
Definition
Multiple factors may be at work, including biological, psychological, and sociocultural factors.

The development of substance dependence is multifactorial, and may include biological, psychological, and/or sociological factors.
Term
A widow tells the nurse that her husband died 3 months ago. She feels alone and vulnerable. Which statement by the widow would indicate adaptive coping skills?
Definition
“I will find a support group.”

The client understands the importance of a support group, and she is willing to accept the help.
Term
A client is suffering from alcoholic hallucinosis. He tells the nurse that he sees bugs crawling on the wall. The nurse explains:
Definition
“You see shadows from the fan rotating. I'll stay with you until you feel less anxious.”

This reinforces reality and may help decrease the client's anxiety by the nurse's therapeutic offering of self.
Term
Bob has just been admitted to the unit with a new diagnosis of anxiety. He looks around nervously, and seems to be uncertain of what to do. To facilitate his relaxation, which action should the nurse initially complete?
Definition
Sit down and talk with Bob about how he is currently feeling.

Although the nurse will eventually allow Bob to unpack, review the rules and regulations of the unit, and provide him with a list of activities, the most important relaxation action is to sit and talk with Bob about how he is currently feeling. This allows him to express anxiety, fears, frustrations, and uncertainty, which must be accomplished before he will be able to relax.
Term
An alcoholic has severe pruritus secondary to neuroleptic drugs. The physician orders cyproheptadine (Periactin) 4 mg tid. Using a 2 mg/5 mL elixir, how many milliliters did the nurse administer?

Definition
10 mL
Term
Which symptom would the nurse expect to observe in a patient with opioid intoxication?
Definition
Euphoria

Euphoria occurs during opioid intoxication.
Term
A client is being discharged from the inpatient psychiatric unit after a 4-day stay. She was admitted with major depression that was a single episode and moderate. During her stay, she was started on Prozac (fluoxetine) at 40 mg PO qd. The nurse's discharge teaching should include which? (Select all that apply.)
Definition
Continue taking Prozac as prescribed. You will continue to see improvement over the next few weeks.

Make sure that you follow up with outpatient psychotherapy as has been arranged.

You may be able to discontinue the medication within 6 months to 1 year, but only under a doctor's supervision. However, there is a chance of recurring episodes.

You should avoid foods with tyramine, including beer, beans, processed meats, and red wine.

Continued improvement may be seen in the first few weeks of treatment with fluoxetine, as the therapeutic effect can take up to 4 weeks to be realized. Compliance with follow-up psychotherapy should be stressed so that the client does not expect the medication to be the only treatment. Although the medication may be tapered and stopped after 6 months, there is a risk for further depressive episodes. The client should avoid foods with tyramine if she were taking an MAOI, not an SSRI antidepressant such as fluoxetine. The medication should not be stopped abruptly because of the risk for further depressive episodes.
Term
A client is brought by the police to the emergency department at midnight because of aggressive, uninhibited behavior, slurred speech, and impaired motor coordination. His blood alcohol level is 347 mg/dL. The physician orders daily administration of thiamine. Which is the most appropriate rationale the nurse would assign to this intervention?
Definition
Prevent Wernicke's encephalopathy.

Thiamine deficiency can lead to Wernicke's encephalopathy, which can be fatal.
Term
Which action should take place when the nurse and client engage in a cognitive therapy session?
Definition
Reviewing the previous week's session.

Reviewing the previous week's session is important to provide continuity in the cognitive therapy process.
Term
The nurse is caring for a 9-year-old client. Which sign would indicate that the client is becoming angry?
Definition
Makes no eye contact with nurse

Making intense eye contact, as well as making no eye contact, can indicate anger.
Term
When planning crisis intervention for a chronically mentally ill client, it is most essential for the nurse to consider which of the following?
Definition
Personal strengths

Each person has strengths as well as weaknesses. Building on the strengths reinforces the positive elements of each client.
Term
The nurse is caring for a client who has attempted to hit his spouse when he gets angry. What is an appropriate outcome for this client?
Definition
The client will not cause harm to others.

This outcome allows for the largest margin of safety for those nearest the client.

Term
An alcoholic was given scopolamine hydrobromide 0.4 mg SC to calm the delirium he was experiencing. Using a 1 mg/mL vial, how many milliliters did the nurse administer SC?
Definition
0.4 mL
Term
The nurse is caring for a client who has continued to use sarcasm and slam doors when he leaves the room. What client teaching should the nurse provide?
Definition
“Let's talk about what is bothering you, and find ways to communicate appropriately.”

This response allows the client to express his feelings, but also places the expectation that alternate ways of communicating will be explored between the client and nurse.
Term
Which type of nurse would most likely assess inmates for physical fitness, criminal responsibility, disposition, and early release?
Definition
Forensic psychiatric nurse

Functional applications of forensic psychiatric nursing include assessment of inmates for physical fitness, criminal responsibility, disposition, and early release. Forensic psychiatric nurses also provide mental health treatment for convicted offenders and those who are not found criminally responsible. In the criminal justice system, forensic psychiatric nurses deal with destructive, aggressive, and socially unacceptable behavior. These nurses provide interventions that encourage individuals to exercise self-control, foster individual change in behavior, and, in the process, protect other members of society and property.
Term
The nurse should include which teaching about the tricyclic group of antidepressant medications?
Definition
Their full therapeutic potential may not be reached until 4 weeks.

It may take several weeks for tricyclic medications to reach their full therapeutic effect.
Term
The nurse is caring for a client who yells incessantly at the nurse. Which nursing response reflects the behavior therapy of shaping?
Definition
The nurse praises the client for speaking in a reasonable tone.

By praising the client for speaking in a reasonable tone, the nurse is shaping the client's behavior.
Term
A client presents to the emergency room with a chief complaint of right upper quadrant pain. He suffers from alcoholism and decreased hepatic functioning. The nurse anticipates that which one of the following will be used to treat alcohol withdrawal symptoms?
Definition
Oxazepam (Serax)

Benzodiazepines are widely used for treating the withdrawal symptoms of alcohol. Chlordiazepoxide (Librium) is commonly used, but because it is a long-acting agent, would not be the drug of choice for this client. In clients with liver disease, accumulation of the longer-acting agents may be problematic, and the use of the shorter-acting benzodiazepine, oxazepam, is more appropriate.
Term
The nurse is discharging a client who has undergone treatment for anger management. Which client statement would demonstrate that the client is ready to go home?
Definition
“I will go for a walk when I begin to feel angry.”

This statement demonstrates that the client has formed an alternate plan to deal with anger, and is ready to be discharged.
Term
The nurse is teaching a class on normal human sexuality. The following information should be included: (Select all that apply.)
Definition
Gender identity develops during adolescence.

Sexual drives vary throughout the life span.
Many medications can impact on sexual functioning.

Self-concept and body image will impact on sexuality.

In a class on normal human sexuality, the nurse needs to include that gender identity develops in childhood; sexual drives vary throughout the life span; many medications can affect sexual functioning; elderly adults can have a healthy, normal interest in sexual activity; and that self-concept and body image will impact on sexuality.

Term
Before a client's discharge from the drug treatment program, the client's wife approaches the nurse and says, “I'm so afraid that when my husband leaves here that he will want to go back to drinking. What can I do to prevent that?” Which therapeutic response should the nurse offer?
Definition
“There is a support group for family members and friends of alcoholics called Al-Anon. It's an informal meeting where you can go and talk with other individuals about day-to-day living with spouses after discharge.”

This is the most therapeutic response because it will guide the client's wife to a support group where she can confidentially discuss concerns about her spouse and address her own issues of codependence. It is also where a lot of teaching and mutual support takes place.
Term
A client has made an appointment to see a primary care provider because of increased anxiety. In teaching the client, which of the following medications would likely be prescribed for anxiety?
Definition
Diazepam (Valium)

Diazepam (Valium) is an antianxiety agent.
Term
The nurse expects to establish a supportive therapeutic relationship with a client with schizoid personality disorder. In developing a plan of care, which nursing action is most appropriate?
Definition
Allow the client's need for distance in a relationship.

The nurse must recognize the client's need for distance in a relationship. Trying to become too close or friendly will cause the client to feel threatened and withdraw.
Term
Kevin's nurse has identified that he has the nursing diagnosis of powerlessness related to poor relationship dynamics with his partner. The nurse would identify which expected outcome criteria?
Definition
Kevin will openly express his opinion, even if it differs from his partner's opinion.

This outcome criterion promotes appropriate assertive behavior in Kevin.
Term
The nurse is assessing a client who is a substance abuser. During the interview, the client minimizes the problem when he says to the nurse, “I use every day, but it rarely interferes with my work.” The nurse determines that the client is using which defense mechanism?
Definition
Denial

Denial is characterized by avoidance of disagreeable realities and unconscious refusal to acknowledge a thought, feeling, need, or desire. The client is denying that he has a substance abuse problem.
Term
In teaching family members about an alcoholic's nutritional needs, which nutritional concept should the nurse emphasize?
Definition
Provide multivitamin supplementation, including thiamine and folate.

Vitamin B deficiencies contribute to the nervous system disorders seen in chronic alcohol abuse. Supplements of these vitamins are important to prevent further complications.
Term
Which client statement indicates selective abstraction to the nurse?
Definition
A client says she was offered several jobs in key organizations, but did not get offered a job at the company she truly hoped to work for.

Selective abstraction (sometimes referred to as mental filter) is a conclusion that is based on only a selected portion of the evidence. The selected portion is usually the negative evidence or what the individual views as a failure, rather than any successes that have occurred. The client has not considered that perhaps her chosen company was not hiring at this time.

Term
The forensic nurse understands that which substances can be gathered and preserved as evidence? (Select all that apply.)
Definition
Debris found on the individual
Gunshot powder
Hairs and fibers
Clothing
Bullets
Term
A widow is unable to cope with the tasks of daily living. A recent hurricane completely destroyed her home. She is unable to identify any available family support. The nurse identifies that the client is experiencing which type of crisis?
Definition
Traumatic stress crisis

Traumatic stress can precipitate a crisis by unexpected external stresses over which the individual has little or no control and from which she feels emotionally overwhelmed and defeated. With no support systems in place and an ongoing problem with accomplishing tasks of daily living, the natural disaster has placed this client into a state of traumatic stress crisis.
Term
The nurse is preparing to work with a client on behavior therapy. The client continues to blame others for her actions, and refuses to take responsibility for herself. The nurse identifies which nursing diagnosis?
Definition
Defensive coping

The client uses defensive coping by blaming others for her actions, and refusing to take self-responsibility.
Term
A client with a diagnosis of schizophrenia experiences confusion over identity by frequently exhibiting echolalia. The nurse expects that this is an attempt by the client to do what?
Definition
Identify with the person speaking

Echolalia is a parrot-like repetition of overheard words or fragments of speech. It is an attempt to identify with the person speaking.
Term
The nurse is monitoring Gillian, who is performing a relaxation exercise. Which sign would indicate to the nurse that the exercise is not working?
Definition
Blood pressure: 150/100

Respirations, blood pressure, and pulse rate decrease when an individual is truly relaxed. Other signs of relaxation include a decrease in muscle tension, pupil constriction, and warm extremities due to peripheral dilation. If Gillian's blood pressure is increased, relaxation is not being realized.
Term
A client has been experiencing repetitive bouts of anger after her husband left her alone with three children to raise, and no job. She asks the nurse what the long-term effects of such anger could be. Which is the appropriate nursing response?
Definition
“Anger can result in depression and low self-esteem.”

Anger can easily lead to feelings of depression and low-self esteem if experienced over a prolonged period. It may also turn into resentment.
Term
A client is admitted with a diagnosis of schizoaffective disorder. Which component would be most important for the nurse to assess?
Definition
Mood and thought disturbance

Schizoaffective disorder is manifested by schizophrenic behaviors, along with symptoms of mood disorders, either manic or depression. Therefore, assessing the client's mood and thought processes is paramount.
Term
A couple is suddenly faced with the decision of placing their elderly parents in a nursing home. They call the crisis intervention center and ask for assistance. The nurse answering the telephone determines that this type of crisis can often be prevented by which of the following?
Definition
Anticipatory guidance

Anticipatory guidance is an educational problem solving process that helps persons and families distinguish between normal and unusual experiences. It provides them with time to process the theoretical situations and consider options before the crisis is actually facing them.
Term
Two students fail their introductory nursing course. One student plans to seek tutoring assistance and retake the course next fall. The second student attempts suicide after receiving the failing grade. Which of the following factors influence the development of a crisis? (Select all that apply.)
Definition
The individual's perception of the event.

The availability of support systems.

The availability of adequate coping mechanisms.

The individual's perception of the event, availability of support systems, and availability of adequate coping mechanisms are factors that influence whether an individual will experience a crisis. Perception of these two students is very different—one believes that success can occur if the class is taken again; the other student clearly believes that this failure means that life is not worth living. An individual who has adequate support systems is less likely to feel overwhelmed and alone. If a client does not have adequate coping mechanisms, they are more likely to fall into crisis than someone who can process the situation by using therapeutic coping skills. The time of the year has little to do with the development of a crisis. Crises can be experienced at any time whenever the situation presents.

Term
A client wishes to use deep breathing exercises in order to relax more. Which teaching should the nurse provide?
Definition
“Breathe in through your nose, and out through your mouth.”

The client should breathe comfortably in through the nose, and out through the mouth when performing deep breathing exercises.
Term
Clients in a group setting have had a verbal disagreement about a topic. One client says, “I have a right to express my opinion.” How should the nurse respond?
Definition
“You are correct, you do have a right to express your opinion.”

Standing up for one's own human rights promotes assertive communication. The client has verbalized an appropriate concept and should be recognized by the nurse for doing so.
Term
The nurse has repeatedly asked a newly admitted client on the unit to unpack her clothing and get settled into her room. Three hours later, the client still has not unpacked, and says she has no intention of doing so. To avoid a confrontation, the nurse proceeds to unpack the client's belongings, telling the client, “It's OK, I will do this for you.” What behavior does the nurse represent?
Definition
Negative operant conditioning

The nurse has provided a response to the specific behavior that prevents an undesirable result from occurring. This is considered negative operant conditioning.
Term
A client who has been utilizing progressive relaxation desires to try another type of muscle relaxation. The nurse suggests modified progressive relaxation. Which concept does the nurse recognize as accurate regarding modified progressive relaxation?
Definition
The muscles are not tensed.

Muscles are alternately tensed and relaxed in progressive relaxation exercises, versus modified progressive relaxation. In modified progressive relaxation, muscles are not tensed, but are focused upon mentally during the relaxation process.
Term
The nurse is caring for a client with prodromal syndrome. What is the appropriate nursing action?
Definition
Provide for client and unit safety.

Prodromal syndrome is characterized by anxiety, tension, verbal abuse and profanity, and hyperactivity. These behaviors should be considered emergent and demand immediate attention to provide for safety.
Term
During the admission assessment, which client statement would alert the nurse for the need for immediate intervention?
Definition
“Life is not worth living.”

This statement indicates that the client could be suicidal, and requires immediate nursing intervention.
Term
The nurse is working with a client who is experiencing a crisis. The client states, “I can no longer function.” The nurse directs the client to a quieter environment. The client does not respond to the instruction. After evaluating the situation, the nurse is aware that the client is exhibiting which?
Definition
A decrease in the perceptual field

Anxiety increases during a crisis state, causing a decrease in the perceptual field. The client is not able to “hear” or “follow” the directions provided by the nurse.
Term
A client was experiencing myoclonic seizures secondary to narcotic withdrawal. The physician ordered clonazepam (Klonopin) 0.5 mg tid to be given as a preventive measure to reduce seizure activity. The pharmacy sent 1-mg tablets. How many tablets did the nurse administer?

Definition
0.5 tablet or 1/2
Term
Which individual is qualified to perform biofeedback exercises for a client?
Definition
A trained biofeedback practitioner

The nurse and physician are not qualified to perform biofeedback exercises for a client without special training as a trained biofeedback practitioner. Only a trained biofeedback practitioner can perform these exercises.
Term
The nurse is caring for a 10-year-old client who verbally lashes out at the staff, and attempts to hit anyone who comes near him. His aggression is more pronounced when he does not get his way. What is the appropriate initial nursing action?
Definition
Provide for safety on the unit.

Although the nurse will encourage the client to talk openly and honestly, place restrictions on physical contact, and role model appropriate communication techniques, it is more important to initially provide for safety on the unit.
Term
Jennifer has been under an unusual amount of stress following the death of her father one year ago. She has not attended work since the death, cannot look at any of her father's belongings, and cries daily for hours at a time over this loss. Which nursing diagnosis does the nurse assign?
Definition
Grieving, complicated, related to father's death

The excessive reactions Jennifer continues to exhibit, such as daily crying, inability to return to work, and inability to look at her father's belongings after a year is indicative of dysfunction in the grieving process.
Term
A client is enrolled full time in a nursing program and works full time at night to support his wife and two young children. He missed clinical this week because he overslept, and he also failed a test. His wife found him in the garage assembling a noose. When she questioned him, he began to cry. She immediately brought him to the emergency department. Which of the following assessment information would the nurse use in developing a care plan? (Select all that apply.)
Definition
Adequacy of social support

Previous coping skills, both adaptive and maladaptive

Perceptions of personal strengths and limitations

Level of precrisis functioning

Adequacy of social support; previous coping skills, both adaptive and maladaptive; perceptions of personal strengths and limitations; and level of precrisis functioning would be useful for the nurse in developing a client's care plan.

Term
A nursing home resident began having symptoms of an anxiety attack. The physician ordered alprazolam (Xanax) 0.25 mg bid. On hand were 0.5-mg tablets. How many tablets did the nurse administer?
Definition
0.5 tablets or 1/2
Term
A client is being discharged on haloperidol (Haldol). Which teaching should the nurse include about the medication?
Definition
“Do not stop taking Haldol abruptly.”

Abrupt withdrawal may precipitate nausea, vomiting, tremors, and lower the seizure threshold.
Term
The nurse determines that the most significant goal for a client experiencing a crisis is which?
Definition
To restore the client to precrisis functioning.

The primary goal in crisis intervention is to determine the precipitating event and return the client to a precrisis level of functioning.
Term
A client voluntarily admitted to a psychiatric unit does not enjoy interacting with others on the unit, and is cold and aloof. The nurse recognizes that this behavior is representative of which one of the following disorders?
Definition
Schizoid personality
Term
Characteristics of _______ ________ personality disorder include procrastination, postponement of routine tasks, irritability, and argumentativeness.
Definition
Passive–aggressive personality
Term
_______ personality characteristics include instability of interpersonal relationships, poor self-image, and lack of control over impulses.
Definition
Borderline personality
Term
Persons with _________ personality disorders lack empathy and remorse, and are callously unconcerned for the feelings of others. These persons use manipulation to control others.
Definition
Antisocial personality
Term
The nurse is preparing to help a client utilize mental imagery. Which nursing statement would accurately describe what the client should do?
Definition
“You may choose something that makes you feel relaxed.”

Choosing something that makes the individual feel relaxed is a key component of mental imagery.
Term
The nurse is caring for a client exhibiting an expressed response pattern. Which behavior would the nurse expect to be absent from the client's presentation?
Definition
Masking

Crying, restlessness, and tension are all signs of an expressed response pattern. Masking is associated with a controlled response pattern.
Term
The client has been on haloperidol (Haldol) for 3 days. He tells the nurse that his neck is stiff and his tongue is pulling to one side of his mouth. The nurse concludes that the client is experiencing:
Definition
Acute dystonia

The client is exhibiting classic signs of acute dystonia: sudden spasms of the neck and the tongue pulling to one side.
Term
_____ ________ occurs when prolonged blockade of dopamine has occurred, which is not the case with this client. Also, the cardinal symptoms of tongue protrusion, lip smacking, chewing, and choreiform movements are absent.
Definition
Tardive dyskinesia
Term
The signs and symptoms of ______ include restlessness and inner agitation.
Definition
akathisia
Term
The nurse is assessing a client who appears uneasy. Which question effectively measures the client's present state of mind?
Definition
“What do you feel is your major life stressor at this time?”

Asking the client about the immediate major life stressor focuses on the client's present state of mind, and allows for the opening of therapeutic dialogue.
Term
A nurse expects to find which characteristic about an individual presenting for treatment of a paraphilia?
Definition
Presenting for treatment because of pressure from his or her partner or the authorities.

Most clients with paraphilias do not come willingly for treatment, as they are not personally distressed by their behaviors.
Term
In planning care for a delusional, paranoid client, it is important for the nurse to assess which of the following characteristics?
Definition
Anger and aggressive acts

The paranoid client is often angry, aggressive, and guarded. Therefore the nurse must assess for these characteristics in order to ensure safety for the client and self.
Term
A crisis is an internal disturbance. The nurse identifies a crisis to be characterized by which of the following?
Definition
Precipitating events that are perceived as a threat to self

Persons in crisis perceive the event as a personal threat to self, and it usually involves a loss or sense of loss.
Term
______/_______ crisis occur in response to situations that trigger emotions related to unresolved conflicts in one's life.
Definition
Maturational/Developmental
Term
____ ______ can precipitate a crisis by unexpected external stresses over which the individual has little or no control and from which she feels emotionally overwhelmed and defeated. With no support systems in place and an ongoing problem with accomplishing tasks of daily living.
Definition
Traumatic stress
Term
Normal life cycle transitions are those that may be anticipated. refers to _____ ______ _______
Definition
Life Transition crisis
Term
______ crisis is an acute response to an external situational stressor.
Definition
Dispositional
Term
An adolescent confides that he had been sexually experimenting with a male peer until recently breaking things off. He reports feeling ambivalent about the encounters and wonders if he is gay. The nurse's best response is:
Definition
“This phase of your development includes experimentation. It doesn't necessarily mean it's a lifelong commitment.”

During adolescence, the individual strives to develop a coherent independent sense of self. This often requires experimentation with a variety of experiences before the self fully forms.

Term
The nurse is using guided imagery with a client who has recently experienced a broken relationship. Which questions should the nurse ask about the client's situation? (Select all that apply.)
Definition
What happened right before the break-up?

Why do you think this break-up happened?

Who was around when your significant other broke up with you?

Where were you when the break-up occurred?

Through guided imagery, the client is asked to “relive” the stressful situation by imagining the setting in which it occurred. Where did it occur? Who was there? What happened just before the stressful situation? What feelings did the client experience in association with the situation? In guided imagery, it is not appropriate to ask the client why he or she feels that this incidence happened at this time.

Term
The nurse working with substance disorder clients expects that which of the following issues influence abuse? (Select all that apply.)
Definition
Biological factors

Ethnic influences

Personality factors

Sociocultural background

Research has shown that there is a hereditary factor involved in the development of substance abuse. There is a high incidence of alcohol use in many ethnic groups and among those living in poverty. Certain personality traits may play a role in the development and maintenance of substance abuse. Amnestic syndrome is the state of organic brain changes related to the chronic use of alcohol; it is not a precursor to the use or abuse of alcohol.
Term
A schizophrenic client, admitted to a psychiatric unit in a catatonic state, is mute and exhibits catalepsy and waxy flexibility. In attempting to communicate with the client, the nurse should give the highest priority to which nursing action?
Definition
Use clear, concrete statements.

Term
In teaching the family members, the nurse expects that maintaining abstinence depends primarily on:
Definition
Goal achievement

The client needs to accept ownership of his problem and motivation to change behaviors.
Term
A schizophrenic client is experiencing severe catatonia. He is unable to speak or provide self-care. To promote communication, the nurse should include which of the following techniques?
Definition
Verbalizing the implied

When working with clients who have greatly impaired communication the nurse can use the technique of verbalizing the implied. By putting into words what the client may be experiencing, empathy is demonstrated and communication is fostered.
Term
The nurse is caring for a client on the unit who has been behaving violently. The physician prepares to test the client for drug usage. Which drugs would the nurse anticipate that could cause a violent behavioral reaction? (Select all that apply.)
Definition
Alcohol

Amphetamines

Anabolic steroids

Cocaine

Alcohol, amphetamines, anabolic steroids, and cocaine have all been associated with violent behavior. Antiinflammatory drugs have not been associated with violent behavior.
Term
A man was recently admitted to an inpatient substance-abuse unit. He was forced into retirement 3 years ago, and has since developed a problem with alcohol. He has tried but cannot cut down his alcohol consumption. It has also caused problems with his wife, and he has stopped interviewing for new jobs. He was stopped once for driving all over the road while under the influence, but only received a warning. Given the above information, the nurse determines his behaviors indicate that he meets the requirements for which of the following DSM-IV-TR diagnostic categories?
Definition
Psychoactive substance dependence

This man has developed tolerance, cannot control intake, and has continued use despite persistent problems related to drinking. This meets the criteria for psychoactive substance dependence in the DSM-IV-TR.
Term
The nurse is evaluating care for a client who was verbally unkind to other clients. The nurse continued to practice appropriate communication in the client's presence. Which outcome would indicate that modeling had been effective?
Definition
Client speaks kindly to other clients.

Modeling refers to the learning of new behaviors by imitating the behavior in others. In this outcome, the client has modeled the nurse by speaking kindly to others.
Term
The nurse is working with a client via covert sensitization. Which nursing intervention reflects this technique?
Definition
Asking the client to visualize the unpleasant stimuli.

Covert sensitization relies on the individual's imagination to produce unpleasant symptoms rather than on medication. The technique is under the client's control and can be used whenever and wherever it is required. This scenario represents this technique accurately.
Term
The nurse considers which question to be most effective when evaluating the outcome of crisis intervention?
Definition
Has the person grown from the experience?

Through adaptive changes, a crisis is resolved and psychological growth is experienced.
Term
The nurse determines which of the following will give the client the most immediate relief from extrapyramidal side effects of neuroleptics?
Definition
Benztropine (Cogentin) 1 mg IM

Cogentin parenterally is the drug of choice for this client. It is the first-line choice of drugs for extrapyramidal symptoms associated with the use of neuroleptics.
Term
In evaluating learning, the nurse asked the client to answer the following statement: “When used in combination with anxiolytic medication, alcohol leads to _____________ effects and caffeine leads to _______________ effects.” (Fill in the blanks.)
Definition
Increased; decreased

Anxiolytic medications work through depression of certain central nervous system (CNS) functions. Alcohol, which is a CNS depressant, would increase/potentiate their effects. Caffeine, which is a CNS stimulant, would decrease/inhibit their effects.
Term
A nursing home resident diagnosed as having schizophrenia complains to the nurse of a stiff neck and difficulty swallowing. Which condition should the nurse assess for?
Definition
Tardive dyskinesia

Tardive dyskinesia is involuntary movement of the tongue, stiff neck, and difficulty in swallowing.
Term
A hospitalized client angrily explained to the nurse that this psychiatric admission was a mistake by stating “I've been taking the medication for 5 years without a problem. I don't need it anymore. My thinking is OK.” Which technique does the nurse understand that the client is using?
Definition
Denial

Denial is a primitive defense mechanism that allows a person to resolve emotional conflict and avoid realities that are disagreeable. This client does not believe there is a problem at all, which is indicative of denial.
Term
________ is the process of returning to an earlier stage of development.
Definition
Regression
Term
This defense mechanism allows the person to divert unacceptable impulses and motives into personally and socially acceptable channels.
Definition
Sublimation
Term
When ______ing, a person attempts to justify behaviors that are not socially acceptable.
Definition
rationalizing
Term
A newly diagnosed schizophrenic client exhibits withdrawn, regressive, and isolative behaviors. The nurse's initial approach should include which action?
Definition
Speak in realistic, literal terms.

When addressing a client with a schizophrenic disorder, use realistic and concrete terms.
Term
A divorced man reports a fear of intimacy because of an inability to achieve and sustain an erection. This has caused him great distress. He has become more isolative and recently broke off a budding relationship with a female coworker. Which components should the nurse explore? (Select all that apply.)
Definition
Whether the client is taking any medications

Whether the client uses alcohol

Whether the client is experiencing an identity crisis
Whether the client was open to receiving therapy

Alcohol and certain medications can cause erectile dysfunction. Interpersonal or intrapersonal conflicts and past traumas can also decrease the ability to perform sexually. Being open to therapy can help to resolve the cause of erectile dysfunction.

Term
Frequently, persons with substance abuse problems are very sensitive. Which nursing intervention would be most appropriate with a sensitive client?
Definition
Emphasize self-diagnosis.

Persons who self-diagnose are usually motivated to change. Self-diagnosis forms the cornerstone of treatment, and provides ownership of the healing process.
Term
A client was admitted to the local mental health unit with symptoms of chronic alcoholism. The physician ordered disulfiram (Antabuse) 375 mg PO. On hand were 250-mg tablets. How many tablets did the nurse administer?
Definition
1.5 tablets
Term
A client is complaining of insomnia. The physician orders flurazepam (Dalmane) 15 mg HS. On hand were 15-mg capsules. How many capsules did the nurse administer?


Definition
1 tablet
Term
The Sexual Assault Nurse Examiner (SANE) is preparing to use a colposcope. When the client asks what this is for, what is the appropriate nursing response?
Definition
“It allows me to examine for tears and abrasions inside the vaginal area
Term
Nursing care for the substance abuse client experiencing alcohol withdrawal delirium should include which intervention?
Definition
Maintain seizure precautions.

Clients undergoing alcohol withdrawal are at high risk for seizures during the first week after cessation of alcohol intake.
Term
A teenager confides that she and her boyfriend engage in sadomasochistic practices. She reports, “It's not a big deal. We're just having fun.” Which reflects the nurse's most immediate appropriate response?
Definition
“Some sadomasochistic acts can result in death, especially those involving sexual arousal by oxygen deprivation.”

This information would be important to ensure her safety, and therefore represents the most immediate appropriate response.
Term
A client tells the nurse that she just failed a class in college. She has never failed a class before. She states, “My parents are going to disown me. They will hate me and never forgive me for this.” The nurse recognizes which type of automatic thought?
Definition
Catastrophic thinking

Catastrophic thinking involves always thinking that the worst will occur without considering the possibility of more likely positive outcomes. The client has failed to recognize that her parents will likely still love her, and will likely forgive her, even if they are disappointed in her failing grade.
Term
______ _______ involves coming to a conclusion about an incident without the facts to support it, or even sometimes despite contradictory evidence to support it.
Definition
Arbitrary influence
Term
_______ involves undervaluing the positive significance of an event.
Definition
Minimization
Term
___________ involves the person taking complete responsibility for situations without considering that other circumstances may have contributed to the outcome. The client has not considered that perhaps the material was too challenging for her.
Definition
Personalization