Mental Health NUR209 Exam 2 Practice

Chapter 14: A client prescribed fluoxetine demonstrates an understanding of the medication teaching when making which statement? A. "I will not take any over-the-counter medication while on the fluoxetine." B. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." C. "I will report increased thirst and urination to my provider." D. "I will make sure to get plenty of sunshine and not use sunscreen to avoid a skin reaction."

B. "I will report any symptoms of high fever, fast heartbeat, or abdominal pain to my provider right away." This describes symptoms of serotonin syndrome, a life-threatening complication of SRRI medication. The other options are incorrect because the client should be wearing sunscreen to avoid sunburn, may take over-the-counter medications if sanctioned by the provider, and would not have been educated to report increased thirst and urination as a side effect of fluoxetine.

Chapter 25: A student nurse on the psychiatric unit expresses being uncomfortable discussing possible suicidal ideations with clients because "It might put ideas in their head about suicide." What is the nurse's best response to this student's concern?

"Actually, it's a myth that asking about suicide puts ideas into someone's head." Asking about suicidal thoughts does not "give person ideas" and is, in fact, a professional responsibility similar to asking about chest pain in cardiac conditions. Talking openly leads to a decrease in isolation and can increase problem-solving alternatives for living. Patients have usually been already thinking about suicide; it is a myth that bringing up the topic will somehow cause someone to become suicidal. Liability is not the reason we ask patients about suicidal thoughts or plan; it is for patient safety. Asking the physician to speak to the patient on that subject does not educate the student regarding the need for asking about suicidal ideation and abdicates professional and ethical responsibility for keeping the patient safe.

Chapter 25: Which statement, made by a patient admitted with a diagnosis of depression, indicates the need for further assessment?

"I think things will be better soon." This response may be a covert, or indirect, clue that the patient is thinking of suicide. The other options are all statements that, while they may be discussed further, are not clues to suicidality but rather clear communication.

Chapter 13: A client diagnosed with bipolar disorder has a nursing care plan that includes several nursing diagnoses listed. Match the nursing diagnosis to the level of priority (1 to 4). 1. Knowledge, deficient 2. Risk for injury 3. Self care defender, bathing, hygiene 4. Nonadherence

2. Risk for injury 3. Self care deficiency, bathing, hygiene 4. Non-adherence 1. Knowledge, deficient

Which of the following statements represent a nontherapeutic communication technique? (Select all that apply.) A. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way?" B. "From what you have said, you have great difficulty sleeping at night." C. "Why didn't you attend group this morning?" D. "It sounds like you have been having a very hard time at home lately." E. "If I were you, I would quit the stressful job and find something else." F. "You mentioned that you have never had friends. Tell me more about that." G. "I'm really proud of you for the way you stood up to your brother when he visited today."

A, C, E, G

Chapter 24: A 24-year-old client diagnosed with borderline personality disorder (BPD) is admitted to the inclient psychiatric unit following a suicide attempt. Which client statements illustrate a primary coping style of persons with BPD? A. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." B. "I promise I am not feeling suicidal. I won't hurt myself." C. "My provider says I might get out of here tomorrow. Do you think I'm ready to go?" D. "I will never again speak to any of my messed up family members. I know that this will help me to be more functional."

A. "Last night the nurse let me go outside and smoke. I can't believe you aren't letting me. I used to think you were the best nurse here." A primary coping style used by clients with BPD is called splitting. Splitting is the inability to incorporate positive and negative aspects of oneself or others into a whole image. The individual may tend to idealize another person (friend, lover, health care professional) at the start of a new relationship and hope that this person will meet all of his or her needs. At the first disappointment or frustration, however, the individual quickly shifts to devaluation, despising the other person. The other options do not describe splitting, which is a primary coping style of clients with BPD.

Chapter 24: Which statement is true of pharmacological therapies associated with the treatment of personality disorders? A. Clients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. B. Clients with personality disorders have been shown to be resistant to accepting medication, and as a result most providers do not prescribe psychotropic drugs to these clients. C. Research has shown that currently available psychotropic drugs have not been shown to be effective in treating personality disorders. D. Clients with narcissistic personality disorder and obsessive-compulsive personality disorder have shown the most benefit from the use of antianxiety medications along with use of selective serotonin reuptake inhibitors.

A. Clients benefit from specific off-label uses of antipsychotics, mood stabilizers, and antidepressants, depending on which personality disorder is evident. At this time in the United States, there are no specifically FDA-approved medications for treating personality disorders. Prescribers are using the medications "off-label" until evidence-based pharmacotherapies are proven to be safe and effective. There is evidence that mood stabilizers, antidepressants, and atypical antipsychotics are helpful in specific personality disorders. Pharmacologic evidence is lacking for the treatment of persons with narcissistic and obsessive-compulsive personality disorders. Although clients with personality disorders usually do not like taking medicine unless it calms them down and are fearful about taking something over which they have no control, providers do attempt to mediate symptoms with psychotropic agents for improved quality of life.

Chapter 13: Which of the following describe the symptoms of the manic phase of bipolar disorder? (Select all that apply.) Select all that apply. A. Distractibility B. Low self-esteem C. Excessive energy D. Withdrawal from environment E. Racing thoughts F. Purposeless movement G. Pressured speech H. Fatigue and increased sleep

A. Distractibility C. Excessive energy E. Racing thoughts F. Purposeless movement G. Pressured speech

Chapter 9: A client is sitting with arms crossed over their chest, with their left leg is rapidly moving up and down, and there is an angry facial expression. When approached by the nurse, the client states harshly, "I'm fine! Everything's great." Which statement related to communication should the nurse focus on when working with this client? A. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. B. Verbal communication is always more accurate than nonverbal communication. C. Verbal communication is more straightforward, whereas nonverbal communication does not portray what a person is thinking. D. Nonverbal communication is about 10% of all communication, and verbal communication is about 90%.

A. Nonverbal and verbal communication may be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message. Communication is roughly 10% verbal and 90% nonverbal, so nurses must pay close attention to nonverbal cues to accurately assess what the client is really feeling. The other options are all untrue of verbal and nonverbal communication and are actually the opposite of what is believed of communication.

Chapter 12: 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? A. Tara will experience more positive signs of schizophrenia such as hallucinations. B. Tara and Aaron have the same expectation of a poor long-term prognosis. C. Tara has a better chance for positive outcomes because of later onset. D. Aaron will be more likely to hold a job and live a productive life.

A. Tara will experience more positive signs of schizophrenia such as hallucinations. Female patients diagnosed with schizophrenia between the ages of 25 and 35 years have better outcomes than do their male counterparts diagnosed earlier. These two patients do not have the same expectation of a poor prognosis. There is no evidence suggesting that Tara will have more positive signs of schizophrenia. It is actually more unlikely that Aaron will be able to live a productive life because of his earlier onset, which has a poorer prognosis.

A 72-year-old client diagnosed with Parkinson's disease is demonstrating behaviors associated with anxiety and has had several falls lately and is reluctant to take medications as prescribed. When the healthcare provider orders lorazepam, 1 mg PO bid, the nurse questions the prescription based primarily on what fact? A. The client is at risk for falls. B. The client should be treated with cognitive therapies because of his advanced age. C. The client has a history of nonadherence with medications. D. The client may become addicted faster than younger clients.

A. The client is at risk for falls. An important nursing intervention is to monitor for side effects of the benzodiazepines, including sedation, ataxia, and decreased cognitive function. In a client who has a history of falls, lorazepam would be contraindicated because it may cause sedation and ataxia leading to more falls. There is no evidence to suggest that elderly clients become addicted faster than younger clients. A history of nonadherence would not lead to you to question this drug order. Medication and other therapies are used congruently with all age levels.

A 55-year-old client recently came to the United States from England on a work visa. The client was admitted for severe depression following the death of a life partner weeks ago. While discussing the death and its effects the client shows little emotion. Which of the following explanations is most plausible for this lack of emotion? A. The response may reflect cultural norms. B. The response may reflect personal guilt. C. The client may have an antisocial personality. D. The client in denial.

A. The response may reflect cultural norms

Chapter 12: 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? A. "I will get you a prn medication for agitation." B. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" C. "You are having problems with your speech. You need to try harder to be clear." D. "You are confused. I will take you to your room to rest a while."

B. "I'm sorry, I didn't understand that. Do you want to talk more about your mother as we did yesterday?" The guidelines that are useful in communicating with a patient with disorganized or bizarre speech are to place the difficulty in understanding on yourself, not the patient, and look for themes that may be helpful in interpreting what the patient wants to say. Telling the patient, he needs to try harder to be clearer is unrealistic since the patient would be unable do this. The other options are not useful in communicating with this patient and attempting to find common themes.

Chapter 9: A client is presenting with behaviors that indicate anger. When approached, the client states harshly, "I'm fine! Everything's great." Which response should the nurse provide to the client? A. "I'm glad everything is good. I am going to give you your schedule for the day and we can discuss how the groups are going." B. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" C. "I don't believe you. You are not being truthful with me." D. "Okay, but we are all here to help you, so come get one of the staff if you need to talk."

B. "It looks as though you are saying one thing but feeling another. Can you tell me what may be upsetting you?" This response uses the therapeutic technique of clarifying; it addresses the difference between the client's verbal and nonverbal communication and encourages sharing of feelings. The other options do not address the client's obvious distress or are confrontational and judgmental. None of the other options provides this support.

A 16-year-old patient being treated for anorexia, has been prescribed medication to reduce compulsive behaviors regarding food now that ideal weight has been reached. Which class of medication is prescribed for this specific issue associated with eating disorders? A. Mood stabilizers B. Antidepressants C. Atypical antipsychotics D. Anxiolytics

B. Antidepressants The antidepressant fluoxetine has proven useful in reducing obsessive-compulsive behavior after the patient has reached a maintenance weight. Anxiolytics would be prescribed for anxiety. Atypical antipsychotic agents may be helpful in improving mood and decreasing obsessional behaviors and resistance to weight gain. Mood stabilizers are not specifically used in treatment of eating disorders.

The nurse is providing teaching to a preoperative client just before surgery. The client is becoming more and more anxious and begins to report dizziness and heart pounding. The client also appears confused and is trembling noticeably. Considering the scenario, what decision should the nurse make? A. To reinforce the preoperative teaching by restating it slowly. B. Do not attempt any further teaching at this time. C. Have a family member read the preoperative materials to the client. D. Have the client read the teaching materials instead of providing verbal instruction.

B. Do not attempt any further teaching at this time. Clients experiencing severe anxiety, as the symptoms suggest, are unable to learn or solve problems. The other options would not be effective because you are still attempting to teach someone who has a severe level of anxiety.

According to current theory, which statement regarding eating disorders is accurate? A. Eating disorders are rarely comorbid with other mental health disorders. B. Eating disorders are possibly influenced by sociocultural factors. C. Eating disorders are frequently misdiagnosed. D. Eating disorders are psychotic disorders in which patients experience body dysmorphic disorder.

B. Eating disorders are possibly influenced by sociocultural factors. The Western cultural ideal that equates feminine beauty with tall, thin models has received much attention in the media as a cause of eating disorders. Studies have shown that culture influences the development of self-concept and satisfaction with body size. Eating disorders are not psychotic disorders. There is no evidence that eating disorders are frequently misdiagnosed. Comorbidity for patients with eating disorders is more likely than not. Personality disorders, affective disorders, and anxiety frequently occur with eating disorders.

Chapter 13: A 31-year-old client admitted with acute mania tells the staff and the other clients that he is on a secret mission for the President of the United States. He states, "I am the only one he trusts, because I am the best!" What term will the nurse use when documenting this behavior? A. Flight of ideas B. Grandiosity C. Rapid cycling D. Unpredictability

B. Grandiosity Grandiosity is inflated self-regard. People with mania may exaggerate their achievements or importance, state that they know famous people, or believe they have great powers. Although clients with mania are unpredictable, the scenario does not describe unpredictability: rapid cycling is switching between mania and depression in a given time period. The scenario does not describe flight of ideas, which means a continuous flow of speech with abrupt topic changes.

Chapter 24: Which statement is true regarding antisocial personality disorder (APD)? (Select all that apply.) Select all that apply. A. Persons with APD usually present for treatment because of awareness of how their behavior is affecting others. B. Persons with APD are concerned with personal pleasure and power. C. Persons with APD display magical thinking. D. It is the least studied of the personality disorders. E. It is characterized by rigidity and inflexible standards of self and others. F. It is characterized by deceitfulness, disregard for others, and manipulation. G. Frontal lobe dysfunction is a brain change identified in APD.

B. Persons with APD are concerned with personal pleasure and power. F. It is characterized by deceitfulness, disregard for others, and manipulation. G. Frontal lobe dysfunction is a brain change identified in APD

Chapter 14: What is the major reason for the hospitalization of a depressed client? A. Inability to go to work B. Suicidal ideation C. Psychomotor agitation D. Loss of appetite

B. Suicidal ideation Suicidal thoughts are a major reason for hospitalization for clients with major depression. It is imperative to intervene with such clients to keep them safe from self-harm. The other options describe symptoms of major depression but aren't by themselves the major reason for hospitalization.

Chapter 14: A 38-year-old client is admitted with major depression. Which statement made by the client alerts the nurse to a common accompaniment to depression? A. "I still pray and read my Bible every day." B. "I've heard others say that depression is a sign of weakness." C. "I still feel bad about my sister dying of cancer. I should have done more for her!" D. "My mother wants to move in with me, but I want to independent."

C. "I still feel bad about my sister dying of cancer. I should have done more for her!" Guilt is a common accompaniment to depression. A person may ruminate over present or past failings. Praying and reading the Bible describes a coping mechanism; the other responses do not describe a common accompaniment to depression.

Chapter 14: A client admitted with major depression and suicidal ideation with a plan to overdose is preparing for discharge and asks you, "Why did I get a prescription for only 7 days of amitriptyline?" The nurse's response is based on what fact? A. Amitriptyline is very expensive, so the client may have to buy fewer at a time. B. The health care provider wants to see whether any side effects occur within the first week of administration. C. Amitriptyline is lethal in overdose. D. The goal is to see how the client responds to the first week of medication to evaluate its effectiveness.

C. Amitriptyline is lethal in overdose. Amitriptyline is a tricyclic antidepressant (TCA); these drugs are known to be lethal in smaller doses than other antidepressants. Because the client had a plan of overdose, the best course of action is to give a small prescription requiring her to visit her provider's office more often for monitoring of suicidal ideation and plan. Tricyclics are not known to be expensive. Antidepressant therapy usually takes several weeks to produce full results, so the client would not be evaluated after only 1 week. Side effects are always a consideration but not the most important consideration with TCAs.

The nurse is caring for a client on day 1 post-surgical procedure. The client becomes visibly anxious and short of breath, and states, "I feel so anxious! Something is wrong!" What action should the nurse take initially in response to the client's actions? A. Reassure the client that what they are feeling is normal anxiety and do deep breathing exercises with her. B. Reassure the client that you will stay until the anxiety subsides. C. Call for staff help and assess the client's vital signs. D. Use the call light to inquire whether the client has been prescribed prn anxiety medication.

C. Call for staff help and assess the client's vital signs. In anxiety caused by a medical condition, the individual's symptoms of anxiety are a direct physiological result of a medical condition, such as hyperthyroidism, pulmonary embolism, or cardiac dysrhythmias. In this case, Lana is postoperative and could be experiencing a pulmonary embolism, as evidenced by the shortness of breath and anxiety. She needs immediate evaluation for any serious medical condition. The other options would all be appropriate after it has been determined that no serious medical condition is causing the anxiety.

Which medication is FDA approved for treatment of anxiety in children? A. Sertraline B. Clomipramine C. Duloxetine D. Fluoxetine

C. Duloxetine A few drugs are approved specifically for anxiety and obsessive-compulsive disorders in children and adolescents. The FDA approved the selective SNRI duloxetine in 2014 for children aged 7 to 17 years for generalized anxiety disorder. The FDA has approved four medications for use in children with obsessive-compulsive disorder. They are clomipramine, fluoxetine, fluvoxamine, and sertraline.

Chapter 12: Which of the following symptoms would alert a healthcare provider to a possible diagnosis of schizophrenia in a 22-year-old male client? A. Withdrawal from college because of failing grades B. Chaotic and dysfunctional relationships with his family and peers C. Hearing voices telling him to hurt his roommate D. Excessive sleeping with disturbing dreams

C. Hearing voices telling him to hurt his roommate People diagnosed with schizophrenia all have at least one psychotic symptom such as hallucinations, delusional thinking, or disorganized speech. The other options do not describe schizophrenia but could be caused by a number of problems.

Chapter 12: 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? A.If treated quickly following diagnosis, schizophrenia can be cured. B. Schizophrenia can be managed by receiving treatment only at the time of acute exacerbations. C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. D. If patients with schizophrenia stay on their drug regimen, they usually lead fully productive lives with no further symptoms.

C. Patients with schizophrenia often do not fully respond to treatment and have residual symptoms and varying degrees of disability. Unfortunately, in most cases, schizophrenia does not respond fully to available treatments; it leaves residual symptoms and causes varying degrees of dysfunction or disability. The other options are all untrue of schizophrenia.

Chapter 24: A 37-year-old client, referred to the mental health clinic with a suspected personality disorder, is withdrawn and suspicious and states, "I've always preferred to be alone" and then adds, "I can read your thoughts whenever I want to." This presentation supports which psychiatric diagnosis? A. Avoidant personality disorder B. Obsessive-compulsive personality disorder C. Schizotypal personality disorder (STPD) D. Narcissistic personality disorder

C. Schizotypal personality disorder (STPD) The main traits that describe STPD are psychoticism such as eccentricity, odd or unusual beliefs and thought processes, and social detachment by preferring to be socially isolated, as well as being overly suspicious or anxious. In obsessive-compulsive personality disorder the main pathological personality traits are rigidity and inflexible standards of self and others, along with persistence of goals long after they are necessary, even if they are self-defeating or negatively affect relationships. People with narcissistic personality disorder come across as arrogant, with an inflated view of their self-importance. They have a need for constant admiration, along with a lack of empathy for others, a factor that strains most relationships over time. Traits of avoidant personality disorder include low self-esteem, feelings of inferiority compared with peers, and a reluctance to engage in unfamiliar activities involving new people.

Chapter 13: Which of the following is true of the relationship between bipolar disorder and suicide? A. Clients need to be monitored only in the depressed phase because this is when suicides occur. B. As long as clients with bipolar disorder adhere to their medication regimen, there is little risk for suicide. C. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. D. Clients with bipolar disorder are not considered high risk for suicide.

C. Suicide is a serious risk those diagnosed with bipolar disorder commit suicide. Mortality rates for bipolar disorder are severe because substantial numbers of individuals with bipolar disorder will make a suicide attempt at least once in their lifetime. Suicides occur in both the depressed and the manic phase. Bipolar clients are always considered high risk for suicide because of impulsivity while in the manic phase and hopelessness when in the depressed phase. Although staying on medications may decrease risk, there is no evidence to suggest that only clients who stop medications commit suicide.

When preparing to hold an admission interview with a client, the nurse pulls up a chair and sits facing the client with their knees almost touching. When the nurse leans in close to speak, the client becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for client's behavior? A. The client is responding to the voices by ending the conversation. B. The nurse failed to explain the purpose of the admission interview. C. The nurse violated the client's personal space by physically being too close. D. The client has issues with sharing personal information.

C. The nurse violated the clients personal space by physically being too close

A client's daughter states, "My mother lives with me since my dad died 6 months ago. For the past couple of months, every time I need to leave the house for work or anything else, Mom becomes extremely anxious and cries that something terrible is going to happen to me. She seems OK except for these times, but it's affecting my ability to go to work." This information supports that the client may be experiencing which anxiety-related disorder? A. Social anxiety disorder B. Agoraphobia C. Panic disorder D.Adult separation anxiety disorder

D. Adult separation anxiety disorder People with separation anxiety disorder exhibit developmentally inappropriate levels of concern over being away from a significant other. There may also be fear that something horrible will happen to the other person. Adult separation anxiety disorder may begin in childhood or adulthood. The scenario doesn't describe panic disorder. Agoraphobia is characterized by intense, excessive anxiety or fear about being in places or situations from which escape might be difficult or embarrassing or in which help might not be available. Social anxiety disorder, also called social phobia, is characterized by severe anxiety or fear provoked by exposure to a social or a performance situation that will be evaluated negatively by others.

Chapter 12: 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)? A. All antipsychotic medications have an equal chance of producing EPSs. B. Advise the mother to ask the provider to change the medication to clozapine instead of risperidone. C. Newer antipsychotic medications have a higher risk for EPSs. D. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics.

D. Risperidone is a newer antipsychotic medication and has a lower risk of EPSs than older antipsychotics. Risperidone is a newer, atypical antipsychotic. All newer antipsychotic medications have a lower incidence of EPSs than older, traditional antipsychotics. The other responses are untrue. There is no reason to advise a medication change at this time.

Chapter 13: A client hospitalized for a psychotic relapse is being discharged home to family. Which topic is important to address when teaching both the client and the family to recognize possible signs of impending mania? A. Decreased social interaction B. Increased appetite C. Increased attention to bodily functions D. Decreased sleep

D. Decreased sleep Changes in sleep patterns are especially important because they usually precede mania. Even a single night of unexplainable sleep loss can be taken as an early warning of impending mania. The other options do not indicate impending mania.

Chapter 24: Clients diagnosed with borderline personality disorder (BPD) exhibit negative effect, which includes rapidly moving from one emotional extreme to another. What term is used to describe this characteristic? a. Denial b. Splitting c. Impulsivity d. Lability

D. Lability One of pathological personality traits seen in persons with BPD is negative effect, which is characterized by emotional lability, that is, rapidly shifting emotions from one extreme to another. Clients exhibiting this trait are often documented as being labile. None of the other options is used to describe this characteristic.

Chapter 14: When the nurse asks whether a client is having any thoughts of suicide, the client becomes angry and defensive, shouting, "I'm sick of you people! All you ever do is ask me the same question over and over. Get out of here!" What fact concerning hostility should the nurse's response be based upon? A. The client is probably experiencing transference. B. The client may be angry at someone else and projecting that anger to staff. C. The client is getting better and is able to be assertive. D. The client may be at high risk for self-harm.

D. The client may be at high risk for self-harm. Overt hostility is highly correlated with suicide; therefore the client may be considered high risk, and appropriate precautions should be taken. The other responses are incorrect with no evidence to support them.

Chapter 25: What is the focus of the SAFE-T assessment tool? (Select all that apply.)

Identify level of suicide risk, stress collaboration with client, development of client focused treatment.

Chapter 25: While intoxicated a client unsuccessfully attempted suicide by using a gun. This method of using a gun to attempt suicide should be described in what terms?

It is high risk, or a hard method. Higher risk methods, also referred to as hard methods, include using a gun, jumping from a high place, hanging, and carbon monoxide poisoning. The other responses are incorrect.

Chapter 25: Which statement is true regarding culture and protective factors against suicide?

Religion and the importance of family are protective factors for Hispanic Americans. Among Hispanic Americans, Roman Catholic religion (in which suicide is a sin) and the importance given to the extended family decrease the risk for suicide. The other options are all incorrect and are in fact the opposite of what is known to be true.