Mental Health Practice 1

A nurse seeks to establish a relationship with a patient readmitted to the hospital. the patient has bipolar disorder, depressed type, and was hospitalized the preceding month. Which statement by the nurse would contribute to establishing trust?

"It must be discouraging to be readmitted to the hospital so soon."

Jonas is a 29-year-old patient with anxiety and a history of alcohol abuse who is an inpatient on the psychiatric unit. He becomes angry and aggressive, strikes another patient, and then attacks a staff member. He is taken to seclusion and medicated with haloperidol and lorazepam. In this case, the haloperidol and lorazepam may be considered:

a restraint

Which of the following statements indicate a non therapeutic communication technique?

a. "Why didn't you attend group this Morning?" c. "What did your boyfriend do that made you leave? Are you angry at him? Did he abuse you in some way? d. "If i were you, I would quit the stressful job and find something else." e. "I'm really proud of you for the way you stood up to your brother when he visited today."

The premise that an individual's behavior and affect are largely determined by his or her attitudes and assumptions about the world underlies:

cognitive-behavioral therapy

According to the DSM-5, there is evidence that symptoms and causes of mental illness are influenced by:

cultural and ethnic factors

One primary goal and benefit of Assertive Community Treatment (ACT) is:

preventing rehospitalization

Sullivan's term security operations and Freud's term of defense mechanisms both reflect actions that serve to:

reduce anxiety

One characteristic of mental health that allows people to adapt to tragedies, trauma, and loss is:

resilience

Lucas states, "I will always be alone because nobody could love me." This is most likely an example of:

schema

Venlafaxine (Effexor) exerts its antidepressant effect by selectively blocking the reuptake of:

serotonin norepinephrine

Vanessa's provider writes orders including medication to treat her depression. Based on current understanding of brain physiology, which of the following neurotransmitters would you expect to see targeted with the medication ordered?

serotonin/norepinephrine

Levels of prevention strategies prominent in outpatient psychiatric care consist of primary prevention, secondary prevention, and _____________ prevention.

tertiary

George W. Bush's New Freedom commission on Mental Health's report emphasized that mental illness is not a hopeless life sentence but a condition from which people can recover. Recovery, which is still the number 1 goal, could be described as:

the ability to work, live, and participate in the community

The term pharmacodynamics refers to the effect of the drug on the body, while pharmacokinetics refers to:

the effect of the person on the drug

A nurse makes a post on a social media page about his peer taking care of a patient with a crime-related gunshot wound during his shift in the emergency department. He does not use the name of the patient. It can be concluded that:

the nurse has violated confidentiality laws and can be held liable.

A client preparing for discharge presents the nurse with a handmade card of appreciation for the care this nurse provided. Should the nurse accept the card?

yes

You are working with Allison on the inpatient psychiatric unit. Which of the following statements reflect an accurate understanding during which phase of the nurse patient relationship the issue of termination should first be discussed?

"Allison, now that we've discussed your reasons for being here and how often we will meet, I'd like to talk about what we will do at the time of your discharge."

Your patient, Emma, is crying in your one to one session while telling you of her father's recent death from a car accident. Which of the following responses illustrates empathy?

"Emma, that must have been such a hard situation to deal with."

You are caring for Maria, a patient who states that she has "ghost sickness." Which is the appropriate nursing response?

"How does 'ghost sickness' make you feel?"

A hospitalized client diagnosed with major depression tells the nurse, "I need my belt to keep my pants up. They keep falling down." which response should the nurse provide?

"I cannot provide your belt, but I will help you get some pants with an elastic waistband.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following responses would be therapeutic?

"It looks as though you are saying one thing but feeling another, Can you tell me what may be upsetting you?"

Bethany, a nurse on the psychiatric unit, has a past history of alcoholism. She has weekly clinical supervision meetings with her mentor, the director of the unit. Which statement by Bethany to her mentor would indicate the presence of countertransference?

"My patient, Laney, has been abusing alcohol. I told her that the only way to recover was to "cold turkey" and to get away from her dysfunctional family and to do it now!"

You are performing a spiritual assessment on a patient. Which patient statement would indicate that there is an experiential concern in the patient's spiritual life?

"My sister will never forgive me for what I did."

Willis has been admitted to your inpatient psychiatric unit with suicidal ideation. He resides in a halfway house after being released from prison, where he was sent for sexually abusing his teenage stepdaughter. In your one-to-one session he tells you of his terrible guilt over the situation and wanting to die because of it. Which of the following responses you could make reflects a helpful trait in a therapeutic relationship?

"You are suffering with guilt over what you did. Let's talk about some goals we could work on that may make you want to keep living."

You have been working closely with a patient for the past month. Today he tells you he is looking forward to meeting with his new psychiatrist but frowns and avoids eye contact while reporting this to you. Which of the following responses would most likely be therapeutic?

"You say you look forward to the meeting, but you appear anxious or unhappy."

James is a 42-year-old patient with schizophrenia. He approaches you as you arrive for day shift and anxiously reports, "Last night demons came to my room and tried to rape me." Which response would be most therapeutic?

"You seem very upset; please tell me more about what you experienced last night."

You are assessing a 6-year-old patient. When assessing a child's perception of a difficult issue, which methods of assessment are appropriate?

-Engage the child in a specific therapeutic game. -Ask the child to draw a picture. -Provide the child with an anatomically correct doll to act out a story. -Allow the child to tell a story.

Which are the purposes of a thorough mental health nursing assessment?

-Establish a rapport between the nurse and patient. -Assess for risk factors affecting the safety of the patient or others. -Identify the nurse's goals for treatment. -Formulate a plan of care.

Orientation phase of a therapeutic relationship includes what?

-Establishing rapport -parameters of the relationship -formal or informal contract -confidentiality -terms of termination

Which nursing actions demonstrate cultural competence?

-Planning mealtime around the patient's prayer schedule -Advising a patient to visit with the hospital chaplain -Researching foods that a lacto-ovo-vegetarian patient will eat -Providing time for a patient's spiritual healer to visit

Gina is admitted for treatment of depression with suicidal ideation triggered by marital discord. Her spouse visits one night and informs Gina that he has decided to file for divorce. The staff are aware of the visit and the husband's intentions regarding divorce but take no further action, feeling that the q15-minute suicide checks Gina is already on are sufficient. Thirty minutes after the visit ends, staff make rounds and discover Gina has hanged herself in her bathroom, using hospital pajamas she had tied together into a rope. Which of the following statements best describes this situation?

-The nurses have created liability for themselves and their employer by failing in their duty to protect Gina. -The nurses have breached their duty to reassess Gina for increased suicide risk after her husband's visit. -Given Gina's history, the nurses should have expected an increased risk of suicide after the husband's announcement. -The nurses are subject to a tort of professional negligence for failing to prevent the suicide by increasing the suicide precautions in response to Gina's increased risk.

Working phase of a therapeutic relationship includes what?

-maintain relationship -gather further data -promote patients problem solving, self esteem and use of language -facilitate behavioral change -evaluate problems and goals -promote practice and expression of alternative adaptive behaviors

Termination phase of a therapeutic relationship includes what?

-summarize goals and objectives achieved -discuss ways for patient to incorporate new coping strategies learned -review situations of realtionship -exchange memories

Which of the following patients may be an appropriate candidate for a release from hospitalization known as against medical advice (AMA)?

37 year old patient hospitalized for 6 days; the provider feels one more day would benefit the patient, but the patient doesn't agree and wishes to be discharged

A friend recognizes that his depression has returned and tells you he is suicidal and afraid he will harm himself. He wishes to be hospitalized but does not have health insurance. Which of the following responses best meets his immediate care needs and reflects the options for care a person in his position typically has?

Assist him in obtaining an outpatient counseling appointment at an area community mental health center, and call him frequently to assure he is safe until his appointment occurs.

Which of the following scenarios describe a HIPAA violation?

Lyla, a nurse on the cardiac unit, gives report to Chloe, the nurse on the step down unit, regarding the Lyla, who will be transferring, while they are walking in the hospital hallway.

Amanda was raised by a rejecting and abusive father and had a difficult childhood. As an inpatient, she frequently comments on how hard her nurse, Jane, works and on how other staff members do not seem to care as much about their patients as Jane does. Jane finds herself agreeing with Amanda. Jane appreciates her insightfulness, and realizes that the other staff members do not appreciate how hard she works and take her for granted. Jane enjoys the time she spends with Amanda and seeks out opportunities to interact with her. What phenomenon is occurring here, and which response by Jane would most benefit her and the patient?

Amanda is experiencing transference; Jane should help Amanda to understand that she is emphasizing in Jane those qualities that were missing in her father.

Which drug group calls for nursing assessment for development of abnormal movement disorders among individuals who take therapeutic dosages?

Antipsychotics

A family who is worried that an adult female might hurt herself asks for her to be admitted to the hospital. An assessment indicates moderate depression with no risk factors for suicide other than a depressed mood. The patient denies any intent or thoughts about self-harm. The family agrees that the patient has not done or said anything to suggest that she might be a danger to herself. Which of the following responses is consistent with the concept of "least restrictive alternative" doctrine?

Arrange for an outpatient counseling appointment the next day.

a client tells the nurse, "I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequences of the nurses action?

Blurred boundaries in the nurse-client relationship

Emily is a 28-year-old nurse on the psychiatric unit. She has been working with Jenna, a 27-year-old who was admitted with depression. Emily and Jenna find they have much in common, including each having a 2-year-old daughter and each having graduated from the same high school. Emily and Jenna discuss getting together for lunch with their daughters after Jenna is discharged. This situation reflects:

Boundary blurring

which of the following structural safety precautions is most important to prevent the most common type of inpatient suicides?

Break away closet bars to prevent hanging

A nurse taught a client about important precautions associated with a new prescription. Afterward, the client accurately summarized major self management strategies associated with this drug. Which step of the nursing process applies to the client's summarization?

Evaluation

Schemata, automatic thoughts, and cognitive distortions are terms that relate to:

Cognitive-behavioral therapy

A nursing student new to psychiatric mental health nursing asks a peer what resources he can use to figure out which symptoms are presented in a specific psychiatric disorder. the best answer would be:

DSM-5

You are caring for Kiley, a 29 year old female patient who is being admitted following a suicide attempt. Which of the following illustrates the concept of patient advocacy?

Dr. Raye, I notice you ordered Prozac for Kiley. she has stated to me that she does not want to take Prozac because she has adverse effects when it was previously prescribed.

A nurse administering a benzodiazepine should understand that the therapeutic effect of benzodiazepines results from potentiating the neurotransmitter:

GABA

Anna, a patient at the community mental health center, tends to stop taking her medications at intervals, usually leading to decompensation. Which of the following interventions would most likely improve her adherence to her medications?

Help Anna to understand her illness and share in decisions about her care.

Which theorist most influenced the professional practice of psychiatric nursing?

Hildegard Peplau

A patient states he has "given up on life." His wife left him, he was fired from his job, and he is four payments behind on his mortgage, meaning he will soon lose his house. Which nursing diagnosis is appropriate?

Hopelessness related to multiple losses

Epidemiological studies contribute to improvements in care for individuals with mental disorders by:

Identifying who in the general population will develop a specific disorder

You and Jack are two of the nurses working on the psychiatric unit. Jack mentions to you that the biological model for mental illness is the one he embraces, and states "it's the only one I really believe." Which of the following statements is true regarding believing in only the biological model?

In believing only the biological model, other influences on mental health including cultural, environmental, social, and spiritual influences are not taken into account.

Julio is a 31-year-old patient who comes to your mental health out-patient clinic. Which of the following would alert you to the potential for somatization?

Julio presents with concerns involving headaches, dizziness, and fatigue.

A nurse stops in to interview a patient on a medical unit and finds the patient lying supine in her bed with the head elevated at 10 degrees. Which initial response(s) would most enhance the chances of achieving a therapeutic interaction?

Locate a chair or stool that would place the nurse at approximately the level of the patient.

Which of these mental health problems has the highest annual prevalence in the US?

Major depressive disorder

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

Marty, a substance abuser who is being discharged from an inpatient alcohol rehab unit

A 43-year-old female patient is brought to the emergency department with complaints of bizarre speech, visual hallucinations, and changes in behavior. She has no psychiatric history. Before ordering a psychiatric consultation, the emergency room physician orders a battery of blood tests as well as an MRI of the brain. The rationale for this is:

Medical conditions and physical illnesses may mimic psychiatric illnesses; therefore, physical causes of symptoms must be ruled out

David has an overnight pass, and he plans to spend this time with his sister and her family. As you meet with the patient and his sister just prior to the pass, the sister mentions that she has missed her brother and needs him to babysit. You notice that the patient becomes visibly agitated when she says this. How do you balance safety and the patient's right to confidentiality?

Meet with the patient's sister, sharing with her the patient's previous disclosure about his anger toward children and the resultant risk that his babysitting would present.

Which statement about mental illness is true?

Mental illness changes with culture, time in history, political systems, and the groups defining it

There is one bed on a locked psychiatric unit. Which of the following patients is appropriate for involuntary admission?

Mia, aged 26 years, a kindergarten teacher who is not in touch with reality and was found wandering in and out of traffic on a busy road.

You enter the room of Andrea, a patient on the psychiatric unit. Andrea is sitting with her arms crossed over her chest and her left leg rapidly moving up and down, and she has an angry expression on her face. When you approach her, she states harshly, "I'm fine! Everything's great." Which of the following is true regarding verbal and nonverbal communication?

Nonverval and verbal communication my be different; nurses must pay attention to the nonverbal communication being presented to get an accurate message.

A person has a high level of resilience. Which other characteristic would the nurse expect this person to have?

Optimism

The nurse is planning care for a patient of the Latin American culture. Which goal is appropriate?

Patient will visit with spiritual healer once weekly.

Brian, a patient with schizophrenia, has been ordered an antipsychotic medication. The medication will likely benefit him, but there are side effects; in a small percentage of patients, it may cause a dangerous side effect. After medication teaching, Brian is unable to identify side effects and responds, "I won't have any side effects because I am iron and cannot be killed." Which response would be most appropriate under these circumstances?

Petition the court to appoint a guardian as a substitute for Brian, as he is unable to comprehend the proposed treatment.

In which part of the nursing care plan would the nurse expect to find this statement: Offer snacks and finger foods frequently.

Plan

Peplau's model of nurse-patient relationship consists of:

Pre-orientation phase Orientation phase Working phase Termination phase

The intervention that can be practiced by an advanced practice registered nurse in psychiatric mental health but cannot be practiced by a basic level registered nurse is:

Psychotherapy

A nurse who is active in local consumer mental health groups and in local and state mental health associations and who keeps aware of state and national legislation affecting mental illness treatment may positively affect the climate for treatment by:

Reducing the stigma of mental illness and advocating for equality in treatment

What is countertransference?

Refers to the nurse's behavioral and emotional response to the client

A nurse assesses a newly admitted client diagnosed with Alzheimer's disease and a urinary tract infection. The nurse asks the client's sibling for information about the home environment, ADLs, and medications. What type of information source is the sibling?

Secondary

A male patient frequently inquires about the female student nurse's boyfriend, social activities, and school experiences. Which of the following initial responses by the student best addresses the issue raised by this behavior?

She limits sharing personal information and stresses the patient-centered focus of the conversation.

Which of the following patients would need monitoring for potential development of the side effect of hypothyroidism?

Shelly, who is taking lithium

A student nurse exhibits the following behaviors or actions while interacting with her patient. Which of these are appropriate as part of a therapeutic relationship?

Sitting attentively in silence with a withdrawn patient until the patient chooses to speak.

The theory of interpersonal relationships developed by Hildegard Peplau is based on the foundation provided by which early theorist?

Sullivan

Which student behavior is consistent with therapeutic communication?

Summarizing the essence of the patient's comments in your own words.

According to Freud, which aspect of the personality motivates an individual to seek perfection?

Superego

Which statement best describes a major difference between a DSM-5 diagnosis and a nursing diagnosis?

The DSM-5 is associated with present symptoms, whereas a nursing diagnosis considers past, present, and potential responses to actual mental health problems

Which statement about nonverbal behavior is accurate?

The meaning of nonverbal behaviors varies with cultural and individual differences.

Which of the following actions best represents the basis or foundation of all other psychiatric nursing care?

The nurse assesses the patient at regular intervals.

Which contribution to modern psychiatric mental health nursing practice was made by Freud?

The theory of personality structure and levels of awareness

What is transference?

When client views a member of healthcare team as having characteristics of another person who has been significant to the patient's personal life. Can be positive or negative.

You are caring for William, a 55 year old patient who recently came to the U.S. from England on a work visa. He was admitted for severe depression following the death of this wife from cancer 2 weeks ago. While telling you about his wife's death and how it has affected him, William shows little emotion. Which of the following explanations is most plausible?

William's response may reflect cultural norms

You are admitting 32 year old Louisa to the psychiatric unit. You pull up your chair and sit close to the patient, with your knees almost touching hers, and lean in close to her to speak. Louisa becomes visibly flustered and gets up and leaves the room. What is the most likely explanation for Louisa's behavior?

You have violated Louisa's personal space by physically being too close.

You have graduated with BSN degree and have taken you first job on a psychiatric unit after becoming a licensed RN. You are providing teaching to Mason, a newly admitted patient on the psychiatric unit, regarding his daily schedule. Which of the following would not be an appropriate teaching statement?

You will attend a psychotherapy group that I lead.

A nurse assesses a newly hospitalized client. Which communication technique will the nurse use most?

direct eye contact

Which of the following statements are true regarding the differences between a social relationship and a therapeutic relationship?

a. In a social relationship, both parties needs are met; in a therapeutic relationship only the patient's needs are to be considered. c. Giving advice is done in social relationships; in therapeutic relationships giving advice is not usually therapeutic. d. In a social relationship, both parties come up with solutions to problems and solutions may be implemented by both (a fiend may lend the other money, etc); in a therapeutic relationship solutions are discussed but are only implemented by the patient

Which of the following nursing actions is appropriate in maintaining a safe therapeutic inpatient milieu? Select all that apply.

a. Interact frequently with both individuals and groups on the unit. c. Initiate and support group interactions via therapeutic groups and activities. d. Provide and encourage opportunities to practice social and other life skills. f. Assess patient belongings and the unit for any dangerous items that could be used by patients to hurt themselves or others.

Which of the following factors contribute to the movement of patients out of large state institutions and into community-based mental health treatment? Select all that apply.

a. States desire to save money by moving the patients to the community, where the federal government would pick up more of the cost. c. A system of coordinated and accessible community care was developed by forward-thinking communities and offered more effective treatment. d. The Community Mental Health Centers Act of 1963 required states to develop and offer care in community-based treatment programs. e. Patient advocates exposed deficiencies of state hospitals and took legal actions, leading to the identification of a right to treatment in the least restrictive setting. f. New psychotropic medications controlled symptoms more effectively, allowing many patients to live and receive care in less restrictive settings.

As a nurse assesses a new client, the nurse makes sure the door remains open. Which type of communication factor is this action?

environmental

Blockage of dopamine transmission can lead to increased pituitary secretions of prolactin. In women, this hyperprolactinemia can result in:

amenorrhea

A nurse spends extra time with a client who has personality features similar to the nurse's estranged spouse. Which aspect of countertransference is most likely to result?

overinvolvement

The criteria for admission to an in patient psychiatric unit is that the patient:

is in imminent danger of harming himself or others, or the patient cannot properly care for his basic needs and cannot protect himself from harm.

In the DSM-5, a major change in how culture is viewed within each disorder is that:

issues related to culture and mental illness are now integrated into the discussion of each disorder rather than separately discussing culture-bound syndromes.

You are caring for Alyssa, a 28 year old patient with bipolar disorder who was admitted in a manic state. According to Maslow's Hierarchy of Needs theory, which fo the following symptoms needs to be the first priority in caring for this patient?

lack of sleep

The nurse administers each of the following drugs to various patients. The patient who should be most carefully assessed for fluid and electrolyte imbalance is the one receiving:

lithium

Using the total environment, including the people, setting, and emotional climate, as therapy is called _______ therapy.

milieu

Providing a safe environment for patients with impaired cognition, planning unit activities to stimulate thinking, and including patients and staff in unit meetings are all part of:

milieu therapy

Julie, a 49-year-old patient diagnosed with schizophrenia at 22 years old, is taking risperidone (Risperdal). Which of the following nursing assessments is the priority assessment with Julie?

monitoring for abnormal involuntary movements

The concepts at the heart of Sullivan's theory of personality are:

needs and anxiety

You are caring for Vanessa, a 38 year old patient with major depression. she has just met with her provider. she states to you, "my provider said something about the medicine she is ordering working on my neurotransmitters. What exactly are neurotransmitters?" Your best response is:

neurotransmitters are chemical messengers in the brain that help regulate specific functions