Psychiatric Nursing Pt. 2

1. Situation: A 30 year old male employee frequently complains oflow back pain that leads to frequent absences from work. Consultation and tests reveal negative results.

The client has which somatoform disorder?

Somatization Disorder

Hypochondriaisis

Conversion Disorder

Somatoform Pain Disorder

Somatoform Pain Disorder
This is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.

Explanation

Somatoform Pain Disorder
This is characterized by severe and prolonged pain that causes significant distress. A. This is a chronic syndrome of somatic symptoms that cannot be explained medically and is associated with psychosocial distress. B. This is an unrealistic preoccupation with a fear of having a serious illness. C. Characterized by alteration or loss in sensory or motor function resulting from a psychological conflict.

2. Situation: A nurse may encounter children with mental disorders. Her knowledge of these various disorders is vital.

When planning school interventions for a child with a diagnosis of attention deficit hyperactivity disorder, a guide to remember is to:

Provide as much structure as possible for the child

Ignore the child’s overactivity.

Encourage the child to engage in any play activity to dissipate energy

Remove the child from the classroom when disruptive behavior occurs

provide as much structure as possible for the child
Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non –confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure.

Explanation

provide as much structure as possible for the child
Decrease stimuli for behavior control thru an environment that is free of distractions, a calm non –confrontational approach and setting limit to time allotted for activities. B. The child will not benefit from a lenient approach. C. Dissipate energy through safe activities. D. This indicates that the classroom environment lacks structure.

3. Freud explains anxiety as:

Strives to gratify the needs for satisfaction and security

Conflict between id and superego

A hypothalamic-pituitary-adrenal reaction to stress

A conditioned response to stressors

Conflict between id and superego
Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model.

Explanation

Conflict between id and superego
Freud explains anxiety as due to opposing action drives between the id and the superego. A. Sullivan identified 2 types of needs, satisfaction and security. Failure to gratify these needs may result in anxiety. C. Biomedical perspective of anxiety. D. Explanation of anxiety using the behavioral model.

4. The following statements describe somatoform disorders:

Physical symptoms are explained by organic causes

It is a voluntary expression of psychological conflicts

Expression of conflicts through bodily symptoms

Management entails a specific medical treatment

Expression of conflicts through bodily symptoms
Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis.

Explanation

Expression of conflicts through bodily symptoms
Bodily symptoms are used to handle conflicts. A. Manifestations do not have an organic basis. B. This occurs unconsciously. D. Medical treatment is not used because the disorder does not have a structural or organic basis.

5. A 10 year old child has very limited vocabulary and interaction skills. She has an I.Q. of 45. She is diagnosed to have Mental retardation of this classification:

Profound

Mild

Moderate

Severe

Moderate
The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

Explanation

Moderate
The child with moderate mental retardation has an I.Q. of 35-50 Profound Mental retardation has an I.Q. of below 20; Mild mental retardation 50-70 and Severe mental retardation has an I.Q. of 20-35.

6. The child with conduct disorder will likely demonstrate:

Easy distractibility to external stimuli.

Ritualistic behaviors

Preference for inanimate objects.

Serious violations of age related norms.

Serious violations of age related norms.
This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder.

Explanation

Serious violations of age related norms.
This is a disruptive disorder among children characterized by more serious violations of social standards such as aggression, vandalism, stealing, lying and truancy. A. This is characteristic of attention deficit disorder. B and C. These are noted among children with autistic disorder.

7. Ritalin is the drug of choice for chidren with ADHD. The side effects of the following may be noted:

Increased attention span and concentration

Increase in appetite

Sleepiness and lethargy

Bradycardia and diarrhea

increased attention span and concentration
The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.

Explanation

increased attention span and concentration
The medication has a paradoxic effect that decrease hyperactivity and impulsivity among children with ADHD. B, C, D. Side effects of Ritalin include anorexia, insomnia, diarrhea and irritability.

8. What would be the best response to the client's repeated complaints of pain:

“I know the feeling is real tests revealed negative results.”

“I think you’re exaggerating things a little bit.”

“Try to forget this feeling and have activities to take it off your mind”

“So tell me more about the pain”

“I know the feeling is real tests revealed negative results.”
Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client’s feelings. D. Giving undue attention to the physical symptom reinforces the complaint.

Explanation

“I know the feeling is real tests revealed negative results.”
Shows empathy and offers information. B. This is a demeaning statement. C. This belittles the client’s feelings. D. Giving undue attention to the physical symptom reinforces the complaint.

9. School phobia is usually treated by:

Returning the child to the school immediately with family support.

Calmly explaining why attendance in school is necessary

Allowing the child to enter the school before the other children

Allowing the parent to accompany the child in the classroom

Returning the child to the school immediately with family support.
Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear

Explanation

Returning the child to the school immediately with family support.
Exposure to the feared situation can help in overcoming anxiety. A. This will not help in relieving the anxiety due separation from a significant other. C. and C. Anxiety in school phobia is not due to being in school but due to separation from parents/caregivers so these interventions are not applicable. D. This will not help the child overcome the fear

10. The following are appropriate nursing diagnosis for the client EXCEPT:

Ineffective individual coping

Alteration in comfort, pain

Altered role performance

Impaired social interaction

Impaired social interaction
The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain.

Explanation

Impaired social interaction
The client may not have difficulty in social exchange. The cues do not support this diagnosis. A. The client maladaptively uses body symptoms to manage anxiety. B. The client will have discomfort due to pain. C. The client may fail to meet environmental expectations due to pain.