Exam 3

Pam, the nurse educator, is teaching a new nurse about seclusion and restraint. Order the following interventions from least (1) to most (5) restrictive: a. With the patient identify the behaviors that are unacceptable and consequences associated with harmful behaviors b. Placing the patient in physical restraints c. Allowing the patient to take a time-out and sit in his or her room d. Offering a PRN medication by mouth e. Placing the patient in a locked seclusion room

a-1, b-5, c-3, d-2, e-4

Two months ago, Natasha's husband died suddenly and she has been overwhelmed with grief. When Natasha is subsequently diagnosed with major depressive disorder, her daughter, Nadia, makes which true statement? a. "Depression often begins after a major loss. Losing dad was a major loss." b. "Bereavement and depression are the same problem." c. "Mourning is pathological and not normal behavior." d. "Antidepressant medications will not help this type of depression."

a. "Depression often begins after a major loss. Losing dad was a major loss."

Which statement demonstrates a well-structured attempt at limit setting? a. "Hitting me when you are angry is unacceptable." b. "I expect you to behave yourself during dinner." c. "Come here, right now!" d. "Good boys don't bite."

a. "Hitting me when you are angry is unacceptable."

What assessment question should the nurse ask when attempting to determine a teenager's mental health resilience? Select all that apply. a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" c. "How do you feel about talking to a mental health counselor?" d. "Where do you see yourself in 10 years?" e. "Do you like the school you go to?"

a. "How did you cope when your father deployed with the Army for a year in Iraq?" b. "Who did you go to for advice while your father was away for a year in Iraq?" d. "Where do you see yourself in 10 years?"

Which statement made by the patient demonstrates an understanding of the effective use of newly prescribed lithium to manage bipolar mania? Select all that apply. a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." c. "Lithium may help me lose the few extra pounds I tend to carry around." d. "I take my lithium on an empty stomach to help with absorption." e. "I've already made arrangements for my monthly lab work."

a. "I have to keep reminding myself to consistently drink six 12-ounce glasses of fluid every day." b. "I discussed the diuretic my cardiologist prescribed with my psychiatric care provider." e. "I've already made arrangements for my monthly lab work."

Taylor, a psychiatric registered nurse, orients Regina, a patient with anorexia nervosa, to the room where she will be assigned during her stay. After getting Regina settled, the nurse informs Regina: a. "I need to go through the belongings you have brought with you." b. "You can use the scale in the back room when you need to." c. "You will be eating five times a day here." d. "The daily structure is based around your desire to eat."

a. "I need to go through the belongings you have brought with you."

Which patient statement supports the diagnosis of anorexia nervosa? a. "I'm terrified of gaining weight." b. "I wish I had a good friend to talk to." c. "I've been told I drink way too much alcohol." d. "I don't get much pleasure out of life anymore."

a. "I'm terrified of gaining weight."

Which nursing response demonstrates accurate information that should be discussed with the female patient diagnosed with bipolar and her support system? Select all that apply. a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." b. "Due to the risk of a manic episode, antidepressant therapy is never used with bipolar disorder. c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

a. "Remember that alcohol and caffeine can trigger a relapse of your symptoms." c. "It's critical to let your healthcare provider know immediately if you aren't sleeping well." d. "Is your family prepared to be actively involved in helping manage this disorder?" e. "The symptoms tend to come and go and so you need to be able to recognize the early signs."

When considering community suicide prevention programs, what population should the nurse plan to service with regular suicide screenings? Select all that apply. a. 10- to 34-year-olds b. Males c. College-educated adults d. Rural population e. Native American

a. 10- to 34-year-olds b. Males e. Native American

When considering an eating disorder, what is a physical criterion for hospital admission? a. A daytime heart rate of less than 50 beats per minute b. An oral temperature of 100°F or more c. 90% of ideal body weight d. Systolic blood pressure greater than 130 mm Hg

a. A daytime heart rate of less than 50 beats per minute

Malika has been overweight all of her life. Now an adult, she has health problems related to her excessive weight. Seeking weight loss assistance at a primary care facility Malika is surprised when the nurse practitioner suggests: a. A trial of SSRI antidepressant therapy b. Mild exercise to start, increasing in intensity over time c. Removing snack foods from the home d. Medication treatment for hypertension

a. A trial of SSRI antidepressant therapy

To provide effective care for the patient diagnosed with schizophrenia, the nurse should frequently assess for which associated condition? Select all that apply. a. Alcohol use disorder b. Major depressive disorder c. Stomach cancer d. Polydipsia e. Metabolic syndrome

a. Alcohol use disorder b. Major depressive disorder d. Polydipsia e. Metabolic syndrome

Which interventions will help make the environment on the unit safer for suicidal patients? Select all that apply. a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected. d. Patient doors are kept open. e. Staying within listening distance of the patient.

a. All windows are kept locked. b. Every shower has a breakaway shower rod. c. Eating utensils are counted when trays are collected.

Which characteristic in an adolescent female is sometimes associated with the prodromal phase of schizophrenia? a. Always afraid another student will steal her belongings. b. An unusual interest in numbers and specific topics. c. Demonstrates no interest in athletics or organized sports. d. Appears more comfortable among males.

a. Always afraid another student will steal her belongings.

In pediatric mental health there is a lack of sufficient numbers of community-based resources and providers, and there are long waiting lists for services. This has resulted in: Select all that apply. a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit c. Markedly increased funding d. Premature termination of services

a. Children of color and poor economic conditions being underserved b. Increased stress in the family unit d. Premature termination of services

When discussing oppositional defiant disorder with a group of parents, what information should the nurse include about the disorder? Select all that apply a. Classic symptoms include anger, irritation, and defiant behavior. b. Children generally outgrow the behaviors without formal treatment. c. Severity is considered mild when symptoms are present in only one setting. d. Disorder is diagnosed equally in both males and females. e. Argumentative and defiant are terms often used to describe the patient.

a. Classic symptoms include anger, irritation, and defiant behavior. b. Children generally outgrow the behaviors without formal treatment. c. Severity is considered mild when symptoms are present in only one setting. e. Argumentative and defiant are terms often used to describe the patient.

Which nursing intervention focuses on managing a common characteristic of major depressive disorder associated with the older population? a. Conducting routine suicide screenings at a senior center. b. Identifying depression as a natural, but treatable result of aging. c. Identifying males as being at a greater risk for developing depression. d. Stressing that most individuals experience just a single episode of major depression in a lifetime.

a. Conducting routine suicide screenings at a senior center.

Tommy, a 12-year-old boy admitted to the pediatric psychiatric unit, has recently been diagnosed with conduct disorder. In the activity room, the games he wanted to play were already in use. He responded by threatening to throw furniture and to hurt his peers who had the game he wanted. Nancy, a registered nurse, recognizes that Tommy's therapy must include: a. Consistency in implementing the consequences of breaking rules b. Empathetic reasoning when Tommy acts out in the activity room c. Teaching Tommy the benefits of socializing d. Solitary time so that Tommy can think about his actions

a. Consistency in implementing the consequences of breaking rules

What assessment data would support a diagnosis of conduct disorder? Select all that apply. a. Evidence of social isolation b. Arrested twice for disorderly conduct c. Expresses difficulty in keeping employment d. Demonstrates objective signs of phobia e. Exhibits signs of chronic self-mutilation

a. Evidence of social isolation b. Arrested twice for disorderly conduct c. Expresses difficulty in keeping employment

Tammy, a 28-year-old with major depressive disorder and bulimia nervosa, is ready for discharge from the county hospital after 2 weeks of inpatient therapy. Tammy is taking citalopram (Celexa) and reports that it has made her feel more hopeful. With a secondary diagnosis of bulimia nervosa, what is an alternative antidepressant to consider? a. Fluoxetine (Prozac) b. Isocarboxazid (Marplan) c. Amitriptyline d. Duloxetine (Cymbalta)

a. Fluoxetine (Prozac)

Safety measures are of concern in eating-disorder treatments. Patients with anorexia nervosa are supervised closely to monitor: Select all that apply. a. Foods that are eaten b. Attempts at self-induced vomiting c. Relationships with other patients d. Weight

a. Foods that are eaten b. Attempts at self-induced vomiting d. Weight

Kyle, a patient with schizophrenia, began to take the first-generation antipsychotic haloperidol (Haldol) last week. One day you find him sitting very stiffly and not moving. He is diaphoretic, and when you ask if he is okay he seems unable to respond verbally. His vital signs are: BP 170/100, P 110, T 104.2°F. What is the priority nursing intervention? Select all that apply. a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol. c. Administer a medication such as benztropine IM to correct this dystonic reaction. d. Reassure him that although there is no treatment for his tardive dyskinesia, it will pass. e. Hold his medication for now and consult his prescriber when he comes to the unit later today.

a. Hold his medication and contact his prescriber. b. Wipe him with a washcloth wet with cold water or alcohol.

What are the nursing responsibilities to a patient expressing suicidal thoughts? Select all that apply. a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication. e. Discussing triggers of depression.

a. Instituting one-to-one observation. b. Documenting the patient's whereabouts and mood every 15 to 30 minutes. c. Ensuring that the patient has no contact with glass or metal utensils. d. Ensuring that patient has swallowed each individual dose of medication.

Which factors tend to increase the difficulty of diagnosing young children who demonstrate behaviors associated with mental illness? Select all that apply. a. Limited language skills b. Level of cognitive development c. Level of emotional development d. Parental denial that a problem exists e. Severity of the typical mental illnesses observed in young children

a. Limited language skills b. Level of cognitive development c. Level of emotional development

The impulse control spectrum can begin in childhood and continue on into adulthood, often morphing into criminal behaviors. Working with patients diagnosed with these disorders, the best examples of expressed emotion by the nursing staff are: a. Low to prevent emotional reactions b. Matched to the patient's level of emotion c. Flat without evidence of any emotional output d. High expression to improve therapeutic patient emotions

a. Low to prevent emotional reactions

Which intervention should the nurse implement when caring for a patient demonstrating manic behavior? Select all that apply. a. Monitor the patient's vital signs frequently. b. Keep the patient distracted with group-oriented activities. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

a. Monitor the patient's vital signs frequently. c. Provide the patient with frequent milkshakes and protein drinks. d. Reduce the volume on the television and dim bright lights in the environment. e. Use a firm but calm voice to give specific concise directions to the patient.

Which chronic medical condition is a common trigger for major depressive disorder? a. Pain b. Hypertension c. Hypothyroidism d. Crohn's disease

a. Pain

When considering the need for monitoring, which intervention should the nurse implement for a patient with anorexia nervosa? Select all that apply. a. Provide scheduled portion-controlled meals and snacks. b. Congratulate patients for weight gain and behaviors that promote weight gain. c. Limit time spent in bathroom during periods when not under direct supervision. d. Promote exercise as a method to increase appetite. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

a. Provide scheduled portion-controlled meals and snacks. c. Limit time spent in bathroom during periods when not under direct supervision. e. Observe patient during and after meals/snacks to ensure that adequate intake is achieved and maintained.

Which nursing intervention is particularly well chosen for addressing a population at high risk for developing schizophrenia? a. Screening a group of males between the ages of 15 and 25 for early symptoms. b. Forming a support group for females aged 25 to 35 who are diagnosed with substance use issues. c. Providing a group for patients between the ages of 45 and 55 with information on coping skills that have proven to be effective. d. Educating the parents of a group of developmentally delayed 5- to 6-year-olds on the importance of early intervention.

a. Screening a group of males between the ages of 15 and 25 for early symptoms.

What is a common behavior observed in a patient diagnosed with intermittent explosive disorder? Select all that apply. a. Short attention span b. Threatens suicide c. Often purges after eating d. Uses alcohol to excess e. States, "Everyone is out to get me."

a. Short attention span b. Threatens suicide d. Uses alcohol to excess e. States, "Everyone is out to get me."

When discussing therapy options, the nurse should provide information about interpersonal therapy to which patient? Select all that apply. a. The teenager who is the focus of bullying at school b. The older woman who has just lost her life partner to cancer c. The young adult who has begun demonstrating hoarding tendencies d. The adolescent demonstrating aggressive verbal and physical tendencies e. The middle-aged adult who recently discovered her partner has been unfaithful

a. The teenager who is the focus of bullying at school b. The older woman who has just lost her life partner to cancer e. The middle-aged adult who recently discovered her partner has been unfaithful

A male patient reports to the nurse, "I'm told I have memories of childhood abuse stored in my unconscious mind. I want to work on this." Based on this statement, what information should the nurse provide the patient? a. To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories. b. How to use a defense mechanism such as suppression so that the memories will be less threatening. c. Psychodynamic therapy will allow the surfacing of those unconscious memories to occur in just a few sessions. d. Group sessions are valuable to identify underlying themes of the memories being suppressed.

a. To seek the help of a trained therapist to help uncover and deal with the trauma associated with those memories.

In an outpatient psychiatric clinic, a nurse notices that a newly admitted young male patient smiles when he sees her. One day the young man tells the nurse, "You are pretty like my mother." The nurse recognizes that the male is exhibiting: a. Transference b. Id expression c. Countertransference d. A cognitive distortion

a. Transference

According to Maslow's hierarchy of needs, the most basic needs category for nurses to address is: a. physiological b. safety c. love and belonging d. self-actualization

a. physiological

Which question should the nurse ask when assessing for what Sullivan's Interpersonal Theory identifies as the most painful human condition? a. "Is self-esteem important to you?" b. "Do you think of yourself as being lonely?" c. "What do you do to manage your anxiety?" d. "Have you ever been diagnosed with depression?"

b. "Do you think of yourself as being lonely?"

Which patient statement does not demonstrate an understanding of a suicide safety plan? a. "I know that when I start thinking about my dad, I'm going to start thinking about killing myself." b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts." c. "My sister is always there for me when I start getting suicidal." d. "I keep the suicide prevention phone number in my wallet."

b. "Going for a really long, hard run helps clear my mind and stops the suicidal thoughts."

Which statement made by a 9-year-old child after hitting a classmate is a typical comment associated with childhood conduct disorder? a. "I'm sorry, I won't hit him again." b. "He deserved it for being a sissy." c. "I didn't think I hit him very hard." d. "He hit me first. You just didn't see it."

b. "He deserved it for being a sissy."

Cognitive-behavioral therapy is going well when a 12-year- old patient in therapy reports to the nurse practitioner: a. "I was so mad I wanted to hit my mother." b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd." c. "I forgot that you told me to breathe when I become angry." d. "I scream as loud as I can when the train goes by the house."

b. "I thought that everyone at school hated me. That's not true. Most people like me and I have a friend named Todd."

Which patient statement acknowledges the characteristic behavior associated with a diagnosis of pica? a. "Nothing could make me drink milk." b. "I'm ashamed of it, but I eat my hair." c. "I haven't eaten a green vegetable since I was 3 years old." d. "I regurgitate and re-chew my food after almost every meal."

b. "I'm ashamed of it, but I eat my hair."

Martin is a 23-year-old male with a new diagnosis of schizophrenia, and his family is receiving information from a home health nurse. The topic of education is suicide prevention, and the nurse recognizes effective teaching when the mother says: a. "Persons with schizophrenia rarely commit suicide." b. "Suicide risk is greatest in the first few years after diagnosis." c. "Suicide is not common in schizophrenia due to confusion." d. "Most persons diagnosed with schizophrenia die of suicide."

b. "Suicide risk is greatest in the first few years after diagnosis."

Which assessment question asked by the nurse demonstrates an understanding of comorbid mental health conditions associated with major depressive disorder? Select all that apply. a. "Do rules apply to you?" b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?" e. "Have you ever been arrested for committing a crime?"

b. "What do you do to manage anxiety?" c. "Do you have a history of disordered eating?" d. "Do you think that you drink too much?"

Which characteristic identified during an assessment serves to support a diagnosis of disruptive mood dysregulation disorder? Select all that apply. a. Female b. 7 years old c. Comorbid autism diagnosis d. Outbursts occur at least once a week e. Temper tantrums occur at home and in school

b. 7 years old c. Comorbid autism diagnosis e. Temper tantrums occur at home and in school

Substance abuse is often present in people diagnosed with bipolar disorder. Laura, a 28-year-old with a diagnosis of bipolar disorder, drinks alcohol instead of taking her prescribed medications. The nurse caring for this patient recognizes that: a. Anxiety may be present. b. Alcohol ingestion is a form of self-medication. c. The patient is lacking a sufficient number of neurotransmitters. d. The patient is using alcohol because she is depressed.

b. Alcohol ingestion is a form of self-medication.

Kara is a 23-year-old patient admitted with depression and suicidal ideation. Which intervention(s) would be therapeutic for Kara? Select all that apply. a. Focus primarily on developing solutions to the problems leading the patient to feel suicidal. b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. c. Avoid talking about the suicidal ideation as this may increase the patient's risk for suicidal behavior. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

b. Assess the patient thoroughly and reassess the patient at regular intervals as levels of risk fluctuate. d. Meet regularly with the patient to provide opportunities for the patient to express and explore feelings. e. Administer antidepressant medications cautiously and conservatively because of their potential to increase the suicide risk in Kara's age group. f. Help the patient to identify positive self-attributes and to question negative self-perceptions that are unrealistic.

Tatiana has been hospitalized for an acute manic episode. On admission the nurse suspects lithium toxicity. What assessment findings would indicate the nurse's suspicion as correct? a. Shortness of breath, gastrointestinal distress, chronic cough b. Ataxia, severe hypotension, large volume of dilute urine c. Gastrointestinal distress, thirst, nystagmus d. Electroencephalographic changes, chest pain, dizziness

b. Ataxia, severe hypotension, large volume of dilute urine

Adolescents often display fluctuations in mood along with undeveloped emotional regulation and poor tolerance for frustration. Emotional and behavioral control usually increases over the course of adolescence due to: a. Limited executive function b. Cerebellum maturation c. Cerebral stasis and hormonal changes d. A slight reduction in brain volume

b. Cerebellum maturation

Obesity can be the end result of a binge-eating disorder. The nurse understands that the best treatment option in persons with a binge-eating disorder promotes: a. Bariatric surgery b. Coping strategies c. Avoidance of public eating d. Appetite suppression medications

b. Coping strategies

Some cultures have lower rates of diagnosed conduct disorders than observed in Western societies. The lower rate of incidence may be contributed to: a. Strict parenting with corporal punishment b. Cultural expression of anger as normal behavior c. Parents' limited tolerance for externalizing behavior d. Widespread acceptance of conduct disorders

b. Cultural expression of anger as normal behavior

The biological approach to treating depression with electrodes surgically implanted into specific areas of the brain to stimulate the regions identified to be underactive in depression is: a. Transcranial magnetic stimulation b. Deep brain stimulation c. Vagus nerve stimulation d. Electroconvulsive therapy

b. Deep brain stimulation

A male patient calls to tell the nurse that his monthly lithium level is 1.7 mEq/L. Which nursing intervention will the nurse implement initially? a. Reinforce that the level is considered therapeutic. b. Instruct the patient to hold the next dose of medication and contact the prescriber. c. Have the patient go to the hospital emergency room immediately. d. Alert the patient to the possibility of seizures and appropriate precautions.

b. Instruct the patient to hold the next dose of medication and contact the prescriber.

Which event experienced in the patient's childhood increases the risk of the development of behaviors associated with intermittent explosive disorder? a. Orphaned at age 4 b. Physically abused from ages 3 to 10 c. Born with a chronic congenital disorder d. One parent was diagnosed with obsessive-compulsive disorder

b. Physically abused from ages 3 to 10

Sigmund Freud, Karl Menninger, and Aaron Beck theorized that hopelessness was an integral part of why a person commits suicide. A more recent theory suggest suicide results from: a. Elevated serotonin levels b. The diathesis-stress model c. Outward aggression turned inward d. A lack of perfectionism

b. The diathesis-stress model

April, a 10-year-old admitted to inpatient pediatric care, has been getting more and more wound up and is losing self-control in the day room. Time-out does not appear to be an effective tool for April to engage in self-reflection. April's mother admits to putting her in time-out up to 20 times a day. The nurse recognizes that: a. Time-out is an important part of April's baseline discipline. b. Time-out is no longer an effective therapeutic measure. c. April enjoys time-out, and acts out to get some alone time. d. Time-out will need to be replaced with seclusion and restraint.

b. Time-out is no longer an effective therapeutic measure.

Gladys is seeing a therapist because her husband committed suicide 6 months ago. Gladys tells her therapist, "I know he was in pain, but why didn't he leave me a note?" The therapist's best response would be: a. "He probably acted quickly on his impulse to kill himself." b. "He did not want to think about the pain he would cause you." c. "He was not able to think clearly due to his emotional pain." d. "He thought you may think it was an accident if there was no note."

c. "He was not able to think clearly due to his emotional pain."

Malika agrees to try losing weight according to the nurse practitioner's outlined plan. Additional teaching is warranted when Malika states: a. "I am willing to admit I am depressed." b. "Psychotherapy will be a part of my treatment." c. "I prefer to have a gastric bypass rather than use this plan." d. "My comorbid conditions may improve with weight loss."

c. "I prefer to have a gastric bypass rather than use this plan."

A patient is telling a tearful story. The nurse listens empathically and responds therapeutically with: a. "The next time you find yourself in a similar situation, please call me." b. "I am sorry this situation made you feel so badly. Would you like some tea?" c. "Let's devise a plan on how you will react next time in a similar situation." d. "I am sorry that your friend was so thoughtless. You should be treated better."

c. "Let's devise a plan on how you will react next time in a similar situation."

Claude is a new nurse on the psychiatric unit. He asks a senior nurse on staff for the "best advice" when working with oppositional defiant disorder. Which statement reflects advice on solid therapeutic communication? a. "When correcting behavior, use a loud firm tone." b. "Use language beyond the patient's education level." c. "When setting limits, be specific and outline consequences." d. "An aggressive body language will make the patients respect your position."

c. "When setting limits, be specific and outline consequences."

Which therapeutic communication statement might a psychiatric-mental health registered nurse use when a patient's nursing diagnosis is altered thought processes? a. "I know you say you hear voices, but I cannot hear them." b. "Stop listening to the voices, they are NOT real." c. "You say you hear voices, what are they telling you?" d. "Please tell the voices to leave you alone for now."

c. "You say you hear voices, what are they telling you?"

A 33-year-old female diagnosed with bipolar I disorder has been functioning well on lithium for 11 months. At her most recent checkup, the psychiatric nurse practitioner states, "You are ready to enter the maintenance therapy stage, so at this time I am going to adjust your dosage by prescribing": a. A higher dosage b. Once a week dosing c. A lower dosage d. A different drug

c. A lower dosage

Which person is at the highest risk for suicide? a. A 50-year-old married white male with depression who has a plan to overdose if circumstances at work do not improve. b. A 45-year-old married white female who recently lost her parents, suffers from bipolar disorder, and attempted suicide once as a teenager. c. A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden. d. An older Hispanic male who is Catholic, is living with a debilitating chronic illness, is recently widowed, and who states, "I wish that God would take me too."

c. A young single white male who is alcohol dependent, hopeless, impulsive, has just been rejected by his girlfriend, and has ready access to a gun he has hidden.

Tomas is a 21-year-old male with a recent diagnosis of schizophrenia. Tomas's nurse recognizes that self-medicating with excessive alcohol is common in this disease and can co-occur along with: a. Generally good health despite the mental illness. b. An aversion to drinking fluids. c. Anxiety and depression. d. The ability to express his needs.

c. Anxiety and depression.

Ted, a former executive, is now unemployed due to manic episodes at work. He was diagnosed with bipolar I 8 years ago. Ted has a history of IV drug abuse, which resulted in hepatitis C. He is taking his lithium exactly as scheduled, a fact that both Ted's wife and his blood tests confirm. To reduce Ted's mania the psychiatric nurse practitioner recommends: a. Clonazepam (Klonopin) b. Fluoxetine (Prozac) c. Electroconvulsive therapy (ECT) d. Lurasidone (Latuda)

c. Electroconvulsive therapy (ECT)

When considering the suggestions of Hildegard Peplau, which activity should the nurse regularly engage in to ensure that the patient stays the focus of all therapeutic conversations? a. Assessing the patient for unexpressed concerns and fears b. Evaluating the possible need for additional training and education c. Reflecting on personal behaviors and personal needs d. Avoiding power struggles with the manipulative patient

c. Reflecting on personal behaviors and personal needs

Child protective services have removed 10-year-old Christopher from his parents' home due to neglect. Christopher reveals to the nurse that he considers the woman next door his "nice" mom, that he loves school, and gets above average grades. The strongest explanation of this response is: a. Temperament b. Genetic factors c. Resilience d. Paradoxical effects of neglect

c. Resilience

When a nurse uses therapeutic communication with a withdrawn patient who has major depression, an effective method of managing the silence is to: a. Meditate in the quiet environment b. Ask simple questions even if the patient will not answer c. Use the technique of making observations d. Simply sit quietly and leave when the patient falls asleep

c. Use the technique of making observations

Which response by a 15-year-old demonstrates a common symptom observed in patients diagnosed with major depressive disorder? a. "I'm so restless. I can't seem to sit still." b. "I spend most of my time studying. I have to get into a good college." c. "I'm not trying to diet, but I've lost about 5 pounds in the past 5 months." d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

d. "I go to sleep around 11 p.m. but I'm always up by 3 a.m. and can't go back to sleep."

Which action reflects therapeutic practices associated with operant conditioning? a. Encouraging a parent to read to their children to foster a love for learning b. Encouraging a patient to make daily journal entries describing their feelings c. Suggesting to a new mother that she spend time cuddling her newborn often during the day d. Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew

d. Acknowledging a patient who is often verbally aggressive for complimenting a picture another patient drew

Which intervention will promote independence in a patient being treated for bulimia nervosa? a. Have the patient monitor daily caloric intake and intake and output of fluids. b. Encourage the patient to use behavior modification techniques to promote weight gain behaviors. c. Ask the patient to use a daily log to record feelings and circumstances related to urges to purge. d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.

d. Allow the patient to make limited choices about eating and exercise as weight gain progresses.

The nurse is providing medication education to a patient who has been prescribed lithium to stabilize mood. Which early signs and symptoms of toxicity should the nurse stress to the patient? Select all that apply. a. Increased attentiveness b. Getting up at night to urinate c. Improved vision d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

d. An upset stomach for no apparent reason e. Shaky hands that make holding a cup difficult

A nurse is assessing a patient who graduated at the top of his class but now obsesses about being incompetent in his new job. The nurse recognizes that this patient may benefit from the following type of psychotherapy: a. Interpersonal b. Operant conditioning c. Behavioral d. Cognitive-behavioral

d. Cognitive-behavioral

Luc's family comes home one evening to find him extremely agitated and they suspect in a full manic episode. The family calls emergency medical services. While one medic is talking with Luc and his family, the other medic is counting something on his desk. What is the medic most likely counting? a. Hypodermic needles b. Fast food wrappers c. Empty soda cans d. Energy drink containers

d. Energy drink containers

Larry, a middle-aged male in a treatment facility, is loudly displaying anger in the day room with a visiting family member. It is obvious to the nurse this pattern has played out before. Violence is often escalated when family members or authority figures: a. Use a soft tone of voice to gain control of the situation b. Move away from the agitated person in fear c. Use simple words to communicate d. Engage in a power struggle

d. Engage in a power struggle

Research supports which intervention implemented on a long-term basis significantly reduces the incidence of suicide and suicide attempts in a patient diagnosed with bipolar disorder? a. A selective serotonin reuptake inhibitor (SSRI) b. Electroconvulsive therapy (ECT) c. One-on-one observation d. Lithium

d. Lithium

Cabot has multiple symptoms of depression including mood reactivity, social phobia, anxiety, and overeating. With a history of mild hypertension, which classification of antidepressants dispensed as a transdermal patch would be a safe medication? a. Tricyclic antidepressants b. Selective serotonin reuptake inhibitors c. Serotonin and norepinephrine reuptake inhibitors d. Monoamine oxidase inhibitor

d. Monoamine oxidase inhibitor

Which characteristic presents the greatest risk for injury to others by the patient diagnosed with schizophrenia? a. Depersonalization b. Pressured speech c. Negative symptoms d. Paranoia

d. Paranoia

A female patient diagnosed with schizophrenia has been prescribed a first-generation antipsychotic medication. What information should the nurse provide to the patient regarding her signs and symptoms? a. Her memory problems will likely decrease. b. Depressive episodes should be less severe. c. She will probably enjoy social interactions more. d. She should experience a reduction in hallucinations.

d. She should experience a reduction in hallucinations.

Linda is terrified of spiders and cannot explain why. Because she lives in a wooded area, she would like to overcome this overwhelming fear. Her nurse practitioner suggests which therapy? a. Behavioral b. Biofeedback c. Aversion d. Systematic desensitization

d. Systematic desensitization

Which activity is most appropriate for a child with ADHD? a. Reading an adventure novel b. Monopoly c. Checkers d. Tennis

d. Tennis

When patients diagnosed with schizophrenia suffer from anosognosia, they often refuse medication, believing that: a. Medications provided are ineffective. b. Nurses are trying to control their minds. c. The medications will make them sick. d. They are not actually ill.

d. They are not actually ill.

Gilbert, age 19, is described by his parents as a "moody child" with an onset of odd behavior about at age 14, which caused Gilbert to suffer academically and socially. Gilbert has lost the ability to complete household chores, is reluctant to leave the house, and is obsessed with the locks on the windows and doors. Due to Gilbert's early and slow onset of what is now recognized as schizophrenia, his prognosis is considered: a. Favorable with medication b. In the relapse stage c. Improvable with psychosocial interventions d. To have a less positive outcome

d. To have a less positive outcome