A. SSRIs are more effective in relieving manifestations. Both SSRIs and TCAs are effective in treating depression, but SSRIs are often preferred due to their more favorable side effect profile. TCAs may actually be more effective for some individuals, especially in severe depression, but their side effects limit their widespread use. SSRIs are not necessarily more effective in all cases.
B. SSRIs produce a more sedative effect. SSRIs generally do not have strong sedative properties. In contrast, TCAs often cause significant sedation due to their antihistaminic effects. Some SSRIs, like fluvoxamine and paroxetine, can cause mild drowsiness, but overall, TCAs are more sedating.
C. TCAs are lethal in overdose. TCAs pose a significant risk in overdose due to their cardiotoxic effects, including arrhythmias, hypotension, and seizures. Even small amounts beyond the therapeutic range can cause fatal outcomes. This is a major reason why SSRIs are preferred in individuals at risk for suicide.
D. TCAs have fewer cardiovascular effects. TCAs have more pronounced cardiovascular side effects, including orthostatic hypotension, tachycardia, and QT prolongation, due to their effects on alpha-adrenergic and sodium channels. In contrast, SSRIs have minimal cardiovascular impact, making them safer for clients with heart conditions.

"Involve incremental exposure while using relaxation techniques." Exposure therapy involves gradually exposing the client to anxiety-provoking situations while using relaxation strategies such as deep breathing, progressive muscle relaxation, and positive self-talk. This approach helps the client manage anxiety and reduce avoidance behaviors over time.

"Involves increasing their interpersonal effectiveness." This is a component of dialectical behavior therapy (DBT), which is used to improve communication and relationship skills in conditions like borderline personality disorder. It is not an effective approach for treating specific phobias like claustrophobia.

"Help the client to practice the new skill in a role-playing situation." Role-playing is commonly used in social anxiety treatment or assertiveness training, where clients rehearse real-life interactions. However, specific phobias like claustrophobia require real-world or simulated exposure rather than role-playing.

"Target behavior with a negative stimulus to extinguish undesirable behavior." This describes aversion therapy, which involves pairing an unpleasant stimulus with an undesirable behavior (e.g., using a bitter nail polish to stop nail-biting). It is not suitable for phobia treatment, where gradual and controlled exposure is preferred over punishment-based approaches.

"Encourage the client to face their fears in a safe environment." Exposure therapy helps clients gradually confront their fears in a controlled, supportive setting. This allows them to build tolerance and confidence while ensuring that the exposure occurs safely and at a manageable pace to prevent overwhelming distress.

A. Flight of ideas. Flight of ideas refers to rapid, continuous speech with abrupt topic changes that may be loosely connected. Though the speech may be difficult to follow, it often retains some logical thread. The client's statement lacks any meaningful connection between words, making flight of ideas an incorrect choice.
B. Word salad. Word salad is a severe form of disorganized speech in which words are randomly strung together without logical connection or coherence. The client's phrase, "Walk tall broom short dog bell," is an example of this pattern, as it consists of unrelated words that do not form a meaningful sentence.
C. Neologisms. Neologisms are newly created or made-up words that have meaning only to the individual using them. While people with schizophrenia may invent words, the client's statement does not contain unfamiliar or fabricated terms, ruling out this option.
D. Clang associations. Clang associations involve speech patterns where words are linked based on sound rather than meaning, such as rhyming or alliteration. The client’s statement does not show this pattern, as the words do not share similar sounds or rhythms.

A. "I check my breasts for lumps every day, but I'm still really scared about getting breast cancer." This statement suggests illness anxiety disorder (formerly hypochondriasis), where a person is excessively worried about having a serious illness despite medical reassurance. While anxiety is present, this condition is classified separately from generalized anxiety disorder or other common anxiety disorders.
B. "I have had several negative pregnancy tests, but I know they are all wrong." This response indicates delusional thinking, which is more characteristic of a psychotic disorder such as delusional disorder rather than an anxiety disorder. People with anxiety disorders typically have excessive worry but remain in touch with reality.
C. "I double-check my pills because I think the pharmacist may be putting poison in them." This statement reflects paranoia and persecutory delusions, which are more commonly seen in psychotic disorders such as schizophrenia or paranoid personality disorder. Anxiety disorders typically do not involve persistent false beliefs of being harmed.
D. “I feel really nervous when my partner goes to work, and I am home alone during the day.” This statement reflects excessive worry and fear, which are key features of anxiety disorders. The fear of being alone may indicate generalized anxiety disorder or separation anxiety, both of which fall under the category of anxiety disorders.

A. "ECT is contraindicated in clients who have psychotic symptoms." ECT is actually an effective treatment for severe depression with psychotic features, as well as treatment-resistant schizophrenia. It is not contraindicated in these cases; rather, it is often recommended when medications are ineffective.
B. "ECT is delivered through electrodes attached to the head." During ECT, electrical stimulation is applied via electrodes placed on the scalp to induce a controlled seizure. This process alters brain chemistry and can rapidly improve severe depressive symptoms, making this statement accurate.
C. "ECT cannot be administered to clients who have suicidal ideation." ECT is commonly used in individuals with severe suicidal ideation, particularly when rapid symptom relief is needed. It can be life-saving in cases of severe, treatment-resistant depression, making this statement incorrect.
D. "ECT is conducted under regional anesthesia." ECT is performed under general anesthesia, not regional anesthesia. The client receives short-acting anesthesia along with a muscle relaxant to prevent injury during the induced seizure.

Melatonin 5 mg orally at bedtime. Melatonin is a natural sleep aid commonly used in clients with Alzheimer’s disease to help regulate the sleep-wake cycle. Since the client has insomnia, this medication is appropriate and can improve sleep quality without significant side effects.

Memantine 10 mg orally twice daily. Memantine is an NMDA receptor antagonist used to treat moderate to severe Alzheimer's disease by slowing cognitive decline and improving daily functioning. Since the client has severe Alzheimer's, memantine is an appropriate and anticipated medication.

Donepezil 10 mg orally once daily. Donepezil is a cholinesterase inhibitor commonly prescribed for mild to severe Alzheimer's disease to enhance memory and cognitive function. It works by increasing acetylcholine levels in the brain and is a first-line treatment for Alzheimer's disease.

Haloperidol 2 mg orally every 12 hours. Haloperidol is an antipsychotic that can cause severe side effects in elderly clients with dementia, including extrapyramidal symptoms, sedation, falls, and an increased risk of death due to cardiovascular complications. Black box warnings advise against using antipsychotics for behavioral disturbances in dementia unless absolutely necessary. Therefore, it is contraindicated in this client.

A. "This medication will help control my child's aggressive behavior." Risperidone is an atypical antipsychotic that is commonly prescribed to manage irritability, aggression, and self-injurious behaviors in children with autism spectrum disorder (ASD). It helps reduce behavioral disturbances, improving overall functioning.
B. "This medication can cause my child to have low blood sugar." Risperidone is more commonly associated with metabolic side effects such as weight gain and an increased risk of high blood sugar (hyperglycemia), rather than low blood sugar (hypoglycemia). Regular monitoring of weight and blood glucose levels may be necessary.
C. "This medication won't require my child to have routine lab tests." While risperidone does not require frequent lab monitoring like some other antipsychotics (e.g., clozapine), periodic assessments of metabolic parameters, including blood glucose, cholesterol, and liver function, may be necessary due to its potential side effects.
D. "This medication might need to be increased if my child has muscle spasms." Muscle spasms, or extrapyramidal symptoms (EPS), can be a side effect of risperidone. If EPS occur, the medication might need to be reduced or adjusted, rather than increased. Additional medications, such as benztropine, may also be considered to manage EPS.

A. A nurse did not clarify a client's prescription that was difficult to read, resulting in a medication error. This is an example of an unintentional tort, specifically negligence. Unintentional torts occur when harm results from a nurse’s failure to follow the standard of care. In this case, failing to clarify an unclear prescription led to a preventable medication error, which could harm the client.
B. A nurse posted private information on social media about a client who has a substance use disorder. This is an intentional tort, specifically invasion of privacy. Sharing a client’s personal health information without consent violates confidentiality laws, such as HIPAA, and is a breach of professional ethics.
C. A nurse placed a client in mechanical restraints without obtaining a prescription, resulting in injury. This is an intentional tort, specifically false imprisonment. The improper use of restraints without authorization or justification violates a client’s rights and can lead to legal consequences, especially if harm occurs.
D. A nurse threatened a client with physical harm after the client became verbally abusive to staff members. This is an intentional tort, specifically assault. Assault occurs when a person is threatened with harm, causing fear, even if physical contact does not occur. Verbal threats of physical harm meet this definition.

A. "I agree with you. I'm sure this will never happen again." This response dismisses the seriousness of the situation and fails to assess the child's safety. Abuse often recurs, and the nurse must take all suspected cases seriously by gathering more information before making assumptions.
B. "This is awful. You should file charges against your partner." While the situation is concerning, this response is judgmental and directive, which may make the parent defensive. The nurse’s role is to assess, support, and report suspected abuse, not to instruct the parent on legal action.
C. "This is clearly child endangerment I will have to call the police." While the nurse has a legal obligation to report suspected child abuse, an immediate accusation may shut down communication. A more effective approach is to gather details while maintaining a nonjudgmental stance before escalating the situation to child protective services.
D. "I'd like to know more about what happened. Let's sit and talk." This response is therapeutic and encourages open communication. It allows the nurse to assess the situation further, provide support, and determine the next steps while maintaining a nonthreatening approach.

A. A client who has a new diagnosis of major depressive disorder. A new diagnosis of major depressive disorder (MDD) can often be managed through outpatient therapy and medication. Assertive Community Treatment (ACT) is typically reserved for individuals with severe, persistent mental illness, particularly those with frequent hospitalizations or difficulty adhering to treatment.
B. A client who has repeated acute care admissions due to schizophrenia. ACT is a specialized, intensive, community-based intervention designed for individuals with severe mental illness, such as schizophrenia, who have difficulty maintaining stability in the community. This model provides continuous, comprehensive care to reduce hospitalizations and improve quality of life.
C. A client who has requested family therapy following the death of a family member. Family therapy is beneficial for grief counseling, but it does not require ACT services. ACT focuses on individuals with chronic psychiatric disorders who need multidisciplinary, long-term support.
D. A client who has physical injuries following an incident of partner violence. Survivors of intimate partner violence may require medical care, counseling, and support services, but ACT is not the appropriate intervention. Instead, referrals to domestic violence shelters, crisis counseling, or legal assistance may be more suitable.