Mental Health Exam 2, Ch. 4-6, 11, 12, 21, 35

A child diagnosed with attention deficit hyperactivity disorder (ADHD) is reprimanded for taking the nurse's pen without asking first. He responds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding with which statement?

"I do like you, but I don't like it when you grab my pen."

A client diagnosed with paranoid schizophrenia refuses food, stating the voices are saying the food is contaminated and deadly. Which response should the nurse provide to this client statement?

"I understand that the voices are very real to you, but I do not hear them."

A client diagnosed with schizophrenia states to the nurse, "My, oh my. My mother is brother. Anytime now it can happen to my mother." What is the nurse's best response?

"I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?"

When a client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me," what would be an appropriate response for the nurse to make?

"It must be frightening to think something is going to harm you."

Which statement made by the nurse would acknowledge that they understand the difference between the ethnicity and culture?

"So, ethnicity refers to shared history and heritage, whereas culture refers to sharing the same beliefs and values."

The mother of a 3-year-old boy just diagnosed with autism spectrum is tearful and states, "The doctor said we need to start therapy right away. I just don't understand how helpful it will be—he's only 3 years old!" What response should the nurse provide to the mother's statement?

"Starting him on treatment now gives your child a much greater chance for a productive life."

When considering the duty to warn and protect third parties, which client statement should the nurse report to the treatment team members?

"That judge is going to really regret putting me in here."

Which question asked by a nurse demonstrates the effective implementation of cultural desire when caring for a client from a different culture?

"What can I do to provide ethnic foods that are still low in fat?"

The nurse assesses the wellness beliefs and values of a client from another culture best when asking which question?

"What do you think is making you ill?"

Which assessment question would produce data that would help a nurse understand healing options acceptable to a client of a different culture?

"What usually helps people who have the same type of illness you have?"

A nurse states, "I am so frustrated trying to communicate with clients when they insist on speaking in their language instead of English. I think if people want to live here, they ought to have to speak our language and act like we do!" Which response by a peer best promotes culturally competent care? (Select all that apply.)

"What you are saying is actually considered cultural imposition, which is imposing our own culture onto someone from a different culture." "When their ability to speak and understand English is very limited, we need to have an interpreter present to make sure they can make their needs and feelings known."

Which of the following clients meets the criteria for an involuntary admission to a psychiatric mental health unit?

A 26-year-old kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road

Which hospitalized patient should the nurse identify as being a candidate for the appropriate use of a release from hospitalization known as against medical advice (AMA)?

A 37-year-old patient scheduled for discharge in 24 hours wishes to be discharged immediately

Which of the following clients would be appropriate to refer to a partial hospitalization program (PHP)?

A client being discharged from an inpatient alcohol rehabilitation unit

The primary goal and benefit of assertive community treatment (ACT) is demonstrated by which situation?

A client diagnosed with schizophrenia has avoided being re-hospitalization for 16 months.

A client diagnosed with paranoid schizophrenia tells the nurse, "I have to get away. The volmers are coming to execute me." The term "volmers" can be assessed as what?

A neologism

Which scenarios describe a Health Insurance Portability and Accountability Act (HIPAA) violation associated with a nurse's behavior?

A nurse on the cardiac unit gives report to the nurse on the step-down unit while transporting a client in the staff elevator.

The family of a child diagnosed with attention deficit hyperactivity disorder (ADHD), inattentive type, is told the evaluation of their child's care will focus on symptom patterns and severity. What is the focus of child's evaluation? (Select all that apply.)

Activities of daily living Personal perception Academic performance Social relationships

Which nursing behavior best demonstrates the concept of cultural competence?

Adjusting personal practice to meet the clients' cultural preferences, beliefs, and practices

Which statement regarding clients' rights after being voluntarily admitted to a behavioral health unit is true?

All rights remain intact.

Which of the following would be assessed as a negative symptom of schizophrenia?

Anhedonia

As an adult, a client who has been diagnosed with childhood-onset conduct disorder is at high risk for developing which comorbid disorder?

Anti Personality disorder

Which of the following classifications of medication may be prescribed in intermittent explosive disorder?

Anticonvulsants

A client, who has been prescribed clozapine 6 weeks ago, reports flulike symptoms including a fever and a very sore throat, the nurse should initiate which nursing intervention?

Arrange for the client to have blood drawn for a white blood cell count.

The case manager is demonstrating an understanding of the primary goals of managed care when engaging in which client intervention?

Arranging for the client to have a screening for prostate cancer

Assessment for oppositional defiant disorder should include which interventions?

Assessing issues that result in power struggles and triggers for outbursts

A 7-year-old, who is described as impulsive and hyperactive, tells the nurse, "I am a dummy, because I don't pay attention, and I can't read like the other kids." The nurse notes that these behaviors are most consistent with which diagnosis?

Attention deficit hyperactivity disorder (ADHD)

A client who presents no danger to himself or to others is forced to take medication against his will. What situation does this represent?

Battery

Which statement best explains the term "worldview"?

Beliefs and values held by people of a given culture about what is good, right, and normal.

Which of the following structural safety precautions is most important when attempting to prevent a common type of inpatient suicide?

Break-away closet bars to prevent hanging

Which social behavior is often a result of a child having been exposed to some form of abuse?

Bullying others

When a nurse says, "I work with a mobile mental health unit," what assumption can a client accurately make about the care being provided?

Care is provided to clients in unconventional settings.

The mother of a 6-year-old child expresses concern over the child's frequent temper outbursts. He deals with any frustration by bullying and hitting and seldom shows any remorse for his actions. The nurse who gathers this data will note that the child's behaviors are most consistent with which diagnosis?

Conduct disorder

When a child demonstrates a temperament that prompts the mother to say, "She is just so different from me; I just can't seem to connect with her." The nurse should plan to provide which intervention?

Counsel the mother regarding ways to better bond with her child.

In order to be most effective, the community mental health nurse involved in assertive community treatment (ACT) needs to possess which characteristic?

Creative problem-solving and intervention skills

A recent Hispanic immigrant comes to the mental health clinic after being referred to by her primary care provider. Josefina came to live in the United States from Brazil 5 years ago. During the initial intake assessment, the client reports headaches and backaches "almost every day" and "can't sleep at night." The client looks away when asked about anxiety or depression and states, "I don't know why I was referred to the mental health clinic." Which assessment information should the nurse further explore to assess for possible somatization?

Denial of anxiety or depression

Which comorbid conditions are commonly associated with oppositional defiant disorder? (Select all that apply.)

Depression Attention deficit hyperactivity disorder (ADHD) Anxiety

Schizophrenia is best characterized as presenting which personality trait?

Deteriorating

What term is used to describe the process implemented when members of a group are introduced to the culture's worldview, beliefs, values, and practices?

Enculturation.

What is the primary advantage of using a case manager when considering the planning and implementation of client care?

Enhances resource management.

Which nursing intervention is appropriate for the management of intermittent explosive disorder?

Establishing a trusting relationship with the client

A 17-year-old client is admitted to the psychiatric unit after threatening his mother during an argument and is diagnosed with conduct disorder. Which of the following would be an appropriate short-term outcome for this client?

Expresses feelings

If a client is placed in seclusion and held there for 24 hours without a written order or examination by a primary healthcare provider, the client has experienced which illegal act?

False imprisonment

If a nurse is charged with leaving a suicidal client unattended, it is being suggested that the nurse's behavior has violated which ethical principle?

Fidelity

A 12-year-old male patient diagnosed with Tourette's disorder is visiting his healthcare provider. The nurse will prepare medication teaching on which class of medication to help manage the tics associated with this disorder? (Select all that apply.)

First-generation antipsychotics Alpha 2-adrenergic agonists Second-generation antipsychotics

In the Chinese tradition, disease is believed to be caused by what factor?

Fluctuations in opposing forces

Which behavior is most indicative of a 4-year-old child diagnosed with Tourette's syndrome?

Frequent eye blinking

A client diagnosed with disorganized schizophrenia would have greatest difficulty with the nursing intervention?

Giving multistep directions

Which of the following symptoms would alert a healthcare provider to a possible diagnosis of schizophrenia in a 22-year-old male client?

Hearing voices telling him to hurt his roommate

What term is used to describe a deviation from expectations by members of the cultural group?

Illness

Which of the following statements are true regarding childhood-onset conduct disorder? (Select all that apply.)

It is characterized by disregard for the rights of others. It is more commonly diagnosed in males. Those with conduct disorder rationalize their aggressive behaviors.

A therapeutic inpatient milieu will include which characteristic?

It provides for the client's safety and comfort.

When considering the ongoing, crucial responsibilities of nurses working on an inpatient psychiatric unit, which activity has highest priority?

Maintaining a therapeutic milieu

An 8-year-old patient is newly diagnosed with attention deficit hyperactivity disorder (ADHD). It is important that the parents be educated to the fact that symptoms will take which form? (Select all that apply).

Mood swings Poor school performance Impulsive behaviors Low frustration tolerance

Which situation demonstrates the nurse functioning in the role of advocate?

Negotiating with the client's HMO for extension of a 3-day hospitalization to 5 days

After the death of a client, what rule of confidentiality should be followed by nurses who provided care for the individual?

Nothing may be disclosed that would have been kept confidential before death.

In addition to physicians, what other members of the mental health disciplines have been identified as having the knowledge, skills, ability, and legal authority to intervene in the full range of mental health care?

Nurses

According to the Western scientific view of health, what causes illness?

Pathogens

The psychiatric community health nurse engages in secondary prevention when implementing which intervention?

Providing stress reduction seminars at the local senior center

The most common course of schizophrenia is an initial episode followed by what course of events?

Recurrent acute exacerbations and deterioration

A client reports to the nurse that once released, "I will make sure she will never again be able to have me committed to a psychiatric hospital again." What action is the nurse obligated to take?

Report the incident to the client's therapist.

The nurse is caring for an admitted client with a history of becoming aggressive when angry and has caused physical injury to another client and two staff members. When this client begins to demonstrate signs of anger while in the day room what intervention should the nurse implement to address the safety of the milieu?

Request that the client accompany the nurse to the client's room

Which factor can reduce the vulnerability of a child to etiological influences predisposing to the development of psychopathology?

Resilience

Which right of the client has been violated if he is medicated without being asked for his permission?

Right to informed consent

Which nursing diagnosis should be considered for a child with attention deficit hyperactivity disorder ADHD?

Risk for injury

A teenaged client is being discharged from the psychiatric unit with a prescription for risperidone. The nurse providing medication teaching to the client's mother should provide which response when asked about the risk her child faces for extrapyramidal side effects (EPSs)?

Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics.

A 52-year-old Chinese American client comes to the emergency room reporting anxiety and states, "I am a failure." During the assessment interview, the client shares that they have recently been reprimanded at work for an error they were responsible for. The nurse should explore which possible trigger for the client's anxiety and feelings of failure?

Shaming the family by being responsible for the error

A client has reached the maintenance phase of schizophrenia. What is the appropriate clinical planning focus for this client?

Social, vocational, and self-care skills

A 5-year-old who consistently omits the sound for 'r' and 's' when speaking is demonstrating which type of disorder?

Speech

Pyromania, a behavior associated with impulse control disorders, causes an individual to engage in what behavior?

Starting fires

Tara and Aaron are twins who are both diagnosed with schizophrenia. Aaron was diagnosed at 23 years old and Tara at 31 years old. Based on your knowledge of early and late onset of schizophrenia, which of the following is true?

Tara has a better chance for positive outcomes because of later onset.

The purpose of the Abnormal Involuntary Movement Scale (AIMS) assessment on a persistently mentally ill client who has been diagnosed with schizophrenia is early detection of

Tardive dyskinesia

Which side effect of antipsychotic medication is generally nonreversible?

Tardive dyskinesia

When a nurse assesses the style of behavior a child habitually uses to cope with the demands and expectations of the environment, he or she is assessing characteristic?

Temperament

When considering client rights, which client can be legally medicated against his or her wishes?

The client may cause imminent harm to self or others.

What are the foundational concerns regarding the use of restraint and seclusion when providing care to children? (Select all that apply.)

The principle of least restrictive intervention is a primary concern. Research suggests both are psychologically and physically harmful.

Which statement is true about the characteristics of the oppositional defiant child?

These behaviors are a predictor of future mental health disorders.

When considering the civil rights of persons diagnosed with mental illness and hospitalized for treatment, which statement is true?

They are assured the same as those for any other citizen.

It is not always guaranteed that all clients who are voluntarily admitted to a behavioral health unit will have the right to which privilege?

To access all personal possessions.

Which nursing intervention is designed to help a schizophrenic client minimize the occurrence of a relapse?

Teach the client and family about behaviors associated with relapse.

Which criterion must be met to refer a client to a partial hospitalization program?

The client is able to return home each day.

A 10-year-old who is frequently disruptive in the classroom begins to fidget in her chair and then moves on to disruptive behavior. What is the most appropriate initial technique for managing this sort of disruptive behavior?

Touch control

A poorly developed sense of empathy is thought to be the result of having what life experience?

Unmet physical and emotional needs

The nurse reads the medical record and learns that a client has asked for treatment, agreed to receive treatment, and to abide by hospital rules. The client has met the criteria for which type of admission?

Voluntarily

Which idea held by the nurse would best promote the provision of culturally competent care?

Western biomedicine is one of several established healing systems.

The nurse is planning long-term goals for a 17-year-old male client recently diagnosed with schizophrenia. Which statement should serve as the basis for the goal-setting process?

Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability.

A 9-year-old patient has been diagnosed with an intellectual development disorder (IDD). Which assessment findings support this diagnosis? (Select all that apply.)

Physically lashes out when frustrated Reads below age level Unable to explain the phrase, "Raining cats and dogs"

A child diagnosed with autism will demonstrate impaired development in which area?

Playing with other children

Most clients who are diagnosed with chronic mental illness are not likely to have their psychiatric mental health experiences covered by which payment method?

Private insurance

The nurse who provides therapeutic milieu management supports the clients best by concentrating on which client need?

Providing a safe place to practice coping skills

What assumption can be made about the client who has been admitted on an involuntary basis? (Select all that apply.)

The client is a danger to self or others or unable to meet basic needs. The client has failed to agree to fully participate in treatment and care planning. The commitment was court ordered.

The use of seclusion or restraint to control the behavior of a client who is at risk of harming self or others gives rise to conflict between which ethical principles?

Autonomy and beneficence

A client was admitted to the behavioral health unit for evaluation and diagnosis after being found wandering the streets. His personal hygiene is poor, and his responses to questions are bizarre and inappropriate. The client's constitutional rights are violated when the nurse makes which statement?

"I am going to help you shower, so you will not smell so bad."

Currently what is understood to be the causation of schizophrenia?

A combination of inherited and nongenetic factors

Which ethical principle refers to the individual's right to make his or her own decisions?

Autonomy

Which behavior consistently demonstrated by a child is a predictor of future antisocial personality disorder in adults?

Callousness

What function is shared by advanced practice and general practice psychiatric nurses?

Membership on a multidisciplinary team

What nursing action supports a client's right to autonomy?

Witnessing the informed consent for electroconvulsive therapy from a client

When considering mental illness, recovery is best described to a client by which statement?

Working, living, and participating in the community

When assessing and planning treatment for a client who has recently arrived in the United States from China, the nurse should be alert to the possibility that the client's explanatory model for his illness reflects which cultural concept?

Yin-Yang