MH Final Ex

2. Client sees no connection between her liver disorder and her alcohol intake. She believes that she drinks very little and that her family is making something out of nothing. The nurse interprets these behaviors as indicative of the client's use of which of the following defense mechanism? a. Denial b. Displacement c. Rationalization d. projection 3. A client diagnosed with substance dependence states to the nurse, "My wife causes me to abuse drugs. She uses and expects me to." The client is using which defense mechanism? a. Rationalization b. Denial c. Reaction formation d. Projection 4. A client who asked for and was refused a request to leave the work left the manager office and went to his room, where he Kicked the wall. Which defense mechanism did he use? a. Displacement. b. Denial. c. Rationalization. d. Projection. 5. The client viewed her therapist as the most wonderful, loving, and insightful therapist she had ever had. When her therapist refused to give her a prescription for Valium, the client shouted ather that she was the "Stupidest, most uncaring, and thickheaded person" and she demandedanother therapist "right away". Which defense mechanism did he use? a. Splitting. b. Denial. c. Rationalization. d. Projection. 6. The nurse confronts the patient with his substance-abusing behavior and its consequences. The nurse recommends enrolling in a treatment program as soon as he recovers from his injuries. Clarence states, "What are you talking about? I don't have substance abuse problem." The nurseidentifies the patient is using a defense mechanism of: A. Denial B. Reaction formation C. Projection D. Sublimation 7. The patient is on standard antipsychotic medication (Haldol), after a week you start noticing that he has involuntary protrusion of the tongue, and his head is pulled to the side. The patient is exhibiting the symptoms of: a. Pseudo-parkinsonism. b. Acute dystonic reaction. c. Tardive dyskinesia. d. Akathisia

a. Denial d. Projection a. Displacement a. Splitting A. Denial b. Acute dystonic reaction.

A patient takes lithium daily. The nurse should monitor the patient for: A. Pharyngitis, mydriasis, and dystonia. B. Alopecia, purpura, and drowsiness. C. Diaphoresis, weakness, and nausea. D. Ascites, dyspnea, and edema. A patient with bipolar disorder is hyperactive and has not slept for 3 days. Mood and behavior are labile. The patient threatens to hit another patient. Which response by the nurse is appropriate? A. "Stop that now. No one did anything to provoke an attack by you." B. "If you try that again, you will be placed in seclusion immediately." C. "Do not hit anyone. If you are unable to control yourself, we will help you." D. "You know we will not let you hit anyone. Why do you continue this behavior?

1) C. Diaphoresis, weakness, and nausea. 2) C. "Do not hit anyone. If you are unable to control yourself, we will help you."

The nurse finds a client crying in his room. The client states, "I'm so sad and lonely. I'm sitting here crying like a baby." The nurse's best response is A. "I think you are a fine man". B. "Why don't you get involved in the activity group?" C. "It's a gray rainy day. That's why you feel down. Everyone is down today." D. "Are you embarrassing because you're crying?" A withdrawn client is assessed as having distorted thinking that is not reality based. A nursing diagnosis that should be considered for her would be a. impaired verbal communication. b. disturbed thought processes. c. disturbed self-esteem. d. defensive coping

1) D. "Are you embarrassing because you're crying?" 2) b. disturbed thought processes.

Case Study: Ms. Mary was directing traffic, shouting "to work, you jerk, for perks," and making obscene gestures at cars. The patient's spouse reports noncompliance with lithium therapy for 3 weeks and not sleeping for 3 days, saying, "I'm too busy." 1. Prior to admission, a patient was directing traffic, shouting "to work, you jerk, for perks,"and making obscene gestures at cars. The patient's spouse reports noncompliance withlithium therapy for 3 weeks and not sleeping for 3 days, saying, "I'm too busy." Featurescharacteristic of bipolar disorder the nurse can identify are: A. Increased muscle tension and anxiety. B. Vegetative signs and poor grooming. C. Poor judgment and hyperactivity. D. Cognitive deficits and low mood. 2. The patient was directing traffic and shouting rhymes on a busy city street. The patient'sspouse reports that the patient has not slept or eaten for 3 days. Which assessment findings have priority concern for this patient's plan of care? A. Pressured speech and grandiosity. B. Hyperactivity, not eating and sleeping. C. Poor concentration and decision making. D. Insulting, provocative behavior directed at staff. 3. A patient with bipolar disorder is hyperactive and has not slept for 3 days. Mood andbehavior are labile. The patient threatens to hit another patient. Which response by the nurse is appropriate? A. "Stop that now. No one did anything to provoke an attack by you." B. "If you try that again, you will be placed in seclusion immediately." C. "Do not hit anyone. If you are unable to control yourself, we will help you." D. "You know we will not let you hit anyone. Why do you continue this behavior?" 4. A patient with bipolar disorder, mania, relapsed after discontinuing lithium. Thehealth care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa) 10mg BID. What is the rationale for addition of olanzapine to the lithium regime? It will: A. Minimize the side effects of lithium. B. Bring hyperactivity under rapid control. C. Potentiate the antimanic action of lithium. D. Be used for long-term control of hyperactivity. 5. Laboratory results show a patient's lithium level is 1.0 mEq/L. Select thecorrect analysis. A. Within therapeutic limits. B. Below therapeutic limits. C. Above therapeutic limits. D. Above therapeutic limits; toxic. 6. The patient with acute mania undresses in the day room and dances. Select the best intervention. A. Quietly ask the patient, "Are you embarrassed? Don't you think you should put your clothes on?" B. Let the patient stay in the day room. Move other patients to a different area. C. Cover the patient with a blanket and walk with the patient to a quiet room. D. Tell the patient firmly, "Stop dancing and put on your clothing." 7. A teaching plan for a patient taking lithium should include instructions to: A. Maintain normal salt and fluids in the diet. B. Drink twice the usual daily amount of fluid. C. Have regular laboratory studies of liver function. D. Avoid eating aged cheese, processed meats, and red wine. 8. A patient takes lithium daily. The nurse should monitor the patient for: A. Pharyngitis, mydriasis, and dystonia. B. Alopecia, purpura, and drowsiness. C. Diaphoresis, weakness, and nausea. D. Ascites, dyspnea, and edema. 9. What critical information should the nurse provide about the use of lithium? A. "You will still have hypersexual tendencies, so be certain to useprotection when engaging in intercourse". B. "Lithium will help you to only feel the euphoria of mania but not theanxiety." C. "It will take 1 to 2 weeks and maybe longer for this medication to startworking fully." D. "This medication is a cure for bipolar disorder." 10. A medication plan for Mary who receives lithium should include: A. Periodic monitoring for renal and thyroid function. B. Dietary teaching to restrict daily sodium intake. C. The importance of blood draws to monitor serum potassium level. D. Discontinuing the drug if weight gain and fine hand tremors arenoticed.

1) C. Poor judgment and hyperactivity. 2) B. Hyperactivity, not eating and sleeping. 3) C. "Do not hit anyone. If you are unable to control yourself, we will help you." 4) B. Bring hyperactivity under rapid control. 5) A. Within therapeutic limits 6) C. Cover the patient with a blanket and walk with the patient to a quiet room. 7) A. Maintain normal salt and fluids in the diet. 8) C. Diaphoresis, weakness, and nausea. 9) C. "It will take 1 to 2 weeks and maybe longer for this medication to start working fully." 10) A. Periodic monitoring for renal and thyroid function.

11. A client diagnosed with schizophrenia is very disturbed and violent. After several doses of haloperidol, the client is calm. Two hours later the nurse sees the client's head rotated to one side in a stiff position, the lower jaw thrust forward, and drooling. Which problem is most likely? A. An acute dystonic reaction B. Tardive dyskinesia C. Waxy flexibility D. Akathisia 12. A client diagnosed with schizophrenia has received fluphenazine decanoate twice a month for 3 years. The clinic nurse notes that the client grimaces and constantly smacks both lips. The client's neck and shoulders twist in a slow, snakelike motion. Which problem would the nurse suspect? A. Agranulocytosis B. Tardive dyskinesia C. Tourette's syndrome D. Anticholinergic effects 13. A nurse sits with a client diagnosed with schizophrenia. The client starts to laugh uncontrollably, although the nurse has not said anything funny. What is the nurse's most therapeutic response? A. "Why are you laughing?" B. "Please share the joke with me." C. "I don't think I said anything funny." D. "You're laughing. Tell me what's happening." 14. The nurse assesses a client diagnosed with schizophrenia. Which assessment finding would the nurse regard as a negative symptom of schizophrenia? A. Auditory hallucinations B. Delusions of grandeur C. Poor personal hygiene D. Psychomotor agitation 15. What assessment findings mark the prodromal stage of schizophrenia? A. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion B. Auditory hallucinations, ideas of reference, thought insertion, and broadcasting C. Stereotyped behavior, echopraxia, echolalia, and waxy flexibility D. Loose associations, concrete thinking, and echolalia neologisms 16. A client diagnosed with schizophrenia has taken a conventional antipsychotic medication for a year. Hallucinations are less intrusive, but the client continues to have apathy, poverty of thought, and social isolation. The nurse would expect a change to which medication? A. Haloperidol B. Olanzapine C. Chlorpromazine D. Diphenhydramine 17. A client diagnosed with schizophrenia has been stable for a year; however, the family now reports the client is tense, sleeps 3 to 4 hours per night, and has difficulty concentrating. The client says, "My computer is sending out infected radiation beams." The nurse can correctly assess this information as an indication of what? A. the need for psychoeducation. B. medication nonadherence. C. chronic deterioration. D. relapse. 18. A client diagnosed with schizophrenia begins to talks about "macnabs" hiding in the warehouse at work. The client's use of "macnabs" should be documented using what term? A. a neologism. B. concrete thinking. C. thought insertion. D. an idea of reference. 19. A client receiving risperidone reports severe muscle stiffness at 1030. By 1200, the client has difficulty swallowing and is drooling. By 1600, vital signs are 102.8° F; pulse 110; respirations 26; 150/90. The client is diaphoretic. What is the nurse's best analysis and action? A. Agranulocytosis; institute reverse isolation. B. Tardive dyskinesia; withhold the next dose of medication. C. Cholestatic jaundice; begin a high-protein, high-cholesterol diet. D. Neuroleptic malignant syndrome; notify health care provider stat. 20. Which finding constitutes a negative symptom associated with schizophrenia? A. Hostility B. Bizarre behavior C. Poverty of thought D. Auditory hallucinations

11. A. An acute dystonic reaction 12. B. Tardive dyskinesia 13. D. "You're laughing. Tell me what's happening." 14. C. Poor personal hygiene 15. A. Withdrawal, misinterpreting, poor concentration, and preoccupation with religion 16. B. Olanzapine 17. D. relapse. 18. A. a neologism. 19. D. Neuroleptic malignant syndrome; notify health care provider stat. 20. C. Poverty of thought

1. Acute onset of disordered thinking is most associated with: A. delirium. B. Alzheimer's disease. C. frontotemporal dementia. D. Dementia with Lewy bodies 2. Karen's AD has progressed. One morning, she attempts to brush her teeth with a spoon. Which problem is evident? A. Aphasia B. Apraxia C. Agnosia D. Perseveration

A. delirium. B. Apraxia

What is the issue with Anxiolytic drugs (Xanax)?

Addiction & tolerance

Fear about being in places from which escape might be difficult

Agorphobia

The defense mechanisms that can only be used in healthy ways are:

Altruism and sublimation

Flooding

An intensive type of exposure therapy by exposing the person totheir worst fears.

Which type of hallucinations are more common in patients with schizophrenia (visual/auditory)?

Auditory

During the third week of treatment, the spouse of a patient in an alcoholism rehabilitation program says, "After this treatment program, I think everything will be all right." Which remark by the nurse will be most helpful to the spouse? A. "It is good that you're supportive of your spouse's sobriety and want to help maintain it." B. "While sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol." C. "It will be important for you to structure life to avoid as much stress as you can. You will need to provide social protection." D. "Alcohol is a lifelong disease of self-destruction. You will need to observe your spouse's behavior carefully."

B. "While sobriety solves some problems, new ones may emerge as one adjusts to living without alcohol."

Behavioral therapy

Behavior is learned and can be modified.

Phobias is often treated by ____?

Beta Blockers

Flight of ideas

Bipolar (manic)

What mental disease is splitting seen most in? Ex.

Borderline PD "I love you, I hate you"

The patient said: "here she comes with a cat catch a rat match"

Clang association

One of Mrs. M's complaints is about insurance. Which of the following does the Mental Health Parity Act provide? o A. Coverage for most uninsured Americans through expanded Medicaid eligibility o B. Health insurance exchanges o C. "Insurance mandate" for coverage D. Equal coverage for mental health disorder

D. Equal coverage for mental health disorder

Delusion

False beliefs

Hallucination

False perceptions

Illusions

False perceptions with an EXTERNAL stimulus

Systematic desensitization

Gradual exposure to the feared object from the least to the most frightening

What affects behavior in bipolar?

High intellect

What makes sure that the client understands instruction with phenothiazine?

Hyperactivity under rapid control

What makes Tardive Dyskinesia unique?

It is a chronic issue (the other s/s of Haldol are acute)

Cognitive therapy

Maladaptive behavior and abnormal mood states are consequence of the negative thought processes.

Elated mood

Mania (bipolar)

The fear of impending doom

Panic Disorders

Auditory hallucination

Schizophrenia

Thought stopping

Snapping a rubber band against your wrist when negative thoughts come to your mind.

What is the goal for a person who is in denial?

The goal is for the patient to overcome denial & accept treatment

What is serotonin syndrome caused by?

Too high dose or drug interaction (MOI w/SRRI)

Negative symptoms of schizophrenia

a. anergia

An example of delusions of persecution.

b. My food is poisoned

1. Consider this comment to three different nurses by a patient diagnosed with an antisocial personality disorder, "Another nurse said you don't do your job right." Collectively, these interactions can be assessed as a. seductive. b. detached. c. manipulative. d. guilt-producing. 2. A nurse reports to the treatment team that a patient diagnosed with an antisocial personality disorder has displayed the behaviors below. This patient is detached and superficial during counseling sessions. Which behavior by the patient most clearly warrants limit setting? a. Flattering the nurse b. Lying to other patients c. Verbal abuse of another patient d. Detached superficiality during counseling 3. A patient diagnosed with borderline personality disorder has a history of self-mutilation and suicide attempts. The patient reveals feelings of depression and anger with life. Which type ofmedication would the nurse expect to be prescribed? a. Benzodiazepine b. Mood stabilizing medication c. Monoamine oxidase inhibitor (MAOI) d. Cholinesterase inhibitor 4. A patient diagnosed with borderline personality disorder was hospitalized several times after multiple episodes of head banging and carving on both wrists. The patient remains impulsive. Which nursing diagnosis is the initial focus of this patient's care? a. Self-mutilation b. Impaired skin integrity c. Risk for injury d. Powerlessness 5. Which statement made by a patient diagnosed with borderline personality disorder indicates the treatment plan is effective? a. "I think you are the best nurse on the unit." b. "I'm never going to get high on drugs again." c. "I felt empty and wanted to hurt myself, so I called you." d. "I hate my mother. I called her today, and she wasn't home." 6. When preparing to interview a patient diagnosed with narcissistic personality disorder, a nurse can anticipate the assessment findings will include a. preoccupation with minute details; perfectionist. b. charm, drama, seductiveness; seeking admiration. c. difficulty being alone; indecisive, submissiveness. d. grandiosity, self-importance, and a sense of entitlement. 7. For which behavior would limit setting be most essential? The patient who a. clings to the nurse and asks for advice about inconsequential matters. b. is flirtatious and provocative with staff members of the opposite sex. c. is hypervigilant and refuses to attend unit activities. d. urges a suspicious patient to hit anyone who stares 8. The nurse caring for an individual demonstrating symptoms of schizotypal personalitydisorder would expect assessment findings to include a. arrogant, grandiose, and a sense of self-importance. b. attention seeking, melodramatic, and flirtatious. c. impulsive, restless, socially aggressive behavior. d. socially anxious, rambling stories, peculiar ideas. 9. Others describe a worker as very shy and lacking in self-confidence. This worker stays in an office cubicle all day, never coming out for breaks or lunch. Which term best describes this behavior? a. Narcissistic b. Histrionic c. Avoidant d. Paranoid 10. What is the priority intervention for a nurse beginning to work with a patient diagnosed with a schizotypal personality disorder? a. Respect the patient's need for periods of social isolation. b. Prevent the patient from violating the nurse's rights. c. Teach the patient how to select clothing for outings. d. Engage the patient in community activities. 11. A patient diagnosed with borderline personality disorder self-inflicted wrist lacerations after gaining new privileges on the unit. In this case, the self-mutilation may have been due to a. an inherited disorder that manifests itself as an incapacity to tolerate stress. b. use of projective identification and splitting to bring anxiety to manageable levels. c. a constitutional inability to regulate affect, predisposing to psychic disorganization. d. fear of abandonment associated with progress toward autonomy and independence 12. A nursing diagnosis appropriate to consider for a patient diagnosed with any of the personality disorders is a. nonadherence. b. impaired social interaction. c. disturbed personal identity. d. diversional activity deficit.

c. manipulative. c. Verbal abuse of another patient b. Mood stabilizing medication a.. Self-mutilation c. "I felt empty and wanted to hurt myself, so I called you." d. grandiosity, self-importance, and a sense of entitlement. d. urges a suspicious patient to hit anyone who stares d. socially anxious, rambling stories, peculiar ideas. c. Avoidant a. Respect the patient's need for periods of social isolation. d. fear of abandonment associated with progress toward autonomy and independence b. impaired social interaction.

Altered perception commonly experienced by patients with schizophrenia.

d. Auditory hallucinations

The defense mechanisms that can only be used in healthy ways are: o a. Suppression and humor. o b. Altruism and sublimation. o c. Idealization and splitting. od. Reaction formation and denial

o b. Altruism and sublimation.

Neurotransmitters for.... - Schizophrenia - Mania/Bipolar - Depression - Anxiety

- High Dopamine & Low GABA - High NE, Dopamine & Low GABA - High Acetylcholine & Low NE, Serotonin, Dopamine - High NE, Serotonin & Low GABA

Illusions- Ex (3)

- Seeing a pen and thinking it is a snake - Belief that the oxygen tank is a ghost - Expecting someone to come to your house and keeps opening the door thinking the guest has arrived.

1. A client has had difficulty keeping a job because of arguing with co-workers and accusing them of conspiracy. Today this client shouts, "They're all plotting to destroy me. Isn't that true?" what is the nurse's most therapeutic response? A "Everyone here is trying to help you. No one wants to harm you." B "Feeling that people want to destroy you must be very frightening." C. "That is not true. People here are trying to help you if you will let them." D. "Staff members are health care professionals who are qualified to help you." 2.A newly admitted client diagnosed with schizophrenia is hypervigilant and constantly scans the environment. The client states, "I saw two doctors talking in the hall. They were plotting to kill me." The nurse may correctly assess this behavior using which term? A. echolalia. B. neologism C. a delusion of reference D. an auditory hallucination. 3.A client diagnosed with schizophrenia says, "My co-workers are out to get me. I also saw two doctors plotting to kill me." How does this client perceive the environment? A. Disorganized B. Dangerous C. Supportive D. Bizarre 4. When a client diagnosed with schizophrenia was discharged 6 months ago, haloperidol was prescribed. The client now says, "I stopped taking those pills. They made me feel like a robot." What are common side effects the nurse should validate with the client? A. Sedation and muscle stiffness B. Sweating, nausea, and diarrhea C. Mild fever, sore throat, and skin rash D. Headache, watery eyes, and runny nose 5. Which hallucination expressed by a client necessitates the nurse to implement safety measures? A. "I hear angels playing harps." B. "The voices say everyone is trying to kill me." C. "My dead father tells me I am a good person." D. "The voices talk only at night when I'm trying to sleep." 6. A client's care plan includes monitoring for auditory hallucinations. Which assessment findings suggest the client may be hallucinating? A. Detachment and overconfidence B. Darting eyes, tilted head, mumbling to self C. Euphoric mood, hyperactivity, distractibility D. Foot tapping and repeatedly writing the same phrase 7. A health care provider considers which antipsychotic medication to prescribe for a client diagnosed with schizophrenia who has auditory hallucinations and poor social function. The client is also overweight and hypertensive. Which drug should the nurse advocate? A. Clozapine B. Ziprasidone C. Olanzapine D. Aripiprazole 8. A nurse observes a client standing immobile, facing the wall with one arm extended in a salute. The client remains immobile in this position for 15 minutes, moving only when the nurse gently lowers the arm. What is the name of this phenomenon? A. Echolalia B. Catatonia (Waxy flexibility). C. Depersonalization D. Thought withdrawal 9. A newly admitted client diagnosed with schizophrenia says, "The voices are bothering me. They yell and tell me I am bad. I have got to get away from them." Select the nurse's most helpful reply. A. "Do you hear the voices often?" B. "Do you have a plan for getting away from the voices?" C. "I'll stay with you. Focus on what we are talking about, not the voices. " D. "Forget the voices and ask some other clients to play cards with you." 10. A client diagnosed with schizophrenia has taken fluphenazine 5 mg po bid for 3 weeks. The nurse now observes a shuffling propulsive gait, a mask-like face, and drooling. Which term applies to these symptoms? A. Neuroleptic malignant syndrome B. Hepatocellular effects C. Pseudoparkinsonism D. Akathisia

1 B "Feeling that people want to destroy you must be very frightening." 2 C. a delusion of reference 3 B. Dangerous 4 A. Sedation and muscle stiffness 5 B. "The voices say everyone is trying to kill me." 6 B. Darting eyes, tilted head, mumbling to self 7 D. Aripiprazole 8 B. Catatonia (Waxy flexibility). 9 C. "I'll stay with you. Focus on what we are talking about, not the voices." 10 C. Pseudoparkinsonism

1. In general, when a nurse admitting a client experiencing an acute schizophrenia episode, she would most likely assess which of the following? a.Open and outgoing personality b.Loss of contact with reality c.Feelings of guilt and worthlessness d.Logical and precise thinking 2.While the nurse was doing the assessment, Jeffery turned to an empty chair talking as if someone was sitting there. The nurse was unable to understand what he was mumbling. This, in fact, indicates that the patient has: a.Delusions. b. Hallucinations. c.Illusions. D. Flight of ideas. 3. According to the previous scenario, which of the following symptoms is considered a negative symptom of schizophrenia? a.The patient was mumbling. b.The patient shouted; "They're coming! They're coming!" c.The patient has anergia. d.The patient believes that everything in the environment refer to him. 4.The client is prescribed a first- generation neuroleptic for his schizophrenia. Discharge teaching by the nurse should include contacting the health provider if which of the following occurs? a.Elevated temperature b.Blurred vision c.Difficulty concentrating d.Inability to remain seated for long period of time 5. The client has been on Haldol since admission. Which assessment by the nurse would best determine the effectiveness of a client's antipsychotic medication? a.The client no longer has hallucinations b.The client is no longer depressed c.The client has made a friend on the unit d.The client requested discharge 6.A client has developed neuroleptic malignant syndrome. A priority nursing intervention would be which of the following? a.Provide comfort and rest b.Measure intake and output c.Encourage client to remain active d.Monitor vital signs and blood pressure 7.A client is admitted to the emergency room with complains of sore throat and fever. The client's mother informs the nurse that the client has been taking Clozaril. Which of the following laboratory tests is a priority at this time? a.Fasting blood sugar b.Cholesterol level c.Blood urea nitrogen d.White blood cell count 8. A new graduate has been assigned four patients whom she must perform an assessment on. Her assessment reveals several clients complain. Which client complains should receive priority? a.A client receiving Cogentin who states, "I can't read my book, everything seems blurred." b.The client receiving Clozapine who states, "I think I might be getting the flu, my throat is sore and I feel very tired." c.A client who was admitted for alcoholism and states, " I took my valium but I still feel nervous. d.A client receiving Prozac who states "This medicine makes me sleepy. Is that that normal?" 9.During a one-to-one session with a client, the nurse notes that the client is unable to stop moving. He frequently stands-up and begins pacing while answering the nurse's questions. The nurse assesses the client's need to be in constant motion as which of the following? a.Akathesia b.Flight-of-ideas c.Echopraxia d.Neuroleptic syndrome 10.Jeffery is encouraged to attend groups but stays in his room instead. Staff and peers encourage his participation, but his hygiene remains poor. He does not seem to care that others wish that he would behave differently. Which is the most likely explanation for Jeffery failure to respond to others efforts to help him behave in more adaptive fashion? Select all that apply: a.He is avolitional. b.He is displaying anergia. c.He is displaying negativism d.He is experiencing social withdrawal. e.He is apathetic due to his schizophrenia.

1 b.Loss of contact with reality 2 b. Hallucinations. 3 c.The patient has anergia. 4 d.Inability to remain seated for long period of time 5 a.The client no longer has hallucinations 6 d.Monitor vital signs and blood pressure 7 d.White blood cell count 8 b.The client receiving Clozapine who states, "I think I might be getting the flu, my throat is sore and I feel very tired." 9 a.Akathesia 10 a.He is avolitional. b.He is displaying anergia. c.He is displaying negativism d.He is experiencing social withdrawal. e.He is apathetic due to his schizophrenia.

1. The nurse is caring for a patient experiencing mania. Which is the most appropriate nursing intervention? o A. Provide consistency among staff members when working with the patient. o B. Negotiate limits so the patient has a voice in the plan of care. o C. Allow only certain staff members to interact with the patient. o D. Attempt to control the patient's emotions. 2. The nurse is planning care for a patient experiencing the acute phase of mania. Which is the priority intervention? o A. Maintain stable cardiac status. o B. Prevent injury. o C. Get the patient to demonstrate thought self control. o D. Ensure that the patient get sufficient sleep and rest. 3. What critical information should the nurse provide about the use of lithium? o A. "You will still have hypersexual tendencies. So be certain to use protection when engaging in intercourse". o B. "Lithium will help you to only feel the euphoria of mania but not the anxiety" o C. "It will take one to two weeks and may be longer for this medication to start working fully". o D. "This medication is a cure for bipolar disorder" 4. The nurse has provided education for a patient in the continuation phase after discharge from the hospital. What indicates that the plan of care has been successful? Select all that apply: o A. Patient identifies three signs and symptoms of relapse. o B. Patient describes the purpose of each medication he has been prescribed. o C. Patient states "I no longer have the disease" o D. Patient identifies two ways to problem-solve a specific situation. 5. A bipolar client tells the nurse "I have the finest tenor voice in the world. The three tenors who do all those TV concerts are going to retire because they can't compete with me." The nurse would make the assessment that the client is displaying o A. flight of ideas o B.Distractibility o C. limit testing o D.Grandiosity

1) A. Provide consistency among staff members when working with the patient. 2) A. Maintain stable cardiac status. 3) C. "It will take one to two weeks and may be longer for this medication to start working fully". 4) A. Patient identifies three signs and symptoms of relapse. o B. Patient describes the purpose of each medication he has been prescribed. o D. Patient identifies two ways to problem-solve a specific situation. 5) D.Grandiosity

1. A client tells the nurse "My doctor thinks my problems with stress relate to the negative way I think about things, and he wants me to learn a new way of thinking." The nurse should be prepared to help the client understand and apply a cognitive technique called: o A. Priority restructuring o B. Reframing/restructuring o C. Guided imagery o D. Assertiveness 2. Which client will probably be at greatest risk for experiencing untoward effects of stress? o A. Mr. A, who sought medical help for his stress-related symptoms and follows a regimen of medication, proper diet, and rest o B. Mr. B, who finds much satisfaction in implementing highly creative innovations in his work o C. Mr. C, who can depend on the interested support of family, friends, and co-workers o D. Mr. D, who chooses not to deal with the stress-producing situation 3. Based on recent findings, which client could the nurse expect to have greater difficulty adjusting to life changes that have occurred over the past year? o A.A 32-year-old woman who is pregnant, divorcing her husband, and changing residences. o B. A 40-year-old man who has received a promotion and undertaken a weight loss program. o C.A 45-year-old woman whose daughter left home to attend college and whose ill mother is moving in o D.A 67-year-old retired man who lost his home in a hurricane 4. The nurse planning to teach a client to use Benson's relaxation techniques to treat hypertension is essentially teaching the client to o A. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode o B. Alter the internal state by acting on electronic signals related to physiologic processes. o C. Replace stress-producing activities with daily stress-reducing pleasant activities. o D. Reduce catecholamine production. 5. A client tells the nurse "I'm told that I should reduce the stress in my life, but I have no idea where to start." The best suggestion for the nurse to make would be. o A. "Why not start by learning to meditate? That technique will cover everything." o B. "In cases like yours, physical exercise works to elevate mood and reduce anxiety. o C. "Most stress is related to conflicts in interpersonal relationships. You can work on becoming more assertive." o D. "Keeping a journal can help you identify sources of stress by looking at activities that put a strain on energy or time or trigger anger or anxiety."

1) B. Reframing/restructuring 2) D. Mr. D, who chooses not to deal with the stress-producing situation 3) A.A 32-year-old woman who is pregnant, divorcing her husband, and changing residences. 4) A. Switch from the sympathetic mode of the autonomic nervous system to the parasympathetic mode 5) D. "Keeping a journal can help you identify sources of stress by looking at activities that put a strain on energy or time or trigger anger or anxiety."

Maggie, our college student, is aware that she needs help. On the three afternoons a week before she starts classes, she has lunch with her 2-year-old daughter on campus than goes to a yoga class right on campus that also provides child care. After yoga, her sister picks up her daughter, and Maggie goes on to class. "I'm trying," Maggie says. "It's still not easy, and I still feel a bit overloaded, but this is at least making some difference! It's a start, a step." Which stage of GAS is Maggie most likely experiencing? A. Alarm B. Resistance C. Exhaustion D. None of the above In GAS, which stage occurs first? A. Alarm B. Resistance C. Exhaustion Which reaction to stress is healthy? A. Distress B. Eustress C. Stressor D. None of the above

1) B. Resistance 2) A. Alarm 3) B. Eustress

1. The nurse is planning care for a patient with depression who will be discharged to home soon. What aspects of teaching should be the priority on the nurse's discharge plan of care? o A. Pharmacological teaching o B. Safety risk o C. Awareness of symptoms increasing depression o D. The need for interpersonal contact 2. The nurse is reviewing orders given for a patient with depression. Which order should the nurse question? o A. A low starting dose of a tricyclic antidepressants o B. An SSRI given initially with a MAOI o C. Electroconvulsive therapy to treat suicidal thoughts o D. Elavil to address the patient's agitation

1) B. Safety risk 2) B. An SSRI given initially with a MAOI

Ms. A keeps mentioning she's writing a prize-winning novel about her life and is pretty sure a famous actor will want to play the role of herself. What type of symptom is she displaying? o A. Flight of ideas o B. Tangential speech o C. Loose associations o D. Grandiose delusion The team meets with Ms. A to identify outcomes and develop a care plan for her. She asks why safety is such a big concern. Why indeed? o A. She's at risk for exhaustion o B. She's at risk for dehydration o C. She's having difficulty perceiving reality o D. All of the above Eric becomes anxious and says, "There are worms under my skin eating the hair follicles." How would you classify this assessment finding? o A. Positive symptom o B. Negative symptom o C. Cognitive symptom o D. Depressive symptom

1) D. Grandiose delusion 2) D. All of the above 3) A. Positive symptom

Anton's symptoms are most indicative of which disorder? o A. Hoarding disorder o B. Body dysmorphic disorder o C. Generalized anxiety disorder o D. Obsessive-compulsive disorder A nurse wants to teach alternative coping strategies to a client experiencing severe anxiety. Which action should the nurse perform first? o A. Verify the client's learning style. o B. Lower the client's current anxiety. o C. Create outcomes and a teaching plan. o D. Assess how the client uses defense mechanisms. 2. A woman is 5'7", 160 lbs. and wears a size 8 shoe. She says, "My feet are huge. I've asked three orthopedists to surgically reduce my feet." This person tries to buy shoes to make her feet look smaller and, in social settings, conceals both feet under a table or chair. Which health problem is likely? o A. Social anxiety disorder o B. Body dysmorphic disorder o C. Separation anxiety disorder o D. Obsessive-compulsive disorder due to a medical condition 3. A client experiencing moderate anxiety says, "I feel undone." What would be the appropriate response by the nurse? o A. "What would you like me to do to help you?" o B. "Why do you suppose you are feeling anxious?" o C. "I'm not sure I understand. Give me an example." o D. "You must get your feelings under control before we can continue." 4. A client fearfully runs from chair to chair crying, "They're coming! They're coming!" The client does not follow the staff's directions or respond to verbal interventions. What is the initial nursing intervention of highest priority? o A. Providing for the client's safety. o B. Encouraging clarification of feelings. o C. Respecting the client's personal space. o D. Offering an outlet for the client's energy. 5. A nurse assesses an individual who commonly experiences anxiety. Which comment by this person indicates the possibility of obsessive-compulsive disorder? o A. "I check where my car keys are eight times." o B. "My legs often feel weak and spastic." o C. "I'm embarrassed to go out in public." o D. "I keep reliving a car accident." 6. When alprazolam is prescribed for a client who experiences acute anxiety, health teaching should include which instruction? o A. Report drowsiness. o B. Eat a tyramine-free diet. o C. Avoid alcoholic beverages. o D. Adjust dose and frequency based on anxiety level. 7. A nurse plans health teaching for a client diagnosed with generalized anxiety disorder who begins a new prescription for lorazepam. What information should be included? (Select all that apply.) o A. Caution in use of machinery o B. Foods allowed on a tyramine-free diet. o C. The importance of caffeine restriction o D. Avoidance of alcohol and other sedatives o E. Take the medication on an empty stomach. 8. Which assessment questions would be most appropriate for the nurse to ask a client with possible obsessive-compulsive disorder? (Select all that apply.) o A. "Are there certain social situations that cause you to feel especially uncomfortable?" o B. "Are there others in your family who must do things in a certain way to feel comfortable?" o C. "Have you been a victim of a crime or seen someone badly injured or killed?" o D. "Is it difficult to keep certain thoughts out of your awareness?" o E. "Do you do certain things over and over again?"

1) D. Obsessive-compulsive disorder 2) B. Lower the client's current anxiety. 3) B. Body dysmorphic disorder 4) C. "I'm not sure I understand. Give me an example." 5) A. Providing for the client's safety. 6) A. "I check where my car keys are eight times." 7) C. Avoid alcoholic beverages. 8) A. Caution in use of machinery o C. The importance of caffeine restriction o D. Avoidance of alcohol and other sedatives 9) B. "Are there others in your family who must do things in a certain way to feel comfortable?" o D. "Is it difficult to keep certain thoughts out of your awareness?" o E. "Do you do certain things over and over again?"

I. A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. § A. Mild § B. Moderate § C. Severe § D. Panic What behaviors might this parent be exhibiting that would indicate panic level anxiety? III. What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic level anxiety?

1) D. Panic 2) Pacing, running, shouting, screaming, withdrawal 3) Maintain a calmer manner, remain with the parent, minimize environmental stimuli, move to a quieter setting, use clear/simple statements, use a low-pitched voice, speak slowly, recognize their distress, be willing to listen

I. A parent is shopping with a 5-year-old child in a large, busy urban mall. The parent suddenly realizes the child is missing. § A. Mild § B. Moderate § C. Severe § D. Panic o II. What behaviors might this parent be exhibiting that would indicate panic level anxiety? o III. What would be some appropriate interventions for the parent whose child is missing at the mall and is experiencing panic level anxiety?

1) D. Panic 2) Pacing, running, shouting, screaming, withdrawal 3) § Maintain a calmer manner, remain with the parent, minimize environmental stimuli, move to a quieter setting, use clear/simple statements, use a low-pitched voice, speak slowly, recognize their distress, be willing to listen

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is using: o a. Projection. o b. Rationalization. o c. Reaction formation. o d. Acting out. A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use of: o a. Altruism. o b. Denial. o c. Undoing. o d. Suppression Each time a client is scheduled for a therapy session she develops headache and nausea. The nurse might interpret this behavior as: o a. Conversion o b. Reaction formation o c. Projection o d. Suppression Client sees no connection between her liver disorder and her alcohol intake. She believes that she drinks very little and that her family is making something out of nothing. The nurse interprets these behaviors as indicative of the client's use of which of the following defense mechanism? o a. Denial o b. Displacement o c. Rationalization o d. Introjection A client reports becoming involved with legislation that promotes gun safety after the death of a child by accidental shooting. Which defense mechanism is the client exhibiting? o a. Sublimation o b. Identification o c. Regression o d. Repression A client diagnosed with substance dependence states to the nurse, "My wife causes me to abuse methamphetamines. She uses and expects me to." The client is using which defense mechanism? o a. Rationalization o b. Denial o c. Reaction formation o d. Projection An 11-year-old child whose father died recently asks his mother for help with picking out clothes for the day and zipping his coat. This behavior is an example of: o a. Regression o b. Displacement o c. Denial o d. Sublimation

1) c. Reaction formation. 2) b. Denial. 3) a. Conversion 4) a. Denial 5) a. Sublimation 6) d. Projection 7) a. Regression

A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is using: o a. Projection. o b. Rationalization. o c. Reaction formation. o d. Acting out. A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use of: o a. Altruism. o b. Denial. o c. Undoing. o d. Suppression Each time a client is scheduled for a therapy session she develops headache and nausea. The nurse might interpret this behavior as: o a. Conversion o b. Reaction formation o c. Projection o d. Suppression Client sees no connection between her liver disorder and her alcohol intake. She believes that she drinks very little and that her family is making something out of nothing. The nurse interprets these behaviors as indicative of the client's use of which of the following defense mechanism? o a. Denial o b. Displacement o c. Rationalization o d. Introjection A client reports becoming involved with legislation that promotes gun safety after the death of a child by accidental shooting. Which defense mechanism is the client exhibiting? o a. Sublimation o b. Identification o c. Regression o d. Repression A client diagnosed with substance dependence states to the nurse, "My wife causes me to abuse methamphetamines. She uses and expects me to." The client is using which defense mechanism? o a. Rationalization o b. Denial o c. Reaction formation o d. Projection An 11-year-old child whose father died recently asks his mother for help with picking out clothes for the day and zipping his coat. This behavior is an example of: o a. Regression o b. Displacement o c. Denial o d. Sublimation Anita, 34, is shopping with her 5-year-old daughter in a large, busy urban mall when she suddenly realizes the child is missing. Which level of anxiety would likely result? o A. Mild o B. Moderate o C. Severe o D. Panic What behaviors might Anita be exhibiting that would indicate panic-level anxiety? o A. Seeing and grasping information efficiently and quickly to make problem solving more effective o B. Voice tremors, perspiration, and headache o C. Dazed, confused, with automatic behaviors aimed at reducing anxiety o D. Running, shouting, and screaming What level of anxiety could actual be a good thing on the day of a nursing exam? o A. Mild o B. Moderate o C. Severe o D. Panic Which was probably "the thing Betsy did next" that helped Anita that night? o A. Left her by herself in a quiet, dark space to calm down. o B. Stayed with her and kept up a steady stream of talk—about anything at all—to distract and soothe her. o C. Introduced her to a bright, pleasant game with other patients her age to create a much-needed distraction from worry. o D. Stayed with her in a quiet spot and listened. What is the difference between anxiety and fear? o a. Fear is a universal experience; anxiety is neurotic. o b. Fear enables constructive action; anxiety is dysfunctional. o c. Fear is a psychological experience; anxiety is a physiological experience. o d. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

1) c. Reaction formation. 2) b. Denial. 3) a. Conversion 4) a. Denial 5) a. Sublimation 6) d. Projection 7) a. Regression 8) D. Panic 9) D. Running, shouting, and screaming 10) A. Mild 11) D. Stayed with her in a quiet spot and listened. 12) d. Fear is a response to a specific danger; anxiety is a response to an unknown danger.

1) The nurse finds a client crying in his room. The client states, "I'm so sad and lonely. I'm sitting here crying like a baby." The nurse's best response is: o a. "I think you are a fine man". o b. "Why don't you get involved in the activity group?" o c. "It's a gray rainy day. That's why you feel down. Everyone is down today." o d. "Are you embarrassing because you're crying?" 2) A withdrawn client is assessed as having distorted thinking that is not reality based. A nursing diagnosis that should be considered for her would be o a. impaired verbal communication. o b. disturbed thought processes. o c. disturbed self-esteem. o d. defensive coping. 3) Jim is sometimes seen moving his lips silently or murmuring to himself when he does not realize others are watching. Sometimes when he is conversing with others, he suddenly stops, appears distracted for a moment, and then resumes. Based on these observations, Jim most likely is experiencing which symptom(s)? Select all that apply: o a. Illusions. o b. Paranoia. o c. Delusional thinking. o d. Auditory hallucinations. o e. Impaired reality testing. o f. Stereotyped behaviors.

1) d. "Are you embarrassing because you're crying?" 2) b. disturbed thought processes. 3) d. Auditory hallucinations; e. Impaired reality testing.

Jim is sometimes seen moving his lips silently or murmuring to himself when he does not realize others are watching. Sometimes when he is conversing with others, he suddenly stops, appears distracted for a moment, and then resumes. Based on these observations, Jim most likely is experiencing which symptom(s)? Select all that apply: a. Illusions. b. Paranoia. c. Delusional thinking. d. Auditory hallucinations. e. Impaired reality testing. f. Stereotyped behaviors. Looseness of associations in a person with schizophrenia indicate a. paranoia. b. mood instability. c. depersonalization. d. poorly organized thinking. Which assessment finding represents a negative symptom of schizophrenia? a. Apathy b. Delusion c. Motor tic d. Hallucination

1) d. Auditory hallucinations; e. Impaired reality testing. 2) d. poorly organized thinking. 3) a. Apathy

1. The major distinction between fear and anxiety is that o a. Fear is a universal experience; anxiety is neurotic. o b. Fear enables constructive action; anxiety is dysfunctional. o c. Fear is a psychological experience; anxiety is a physiological experience. o d. Fear is a response to a specific danger; anxiety is a response to an unknown danger. 2. The nurse is told he will be assigned to an anxious client who is being admitted from the emergency department. The initial action of the nurse should be to o a. Assess the client's use of defense mechanisms. o b. Assess the client's level of anxiety. o c. Limit environmental stimuli. o d. Provide antianxiety medication. 3. A 20-year-old was sexually molested at age10 years by an older man but can no longer remember the incident. The ego defense mechanism in use is o a. Projection. o b. Repression. o c. Displacement. o d. Reaction formation. 4. The defense mechanisms that can only be used in healthy ways are o a. Suppression and humor. o b. Altruism and sublimation. o c. Idealization and splitting. o d. Reaction formation and denial. 5. A person who recently gave up smoking and now talks constantly about how smoking fouls the air, causes cancer, "burns" money that could be better spent to feed the poor, and so forth is using o a. Projection. o b. Rationalization. o c. Reaction formation. o d. Acting out. 6. A man keeps his wife's clothing in the closet and bureau of his bedroom although she has been dead for 3 years. This behavior suggests the use of o a. Altruism. o b. Denial. o c. Undoing. o d. Suppression.

1) d. Fear is a response to a specific danger; anxiety is a response to an unknown danger. 2) b. Assess the client's level of anxiety. 3) b. Repression. 4) b. Altruism and sublimation. 5) c. Reaction formation. 6) b. Denial.

Mr.Young arrived in the emergency department at 2 AM, he involved in a car accident. The police on the scene administered a Breathalyzer test that revealed a blood alcohol level of .3%. A nursing history conducted reveals an extensive drinking history. Mr.Young has a liver disease. When interviewing him, he mentioned that he has suicidal thoughts. Using the previous scenario, answer questions 1 to 20 1. Which patient behaviors/symptoms should the nurse suspect as related to alcohol withdrawal? A. Mild disorientation and confusion. B. Tactile, auditory hallucinations, and paranoid delusions. C. Tremors, nausea, and vomiting. D. Paranoid delusions, fever, fluctuating levels of consciousness. 2. An alcohol-dependent patient was hospitalized at 4 AM on Saturday. The patient's last drink was at 2 AM. When would the nurse expect withdrawal symptoms to begin? A. Between 8 AM and 10 AM Saturday. B. Between 10 AM and 4 PM Saturday. C. Between 4 PM Saturday and 4 AM Sunday. D. Between 2 AM Sunday and 2 AM Monday 3. If the nurse wants to predict the onset of withdrawal symptoms, which question should she ask to Mr. Young? A. "How often do you usually drink?" B. "When did you last have something to drink?" C. "How much alcohol do you usually have?" D. "What is your experience with withdrawal?" 4. Before initiating treatment, Mr. Young points to the traction apparatus and screams that he sees a hangman's noose. The assessment that can be made is that the client is experiencing: A. An illusion. B. A delusion. C. Hallucinations. D. Amnesia. 5. Which medication class is the treatment of choice given to treat symptoms of alcohol withdrawal? A. Antipsychotics, such as Haloperidol (Haldol). B. Antidepressants, such as Fluoxetine (Prozac). C. Anticonvulsants, such as Valproic acid (Depakote). D. Benzodiazepines, such as chlordiazepoxide (Librium). 6. Eight hours after admission, the nurse observes that Mr. Young has moderate tremors, nausea, and elevated blood pressure. Which medication should the nurse expect the physician to prescribe? A. Librium 75 mg PO. B. Ativan 2 mg PO. C. Citalopram (Celexa) 60 mg/day D. Paroxetine (Paxil) (20-50 mg/day) 7. What is the therapeutic action of benzodiazepines? A. Potentiate effects of GABA. B. Block reuptake of dopamine. C. Block reuptake of serotonin. D. Activate opioid receptors. 8. Which finding supports that Mr. Young probably has liver disease? A. Decreased uric acid. B. Increased SGOT/AST. C. Hyperkalemia. D. Reduced alkaline phosphatase. 9. While in treatment, Mr. Young was prescribed Disulfiram (Antabuse). Mr.Young asks, "What is the purpose of this medication?" The nurse's explanation should be based on the information that Disulfiram: A. Is the treatment of choice to prevent Wernick-Korsakoff syndrome. B. Replaces alcohol with a chemical drug. C. Is a deterrent to the use of alcohol by causing unpleasant physical effects. D. Block the craving for and the action of Opiates. 11. During the first 72 hours, what is the priority goal for alcohol detoxification? A. Discourage drug-seeking behaviors. B. Physiologic stabilization. C. Monitor liver function tests. D. Enhancement of coping skills. 12. What is the rationale for giving thiamine (B1) and a multivitamin? A. Treat / reduce the risk of Wernicke's disease. B. Prevent occurrence of delirium tremens. C. Lessen alcohol withdrawal symptoms. D. Help increase the client's appetite. 13. Mr. Young asks the nurse how Antabuse works. The nurse should respond as follows: A. Decrease cravings for alcohol. B. Raise the level of Acetaldehyde. C. Block the effects of endorphins. D. Prevent client from drinking. 14. Which condition would the nurse be most concerned about when caring for a patient who abuses alcohol? A. Cirrhosis of the liver. B. Suicidal potential. C. Wernicke's encephalopathy. D. Korsakoff's psychosis. 15. Consequences of drinking alcohol while taking Antabuse include: A. Severe headache, nausea and vomiting, hypotension, and tachycardia. B. Diaphoresis and elevated blood pressure. C. Peripheral vascular collapse and electrolyte imbalance. D. Paranoid delusions, fever, fluctuating levels of consciousness. 16. The nurse explains the potential consequences of drinking alcohol and all products with alcohol. Which product is acceptable for Mr. Young to use? A. Cough medicine. B. Mouthwash. C. Aftershave lotion. D. Petroleum jelly. 17. The patient admitted to an alcoholism rehabilitation program and tells the nurse, "I'm actually a social drinker. I usually have one drink at lunch, two cocktails in the afternoon, wine with dinner, and a few drinks during the evening." Which defense mechanism is evident? A. Denial. B. Projection C. Introjection. D. Rationalization 18. An alcohol dependent patient says, "Drinking helps me cope with being a single parent." Which response by the nurse would help the patient conceptualize the drinking more objectively? A. "Sooner or later, alcohol will kill you. Then what will happen to your children?" B. "I hear a lot of defensiveness in your voice. Do you really believe this?" C. "If you were coping so well, why were you hospitalized again?" D. "Tell me what happened the last time you drank." 19.A nurse reviews vital signs for a patient admitted last night with an injury sustained while intoxicated. The medical record shows these blood pressure and pulse readings: Admission, 2 AM - 118/78 mm Hg and 72 beats/min 4 AM - 126/80 mm Hg and 76 beats/min 6 AM - 128/82 mm Hg and 72 beats/min 8 AM - 132/88 mm Hg and 80 beats/min 10 AM - 148/94 mm Hg and 96 beats/min What is the nurse's priority action? A. Force fluids. B. Consult the health care provider. C. Obtain a clean-catch urine sample. D. Place the patient in a vest-type restraint. 20 . Mr. Young believes spiders are spinning entrapping webs in the room. The patient is fearful, agitated, and diaphoretic. Which nursing intervention is indicated? A. Check the patient every 15 minutes. B. One-on-one supervision. C. Keep the room dimly lit. D. Force fluids.

C. Tremors, nausea, and vomiting. A. Between 8 AM and 10 AM Saturday. B. "When did you last have something to drink?" A. An illusion. D. Benzodiazepines, such as chlordiazepoxide (Librium). B. Ativan 2 mg PO. A. Potentiate effects of GABA. B. Increased SGOT/AST. C. Is a deterrent to the use of alcohol by causing unpleasant physical effects. B. Physiologic stabilization. A. Treat / reduce the risk of Wernicke's disease. B. Raise the level of Acetaldehyde. B. Suicidal potential. A. Severe headache, nausea and vomiting, hypotension, and tachycardia. D. Petroleum jelly. A. Denial. D. "Tell me what happened the last time you drank." B. Consult the health care provider. B. One-on-one supervision.

3. A patient with bipolar disorder is hyperactive and has not slept for 3 days. Mood and behavior are labile. The patient threatens to hit another patient. Which response by the nurse is appropriate? A."Stop that now. No one did anything to provoke an attack by you." B."If you try that again, you will be placed in seclusion immediately." C."Do not hit anyone. If you are unable to control yourself, we will help you." D."You know we will not let you hit anyone. Why do you continue this behavior?" 4. A patient with bipolar disorder, mania, relapsed after discontinuing lithium. The health care provider prescribes lithium 600 mg BID and olanzapine (Zyprexa) 10 mg BID. What is the rationale for addition of olanzapine to the lithium regime? It will: A. Minimize the side effects of lithium. B. Bring hyperactivity under rapid control. C. Potentiate the antimanic action of lithium. D. Be used for long-term control of hyperactivity. 5. Laboratory results show a patient's lithium level is 1.0 mEq/L. Select the correct analysis. A.Within therapeutic limits. B. Below therapeutic limits. C. Above therapeutic limits. D.Above therapeutic limits; toxic. 6. The patient with acute mania undresses in the day room and dances. Select the best intervention. A. Quietly ask the patient, "Are you embarrassed? Don't you think you should put your clothes on?" B. Let the patient stay in the day room. Move other patients to a different area. C.Cover the patient with a blanket and walk with the patient to a quiet room. D.Tell the patient firmly, "Stop dancing and put on your clothing." 7.A teaching plan for a patient taking lithium should include instructions to: A. Maintain normal salt and fluids in the diet. B.Drink twice the usual daily amount of fluid. C.Have regular laboratory studies of liver function. D. Avoid eating aged cheese, processed meats, and red wine. 8. A patient takes lithium daily. The nurse should monitor the patient for: A.Pharyngitis, mydriasis, and dystonia. B.Alopecia, purpura, and drowsiness. C.Diaphoresis, weakness, and nausea. D.Ascites, dyspnea, and edema. 9.What critical information should the nurse provide about the use of lithium? A."You will still have hypersexual tendencies, so be certain to use protection when engaging in intercourse". B."Lithium will help you to only feel the euphoria of mania but not the anxiety." C."It will take 1 to 2 weeks and maybe longer for this medication to start working fully." D. "This medication is a cure for bipolar disorder." 10. A medication plan for Mary who receives lithium should include: A Periodic monitoring for renal and thyroid function. B.Dietary teaching to restrict daily sodium intake. C.The importance of blood draws to monitor serum potassium level. D. Discontinuing the drug if weight gain and fine hand tremors are noticed.

C."Do not hit anyone. If you are unable to control yourself, we will help you." B. Bring hyperactivity under rapid control. A.Within therapeutic limits. C.Cover the patient with a blanket and walk with the patient to a quiet room. A. Maintain normal salt and fluids in the diet. C.Diaphoresis, weakness, and nausea. C."It will take 1 to 2 weeks and maybe longer for this medication to start working fully." A Periodic monitoring for renal and thyroid function.

Ms. Mary was directing traffic, shouting "to work, you jerk, for perks," and making obscene gestures at cars. The patient's spouse reports noncompliance with lithium therapy for 3 weeks and not sleeping for 3 days, saying, "I'm too busy." 1.Prior to admission, a patient was directing traffic, shouting "to work, you jerk, for perks," and making obscene gestures at cars. The patient's spouse reports noncompliance with lithium therapy for 3 weeks and not sleeping for 3 days, saying, "I'm too busy." Features characteristic of bipolar disorder the nurse can identify are: A.Increased muscle tension and anxiety. B.Vegetative signs and poor grooming. C.Poor judgment and hyperactivity D.Cognitive deficits and low mood. 2. The patient was directing traffic and shouting rhymes on a busy city street. The patient's spouse reports that the patient has not slept or eaten for 3 days. Which assessment findings have priority concern for this patient's plan of care? A.Pressured speech and grandiosity. B.Hyperactivity, not eating and sleeping. C.Poor concentration and decision making. D.Insulting, provocative behavior directed at staff.

C.Poor judgment and hyperactivity B.Hyperactivity, not eating and sleeping.

What is the most important health teaching of Anxiolytic drugs (Xanax)? Drug interaction?

CNS depressents No alcohol while taking it

What type of symptoms do we worry about the most in patients with schizophrenia (negative/positive)?

Positive s/s

Clang Association- Def

Rhyming with no meaning

Hallucination- Ex

Sees a snake that's not there

Exam Questions 9. The patient is taking Thorazine (Chlorpromazine), the patient starts experiencing masked like face and shuffling gait and pill rolling phenomena, the patient is experiencing: a. Pseudo-parkinsonism. b. Acute dystonic reaction. c. Tardive dyskinesia. d. Akathisia 10. Ms. Mary is being treated with Fluoxetine (Prozac), she had a grand mal seizure. Prior to theseizure, she had seemed confused, and her forehead felt hot. Ms. Mary does not have aseizure-disorder history. Which action should the nurse take? a. Monitor the patient and notify the clinic if there are more seizures. b. Hold all medications and call the physician immediately. c. Hold tonight's sertraline and encourage her to drink more fluids. d. Administer an antipyretic drug to lower her fever and prevent seizures. 11. The nurse is reviewing orders given to a patient with major depressive disorders. Whichorder should the nurse question? A. A low starting dose of a tricyclic antidepressants. B. An SSRI given initially with a MAOI C. Electroconvulsive therapy to treat suicidal thoughts. D. Elavil to address the patient's agitation. 12. The patient is taking MAOI and would like to switch to Fluoxetine, which is the most importantinformation the nurse should provide: a. Wait for at least 2-5 weeks before starting Fluoxetine. b. Monitor vital signs and switch to Fluoxetine immediately. c. Avoid foods containing tyramine and switch to Fluoxetine immediately. d. Observe for side effects and report them to the nurse immediately. 13. Your patient was diagnosed with eating disorders, which medications would be the most likely tobe prescribed for your patient? a. Anxiolytic such as Xanax. b. SSRIs such as Fluoxetine. c. Antipsychotics such as olanzapine. d. Mood stabilizer such as lithium. 14. What signs and symptoms should the nurse expect to assess if a client taking a MAOantidepressant ingests foods containing tyramine? a. Severe headache, palpitations, and chest pain. b. Muscle stiffness and shuffling gait. c. Sore throat and fever. d. Diarrhea, nausea and vomiting.

a. Pseudo-parkinsonism. b. Hold all medications and call the physician immediately. B. An SSRI given initially with a MAOI a. Wait for at least 2-5 weeks before starting Fluoxetine. b. SSRIs such as Fluoxetine. a. Severe headache, palpitations, and chest pain.

1. An older adult patient takes multiple medications daily. Over 2 days, the patient developed confusion, slurred speech, an unsteady gait, and fluctuating levels of orientation. These findings are most characteristic of a.delirium. b.dementia. c.amnestic syndrome. d.Alzheimer's disease. 2. A patient with fluctuating levels of awareness, confusion, and disturbed orientation shouts, "Bugs are crawling on my legs. Get them off!" Which problem is the patient experiencing? a.Aphasia b.Dystonia c.Tactile hallucinations d.Mnemonic disturbance 3. A patient with fluctuating levels of consciousness, disturbed orientation, and perceptual alteration begs, "Someone get these bugs off me." What is the nurse's best response? a."No bugs are on your legs. You are having hallucinations." b."I will have someone stay here and brush off the bugs for you." c."Try to relax. The crawling sensation will go away sooner if you can relax." d."I don't see any bugs, but I can tell you are frightened. I will stay with you." 4. What is the priority nursing diagnosis for a patient with fluctuating levels of consciousness, disturbed orientation, and visual and tactile hallucinations? a.Risk for injury related to altered cerebral function, fluctuating levels of consciousness, disturbed orientation, and misperception of the environment b.Bathing/hygiene self-care deficit related to cerebral dysfunction, as evidenced by confusion and inability to perform personal hygiene tasks c.Disturbed thought processes related to medication intoxication, as evidenced by confusion, disorientation, and hallucinations d.Fear related to sensory perceptual alterations as evidenced by visual and tactile hallucinations 5. A patient diagnosed as mild stage Alzheimer's disease tires easily and prefers to stay home rather than attend social activities. The spouse does the grocery shopping because the patient cannot remember what to buy. Which nursing diagnosis applies at this time? a.Self-care deficit b.Impaired memory c.Caregiver role strain d.Adult failure to thrive 6. During morning care, a nurse asks a patient diagnosed with dementia, "How was your night?" The patient replies, "It was lovely. I went out to dinner and a movie with my friend." Which term applies to the patient's response? a.Sundown syndrome b.Confabulation c.Perseveration d.Delirium 7. What side effects should the nurse monitor for when caring for a patient prescribed donepezil (Aricept)? Select all that apply. · a. Insomnia · b. Constipation · c. Bradycardia · d. Signs of dizziness · e. Reports of headache

a.delirium. c.Tactile hallucinations b."I will have someone stay here and brush off the bugs for you." a.Risk for injury related to altered cerebral function, fluctuating levels of consciousness, disturbed orientation, and misperception of the environment b.Impaired memory b.Confabulation · a. Insomnia · c. Bradycardia · d. Signs of dizziness · e. Reports of headache

1) As a client converses with the nurse, she states "I dreamed I was stoned. When I woke up, I was feeling emotionally drained, as though I hadn't rested well." If the nurse needs clarification of "stoned," it would be appropriate to say a. "It sounds as though you were quite uncomfortable with the content of your dream." b. "Can you give me an example of what you mean by stoned?" c. "I understand what you're saying. Bad dreams leave me feeling tired, too." d. "So, all in all, you feel as though you had a rather poor night's sleep?" 2) The client has disclosed several of his concerns and associated feelings. If the nurse wishes to seek clarification he could say a. What are the common elements here?" b. "Tell me again." c. "Am I correct in concluding that . . ." d. "Tell me everything from the beginning." 3) During the first interview with a woman who has just lost her son in a car accident, the nurse feels so sorry for the woman that she reaches out and touches her. The nurse's response a. Is empathetic and will encourage the woman to continue to express her feelings. b. Will be perceived by the client as intrusive and overstepping boundaries. c. Is inappropriate because a "no touch" rule should be applied to all psychiatric clients d. May be premature as the cultural and individual interpretation of touch is unknown 4) During a nurse-client interview the client attempts to shift the session focus from himself to the nurse by asking personal questions. The nurse should respond by saying a. "You have no right to ask questions about my personal life." b. "Nurses prefer to direct the interview." c. "You've turned the tables on me." d. "This time we spend together is for you to discuss your concerns. 5) A client seeks to elicit personal information about the nurse by asking several direct questions about the nurse's living arrangements. To refocus the interview the nurse should say a. "I am uncomfortable when you ask me personal questions, so please stop." b. "It seems a bit odd that you are focusing on me rather than on yourself." c. "Your questioning is manipulative and distracting us from our purpose." d. "This is your time to focus on your situation. Tell me about your concerns."

b. "Can you give me an example of what you mean by stoned?" c. "Am I correct in concluding that . . ." d. May be premature as the cultural and individual interpretation of touch is unknown d. "This time we spend together is for you to discuss your concerns. d. "This is your time to focus on your situation. Tell me about your concerns."

1. Maslow's theory of human needs has provided nursing with a framework for o A. Holistic assessment o B. Determining moral development o C. Identifying potential for success in therapy o D. Conducting nurse-client interpersonal interactions · 2. Sullivan viewed anxiety as o A. Emotional experience felt after the age of 5 years o B. A sign of guilt in adults o C. Any painful feeling or emotion arising from social insecurity o D. Adults trying to go beyond experiences of guilt and pain · 3. One implication of Freud's theory of the unconscious on psychiatric mental health nursing is related to the consideration that conscious and unconscious influences can help nurses better understand: o A. The root causes of client suffering o B. The client's immature behavior o C. The client's interpersonal interactions o D. The client's psychological ability to reason · 4. Which of the following contributions to modern psychiatric nursing practice was made by Freud? o A. The theory of personality structure and levels of awareness o B. The concept of "A self-actualized personality" o C. The thesis that culture and society exert significant influence on personality o D. Provision of a developmental model that includes the entire life span · 5. The concept at the heart of Sullivan theory of personality are o A. Needs and anxiety o B. Basic needs and meta-needs o C. Developmental tasks and psychosocial crises o D. Self-esteem and self -actualization

o A. Holistic assessment o C. Any painful feeling or emotion arising from social insecurity o A. The root causes of client suffering o A. The theory of personality structure and levels of awareness o A. Needs and anxiety

1. A person has a high level of resilience. Which other characteristic would the nurse expect this person to have? o A. Optimism o B. Addiction o C. Aggressiveness o D. Depressed affect 2. Which of these mental health problems has the highest annual prevalence in the United States? o A. Schizophrenia o B. Alzheimer's disease o C. Major depressive disorder o D. Generalized anxiety disorder

o A. Optimism o C. Major depressive disorder

1. In-client hospitalization for persons with mental illness is generally reserved for clients who demonstrate which characteristic? o A. present a clear danger to self or others o B. are noncompliant with medication at home o C. have limited support systems in the community o D. develop new symptoms during the course of an illness · 2. A client was hospitalized for 24 hours after a reaction to a psychotropic medication. While planning discharge, the case manager learned that the client received a notice of eviction immediately prior to admission. What is the case manager's most appropriate action? o A. Postpone the client's discharge from the hospital o B. Contact the landlord who evicted the client to further discuss the situation o C. Arrange a temporary place for the client to stay until new housing can be arranged o D. Determine whether the adverse medication reaction was genuine because the client had nowhere to live. · 3. What action is an example of tertiary prevention? o A. Helping a person diagnosed with a serious mental illness learn to manage money o B. Teaching older adults how to deal with loneliness to prevent depression o C. Teaching school-age children about the dangers of drugs and alcohol o D. Genetic counseling with a young couple expecting their first child · 4. A client diagnosed with schizophrenia had an exacerbation related to medication non-adherence and was hospitalized for 5 days. The client's thoughts are now more organized, and discharge is planned. The client's family says, "It's too soon for discharge. We will just go through all this again." What action should the nurse take? o A. ask the case manager to arrange a transfer to a long-term care facility o B. notify hospital security to handle the disturbance and escort the family off the unit. o C. explain that the client will continue to improve if the medication is taken regularly o D. contact the health care provider to meet with the family and explain the discharge rationale · 5. A nurse inspects an inpatient psychiatric unit and finds that exits are free of obstructions, no one is smoking, and the janitor's closet is locked. What do these observations relate to? o A. coordinating care of clients o B. management of milieu safety o C. management of the interpersonal climate o D. use of therapeutic intervention strategies · 6. The psychiatric unit has one bed available. Which client should be admitted from the emergency department? o A. The client feeling anxiety and a sad mood after separation from a spouse of 10 years. o B. The client who self-inflicted a superficial cut on the forearm after a family argument o C. The client experiencing dry mouth and tremor related to taking antipsychotic medication. o D. The client who is a new parent and hears voices saying, "Smother your baby." · 7. A suspicious, socially isolated client lives alone, eats one meal a day at a local shelter, and spends the remaining daily food allowance on cigarettes. What is the community psychiatric nurse's best initial action? o A. Exploring ways to help the client stop smoking o B. Reporting the situation to the manager of the shelter o C. Assessing the client's weight; determine foods and amounts eaten o D. Arranging hospitalization for the client in order to formulate a new treatment plan · 8. A nurse surveying medical records would find evidence suggesting which client's rights have been violated? o A. A client was not allowed to have visitors o B. A client's belongings were searched at admission o C. A client with suicidal ideation was placed on continuous observation o D. Physical restraint was used after a client was assaultive toward a staff member · 9. Which principle has the highest priority when addressing a behavioral crisis in an inpatient setting? o A. Resolve the crisis with the least restrictive intervention possible o B. Swift intervention is justified to maintain the integrity of a therapeutic milieu o C. Rights of an individual client are superseded by the rights of the majority of clients o D. Clients should have opportunities to regain control without intervention if the safety of others is not compromised · 10. A nurse receives these three phone calls regarding a newly admitted client. Which role was fulfilled? A. The psychiatrist wants to complete an initial assessment B. An internist wants to perform a physical examination C. The client's attorney wants an appointment with the client. The nurse schedules the activities for the client. o D. Advocate o E. Case manager o F. Milieu manager o G. Provider of care Refer the request to the health care provider. · 11. What is an example of primary prevention? o A. Assisting a person diagnosed with a serious mental illness to fill a pill-minder o B. Helping school-age children identify and describe normal emotions o C. Leading a psychoeducational group for persons with depression o D. Medicating an acutely ill client who assaulted a staff person

o A. present a clear danger to self or others o C. Arrange a temporary place for the client to stay until new housing can be arranged o A. Helping a person diagnosed with a serious mental illness learn to manage money o C. explain that the client will continue to improve if the medication is taken regularly o B. management of milieu safety o D. The client who is a new parent and hears voices saying, "Smother your baby." o A. Exploring ways to help the client stop smoking o A. A client was not allowed to have visitors o C. Rights of an individual client are superseded by the rights of the majority of clients o F. Milieu manager o B. Helping school-age children identify and describe normal emotions

1. A parent says, "My 2-year-old child refuses toilet training and shouts 'No!' when given directions. What do you think is wrong?" What is the nurse's best reply? o A. "Your child needs firmer control. It is important to set limits now." o B. "This is normal for your child's age. The child is striving for independence." o C. "There may be developmental problems. Most children are toilet trained by age 2." o D. "Some undesirable attitudes are developing. A child psychologist can help you develop a plan." · 2. A 26-month-old displays negative behavior, refuses toilet training, and often says, "No!" Which psychosocial crisis is evident? o A. Trust versus mistrust o B. Initiative versus guilt o C. Industry versus inferiority o D. Autonomy versus shame and doubt · 3. A 4-year-old grabs toys from other children and says, "I want that now!" From a psychoanalytic perspective, this behavior is a product of impulses originating in which system of the personality? o A. Id o B. Ego o C. Superego o D. Preconscious · 4. The parent of a 4-year-old rewards and praises the child for helping a sibling, being polite, and using good manners. These qualities are likely to be internalized and become part of which system of the personality? o A. Id o B. Ego o C. Superego o D. Preconscious · 5. A nurse supports a parent for praising a child who behaves in helpful ways to others. When this child behaves with politeness and helpfulness in adulthood, which feeling will most likely result? o A. Guilt o B. Anxiety o C. Humility o D. Self-esteem · 6. A nurse uses Maslow's hierarchy of needs to plan care for a client diagnosed with mental illness. Which problem will receive priority? o A. Refusal to eat or bathe o B. Reporting feelings of alienation from family o C. Reluctance to participate in unit social activities o D. Being unaware of medication action and side effects · 7. Operant conditioning is part of the treatment plan to encourage speech in a child who is nearly mute. Which technique applies? o A. Encourage the child to observe others talking o B. Include the child in small group activities o C. Give the child a small treat for speaking o D. Teach the child relaxation techniques · 8. A nurse influenced by Peplau's interpersonal theory works with an anxious, withdrawn client. What principle will the interventions be focused on? o A. Rewarding desired behaviors o B. Using assertive communication o C. Changing the client's self-concept o D. Administering medications to relieve anxiety · 9. A client participated in psychotherapy weekly for 5 months. The therapist used free association, dream analysis, and facilitated transference to help the client understand conflicts and foster change. What is the term that applies to this method? o A. Rational-emotive behavior therapy o B. Psychodynamic psychotherapy o C. Cognitive-behavioral therapy o D. Operant conditioning · 10. A psychotherapist works with an anxious, dependent client. Which strategy is most consistent with psychoanalytic psychotherapy? o A. Identifying the client's strengths and assets o B. Praising the client for describing feelings of isolation o C. Focusing on feelings developed by the client toward the therapist o D. Providing psychoeducation and emphasizing medication adherence · 11. A client says to the nurse, "My father has been dead for over 10 years but talking to you is almost as comforting as the talks he and I had when I was a child." Which term applies to the client's comment? o A. Superego o B. Transference o C. Reality testing o D. Countertransference · 12. A client repeatedly stated, "I'm stupid." Which statement by that client would show progress resulting from cognitive-behavioral therapy? o A. "Sometimes I do stupid things." o B. "Things always go wrong for me." o C. "I always fail when I try new things." o D. "I'm disappointed in my lack of ability." · 13. A nurse presents a community education program about mental illness. Which comment by a participant best demonstrates a correct understanding of mental illness from a biological perspective? o A. "Some people experience life events so traumatic that they cannot be overcome." o B. "Disturbed and conflicted family relationships are usually a starting place for mental illness." o C. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault." oD. "Mental illness is the result of developmental complications that cause a person not to grow to their full potential."

o B. "This is normal for your child's age. The child is striving for independence." o D. Autonomy versus shame and doubt o A. Id o C. Superego o D. Self-esteem o A. Refusal to eat or bathe o C. Give the child a small treat for speaking o B. Using assertive communication o B. Psychodynamic psychotherapy o C. Focusing on feelings developed by the client toward the therapist o B. Transference o A. "Sometimes I do stupid things." o C. "My friend has had bipolar disorder for years and many problems have resulted. It's not her fault."

1. The nurse caring for a college student who attempted suicide by overdose believes brain biochemical dysfunction contributes to suicidal behavior. The nurse will be better able to plan necessary health teaching if she identifies the probable neurotransmitter alteration of: o A. Acetylcholine excess o B. Serotonin deficiency o C. Dopamine excess o D. γ-aminobutyric acid deficiency 2. 20-year-old economics major became severely depressed after failing two examinations in economics. She cried for 2 hours, then called her parents who live in a neighboring state, planning to ask if she could return home. Her parents were in Europe. When her roommate went home for the weekend, the client gave her three expensive sweaters to keep. Later, the dormitory resident assistant returned a book to the client's room and found her unconscious on the floor, with an empty pill bottle nearby. The client behavior that provided a clue to the suicide attempt was: o A. Calling her parents o B. Staying in her dorm room o C. Giving away her sweaters o D. Excessive crying 3. The nurse uses the SAD PERSONS scale as he interviews a client who has expressed suicidal ideation. This tool provides data relevant to: o A. Mood disturbance o B. Suicide potential o C. Current stress level o D. Level of anxiety 4. A college student who attempted suicide by overdose was treated in the emergency department. Because the client lives in the dorm, her roommate is away, and her parents are in Europe, the decision was made to hospitalize her. The nursing diagnosis of highest priority would be: o A. Powerlessness o B. Social isolation o C. Compromised family coping o D. Risk for self-directed violence 5. The nurse's efforts to assist a suicidal client to examine alternatives to suicide are best supported by: o A. Tricyclic antidepressants o B. The client's ambivalence o C. Suicide precautions o D. Hospitalization 6. When the nurse and client construct a no-suicide contract, the preferable wording would be: o A. "I will not try to harm myself during the next 24 hours." o B. "In the next 24 hours I will not, for any reason, accidentally or purposely, kill myself." o C. "I will not kill myself until I call you." o D. "I will not make a suicide attempt while I am hospitalized." 7. The most helpful response for the nurse to make when a client being treated as an outpatient states "I am considering committing suicide" is: o A. "I am glad you shared this. There is nothing to worry about. We will handle it together." o B. "We need to talk about the things you have to live for." o C. "I think you should admit yourself to the hospital to get help with this." o D. "Bringing this up is a very positive action on your part." 8. The statement that provides the best rationale for the nursing intervention of monitoring the severely depressed client closely during antidepressant therapy is: o A. As depression lifts, physical energy becomes available to carry out a plan forsuicide B. Suicide may be precipitated by a variety of internal and external events o C. Suicidal clients have difficulty using social supports o D. Suicide is an impulsive act 9. The most appropriate response by the nurse when a despondent client says "nothing matters anymore" would be: o A. "Are you having thoughts of suicide?" o B. "I am not sure I understand what you are trying to say." o C. "Try to stay hopeful. Things have a way of working out." o D. "Tell me more about the things that interested you before you began to feel depressed."

o B. Serotonin deficiency o C. Giving away her sweaters o B. Suicide potential D. risk for self-directed violence o B. The client's ambivalence B. in the next 24 hours, I will not, for any reason, accidentally or purposely, kill myself D. bringing this up is a very positive action on your part A. as depression lifts physical energy becomes available to carry out a plan for suicide A. are you having thoughts of suicide

1) Which individual may need involuntary hospitalization? o A. A person with alcoholism who has been sober for 6 months but begins drinking again o B. An individual with schizophrenia who stops taking prescribed antipsychotic drugs o C. An individual with bipolar disorder, manic phase, who has not eaten in 4 days o D. Someone who repeatedly phones a national TV broadcasting service with news tip 2) JS continues to argue with staff. He is not aggressive, but refuses all treatment. Legal and clients' rights are suspended when a client is hospitalized involuntarily. o A. True o B. False o C. Depends on the state D. Depends on the physician assessment

o C. An individual with bipolar disorder, manic phase, who has not eaten in 4 days o B. False

1) Nursing behaviors associated with the implementation phase of the nursing process are concerned with o A. Gathering accurate and sufficient client-centered data o B. Participating in mutual identification of client outcomes o C. Carrying out interventions and coordinating care o D. Comparing client responses and expected outcomes · 2) During the initial assessment interview the client becomes anxious and evasive when the nurse asks her if she has ever heard voices when no one else was around. The client asks, "What do you need to know that for?" The nurse should say o A. "Please be honest about this," after repeating the question o B. "Sometimes questions seem highly personal, but we have our reasons for asking each one." o C. "What purpose do you think we might have in asking about whether you hear voices?" o D. "I can see this subject makes you uncomfortable. We can discuss it at another time." · 3) Which of the following statements is most true about the difference between delusions and hallucinations? o a. Delusions are false believes while hallucinations are false perceptions. o b. Delusions are systems, hallucinations are believes o c. Delusions are always true and hallucinations are always false o d. Delusions are based on facts and hallucinations are based on believes. · 4) The patient rushes up to you and says "They're after me. They want to torture me and kill me." This is an example of: o a. Idea of reference b. Auditory hallucinations c. Delusions of persecution d. Abstract thinking · 5) The nurse asks the patient: "What brought you to the hospital?" The patient replies: "A bus". This is an example of: o a. Concreteness of thought o b. Blocking of thought o c. Irrelevant answer o d. incoherence

o C. Carrying out interventions and coordinating care o D. "I can see this subject makes you uncomfortable. We can discuss it at another time." o a. Delusions are false believes while hallucinations are false perceptions. c. Delusions of persecution o a. Concreteness of thought

1) We know that Eleanor has come to the clinic for help with sleep. Which function of the brain controls this? o A. Homeostasis o B. ANS regulation o C. Circadian rhythm o D. Impulse conduction 2) Which part of the brain is most responsible for Eleanor's difficulty with delivering her lectures and remembering whether she has eaten? o A. Brainstem o B. Cerebrum o C. Cerebellum o D. Hypothalamus 3) Which neuroimaging technique would reveal problems in the anatomical structure of the brain but not problems in function? o A. CT o B. PET o C. SPECT o D. None of the above 4) A patient has decreased circulating levels of GABA. Which health problem is this most likely to suggest? o A. Alzheimer's disease o B. Parkinson's disease o C. Anxiety disorders o D. Insomnia 5) Eleanor is treated with a _____, which helps to slow the destruction of acetylcholine. o A. 5-HT2A (serotonin) antagonist o B. GABA o C. D2 (dopamine) antagonist o D. cholinesterase inhibitor 6) When the wife of a client with schizophrenia asks which neurotransmitter is implicated in the development of schizophrenia, the nurse should state "The current thinking is that the thought disturbances are related to o A. excess dopamine o B. serotonin deficiency o C. histamine decrease o D. increased γ-aminobutyric acid [GABA] 7) A client is seen in the emergency department for symptoms of acute anxiety related to the death of her mother in an automobile accident 2 hours ago. To prepare a care plan, the nurse must correctly hypothesize that the client will need teaching about a drug from the group called o A. tricyclic antidepressants o B. antimanic drug o C. benzodiazepines o D. neuroleptic drugs 8) A client's husband is a chemist. He asks the nurse the action by which SSRIs lift depression. The nurse should explain that SSRIs o A. make more serotonin available at the synaptic gap o B. destroy increased amounts of neurotransmitter o C. increase production of acetylcholine and dopamine oD. block muscarinic and α1 norepinephrine receptors

o C. Circadian rhythm o B. Cerebrum o A. CT o C. Anxiety disorders o D. cholinesterase inhibitor o A. excess dopamine o C. benzodiazepines o A. make more serotonin available at the synaptic gap

1) You are about to initiate your first contact with Becky. Which is the most suitable goal in establishing the therapeutic relationship? o A. Establish friendship and a sense of fun o B. Ensure that mutual needs will be met o C. Establish clear boundaries while identifying patientneeds o D. Ensure two-way communication to give or ask for help 2) You notice that you look forward to talking to Becky because her dark sense of humor reminds you of your best friend in high school. You also begin to make little cynical jokes, hoping to have a good laugh together. What is this relationship showing early signs of? o A. Accountability o B. Self-reflection o C. Transference o D. Countertransference 3) After your first conversation, Becky withdraws from you again before you've even really begun. Which statement will contribute most to establishing Becky's trust? o A. "Weren't you complying with your medication regimen?" o B. "It must be discouraging to be readmitted to the hospital so soon." o C. "Everyone with bipolar disorder ends up in the hospital occasionally." o D. "You must take your drugs as prescribed, or you will be hospitalized." 4) Becky tells you, "I have something secret to tell you, but you can't tell anyone else." The nurse agrees. What is the likely consequence of the nurse's action? o A. Healthy feelings of sympathy by the nurse toward the client o B. Blurred boundaries in the nurse-client relationship o C. Improved rapport between the nurse and client o D. Enhanced trust between the nurse and client 5) As Becky is preparing for discharge, she presents you with a handmade card of appreciation for the care you provided. Should you accept the card? o A. Yes o B. No o C. Depends on state laws o D. Depends on her illness

o C. Establish clear boundaries while identifying patientneeds o D. Countertransference o B. "It must be discouraging to be readmitted to the hospital so soon." o B. Blurred boundaries in the nurse-client relationship o A. Yes

1) A person requests help for cocaine withdrawal symptoms. Which is least likely to be part of this individual's treatment plan? o A. Diazepam. o B. Bupropion. o C. Inpatient care. o D. Group therapy. 2) A patient is admitted to the ED experiencing respiratory distress due to opioid overdose. As soon as his respiration is stabilized, which drug should be administered? o A. Naloxone o B. Bupropion o C. Methadone o D. Clonidine 3) Shortly before kicking Antony out, his girlfriend had stayed home from a planned night out with her friends to pour all the alcohol in their apartment down the drain. What type of behavior is evident? o A. Enabling o B. Tolerance o C. Codependence o D. Use of defense mechanisms 4) Which method of suicide has the highest lethality? o A. Ingesting pills o B. Cutting one's wrists o C. Inhaling natural gas o D. Self-inflicted gunshot wound 5) Considering Gina's behavior on the fourth day of hospitalization, which factor should the nurse consider? o A. The patient is showing improvement and may be ready for discharge o B. The patient may have decided to commit suicide; the nurse should reassess suicidality o C.The patient is feeling rested, supported by the therapeutic milieu, and less depressed o D.The patient is benefiting from the antidepressant she has been taking for 4 day

o C. Inpatient care. o A. Naloxone o C. Codependence o D. Self-inflicted gunshot wound o B. The patient may have decided to commit suicide; the nurse should reassess suicidality

1) According to Freud, which aspect of the personality motivates an individual to seek perfection? o A. Id o B. Ego o C. Superego o D. Not sure 2) As you begin working with her, you notice Ms. V has an uncanny resemblance to your younger sister. As a child, this sister lied and criticized you constantly, then screamed and cried to others if you challenged her. You realize that you are responding negatively to this patient. What's going on here? o A. Mutuality o B. Self-system o C. Self-actualization oD. Countertransference

o C. Superego o D. Countertransference

1) Which type of prevention is Edgar's team most focused on? o A. Primary prevention o B. Secondary prevention o C. Tertiary prevention o D. It's too late for prevention; Edgar already has a depressive disorder 2) 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? o A. "Your belt is locked in the business office for safekeeping, along with all your other valuables." o B. "For safety reasons, hospitalized clients are not allowed to keep certain personal possessions." o C. "I cannot provide your belt, but I will help you get some pants with an elastic waistband." o D. "I will ask the psychiatric technician to get your belt for you." 3) Which of the following types of care would a nurse recommend for a client who has been recently released from prison with a serious mental illness and requires assistance with daily living? o A. Long term care facility o B. Crisis stabilization unit o C. Forensic care program o D. Geriatric care center 4) Which of the following initiated the movement for the deinstitutionalization of clients who have mental illnesses? o A. The CDC global health act o B. The Special Initiative for Mental Health o C. The Passing of the Community Mental Health Act o D. The Development of National Institute for Mental Health

o C. Tertiary prevention o C. "I cannot provide your belt, but I will help you get some pants with an elastic waistband." o C. Forensic care program o C. The Passing of the Community Mental Health Act

1) A nurse is presenting information over the mental health services over the last 50 years to a group of a newly licensed nurses, in 1946 the national mental health act was signed into laws which resulted in which of the following: o A. The establishment of the mental health court to determine soundness or fitness to stand trial o B. The development of mental health centers throughout community settings o C. The creation of the National Institute for Mental Health 2) Which statement about mental illness is true? o a. Mental illness is a matter of individual nonconformity with societal norms. o b. Mental illness is present when individual irrational and illogical behavior occurs. o c. Mental illness changes with culture, time in history, political system and group defining it. o d. Mental illness is evaluated solely by considering individual control over behavior and appraisal of reality.

o C. The creation of the National Institute for Mental Health o c. Mental illness changes with culture, time in history, political system and group defining it.

1) As Mr. R's sister has suspected, Mr. S sometimes forgets to eat. In which part of the nursing care plan would the nurse expect to find this statement: "Offer snacks and finger foods frequently." o A. Assessment o B. Diagnosis o C. Planning and outcomes identification o D. Implementation o E. Evaluation 2) You teach Mr. R's sister about important precautions associated with a new prescription. Afterward, she accurately summarizes major self-management strategies associated with this drug. Which step of the nursing process applies to her summarization? o A. Assessment o B. Analysis o C. Planning/outcomes identification o D. Intervention o E. Evaluation 3) Which of the following is considered part of the planning (generating solutions) step of the nursing process? o A. Prioritizing nursing care and the awareness of possible negative effects of chosen interventions o b. Linking Cues o c. Clustering information o d. Providing evidence for the hypothesis that has been created 4) A nursing is caring for a client and notes that the client has become increasingly restless over the last hour. This is an example of which of the following steps of the CJAM? o A. Taking action o B. Prioritizing hypotheses o C. Analyzing cues o D. Recognizing cues

o D. Implementation o E. Evaluation o A. Prioritizing nursing care and the awareness of possible negative effects of chosen interventions o D. Recognizing cues

1. Four individuals have given information about their suicide plans. Which plan evidence the highest suicide risk? o A. Turning on the oven and letting gas escape into the apartment during the night o B. Cutting the wrists in the bathroom while the spouse reads in the next room o C. Overdosing on aspirin with codeine while the spouse is out with friends o D. Jumping from a railroad bridge located in a deserted area late at night 2. Which measure would be considered a form of primary prevention for suicide? o A. Psychiatric hospitalization of a suicidal client o B. Referral of a formerly suicidal client to a support group o C. Suicide precautions for 24 hours for newly admitted clients o D. Helping school children learn to manage stress and be resilient 3. Which change in the brain's biochemical function is most associated with suicidal behavior? o A. Dopamine excess o B. Serotonin deficiency o C. Acetylcholine excess o D. γ-aminobutyric acid deficiency 4. A college student who failed two tests cried for hours and then tried to telephone a parent but got no answer. The student then gave several expensive sweaters to a roommate and asked to be left alone for a few hours. Which behavior provides the strongest clue of an impending suicide attempt? o A. Calling parents o B. Excessive crying o C. Giving away sweaters o D. Staying alone in dorm room 5. A person intentionally overdosed on antidepressants. Which nursing diagnosis has the highest priority? o A. Powerlessness o B. Social isolation o C. Risk for suicide o D. Compromised family coping 6. A person who attempted suicide by overdose was treated in the emergency department and then hospitalized. What is the initial outcome for this client? o A. verbalizing a will to live by the end of the second hospital day. o B. describing two new coping mechanisms by the end of the third hospital day. o C. accurately delineating personal strengths by the end of first week of hospitalization. o D. exercising suicide self-restraint by refraining from attempts to harm self for 24 hours. 7. A college student who attempted suicide by overdose was hospitalized. When the parents were contacted, they responded, "We should have seen this coming. We did not do enough." What does the parents' reaction reflect? o A. guilt o B. denial o C. shame o D. rescue feelings 8. What is the most critical question for the nurse to ask an adolescent who has threatened to take an overdose of pills? o A. "Why do you want to kill yourself?" o B. "Do you have access to medications?" o C. "Have you been taking drugs and alcohol?" o D. "Did something happen with your parents?" 9. It has been 5 days since a suicidal client was hospitalized and prescribed antidepressant medication. The client is now more talkative and shows increased energy. What is the highest priority nursing intervention? o A. Supervise the client 24 hours a day o B. Begin discharge planning for the client o C. Refer the client to art and music therapists o D. Consider discontinuation of suicide precautions 10. A nurse interacts with a client who has a history of multiple suicide attempts. What is the most helpful response for a nurse to make when the client states, "I am considering committing suicide."? o A. "I'm glad you shared this. Please do not worry. We will handle it together." o B. "I think you should admit yourself to the hospital to keep you safe." o C. "Bringing up these feelings is a positive action on your part." o D. "We need to talk about the good things you have to live for." 11. Which intervention will the nurse recommend for the distressed family and friends of someone who has committed suicide? o A. Participating in reminiscence therapy o B. Psychological postmortem assessment o C. Attending a self-help group for survivors o D. Contracting for at least two sessions of group therapy 12. Which statement provides the best rationale for closely monitoring a severely depressed client during antidepressant medication therapy? o A. As depression lifts, physical energy becomes available to carry out suicide o B. Clients who previously had suicidal thoughts need to discuss their feeling o C. For most clients, antidepressant medication results in increased suicidal thinking o D. Suicide is an impulsive act. Antidepressant medication does not alter impulsivity 13. A depressed client says, "Nothing matters anymore." What is the most appropriate response by the nurse? o A. "Are you having thoughts of suicide?" o B. "I am not sure I understand what you are trying to say." o C. "Try to stay hopeful. Things have a way of working out." o D. "Tell me more about what interested you before you became depressed." 14. A nurse counsels a client with recent suicidal ideation. Which is the nurse's most therapeutic comment? o A. "Let's make a list of all your problems and think of solutions for each one." o B. "I'm happy you're taking control of your problems and trying to find solutions." o C. "When you have bad feelings, try to focus on positive experiences from your life." D. "Let's consider which problems are very important and which are less important.

o D. Jumping from a railroad bridge located in a deserted area late at night o D. Helping school children learn to manage stress and be resilient o B. Serotonin deficiency o C. Giving away sweaters o C. Risk for suicide o D. exercising suicide self-restraint by refraining from attempts to harm self for 24 hours. o A. guilt o B. "Do you have access to medications?" o A. Supervise the client 24 hours a day o C. "Bringing up these feelings is a positive action on your part." o C. Attending a self-help group for survivors o A. As depression lifts, physical energy becomes available to carry out suicide o A. "Are you having thoughts of suicide?" D. "Let's consider which problems are very important and which are less important.

1) After several therapeutic encounters with a client who recently attempted suicide, the behavior that would cause the nurse to consider the possibility of countertransference is that o A. The client's reactions toward the nurse seem realistic and appropriate. o B. The client states the nurse is concerned about her, just like her father. o C. The nurse develops a trusting relationship with the client. o D. The nurse feels exceptionally happy when the client's mood begins to lift. 2) At what point in the nurse-client relationship should the nurse plan to firstaddress the issue of termination? o A. In the working phase o B. In the termination phase o C. In the orientation phase o D. When the client initially brings up the topic 3) The nurse introduces the matter of a contract during the first session becausecontracts o A. Specify what the nurse will do for the client. B. Are indicative of the feeling tone established between the participants. C. Are binding and prevent either party from prematurely ending the relationship. D. Spell out the participation and responsibilities of both parties. 4) The remark by a client that would indicate passage into the working phase of the nurse-client relationship is o A. "I don't have any problems." B. "It is so difficult for me to talk about problems." C. "I don't know how talking about things twice a week can help." D. "I think I would like to find a way to deal with my anger without blowing up." 5) The nurse attempts to explain to the family of a mentally ill client how the nurse-client relationship differs from other interpersonal relationships. The best explanation is that o A. The focus is on the client; problems are discussed by the nurse and client; and solutions are implemented by the client. o B. The focus shifts from nurse to client; advice is given by both parties; and solutions are implemented by each. o C. The focus is socialization; mutual needs are met; and feelings are shared. o D. The focus is creation of a partnership in which each member is concerned with growth and satisfaction of the other. 6) The nurse wishes to demonstrate genuineness within the context of the nurse-client relationship with his client who has been diagnosed with schizophrenia. The nurse will need to: o A. Use extensive self-revelation in client interactions. o B. Encourage the client to depend on him for support and reassurance. o C. Consistently make value judgments about client behaviors. o D. Be aware of his own feelings and use congruent communication strategies. 7) The nurse caring for a withdrawn, suspicious client finds himself feeling angry with the client. The nurse should o A. Suppress the angry feelings. o B. Express the anger openly and directly. o C. Tell the nurse manager to assign the client to another nurse. o D. Discuss the anger with a clinician during a supervisory session. 8) A client says, "I've done a lot of cheating and manipulating in my relationships." A nonjudgmental response by the nurse would be o A. "How do you feel about that?" o B. "It's good that you realize this." o C. "What a rotten way to behave." o D. "Have you outgrown that immature behavior?" 9) The client mentions to the nurse "I'm still on restriction to the unit and I'd really like to start attending off-unit activities. Would you ask the doctor to upgrade my privileges?" The best response for the nurse would be o A. "I'll be glad to mention it when I see the doctor later today." o B. "That's a good topic for you to take up with the doctor. You'll be meeting at 2 PM." o C. "Why are you asking me to do this when you're perfectly capable of speaking for yourself?" D. "Do you think you are so unimportant that you can't speak to a doctor and that a nurse must intercede?

o D. The nurse feels exceptionally happy when the client's mood begins to lift. o C. In the orientation phase D. Spell out the participation and responsibilities of both parties. D. "I think I would like to find a way to deal with my anger without blowing up." A. The focus is on the client; problems are discussed by the nurse and client; and solutions are implemented by the client. o B. Encourage the client to depend on him for support and reassurance. o D. Discuss the anger with a clinician during a supervisory session. o A. "How do you feel about that?" o B. "That's a good topic for you to take up with the doctor. You'll be meeting at 2 PM."

1) The nursing care plan contains the direction "observe for refeeding syndrome." The nurse should closely monitor for complications associated with o A. renal dysfunction. o B. central nervous system dysfunction. o C. endocrine dysfunction. o D. cardiovascular dysfunction. 2) The nurse is planning care for a patient with an eating disorder. What outcomes are appropriate? Select all that apply? o A. The patient will experience a decrease in depression. o B. The patient will identify methods to control anxiety. o C. The patient will collect different kinds of cookbooks. o D. The patient will identify two people to contact if suicidal thoughts occur. 3) A client, age 18 years, is referred to the mental health center by the primary care physician. The following history is given. The client and her mother began to visit colleges to which theclient had applied. When not traveling, the client spent the summer cooking gourmet meals for her family. Eventually, the mother noticed that the client was eating only tiny portions of the food, saying she wasn't hungry because she had tasted while she cooked. At summer's end the client had a physical examination for the school sports program. Her weight had dropped from 130 to 95 pounds and she had amenorrhea. The history and symptoms are most consistent with the medical diagnosis of o A. anorexia nervosa. o B. bulimia nervosa. o C. binge eating. o D. eating disorder not otherwise specified

o D. cardiovascular dysfunction. o A. The patient will experience a decrease in depression. oB. The patient will identify methods to control anxiety. o D. The patient will identify two people to contact if suicidal thoughts occur. o A. anorexia nervosa.

1) In a treatment team planning meeting a nurse states her concern about whether the staff is behaving ethically in using restraint to prevent one client from engaging in self-mutilating behavior when the care plan for another self-mutilating client calls for one-on-one supervision. The ethical principle that should govern the situation is. o A. beneficence o B. autonomy o C. fidelity o D. justice · 2) The nursing intervention that constitutes false imprisonment is: o A. The client is confused and combative. He insists that no one can stop him from leaving. The nurse restrains him without a physician's order, then seeks the order. o B. The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts him to his room and tells him to stay there or he'll be put into seclusion. o C. A psychotic client, admitted as an involuntary patient, runs out of the psychiatric unit. The nurse runs after him and succeeds in talking the client into returning to the unit. o D. A client, hospitalized as an involuntary admission, attempts to leave the unit. The nurse calls the security team and, acting on established protocol, they prevent him from leaving. · 3) A male adolescent was admitted to a psychiatric unit after a violent physical outburst. He asks the nurse to promise to keep confidential a plan he has to kill his father. The nurse should respond by saying o A. "Those kinds of thoughts will make your hospitalization longer." o B. "I can make that promise to you based on nurse-client privilege." o C. "You really should share this thought with your psychiatrist." o D. "I am obligated to share information with the treatment team." · 4) A client approaches the unit charge nurse and states he wants to talk to the mental health advocate immediately about getting released. The unit has no pay phone and agency policy does not permit clients to enter the nurses' station. The nurse should o A. tell the client to secure a physician's order to leave the unit to make the call o B. give the client a pen and paper and ask him to write the advocate o C. document the request in the client's medical record. o D. call the advocate and convey the client's request · 5) What is the nurse's duty when a client tells the nurse he plans to kill his wife and her lover as soon as he is released from the hospital? The nurse must o A. document this information in the client's record and report it to the physician and team. o B. immediately call the client's wife and her lover to warn them. o C. immediately call to warn the client's wife but not her lover. o D. file a report with the local law enforcement authorities · 6) The nurse caring for a 72-year-old client admitted for treatment of depression notes that the physician's order to begin therapy with an antidepressant calls for a dose greater than the usual adult dose. The nurse should o A. consult a drug reference. o B. implement the order. o C. give the usual adult dose. o D. hold the medication and consult the physician. · 7) A client tells the nurse "When I saw my therapist yesterday, he stroked my breast and suggested that he will give me a pass to leave the hospital if I will meet him at his apartment." What action should the nurse take? o A. None; psychiatric clients are not reliable. o B. Report the client's statements to the unit nurse manager. o C. Discuss the statements with the medical director. o D. Call the state medical board. · 8) A client became aggressive, struck another client, and required seclusion. The best documentation is o A. "Client apparently doesn't like client X, as evidenced by his striking client X when client attempted to leave day room to go to bathroom. Seclusion necessary at 2:15 PM. Plan: Maintain seclusion for 8 hours and keep this client and client X away from each other for 24 hours." o B. "Seclusion ordered by Dr. at 2:15 PM when voices told the client to hit another client." o C. "Client pacing, shouting at people not present in the environment. Chlorpromazine 50 mg administered po at 1 PM with no effect by 2 PM. At 2:15 PM client shouted that he would punch the first person who got near him, then struck client X on the jaw with his fist as client X walked out of day room to go to bathroom. Client physically restrained by staff and placed in seclusion by order of Dr. Y." o D. "Seclusion ordered by Dr. Y for aggressive behavior, begun at 2:15 PM. Maintained for 2 hours without incident. Outcome: Client calmer

o D. justice o B. The client has been "pesky," seeking the attention of nurses in the nurses' station much of the day. Now the nurse escorts him to his room and tells him to stay there or he'll be put into seclusion. o D. "I am obligated to share information with the treatment team." o D. call the advocate and convey the client's request o A. document this information in the client's record and report it to the physician and team. o D. hold the medication and consult the physician. o B. Report the client's statements to the unit nurse manager. o C. "Client pacing, shouting at people not present in the environment. Chlorpromazine 50 mg administered po at 1 PM with no effect by 2 PM. At 2:15 PM client shouted that he would punch the first person who got near him, then struck client X on the jaw with his fist as client X walked out of day room to go to bathroom. Client physically restrained by staff and placed in seclusion by order of Dr. Y."

1. For psychiatric nurses, a major difference between caring for clients in the community and caring for clients in the hospital is that: o a. Treatment is negotiated rather than imposed in the community setting. o b. Fewer ethical dilemmas are encountered in the community settings. o c. Cultural considerations are less important during treatment in the community. o d. The focus in the community setting is solely on managing symptoms of mental illness. · 2. A significant influence allowing psychiatric treatment to move from the hospital to the community was: o a. Television o b. The discovery of psychotropic medications o c. Identification of external causes of mental illness o d. The use of collaborative approach by clients and staff focusing on rehabilitation · 3. A typical treatment goal for a client with mental illness being treated in the community setting is that the client will: o a. Experience destabilization of symptoms o b. Take medications as prescribed o c. Learn to live with dependency and decreased opportunities o d. Accept guidance and structure of significant others · 4. Which action on the part of a community psychiatric nurse visiting the home of a client would be considered inappropriate: o a. Turning off an intrusive TV program without the client's permission o b. Facilitating the client's access to a community kitchen for two meals a day o c. Going beyond the professional role boundary to hang curtains for an elderly client o d. Arranging to demonstrate the use of public transportation to a mental health clinic

o a. Treatment is negotiated rather than imposed in the community setting. o b. The discovery of psychotropic medications o b. Take medications as prescribed o a. Turning off an intrusive TV program without the client's permission

1. As a nurse prepares to administer medication to a patient diagnosed with a borderline personality disorder, the patient says, "Just leave it on the table. I'll take it when I finish combing my hair." What is the nurse's best response? o a. Reinforce this assertive action by the patient. Leave the medication on the table as requested. o b. Respond to the patient, "I'm worried that you might not take it. I'll come back later. o c. Say to the patient, "I must watch you take the medication. Please take it now. o d. Ask the patient, "Why don't you want to take your medication now"? 2. What is an appropriate initial outcome for a patient diagnosed with a personality disorder who frequently manipulates others? The patient will o a. Identify when feeling angry. o b. use manipulation only to get legitimate needs met. o c. acknowledge manipulative behavior when it is called to his or her attention. o D. accept fulfillment of his or her requests within an hour rather than immediately. 3. Sydney is admitted to the psych unit for evaluation. Which behaviors would be consistent with a diagnosis of borderline personality disorder? o A. Splitting o B. Inflexible standards o C. Lack of empathy o D. Absence of remorse 4. Which behavior indicates that Sydney, our patient diagnosed with borderline personality disorder, is improving? o A. She cries when her roommate refuses to go to the dining room with her. o B. She yells at the group facilitator when he points out that she is monopolizing the group. o C. She informs a staff member that she is having thoughts of harming herself. o D. She tells the evening staff that the day staff excused her from group to smoke when she got upset. 5. Perfectionism is a trait likely to be evident in a person with which personality disorder? o A. Obsessive-compulsive o B. Narcissistic o C. Antisocial o D. Avoidant 6. Antisocial, obsessive-compulsive, and schizotypal personality disorders occur most frequently in o A. adolescents. o B. children. o C. women. o D. men.

o c. Say to the patient, "I must watch you take the medication. Please take it now. o c. acknowledge manipulative behavior when it is called to his or her attention. o A. Splitting o C. She informs a staff member that she is having thoughts of harming herself. o A. Obsessive-compulsive o D. men.

1. A client asks, "What are neurotransmitters? My doctor said mine are imbalanced." What is the nurse's best response? o A. "How do you feel about having imbalanced neurotransmitters?" o b. "Neurotransmitters protect us from harmful effects of free radicals." o c. "Neurotransmitters are substances we consume that influence memory and mood." o d. "Neurotransmitters are natural chemicals that pass messages between brain cells." · 2. The nurse prepares to assess a client diagnosed with major depressive disorder for disturbances in circadian rhythms. Which question should the nurse ask this client? o A. "Have you ever seen or heard things that others do not?" o B. "What are your worst and best times of the day?" o C. "How would you describe your thinking?" o D. "Do you think your memory is failing?" · 3. The nurse administers a medication that potentiates the action of ã-aminobutyric acid (GABA). Which effect would be expected? o A. Reduced anxiety o b. Improved memory o c. More organized thinking o d. Fewer sensory perceptual alterations · 4. A fearful client has an increased heart rate and blood pressure. The nurse suspects increased activity of which neurotransmitter? o A. GABA o b. Norepinephrine o c. Acetylcholine o d. Histamine · 5. A client has acute anxiety related to an automobile accident 2 hours ago. The nurse should teach the client about medication from which group? o A. Tricyclic antidepressants o B. Antipsychotic drugs o C. Mood stabilizers o D. Benzodiazepines · 6. A client diagnosed with bipolar disorder displays aggressiveness, agitation, talkativeness, and irritability. The nurse expects the health care provider to prescribe a medication from which group? o A. Psychostimulants o B. Mood stabilizers o C. Anticholinergics o D. Antidepressants

o d. "Neurotransmitters are natural chemicals that pass messages between brain cells." o B. "What are your worst and best times of the day?" o A. Reduced anxiety o b. Norepinephrine o D. Benzodiazepines o A. Psychostimulants

1. Which statement best describes a major difference between a DSM-V diagnosis and a nursing diagnosis? o a. There is no functional difference between the two. Both serve to identify a human deviance. o b. The DSM-V diagnosis disregards culture, whereas the nursing diagnosis takes culture into account. o c. The DSM-V is associated with present distress or disability, whereas a nursing diagnosis considers past and present responses to actual mental health problems. o d. The DSM-V diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a client is experiencing. 2. Resilience, the capacity to rebound from stressors via adaptive coping, is associated with positive mental health. Your friend has just been laid of from his job. Which of the following responses on your part most likely contribute to enhanced resilience? o a. Using your connection to set up an interview with your employer. o b. Connecting him with a friend with the family who owns his owns business. o c. Supporting him in arranging, preparing for, and completing multiple interviews. o d. Helping him to understand that the layoff resulted from troubles in the economy and is not his fault. 3. Which of the following situations best supports the stress-diathesis model of mental illness development? o a. The rate of suicide increases during times of national disaster and despair. o b. Four of five siblings in the Jones family develop bipolar disorder by the age of 30. o c. A man with no prior mental health problems experiences sadness after his divorce. o d. A man develops schizophrenia, but his identical twin remains free of mental illness.

o d. The DSM-V diagnosis impacts the choice of medical treatment, whereas the nursing diagnosis offers a framework for identifying interventions for phenomena a client is experiencing. o c. Supporting him in arranging, preparing for, and completing multiple interviews. o d. A man develops schizophrenia, but his identical twin remains free of mental illness.

1. Four teenagers died in an automobile accident. One week later, which behavior by the parents of these teenagers most clearly demonstrates resilience? The parents who o a. visit their teenager's grave daily. o b. return immediately to employment. o c. discuss the accident within the family only. o d. create a scholarship fund at their child's high school. 2. A woman just received notification that her husband died. She approaches the nurse who cared for him during his last hours and says angrily, "If you had given him your undivided attention, he would still be alive." How should the nurse analyze this behavior? o a. The comment suggests potential allegations of malpractice. o b. In some cultures, grief is expressed solely through anger. o c. Anger is an expected emotion in an adjustment disorder. o d. The patient had ambivalent feelings about her husband. 3. A store clerk was killed during a robbery 2 weeks ago. His widow, who has a long history of schizoaffective disorder, cries spontaneously when talking about his death. Select the nurse's most therapeutic response. o a. "Are you taking your medications the way they are prescribed?" o b. "This loss is harder to accept because of your mental illness. Do you think you should be hospitalized?" o c. "I'm worried about how much you are crying. Your grief over your husband's death has gone on too long." o d. "The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings." 4. Which scenario demonstrates a dissociative fugue? o a. After being caught in an extramarital affair, a man disappeared but then reappeared months later with no memory of what occurred while he was missing. o b. A man is extremely anxious about his problems and sometimes experiences dazed periods of several minutes passing without conscious awareness of them. o c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of "blackouts" despite not drinking. o d. A woman reports that when she feels tired or stressed, it seems like her body is not real and is somehow growing smaller. 5. The nurse who is counseling a patient with dissociative identity disorder should understand that the assessment of highest priority is o a. risk for self-harm o b. cognitive function. o c. memory impairment. o d. condition of self-esteem 6. A patient states, "I feel detached and weird all the time. It is as though I am looking at life through a cloudy window. Everything seems unreal. It really messes up things at work and school." This scenario is most suggestive of which health problem? o a. Acute stress disorder o b. Dissociative amnesia o c. Depersonalization disorder o d. Disinhibited social engagement disorder 7. A patient diagnosed with depersonalization disorder tells the nurse, "It's starting again. I feel as though I'm going to float away." Which intervention would be most appropriate at this point? o a. Notify the health care provider of this change in the patient's behavior. o b. Engage the patient in a physical activity such as exercise. o c. Isolate the patient until the sensation has diminished. o d. Administer a prn dose of antianxiety medication.

o d. create a scholarship fund at their child's high school. b. In some cultures, grief is expressed solely through anger. o d. "The unexpected death of your husband is very painful. I'm glad you are able to talk about your feelings." o c. A woman finds unfamiliar clothes in her closet, is recognized when she goes to new restaurants, and complains of "blackouts" despite not drinking. o a. risk for self-harm o c. Depersonalization disorder o b. Engage the patient in a physical activity such as exercise.

Compare and contrast the four levels of anxiety in relation to perceptual field, ability to problem solve, physical and other defining characteristics, and intervention provided A recent diagnosis of cancer has caused a client severe anxiety. Which of the following interventions should the nurse include in the care plan? Select all that apply. § a. Maintain a calm, non-threatening environment § b. Explain relevant aspects of chemotherapy § c. Encourage the client to verbalize her concerns regarding the diagnosis § d. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress § e. Provide distractions for the client during periods of stress § f. Teach the stages of grieving to the client

§ a. Maintain a calm, non-threatening environment § c. Encourage the client to verbalize her concerns regarding the diagnosis § d. Encourage the client to use deep-breathing exercises and other relaxation techniques during periods of increased stress