NCLEX RN Mental Health and

NCLEX RN Mental Health and Psychiatric Nursing (Alzheimers, Delirium and Dementia)

• A client with depression has been hospitalized for treatment after taking a leave of

absence from work. The client’s employer expects the client to return to work following inpatient treatment. The client tells the nurse, “I’m no good. I’m a failure”. According to

cognitive theory, these statements reflect:

• Learned behavior.
• Punitive superego and decreased self-esteem.
• Faulty thought processes that govern behavior.
• Evidence of difficult relationships in the work environment.

Correct Answer: C. Faulty thought processes that govern behavior

The client is demonstrating faulty thought processes that are negative and that govern his behavior in his work situation – issues that are typically examined using a cognitive theory approach. Cognitive-behavioral theorists suggest that depression results from maladaptive, faulty, or irrational cognitions taking the form of distorted thoughts and judgments. Depressive cognitions can be learned socially (observationally) as is the case when children in a dysfunctional family watch their parents fail to successfully cope with stressful experiences or traumatic events. Or, depressive cognitions can result from a lack of experiences that would facilitate the development of adaptive coping skills.Option A: Issues involving learned behavior are best explored through behavior theory, not cognitive theory. Behavioral theory seeks to explain human behavior by analyzing the antecedents and consequences present in the individual’s environment and the learned associations he or she has acquired through previous experience.Option B: Issues involving ego development are the focus of psychoanalytic theory.Psychoanalysis is defined as a set of psychological theories and therapeutic methods which have their origin in the work and theories of Sigmund Freud. The primary assumption of psychoanalysis is the belief that all people possess unconscious thoughts, feelings, desires, and memories. The aim of psychoanalysis therapy is to release repressed emotions and experiences, i.e., make the unconscious conscious. It is only having a cathartic (i.e., healing) experience can the person be helped and “cured.” Option D: This is incorrect because there is no evidence in this situation that the client has conflictual relationships in the work environment. A good psychological work environment consists, among other things, in having colleagues you work well with and that help you 1 / 4

thrive. It may also be a manager who recognizes and is attentive to both individual and collective contributions to solving both large and small work tasks

• Nurse Jessie is assessing a client suffering from stress and anxiety. A common

physiological response to stress and anxiety is:

• Urticaria
• Vertigo
• Sedation
• Diarrhea

Correct Answer: D. Diarrhea

Diarrhea is a common physiological response to stress and anxiety. The ability of stress to impair physiological processes such as growth, reproduction, and immune competence and its association with diseases such as cardiovascular disease, type 2 diabetes, anxiety, and depression are well known. While acute responses to stress are generally considered effective in dealing with immediate threats, prolonged activation of stress processes could have significant adverse consequences for individuals Option A: Hives are red, swollen, itchy bumps on the skin. Some people get them as part of an allergic reaction to food, medicine, or an insect sting. Others notice hives popping up on their skin on a more regular basis. Stress can also cause hives and can make hives you already have even worse. Stress is also one of the most common triggers of rosacea flare- ups. Rosacea appears as a red flush that spreads across the nose, cheeks, and chin.Option B: About 5 percent of American adults experience vertigo, and many people notice it when they’re feeling stressed or anxious. Even though stress doesn’t directly cause vertigo, it can contribute to dysfunction of the part of your inner ear that controls balance, called your vestibular system.Option C: Stress does not cause sedation. During stress, activation of the sympathoadrenal medullary (SAM) system results in the release of noradrenaline from sympathetic nerve terminals and adrenaline and noradrenaline from the adrenal medulla, which results in a range of rapid physiological and behavioral responses such as increases in heart rate (HR) and blood pressure and heightened vigilance.

• A tentative diagnosis of opiate addiction, Nurse Candy should assess a recently

hospitalized client for signs of opiate withdrawal. These signs would include:

• Rhinorrhea, convulsions, subnormal temperature
• Nausea, dilated pupils, constipation 2 / 4

• Lacrimation, vomiting, drowsiness
• Muscle aches, papillary constriction, yawning

Correct Answer: D. Muscle aches, papillary constriction, yawning

These adaptations are associated with opiate withdrawal which occurs after cessation or reduction of prolonged moderate or heavy use of opiates. According to Diagnostic and Statistical Manual of Mental Disorders (DSM–5) criteria, signs and symptoms of opioid withdrawal include lacrimation or rhinorrhea, piloerection “goose flesh,” myalgia, diarrhea, nausea/vomiting, pupillary dilation and photophobia, insomnia, autonomic hyperactivity (tachypnea, hyperreflexia, tachycardia, sweating, hypertension, hyperthermia), and yawning.Option A: Opioid withdrawal syndrome is a life-threatening condition resulting from opioid dependence. Opioids are a group of drugs used for the management of severe pain. They are also commonly used as psychoactive substances around the world. Opioids include drugs such as morphine, heroin, oxycontin, codeine, methadone, and hydromorphone hydrochloride. They produce mental relaxation, pain relief, and euphoric feelings.Option B: The principal site in the brain that triggers the onset of opioid withdrawal syndrome is the locus coeruleus at the base of the brain. Neurons present in locus coeruleus are noradrenergic and have an increased number of opioid receptors. The locus coeruleus region is the main source of NAergic innervation of the limbic system and cerebral and cerebellar cortices. The NAergic activity in locus coeruleus neurons, an opioid receptor linked mechanism, is a prime causative site of opioid withdrawal symptoms.Furthermore, research has also shown that gray matter and nucleus raphe magnus is also involved in the presentation of opioid withdrawal syndrome.

Option C: Sedative-hypnotic withdrawal symptoms may resemble opioid withdrawal

characteristics, but opioid withdrawal is also characterized by lacrimation, rhinorrhea, and pupillary dilation. Hallucinogen and stimulant intoxication can also cause pupillary dilation, but other symptoms of opioid withdrawal-like nausea, diarrhea, vomiting, lacrimation, and rhinorrhea are usually not present.

• A nurse who explains that a client’s psychotic behavior is unconsciously motivated

understands that the client’s disordered behavior arises from which of the following?

• Abnormal thinking
• Altered neurotransmitters
• Internal needs
• Response to stimuli

Correct Answer: C. Internal needs 3 / 4

The concept that behavior is motivated and has meaning comes from the psychodynamic framework. According to this perspective, behavior arises from internal wishes or needs. Much of what motivates behavior comes from the unconscious. The psychodynamic approach includes all the theories in psychology that see human functioning based upon the interaction of drives and forces within the person, particularly unconscious, and between the different structures of the personality.Option A: According to Freud (1915), the unconscious mind is the primary source of human behavior. Like an iceberg, the most important part of the mind is the part you cannot see.Our feelings, motives, and decisions are actually powerfully influenced by our past experiences and stored in the unconscious.Option B: Psychodynamic theory states that events in our childhood have a great influence on our adult lives, shaping our personality. Events that occur in childhood can remain in the unconscious, and cause problems as adults. Personality is shaped as the drives are modified by different conflicts at different times in childhood (during psychosexual development).Option D: The remaining responses do not address the internal forces thought to motivate behavior. Psychodynamic theory is strongly determinist as it views our behavior as caused entirely by unconscious factors over which we have no control. Unconscious thoughts and feelings can transfer to the conscious mind in the form of parapraxes, popularly known as Freudian slips or slips of the tongue. We reveal what is really on our minds by saying something we didn’t mean to.

• Initial interventions for Marco with acute anxiety include all except which of the

following?

• Touching the client in an attempt to comfort him.
• Approaching the client in a calm, confident manner.
• Encouraging the client to verbalize feelings and concerns.
• Providing the client with a safe, quiet, and private place.

Correct Answer: A. Touching the client in an attempt to comfort him

The emergency nurse must establish rapport and trust with the anxious client before using therapeutic touch. Touching an anxious client may actually increase anxiety. Converse using a simple language and brief statements. When experiencing moderate to severe anxiety, patients may be unable to understand anything more than simple, clear, and brief instruction.Option B: Interact with the patient in a peaceful manner. The nurse or health care provider can transmit his or her own anxiety to the hypersensitive patient. The patient’s feeling of stability increases in a calm and non-threatening environment. Accept a patient’s defenses;

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