Archer Mental Health/ Abuse/Neglect
Additional Info
A combination of medications and behavioral therapy works best for smoking cessation rather
than either treatment alone. Most smoking cessation medications work by reducing nicotine
withdrawal and craving. Medicines for smoking cessation include nicotine replacement therapy
(NRT), varenicline, and bupropion.
Varenicline is a preferred option for most patients. Varenicline is administered as an oral pill. It
works by relieving nicotine withdrawal symptoms and blocking the smoking-related reward
feeling. For a patient taking varenicline, starting the medication one week before quitting
cigarettes is recommended. The patient may continue the treatment for up to twelve weeks. The
most common side effect of varenicline is nausea. Adversely, neuropsychiatric effects such as
vivid dreams, depression, and suicidal ideation have been reported. Varenicline should not be
used in patients with a history of suici - ANS-The nurse is caring for a client who is receiving
prescribed varenicline. Which of the following statements would indicate a therapeutic response
if made by the client?
A. "I am not smoking cigarettes anymore."
B. "My depression has gotten better."
C. "I am sleeping eight hours a night."
D. "I can focus on one task at a time."
Submit Answer
Explanation
Choice A is correct. A milieu environment is the type of care environment that is the most
therapeutic and the most conducive for the treatment of clients with emotional and behavioral
issues. A milieu environment is planned and maintained in a manner that eliminates all possible
stressors so that the clients with emotional and behavioral problems can concentrate their
energies and thoughts on the things impacting them rather than external stressors that have
been eliminated from the environment of care.
Choice B is incorrect. A locked environment is not the type of care environment that is the most
therapeutic and the most conducive for the treatment of clients with emotional and behavioral
issues. Clients are placed in a locked environment only when all alternative measures are not
possible or practical, and the client is in grave danger to themselves and others, as consistent
with the regulations of t - ANS-Which type of care environment is the most therapeutic and the
most conducive for the treatment of clients with emotional and behavioral issues?
A. A milieu environment
B. A locked environment
C. One employing mindfulness therapy
D. One employing universal seclusion
Submit Answer
,Explanation
Choice A is correct. A TSH is the standard of care before diagnosing a mood disorder such as
bipolar disorder or major depressive disorder. While this test does not confirm the presence of a
mood disorder, it excludes alterations of the thyroid, which could alternatively explain the client's
symptoms.
Choices B, C, and D are incorrect. A CMP would not necessarily explain mood symptoms. Most
certainly, electrolyte alterations may influence mood, but not to the extent of an actual disorder
as it would be transient. An HbA1c would be useful to determine if the client has diabetes
mellitus as well as how they are managing their glucose levels. CRP would be an inflammatory
marker and is not specific to a psychiatric disorder.
Additional Info
TSH levels would help exclude thyroid disorders that may explain bipolar symptoms.
Hypothyroidism may cause an individual to experience depressive mood symptoms, wherea -
ANS-The nurse is assessing a client with possible bipolar I disorder. The nurse anticipates that
the primary healthcare provider (PHCP) will prescribe which laboratory testing?
A. Thyroid Stimulating Hormone (TSH)
[39%]
B. Complete Metabolic Panel (CMP)
[47%]
C. Glycated Hemoglobin A1C (HbA1c)
[3%]
D. C-Reactive Protein (CRP)
[11%]
Explanation
Choice A is correct. Alprazolam (Xanax) is a type of benzodiazepine. The patient is presenting
with classic benzodiazepine drug withdrawal symptoms: anxiety, coarse hand/tongue/eyelid
tremors, irritability, increased autonomic activity (tachycardia and sweating), orthostatic
hypotension, and insomnia.
Choice B is incorrect. Typical nicotine withdrawal symptoms include headache, nervousness,
poor concentration, anger, hunger, and restlessness.
Choice C is incorrect. Adderal is an amphetamine drug. Typical amphetamine withdrawal
symptoms include dysphoric mood, fatigue, insomnia or hypersomnia, and psychomotor
agitation.
Choice D is incorrect. Typical withdrawal symptoms of cocaine are similar to amphetamine
withdrawal symptoms: dysphoric mood, fatigue, insomnia or hypersomnia, and psychomotor
agitation.
,NCSBN Client Need Topic: Psychological medications, Subtopic: Chemical and other
dependencies/substance - ANS-A patient presents with dizziness upon standing, bilateral hand
tremors, inability to sleep, irritability, sweating, and a heart rate of 95. From what substance is
the patient most likely experiencing these withdrawal symptoms?
A. Alprazolam
B. Nicotine
C. Adderall
D. Cocaine
Submit Answer
Explanation
Choice A is correct. Asking the patient if he or she is afraid of someone at home or if they are
being hurt at home is the first critical step in a comprehensive assessment. Intimate partner
violence (IPV) is a serious problem for men and women of all socioeconomic and cultural
backgrounds. Age is also not a defining factor for potential victims, either. Nurses should
suspect IPV when injuries are not consistent with the history given by the client.
Choice B is incorrect. Referring the patient to a shelter before a complete assessment is done
may lead to inappropriate care.
Choice C is incorrect. While collaboration with other health professionals may be necessary, the
first step is a comprehensive assessment by the nurse.
Choice D is incorrect. Documentation alone does not address, reduce, or solve the concern.
NCSBN Client Need Topic: Safe & Effective Care Management, Subtopic: Safety & Infection
Contr - ANS-A woman comes into the emergency department with multiple bruises on the face
and head. The nurse suspects that intimate partner violence (IPV) may be the cause of her
injuries. What is the most appropriate action for the nurse to take at this time?
A. Ask the person if she is afraid of someone at home who is hurting her.
B. Refer the person to a shelter for battered women.
C. Call a social worker to assess the person for IPV.
D. Document the concern in the chart, but do nothing else.
Submit Answer
Explanation
Choice A is correct. Based on Kubler-Ross' stages of death and dying, this statement indicates
the client is currently in the bargaining stage. Clients in this stage often attempt to buy time for
some future event or occasion.
Choice B is incorrect. Depression, according to Kubler-Ross, is characterized by sadness,
sorrow, tearfulness, and feelings of helplessness/hopelessness. During this stage, the client
would not be asking for more time.
Choice C is incorrect. According to Kubler-Ross, the anger stage is characterized by
expressions of anger and rage. During this stage, the client would not be asking for more time.
Choice D is incorrect. Denial, according to Kubler-Ross, is characterized by the subconscious
thought that death is not imminent.
, Learning Objective
Correlate the client's statement with the bargaining stage of Kubler-Ross' stages of death and
dying.
Additional Info
The stages of death - ANS-You are caring for a client at the end of life with a terminal disease.
You overhear this client saying, "Lord, just give me two more months so I can go to my
grandson's wedding." What is this client demonstrating with these words?
A. Bargaining
B. Depression
C. Anger
D. Denial
Submit Answer
Explanation
Choice A is correct. Before addressing any existing psychiatric issues which may be present,
the client must be fully assessed medically. If one or more medical issues are identified, those
issues must be addressed and stabilized. In general, before a client is allowed to be transferred
to an inpatient psychiatric treatment facility or floor for treatment, facilities require the client to
receive medical clearance (including a urine drug screen, alcohol screen, and a pregnancy test
(if applicable)). Various medical conditions may cause a client to present with psychiatric-like
symptoms (e.g., substance intoxication/withdrawal, certain electrolyte imbalances,
encephalopathy/delirium, infections, traumatic brain injuries, various endocrine disorders, brain
malignancy, etc.) and must be ruled out as an underlying cause. Additionally, any client-specific
concern must be addressed. Here, since the client was - ANS-A client was brought to a local
emergency department after police officers located the client walking in a neighborhood at night
without shoes in the snow. The client appears confused and disoriented. Which of the following
is the priority at this point?
A. Assess and stabilize the client medically
B. Perform a mental assessment and stabilize the client psychologically
C. Locate the nearest family members to obtain the client's history
D. Arrange for a transfer to the nearest psychiatric medical facility
Submit Answer
Explanation
Choice A is correct. Clients with anorexia nervosa have the desire to please others. They need
to be accurate or perfect to cope with their stress.
Choices B, C, and D are incorrect. These statements apply to clients with bulimia nervosa, not
anorexia.
