PMHN Practice Exam 3

If a patient states he feels "life is pointless," an appropriate response is: "Everyone feels down at some time in his life." "Just be patient. You will feel better soon." "Why don't you try to think of some positive things in your life." "I can see you are upset. What are you feeling now?"

"I can see you are upset. What are you feeling now?" Rationale: If a patient states he feels "life is pointless," an appropriate response is "I can see you are upset. What are you feeling now?" because this acknowledges the patient's feelings and encourages the patient to explore the cause of the feelings without rejecting or belittling the patient's expressions. Statements that may be construed as suicidal should always be taken seriously and dealt with forthrightly, such as by asking the patient if he is considering suicide.

Which of the following statements by a patient indicates a readiness to learn? "I don't need to be hospitalized as there's nothing wrong with me.". "It's my mother's fault I ended up here." "I already know all I need to." "I need to be in better control of my life."

"I need to be in better control of my life." Rationale: "I need to be in better control of my life" is the statement that indicates a readiness to learn because the patient is expressing motivation. The four types of readiness to learn include (1) physical readiness (health, gender, vision, hearing), (2) emotional readiness (motivation, frame of mind, anxiety level, support system, developmental stage), (3) experiential readiness (cultural background, orientation, aspiration level, and (4) knowledge readiness (cognitive ability, learning style, learning disabilities, educational background).

Which of the following feedback is specific and descriptive? "You were very sarcastic in the group meeting today." "Marvin became upset when you made a joke about his failure to maintain sobriety." "You tend to be thoughtless when you address other patients in the group." "You should treat others with more respect in group meetings."

"Marvin became upset when you made a joke about his failure to maintain sobriety." Rationale: The feedback that is specific and descriptive is "Marvin became upset when you made a joke about his failure to maintain sobriety" because it gives the essential facts. "You were very sarcastic in the group meeting today" is evaluative ("very sarcastic") without outlining the specific problem. "You tend to be thoughtless when you address other patient in the group" is too general. "You should treat others with more respect in group meetings" is giving advice ("you should") as opposed to feedback.

Which of the following statements by a psychiatric and mental health nurse demonstrates a good understanding of peer review? "I don't mind reviewing someone as long as my review is anonymous." "My peer review is going to get him fired for incompetence!" "Peer review is a good learning experience for me and the person I'm reviewing." "The supervisor should do the peer reviews because the supervisor has more authority."

"Peer review is a good learning experience for me and the person I'm reviewing." Rationale: The statement by a psychiatric and mental health nurse that demonstrates a good understanding of peer review is "Peer review is a good learning experience for me and the person I'm reviewing." The point of peer review is that the reviews are done by peers, those of the same rank, and not supervisors and never anonymously. The reviewer and the reviewee should discuss the review, with the reviewer prompting the reviewee to seek solutions to any problems that may have been identified.

If a family member of a patient asks the psychiatric and mental health nurse what constitutes probable cause for involuntary commitment, the best response is: "You should ask an attorney about that." "The person is a threat to herself or others." "The person is uncooperative with the family." "The person is no longer able to work and is homeless."

"The person is a threat to herself or others." Rationale: While laws may vary slightly from one state to another in relation to involuntary commitment, generally probable cause is present if a person is a threat to herself or others (and usually the threat must be imminent). A second criterion is usually that the person is too disabled to provide self-care; however, this last criterion can be interpreted in a wide variety of ways (the reason so many mentally ill individuals are homeless and living on the streets) and is rarely utilized.

During the initial interview, the patient states repeatedly that his boss is to blame for all of the patient's problems and that the boss "is going to pay." The psychiatric and mental health nurse should respond by asking: "Why do you feel that way?" "What thoughts have you had about hurting your boss?" "Can you think of other reasons for your problems?" "Do you think that this anger toward your boss is productive?"

"What thoughts have you had about hurting your boss?" Rationale: If, during an interview the patient blames his boss for his problems and states that the boss is "going to pay," this is an implied threat. Because of the duty to warn those who might be in danger from a patient with mental health issues, the psychiatric and mental health nurse should ask directly, "What thoughts have you had about hurting your boss?" in order to assess whether there is a risk of violence. In some cases, orientation may be extended to include the current situation of the patient.

Which of the following is an example of giving a broad opening as a therapeutic communication technique? "What seemed to lead up to your panic attack?" "What would you like to discuss this morning?" "I notice that you are wringing your hands." "I understand what you are saying."

"What would you like to discuss this morning?" Rationale: Therapeutic communication includes: Giving a broad opening: "What would you like to discuss this morning?" This allows the patient to control the interaction and shows respect for the individual. Establishing time sequence: "What seemed to lead up to your panic attack?" This helps to establish the relationship among different events. Observing: "I notice that you are wringing your hands." This helps the patient to recognize behaviors. Accepting: "I understand what you are saying." This helps to convey regard for the patient and reception for the patient's ideas.

Which of the following statements could be considered a violation of professional conduct? "You look very nice today." "Did you have a good weekend?" "I like your shoes. Are they comfortable?" "I think your comments about the patient's sexuality are inappropriate."

"You look very nice today." Rationale: "You look very nice today" could be considered a violation of professional conduct if the person to whom the comment is directed feels uncomfortable or if other people hear the comment and feel uncomfortable. Even though people working together often forge friendships, comments about physical appearance in the workplace are almost always inappropriate and can be easily misconstrued. Commenting on shoes is probably safe as are general questions, such as "Did you have a good weekend?" It is acceptable to directly address inappropriate comments by others.

Considering Maslow's hierarchy, in which order should the following nursing diagnoses for a patient be prioritized (first to last)? (1) Deficient fluid volume, (2) risk for self-injury, (3) sexual dysfunction, and (4) low self- esteem (1) Low self-esteem, (2) risk for self-injury, (3) low self-esteem, and (4) sexual dysfunction (1) Deficient fluid volume, (2) low self-esteem, (3) risk for self-injury, and (4) sexual dysfunction (1) Risk for self-injury, (2) deficient fluid volume, (3) sexual dysfunction, and (4) low self- esteem

(1) Deficient fluid volume, (2) risk for self-injury, (3) sexual dysfunction, and (4) low self- esteem Rationale: Considering Maslow's hierarchy, the order in which the nursing diagnoses for a patient should be prioritized (first to last) is: Physiological needs: Deficient fluid volume. Safety needs: Risk for self-injury.Love/belonging needs: Sexual dysfunction. Esteem needs: Low self-esteem. Physiological needs, especially those that are critical to life, should always be a top priority. However, prioritizing does not necessarily mean that the first priority must be dealt with before the psychiatric and mental health nurse can deal with the second priority because, in reality, many diagnoses may be attended to simultaneously.

An example of primary prevention is: -Providing parenting classes for prospective parents -Referring patients for treatment -Conducting an ongoing assessment of high-risk patients -Monitoring the effectiveness of treatment and services

-Providing parenting classes for prospective parents Rationale: An example of primary prevention is providing parenting classes for prospective parents because the goal is to prevent issues, such as abuse and neglect, by providing education and support. Primary prevention goals are to identify high-risk populations and to intervene in order to decrease risk or to minimize negative consequences. Other examples of primary prevention include teaching mental health concepts to community members, providing education on dealing with life transitions (widowhood, marriage, adolescence, empty-nest), and educating people about the negative effects of alcohol and drugs.

The Peer-to-Peer program of the National Alliance on Mental Illness (NAMI) focuses on providing classes for: Family and caregivers of a children and adolescents with mental health conditions Families, partners, and friends of adults with mental illness Families, partners, and friends of military service members or veterans Adults with mental illness about mental illness

Adults with mental illness about mental illness Rationale: While most other programs of the National Alliance on Mental Illness (NAMI) provide classes to support family, partners, and friends of patients with mental illness or to educate mental health staff, the Peer-to-Peer program is aimed at people with mental illness. Peer-to-Peer provides 10 sessions of education about dealing with mental illness to assist those who want guidance in working toward recovery and to help people develop their own relapse prevention programs and learn to better interact with healthcare providers.

The organization that provides a wide range of continuing education courses, webinars, and podcasts regarding psychiatric mental health nursing is the: American Nurses Credentialing Center (ANCC) National Alliance on Mental Illness (NAMI) American Psychiatric Nurses Association (APNA) American Psychiatric Nurses Association (APNA)

American Psychiatric Nurses Association (APNA) Rationale: The organization that provides a wide range of continuing education courses, webinars, and podcasts regarding psychiatric mental health nursing is the American Psychiatric Nurses Association (APNA). Both members and non-members can browse lists of continuing education resources in the eLearning Center although some courses are restricted to APNA members. Additionally, the APNA sponsors two conferences annually. The APNA also advocates for mental health care and represents more than 9000 nurses psychiatric and mental health nurses.

The patient that would likely derive the most benefit from Assertive Community Treatment (ACT) is a: 65-year-old male with history of liver disease and severe alcohol use disorder. 40-year-old male with history of history of severe schizophrenia and alcohol use disorder. 30-year-old female recovering from injuries related to intimate-partner abuse. 20-year-old male recovering from methamphetamine use disorder.

40-year-old male with history of history of severe schizophrenia and alcohol use disorder. Rationale: The patient that would likely derive the most benefit from Assertive Community Treatment (ACT) is a 40-year-old male with history of history of severe schizophrenia and alcohol use disorder. ACT is designed to treat patient with severe and complex multiple health problems. A case manager is part of a team of members with specialties in psychiatry, social work, nursing, vocational rehabilitation, and substance abuse with services provided 24 hours a day every day of the year in order to lesson symptoms, meet the patients' needs, lesson the families' burdens, and promote independence.

According to Piaget's stages of development, adjusting schemas in response to new information is a process called: Assimilation Accommodation Acclimation Actuation

Accommodation Rationale: According to Piaget's stages of development, adjusting schemas (theories about the manner in which the world functions) in response to new information is a process called accommodation. Applying the schemas to new situations is a process Piaget called assimilation. Piaget believed that there were three tasks that were essential to development and needed to be mastered during childhood: (1) how the world functions, (2) how this functioning is represented in the child's mind, and (3) how this functioning is represented in the minds of others.

The four nonverbal behaviors that are associated with active listening include sitting: Beside the patient, maintaining open posture, leaning back comfortably, and maintaining eye contact Across from patient, maintaining closed posture, leaning forward, and avoiding eye contact Across from patient, maintaining open posture, leaning forward, and maintaining eye contact Beside the patient, maintaining open posture, leaning forward and maintaining eye contact

Across from patient, maintaining closed posture, leaning forward, and avoiding eye contact Rationale: The four nonverbal behaviors associated with active listening include: Sit across from patient: Facing the patient directly helps to convey interest. Maintain open posture: Keeping the arms and legs uncrossed helps to show the person is open to the other person's ideas and is less defensive than a closed position. Lean forward: Leaning toward the patient slightly shows engagement in the interaction. Maintain eye contact: Maintaining eye contact helps to show interest in the person; however, the psychiatric and mental health nurse should keep cultural differences in mind as direct eye contact is not the norm in all cultures

The organization that provides a wide range of continuing education courses, webinars, and podcasts regarding psychiatric mental health nursing is: American Nurses Credentialing Center (ANCC) National Alliance on Mental Illness (NAMI) American Psychiatric Nurses Association (APNA) American Psychiatric Nurses Association (APNA)

American Psychiatric Nurses Association (APNA) Rationale: The organization that provides a wide range of continuing education courses, webinars, and podcasts regarding psychiatric mental health nursing is the American Psychiatric Nurses Association (APNA). Both members and non-members can browse lists of continuing education resources in the eLearning Center although some courses are restricted to APNA members. Additionally, the APNA sponsors two conferences annually. The APNA also advocates for mental health care and represents more than 9000 nurses psychiatric and mental health nurses.

If a patient refuses to take prescribed medications and the psychiatric and mental health nurse threatens to place the patient in restraints and seclusion until the patient cooperates, this may be considered: Battery False imprisonment Assault Malpractice

Assault Rationale: If a patient refuses to take prescribed medications and the psychiatric and mental health nurse threatens to place the patient in restraints and seclusion until the patient cooperates, this may be considered assault, which is an action that results in the patient fearing being touched or handled in an injurious or offensive manner without consent or authority. Battery occurs when harmful or injurious contact occurs. It may or may not result in actual injury. False imprisonment is keeping a patient in unjustified detention. Malpractice is a form of negligence related to professional duties.

If a patient who has an advance directive stating specifically that the patient does not want to be resuscitated attempts suicide by hanging and is found by a family member but is nonresponsive after being cut down, the correct action is to: Allow patient to die. Attempt to resuscitate the patient. Attempt resuscitation while contacting legal counsel. Ask family member for guidance regarding resuscitation.

Attempt to resuscitate the patient. Rationale: If a patient who has an advance directive stating specifically that the patient does not want to be resuscitated attempts suicide by hanging and is found by a family member but is nonresponsive after being cut down, the correct action is to attempt resuscitation. While people have the right to state their preference for no resuscitation, in most states this directive is not legally binding. Additionally, the do-not-resuscitate directive was never intended to facilitate suicide.

Following the death of her infant daughter, a patient suddenly started attending church and praying obsessively while neglecting her husband and other children. According to Kübler-Ross's stages of grief, the patient is probably in what stage? Denial Anger Depression Bargaining

Bargaining Rationale: The patient is probably in the stage of bargaining, which is often characterized by increased religious practice, such as praying, as a way to "bargain" with God to help the person cope or to somehow (even magically) change the outcome. Stages include: Stage 1: Denial Stage 2: Anger Stage 3: Bargaining Stage 4: Depression Stage 5: Acceptance

An example of an objective personality test is: Beck Depression Inventory (BDI) Sentence completion test Thematic Apperception Test (TAT) Rorschach test

Beck Depression Inventory (BDI) Rationale: An example of an objective personality test is Beck Depression Inventory (BDI). Objective tests require the person taking the test to choose an answer, either true-false or multiple choice, and do not allow for any free expression. Other objective tests include the Minnesota Multiphasic Personality Inventory (MMPI) and the Tennessee Self-Concept Scale (TSCS). Projective tests, on the other hand, are unstructured and the responses are evaluated by the person administering the test. Projective tests include the Rorschach test, the sentence completion test, and the Thematic Apperception Test (TAT).

When facilitating change to incorporate evidence-based findings into patient care management, the first step is: Understanding Acting Deciding Believing

Believing Rationale: The first step in facilitating change to incorporate evidence-based findings into patient care management is believing because unless the psychiatric and mental health nurse believes that change is possible, the nurse is defeated before beginning. The next step is to decide on a course of action, considering various options. Next is acting and carrying out the processes of change. This is followed by honestly evaluating the results and, last, acquiring understanding of the process.

Which of the following disorders is frequently associated with sexual abuse and incest? Conduct disorder Antisocial personality disorder Bipolar disorder Borderline personality disorder

Borderline personality disorder Rationale: Borderline personality disorder is frequently associated with a history of neglect and abuse, especially sexual abuse and incest. Studies indicate that 20 to 70% of patients with borderline personality disorder report having experienced sexual abuse, but authorities believe the percentage is higher because of patients' reluctance to admit to having been victims of sexual abuse or incest. Borderline personality disorder is characterized by fear of abandonment, unstable interpersonal relationships, poor self-image, impulsivity, suicidal ideation/self-mutilating behavior, affective instability, poor anger control, feeling of emptiness, and dissociative reactions.

Considering para-verbal communication, if a person speaks slowly and in a low-pitched monotone voice, the listener is likely to feel that the speaker is: Bored with the conversation Intelligent and deliberate Confused about the topic of conversation Angry about something

Bored with the conversation Rationale: Considering para-verbal communication, if a person speaks slowly and in a low-pitched monotone voice, the listener is likely to feel that the speaker is bored with the conversation. Para-verbal communication refers to the cadence of speech (slow, fast, deliberate) as well as the tone (low-pitched, high-pitched, monotone, trembling voice) and volume (loud, quiet). Para- verbal communication often communicates the feelings of the speaker, even though that may be unintentional. For example, when people are angry, their speech tends to be louder, more high- pitched, and more rapid.

Patients with bipolar disorder are often treated with interpersonal and social rhythm therapy. This therapy helps patients: - Recognize triggers to mood changes -Manage stress -Establish consistent sleep and physical activity schedules -Cope with bipolar disorder

C. Establish consistent sleep and physical activity schedules. Rationale: Interpersonal and social rhythm therapy helps patients with bipolar disorder establish consistent sleep and physical activity schedules. The patients utilize a self-monitoring instrument to monitor their daily activities, including their sleep patterns. Maintaining consistent patterns of activities and sleeping at the same time and for the same duration each night helps to reduce manic and depressive episodes. Patients may also engage in cognitive behavioral therapy, family therapy, and group therapy. If symptoms are severe and the patient does not respond to other treatments, electroconvulsive therapy (ECT) may be considered.

Which of the following SSRIs should be avoided in patients with congenital long QT syndrome (LQTS)? Fluoxetine (Prozac®) Paroxetine (Paxil®) Sertraline (Zoloft®) Citalopram (Celexa®)

Citalopram (Celexa®) Rationale: The SSRI that should be avoided in patients with congenital long QT syndrome (LQTS) is citalopram because it may cause QT prolongation, and doses of the drug should be limited to no more than 40 mg/day to avoid this adverse effect. Long QT syndrome (congenital or induced), a disruption of the electrical system of the heart, is characterized by irregular cardiac rhythms because depolarization after a contraction is delayed. Patients may develop palpitations and ventricular fibrillation, which can result in death. Long QT syndrome may also result from malnutrition that leads to decreased levels of potassium or magnesium, as may occur with anorexia nervosa.

An appropriate primary intervention for patients at risk of emotional illness resulting from trauma, such as an act of violence, is to: Clarify the patient's problem. Refer for inpatient treatment. Provide behavioral modification therapy. Institute a suicide prevention plan.

Clarify the patient's problem. Rationale: An appropriate primary intervention for patients at risk of emotional illness resulting from trauma, such as an act of violence, is to clarify the patient's problem to ensure that both the patient and the psychiatric and mental health nurse are perceiving the problem in the same manner. Other primary interventions related to trauma include focusing on a reality approach, avoiding lengthy explanations of the problem, helping the patient understand what precipitated the problem, acknowledging the patient's feelings, and showing unconditional acceptance.

An older adult with a urinary infection may exhibit: Confusion Hallucinations Depression Anxiety

Confusion Rationale: An older adult with a urinary infection may exhibit confusion rather than the more typical symptoms of burning and frequency experienced by younger adults, so urinary tract infection should be suspected in an older adult who has sudden onset of confusion or sudden worsening of pre-existing dementia. Confusion is more likely to occur with severe infections that have spread to the kidneys. The confusion associated with urinary tract infection usually clears rapidly once the infection is treated.

A patient who has developed sudden onset of blindness with no identifiable physical cause seems completely unconcerned about the deficit. This suggests: Somatization disorder Pain disorder Conversion disorder Body dysmorphic disorder

Conversion disorder Rationale: Conversion disorder: Sudden onset of sensory (seeing, hearing) or motor (paralysis, weakness) deficits without identifiable physical cause. La belle indifference (unconcern) is common. Somatization disorder: Combinations of multiple physical symptoms, usually involving pain and sexual, gastrointestinal and/or pseudoneurological symptoms. Pain disorder: Pain that is unrelieved by analgesia and is affected by psychological status. Body dysmorphic disorder: Preoccupation with imagined physical defect or exaggeration of a physical defect, such as belief that one's nose is hideous, and often seeking surgical correction.

A psychiatric and mental health nurse finds herself feeling very angry toward a patient whose physical appearance and manner remind her of her abusive father. This is an example of which of the following? Countertransference Transference Displacement Projection

Countertransference Rationale: If a psychiatric and mental health nurse finds herself feeling angry toward a patient whose physical appearance and manner remind her of her abusive father, this is an example of countertransference because the nurse is displacing feelings toward her father onto the patient. It's important to recognize countertransference and to examine the cause in order to increase self-awareness. In some cases, the nurse may need to discuss the issue with colleagues. Transference occurs when the patient displaces feelings for others onto the nurse.

Patients with paraphilias often come into therapy as a result of: Desire for change Co-morbidity with serious psychiatric disorders Family pressure Criminal prosecution

Criminal prosecution Rationale: Patients with paraphilias often come into therapy as the result of criminal prosecution related to the activity. Most people with paraphilias do not desire to change the behavior, and most are very secretive about the practices. Common elements of paraphilias include sexual fantasies or arousal and sexual intercourse related to non-human or non-living objects, children, or non- consenting adults. Arousal often results from suffering or humiliation of the victim. Paraphilias usually start after puberty and persist throughout life, often resulting in significant social and occupational impairment.

When utilizing a cognitive behavioral therapy (CBT) approach with a patient who has anxiety disorder and panic attacks, the psychiatric and mental health nurse asks the patient, "What is the worst thing that can happen to you?" This technique is an example of: Positive reframing Decatastrophizing Thought stopping Assertiveness

Decatastrophizing Rationale: Asking a patient with anxiety disorder and panic attacks, "What is the worst thing that can happen to you?" is an example of decatastrophizing, in which the psychiatric and mental health nurse uses questions to help the patient view the situation more realistically. Thought stopping, forcing oneself to stop thinking about a stressor, can be used to stop negative thoughts. Positive reframing is a technique in which the patient reframes negative thoughts, such as "I'm dying" into more positive thoughts, such as "This is just anxiety and will pass." Assertiveness training may help the patient can confidence.

If a psychiatric and mental health nurse knows the employer of a patient and tells the employer that the patient is too mentally unstable to work, and the patient loses his job as a result, this may constitute: Defamation of character Libel Invasion of privacy Battery

Defamation of Character Rationale: If a psychiatric and mental health nurse knows the employer of a patient and tells the employer that the patient is too mentally unstable to work and the patient loses his job as a result, this may constitute defamation of character since the information was detrimental to the patient's reputation. Defamation of character generally involves accusations that are malicious or false. Sharing information about the patient is a breach of confidentiality. If the nurse had put the information in writing, this would represent libel as opposed to slander, which involves orally giving malicious or false information.

Patients who are treated with lithium to control the symptoms of bipolar disorder must be advised to avoid: Sun exposure Sodium in the diet Dehydration Tobacco products

Dehydration Rationale: Patients who are treated with lithium to control the symptoms of bipolar disorder must be advised to avoid dehydration because this may cause the blood level of lithium to increase, resulting in toxicity. Patients should drink 8 to 10 glasses of liquid (primarily water) daily and may need increased fluids during hot weather. Patients should not be on a low sodium diet but should maintain a fairly consistent level of sodium intake because lithium levels increase with lower sodium levels and decrease with higher.

If the psychiatric and mental health nurse delegates a task to an unlicensed assistive personnel who states she has no training in the task and doesn't feel comfortable doing it, the most appropriate response is to: Delegate the task to someone else. Report the unlicensed personnel to a supervisor. Assure the unlicensed personnel that the task is easy. Tell the unlicensed personnel that you will check in frequently.

Delegate the task to someone else. Rationale: If the psychiatric and mental health nurse delegates a task to an unlicensed assistive personnel who states she has no training in the task and doesn't feel comfortable doing it, the most appropriate response is to delegate the task to someone else because no unlicensed personnel should be expected to carry out tasks for which they are not trained. However, if the task is one that unlicensed assistive personnel are expected to do, the nurse should later provide or facilitate the needed training.

A patient who has been diagnosed with bipolar disorder but has consistently refused to take medications or attend therapy, insisting that he has been misdiagnosed and has only "mild stress," is probably experiencing: Dissociation Resistance Denial Suppression

Denial Rationale: A patient who has been diagnosed with bipolar disorder but has consistently refused to take medications or attend therapy, insisting that he has been misdiagnosed and has only "mild stress" is probably experiencing denial, an ego defense mechanism. Denial occurs when a patient refuses to acknowledge a painful truth, such as a diagnosis of bipolar disorder. Denial may also include the failure to recognize the behavior or attitudes that allow problems to continue.

The Hamilton Rating Scale for Depression is intended for: Diagnosing depression Self-assessment of depression Determining the severity of diagnosed depression Determining suicidal ideation associated with depression

Determining the severity of diagnosed depression Rationale: The Hamilton Rating Scale for Depression (HAM-D) is completed by the observer and is intended to determine the severity of diagnosed depression. The items on the scale are scored from 0 to 4 or 0 to 2, depending on the nature of the item. The seventeen items included for evaluation of depression include depressed mood; guilt; suicide; initial, middle, and delayed insomnia; work and interest; retardation; agitation: psychic and somatic anxiety; somatic (gastrointestinal); somatic (general); genital; hypochondriasis; insight; and weight loss. Four other items are assessed for general information: diurnal variation, depersonalization, paranoia, and obsessional symptoms.

The Hamilton Rating Scale for Depression is intended for: Diagnosing depression Self-assessment of depression Determining the severity of diagnosed depression Determining suicidal ideation associated with depression

Determining the severity of diagnosed depression Rationale: The Hamilton Rating Scale for Depression (HAM-D) is completed by the observer and is intended to determine the severity of diagnosed depression. The items on the scale are scored from 0 to 4 or 0 to 2, depending on the nature of the item. The seventeen items included for evaluation of depression include depressed mood; guilt; suicide; initial, middle, and delayed insomnia; work and interest; retardation; agitation: psychic and somatic anxiety; somatic (gastrointestinal); somatic (general); genital; hypochondriasis; insight; and weight loss. Four other items are assessed for general information: diurnal variation, depersonalization, paranoia, and obsessional symptoms.

A psychiatric and mental health nurse has developed a successful strategy for working with a difficult patient and would like to share this strategy with other team members. The best method is likely to: Ask the supervisor to direct the team to use the strategy. Write out the steps to the strategy and give to each team member. Discuss the strategy during a team meeting. Ask the physician to write the strategy as a physician order.

Discuss the strategy during a team meeting. Rationale: If a psychiatric and mental health nurse has developed a successful strategy for working with a difficult patient and would like to share this strategy with other team members, the best method is likely to discuss the strategy during a team meeting rather than trying to impose the strategy on others without discussion. During discussion, the nurse may discover that others have also devised successful strategies and have input about strategies that are less successful.

A patient who lost his job because of his inability to complete his work tasks yells at the psychiatric and mental health nurse that she is "mean and stupid" and ruining his life. Which ego defense mechanism is the patient using? Identification Displacement Sublimation Projection

Displacement Rationale: Displacement: Expressing strong feelings generated by one person to another who is less threatening. In this case, yelling at the nurse instead of the boss who fired him. Identification: Modeling behavior or attitudes on those of another, such as entering the same profession as a mentor. Sublimation: Substituting behavior that is acceptable for one that is not, such as chewing gum instead of smoking. Projection: Unconsciously blaming unacceptable feelings/actions on someone else, such as by attacking gay people to deny homosexual attraction.

A patient whose husband died in a car accident eight months earlier is in a deep state of despair and is unable to function in normal activities. She has exaggerated expressions of anger, sadness, and guilt and often blames herself. This type of grief is: Prolonged Inhibited Distorted Anticipatory

Distorted Rationale: Distorted grief, which results in severe despair, inability to function, exaggerated expressions of grief (anger, sadness, guilt), and self-blame, is a maladaptive grief response. Prolonged grief may persist for years with the person vacillating between anger and denial. Inhibited/Delayed grief occurs when the person is not able to get past the denial stage of grief and cannot come to emotional terms with the death. Anticipatory grief is grieving that occurs before an anticipated loss, such as when a partner is nearing death.

A patient whose partner has left him for someone else and who spends an hour discussing all of the positive aspects of being single is probably utilizing the ego defense mechanism of: Displacement Intellectualism Denial Rationalization

Intellectualism Rationale: Intellectualism: Using rational intellectual processes to deal with stress and loss, such as by discussing positive aspects of being single. Displacement: Transferring feelings from one person or thing to another, such as being angry with a boss and taking the anger out on a spouse. Denial: Completely refusing to acknowledge a situation that is stressful, such as ignoring a child's drug use. Attempting to find excusRationalization: es for unacceptable behavior or feelings, such as drinking to relieve the stress of work.

Therapy for obsessive-compulsive disorder (OCD) usually includes: Psychodynamic psychotherapy Flooding Meditation Exposure and response prevention (ERP)

Exposure and response prevention (ERP) Rationale: Therapy for obsessive-compulsive disorder (OCD) usually includes exposure and response prevention (ERP), a specific component of cognitive behavioral therapy (CBT) designed to help patients with OCD lesson or extinguish compulsive responses. Patients rank order stressors and then, in a systematic manner, are exposed to triggers while trying not to respond with ritualistic behavior. Over time, patients should be able to face triggers without responding, but compliance with therapy is relatively poor. Other aspects of CBT are also included in therapy, and some benefit from meditation. Psychodynamic psychotherapy does not generally help relieve OCD symptoms.

A 16-year-old male admitted to the mental health unit for alcohol use disorder has repeatedly failed to maintain sobriety and consistently missed support meetings while partying with his friends. What is the most likely reason that the patient is not compliant with treatment? Disturbance of body image Embarrassment Fear of being different from peers Guilt about illness

Fear of being different from peers Rationale: A 16-year-old patient who has repeatedly failed to maintain sobriety and consistently missed support meetings while partying with his friends has most likely done so out of fear of being different from his peers. Peer relationships are especially important to adolescents who are still developing a sense of self, so if an adolescent is involved in drinking with his friends, he may be reluctant to change the dynamic by remaining sober and may feel he will be abandoned or ridiculed if his behavior changes.

The most common behavioral therapy used to help patients with Tourette's syndrome control tics is: Interoceptive exposure Contingency management Massed negative practice Habit reversal training.

Habit reversal training Rationale: The most common behavioral therapy used to help patients with Tourette's syndrome control tics is habit reversal training, which helps patients recognize habitual pattern and motor sequences associated with tics so they can identify the times and conditions under which the urge to tic occurs. People learn routines to counter the tic, such as breathing slowly with the mouth closed to control vocal tics or covering the mouth as for a cough with a tic that involves sticking out the tongue

A group cognitive behavioral therapy (CBT) approach that focuses on relapse prevention for substance use disorders will likely: Stress the importance of attending Alcoholics or Narcotics Anonymous® (AA) meetings. Stress mindfulness and accepting oneself. Help patients identify situations that make them vulnerable to relapse. Advise patients to serve as mentors for each other.

Help patients identify situations that make them vulnerable to relapse. Rationale: A cognitive behavioral therapy (CBT) approach that focuses on relapse prevention for drug use disorders will likely help patients identify situations that make them vulnerable to relapse. Therapy may include training in behavioral skills and the use of cognitive interventions to assist them to identify triggers or situations that result in relapse as well as to provide tools they can use if faced with a situation that is placing the patient at risk, such as when associates are engaging in addictive behavior.

If the patient is in the precontemplation stage of change regarding smoking, according to the Transtheoretical Model (TTM), the initial step in helping the patient quit smoking through a self-help program should be to: Advise the patient to wait until the patient is psychologically ready. Advise the patient to immediately begin the self-help program. Advise the patient that self-help programs are generally ineffective. Help the patient progress beyond the stage of precontemplation.

Help the patient progress beyond the stage of precontemplation. Rationale: If the patient is in the precontemplation stage of change regarding smoking, according to the Transtheoretical Model (TTM), the initial step in helping the patient quit smoking through a self- help program should be to help the patient progress beyond the state of precontemplation with a brief intervention, which may include educating the patient and helping motivate the patient to change. Studies have shown that failure rates are high if patients attempt change from a baseline precontemplation stage (92%) with the failure rate decreasing if the patient begins at Contemplation (85%) or Preparation (75%).

According to Erikson's psychosocial theory and stages of development, a 30-year-old male who remains very insecure and dependent on his parents and still lives at home has probably not successfully achieved the stage of: Trust vs mistrust Identity vs role confusion Industry vs inferiority Initiative vs guilt

Identity vs role confusion Rationale: According to Erikson's psychosocial theory and stages of development, a 30-year-old male who remains very insecure and dependent on his parents and still lives at home has probably not successfully achieved the stage of identity vs role confusion, which usually occurs during adolescence from age 12 to 20. The major tasks during this stage are to integrate tasks of earlier stages (developing trust, self-control, sense of purpose, and self-confidence) and to develop a strong sense of the independent self.

If the psychiatric and mental health nurse overhears other staff beginning to discuss difficulties caring for an unnamed patient in the staff dining room where other staff are present, the nurse should: Intervene to tell staff that their comments can be overheard. Reprimand the staff for violating privacy. Take no action as the patient was unnamed. Report the violation of privacy to a supervisor.

Intervene to tell staff that their comments can be overheard. Rationale: If the psychiatric and mental health nurse overhears other staff beginning to discuss difficulties caring for an unnamed patient in the staff dining room where other staff is present, the nurse should intervene to tell staff that their comments can be overheard. Staff members often discuss patient care issues over lunch or breaks without considering that others may overhear. It is a violation of privacy whether or not the patient is named because some identifying information (age, gender, diagnosis) may be divulged unintentionally.

Which of the following ethnic groups is most likely to believe that mental illness is the result of a loss of self-control or punishment for bad behavior? Mexican Americans Japanese Americans Puerto Ricans Chinese

Japanese Americans Rationale: The ethnic group that is most likely to believe that mental illness is the result of a loss of self- control or punishment for bad behavior is Japanese American. Puerto Ricans often believe that mental illness results from heredity or from prolonged suffering. Chinese are more likely to believe that mental illness results from evil spirits or a lack of harmony in emotions. Mexican Americans attribute mental illness to a variety of causes, including God, spirituality, and interpersonal relationships.

Which of the following could be an example of elder neglect? Insulting, name-calling Lack of dentures Physically restraining the patient Misusing patient's financial resources

Lack of Dentures Rationale: Lack of dentures, hearing aids, or glasses may be examples of elder neglect, which may be intentional or unintentional. However, one cannot jump to conclusions. For example, the patient may have refused to wear dentures or may be unable to afford them. Other signs of neglect may include inadequate access to food or fluids, inadequate heating or air conditioning, unclean personal belongings/clothes, and lack of necessary medications. Insulting, name calling, physically restraining the patient, and misusing the patient's financial resources are indications of abuse.

For patients with dissociative amnesia, the type of amnesia that involves the inability to recall a traumatic event for a few hours or few days after the event is classified as: Localized Selective Generalized Systematized

Localized Rationale: Dissociative amnesia: Localized: Inability to recall a traumatic event for a few hours or few days after the event. Selective: Inability to recall some aspects of a traumatic event for a period after the trauma.Generalized: Inability to recall any of previous history, including identity. Systematized: Inability to recall a specific category of information or a specific person or event. Continuous: Inability to recall events after a specific time until the present.

The primary focus of the Substance Abuse and Mental Health Services Administration (SAMHSA) is to: Reduce the costs associated with substance abuse and mental health. Make information, services, and research about substance abuse and mental health more easily accessible. Provide continuing education courses regarding substance abuse and mental health issues to healthcare providers. Serve as a political action committee to promote improvements in care for those with substance abuse or mental health issues.

Make information, services, and research about substance abuse and mental health more easily accessible. Rationale: The primary focus of the Substance Abuse and Mental Health Services Administration (SAMHSA), an agency within the U.S. Department of Health and Human Services, is to make information, services, and research about substance abuse and mental health more easily accessible and to reduce the impact of these issues on communities. SAMHSA has a number of Strategic Initiatives, such as "Trauma and Justice," and "Prevention of Substance Abuse and Mental Illness," as well as advisory councils and committees.

If a patient is being evaluated for depression and laboratory results show that the patient's free T4 level is 0.6 ng/dL (normal value 0.8 to 1.5 ng/dL) and the TSH level is 7.4 U/mL (normal value is 0.4 to 4.0 mIU/L), this suggests that depression: May result from hypoparathyroidism related to pituitary dysfunction May result from hypothyroidism related to thyroid dysfunction May result from hyperparathyroidism related to thyroid dysfunction Is likely unrelated to thyroid dysfunction

May result from hypothyroidism related to thyroid dysfunction Rationale: If a patient is being evaluated for depression and laboratory results show that the patient's free T4 level is 0.6 ng/dL (normal value 0.8 to 1.5 ng/dL) and the TSH level is 7.4 mIU/mL (normal value 0.4 to 4.0 mIU/L), this suggests that depression may result from hypoparathyroidism related to thyroid dysfunction. Typically, the TSH level rises to stimulate the thyroid to produce T4, so the levels may remain normal for a while because of the increased TSH or may begin to fall. If thyroid dysfunction were related to pituitary dysfunction, the TSH level would generally be decreased instead of elevated.

When utilizing sensory stimulation therapy (SST) to improve cognition in a patient with dementia, it is essential to choose sensory input that is: Meaningful to the patient Identified through testing Easy to demonstrate Beneficial to multiple patients

Meaningful to the patient Rationale: If utilizing sensory stimulation therapy (SST) to improve cognition in a patient with dementia, it is important to choose sensory input that is meaningful to the patient. For example, the psychiatric and mental health nurse may show the patient family pictures and talk with the patient about the family, encouraging the patient to retrieve memories, or may play music that the patient has previously enjoyed. Certain smells, such as perfume or food smells, may also be used to elicit memories.

If a patient complains of difficulty focusing attention on more than an immediate task and difficulty concentrating as well as experiencing frequent headaches, GI upset, and muscle tension, the level of anxiety would likely be classified as: Mild Moderate Severe Panic

Moderate Rationale: If a patient complains of difficulty focusing attention on more than an immediate task and difficulty concentrating as well as experiencing frequent, headache, GI upset, and muscle tension, the level of anxiety would likely be classified as moderate. Patients often function better with mild anxiety but may feel restless and complain of insomnia and hypersensitivity to noise or other distraction. With severe anxiety, patients may have difficulty completing tasks or solving problems and behavior may focus on relieving anxiety. Physical symptoms may resemble a panic attack. With panic, patients cannot think or act rationally and may experience hallucinations and delusions.

If a patient's family caregivers are interested in taking classes or training to better help them assist the patient and to cope more effectively with the patient's illness, the most appropriate referral is to the: National Alliance on Mental Illness (NAMI) Substance Abuse and Mental Health Services Administration (SAMHSA) American Psychiatric Nurses Association (APNA) National Institute of Mental Health (NIMH)

National Alliance on Mental Illness (NAMI) Rationale: If a patient's family caregivers are interested in taking classes or training to better help them assist the patient and cope more effectively with the patient's illness, the most appropriate referral is to the National Alliance on Mental Illness (NAMI). . Family-to-FamNAMI's Family-to-Family program is especially intended for family caregivers of those with severe mental illnessily comprises a 12-week course that is free. NAMI Basics is a course intended for parents/caregivers of children and adolescents with mental illness.

When assessing a 35-year-old Arab American female, the psychiatric and mental health nurse notes that, while discussing her family, the patient uses a louder voice than while discussing other issues. This probably means that issues about her family are: A private matter A cause for shame Of lesser importance than other issues Of special importance

Of Special Importance Rationale: If, when assessing a 35-year-old Arab American female, the psychiatric and mental health nurse notes that, while discussing her family, the patient uses a louder voice than while discussing other issues, this probably means that issues about her family are of special importance because speaking more loudly about important issues is characteristic of Arab Americans. People in this culture often stand close to others but avoid physical and eye contact with those of the opposite gender. However, it's important to remember what holds true in general for a culture may not hold true for an individual in the culture.

If a psychiatric and mental health nurse with many years of experience observes that a new nurse lacks essential skills, the most productive approach is to: Suggest the nurse take some continuing education courses. Provide study materials to help improve the nurse's skills. Report the nurse's lack of skills to the department head. Offer to serve as a mentor for the nurse.

Offer to serve as a mentor for the nurse. Rationale: If a psychiatric and mental health nurse with many years of experience observes that a new nurse lacks essential skills, the most productive approach is to offer to serve as a mentor for the nurse. Many new nurses lack essential skills because they have little experience to draw from and may be overwhelmed with the responsibilities of working. Mentoring is usually an ongoing process that lasts for months and even a year or more. Mentoring may be a formal or informal arrangement.

If a violent adult patient requires physical restraints, the patient be must be evaluated by a licensed independent practitioner within: 30 minutes One hour Two hours Four hours

One hour Rationale: If a violent adult patient requires physical restraints, the patient must be evaluated by a licensed independent practitioner within one hour of having the restraints applied. The same applies for the use of seclusion. Additionally, the patient must be evaluated personally every 8 hours after the initial evaluation, and physician's orders are required every 4 hours to continue the restraints or isolation. A nurse must closely supervise the patient and document an assessment every one to two hours.

Which of the following is an appropriate intervention for a nursing diagnosis of "disturbed thought processes?" Encourage patient to discuss delusions. Give detailed explanations about unit procedures. Keep a dim light on during the night to comfort the patient. Orient the patient to reality frequently and in various ways.

Orient the patient to reality frequently and in various ways. Rationale: The appropriate intervention for a nursing diagnosis of "disturbed thought processes" is to orient the patient to reality frequently and in various ways, such as by placing clocks within view and large signs as reminders. Explanations should be kept simple to avoid overloading the patient, and the psychiatric and mental health nurse should speak slowly and in a quiet voice to avoid agitating the patient. The patient should not be encouraged to discuss the delusions but should be encouraged to discuss real events or people.

The evidence-based Suicide Assessment Five-step Evaluation and Triage (SAFE-T) tool indicates that a patient has modifiable risk factors for suicide and strong protective factors, resulting in an overall low-risk factor although the patient admits to thoughts of death but denies a plan or intent. The intervention that is most indicated is: Outpatient treatment and crisis numbers Crisis plan and crisis numbers Admission to inpatient facility and crisis plan Admission to inpatient facility with suicide precautions

Outpatient treatment and crisis numbers Rationale: Since the evidence-based SAFE-T tool indicates that the patient is at low risk for suicide because risks (such as access to guns and health concerns) are modifiable and protective factors (such as religious beliefs and social supports) are strong, the intervention that is most indicated is outpatient treatment with crisis numbers to call if the patient needs support. The SAFE-T tool has 5 steps: (1) assessment of risk factors, (2) assessment of protective factors, (3) suicide inquiry (specific questions about plans, intent, ideation), (4) assignment of risk level (low, moderate, high) and appropriate intervention, and (5) documentation and plans.

A patient with phobic disorder has a nursing diagnosis of social isolation. The most appropriate outcome is that the patient will: Be able to function despite presence of phobic object. Participate in group activities voluntarily. Carry out role-related activities. Acknowledge the need for social connections.

Participate in group activities voluntarily. Rationale: An appropriate outcome for a patient with a phobic disorder and a nursing diagnosis of social isolation is "Patient will participate in group activities voluntarily," as this action would demonstrate that the patient no longer feels compelled to be isolated. The psychiatric and mental health nurse should remain supportive and honest, attending meetings with the patient if necessary to alleviate fears, teaching the patient thought stopping activities to alleviate anxiety, and providing positive reinforcement.

Which of the following is a Serious Reportable Event (SRE) related to patient protection? Patient is raped by a member of the staff on the hospital grounds. Patient receives an electric shock from faulty wiring. Patient dies because of a medical error. Patient cuts his wrists while hospitalized.

Patient cuts his wrists while hospitalized. Rationale: The National Quality Forum's (NQF's) Serious Reportable Events (SREs) are those events that are harmful to patients. The SREs are divided into different areas of focus. Those events that focus on Patient Protection are especially applicable to psychiatric and mental health nursing. These events include (1) discharge of a patient unable to make decisions to other than an authorized person, (2) death or serious injury related to elopement/disappearance, and (3) suicide, attempted suicide, or self-harm resulting in serious injury while hospitalized.

Which of the following is an example of the ego defense mechanism of rationalization? Patient states she beats her child because the child needs to learn to have self-control. Patient who is prejudiced against other races accuses others in the group of being bigots. Patient attends outpatient therapy to placate spouse but refuses to participate. Patient who experienced loss of a child refuses to think about or discuss the child's death.

Patient states she beats her child because the child needs to learn to have self-control. Rationale: An example of the ego defense mechanism of rationalization is when a patient states that she beats her child because the child needs to learn to have self-control. The patient is trying to blame her bad behavior on the child so that she can avoid feeling guilty or acknowledging responsibility for her own behavior. Patients often try to present the rationalization in such a way that the behavior appears positive, such as by helping the child to achieve better self-control, rather than negative.

If a 16-year-old female is severely anorexic, weighing 85 pounds and experiencing amenorrhea, hair loss, and cardiac abnormalities, according to Maslow's Hierarchy of Needs, which of the following needs is most dominant in this patient? Physiological Safety and security Belonging/Love Self-actualization

Physiological Rationale: If a 16-year-old female is severely anorexic, weighing 85 pounds and experiencing amenorrhea, hair loss, and cardiac abnormalities, according to Maslow's Hierarchy of Needs, the need that dominates is physiological because the patient is literally starving herself to death. Physiological needs form the base of Maslow's hierarchy because these needs must be met first. The next level is safety and security needs followed by belonging and love needs, and esteem needs. The highest level is self-actualization.

Which of the following is an example of a situational crisis? Retirement Marriage Poverty Parenthood

Poverty Rationale: Poverty is an example of a situational crisis, which is acute response to a stressor that relates to external circumstances. Other situational crises may include losing a job, environmental conditions (storms, tornados, hurricanes), and trauma (auto accident, falls). A maturational crisis, on the other hand, are experiences that are associated with different stages of growth and development, including adolescences, marriage, empty-nest situation, and retirement.

The public health model (Caplan) of mental health care is based on the concepts of: Primary, secondary, and tertiary prevention Education, research, and application Patient, family, and community Community care, independence, monitoring

Primary, secondary, and tertiary prevention Rationale: The public health model (Caplan) of mental health care is based on the concepts of primary, secondary, and tertiary prevention. Primary prevention focuses on both preventive efforts for the individual and the environment to assist people to increase their ability to cope and to decrease stressors in the community. Secondary prevention involves promptly providing effective treatment for identified problems. Tertiary prevention aims to prevent complications of existing conditions and to promote rehabilitation.

A male patient has been following a female patient and claims that the female is "flirting" with him and using "sexual innuendos;" however, the female patient complains that the male patient is harassing and scaring her, and staff observations concur with the female patient's complaints. The male patient is most likely exhibiting: Introjection Projection Compensation Identification

Projection Rationale: If a male patient has been following a female patient and claims the female is "flirting" with him and using "sexual innuendoes" but the female patient complains that the male patient is harassing and scaring her, and staff observations concur with the female patient's complaints, then the male patient is most likely exhibiting projection, an ego defense mechanism in which the male patient is projecting his own feelings of attraction onto the female patient.

The primary purpose of the American Nurses Credentialing Center (ANCC) is to: Provide political support for nurses. Provide nursing education. Promote the career of nursing. Promote nursing excellence.

Promote nursing excellence. Rationale: The primary purpose of the American Nurses Credentialing Center (ANCC), a subsidiary of the ANA, is to provide nursing excellence and to improve health care both in the United States and internationally. The ANCC provides a number of different programs and services, including an accreditation program for nursing education, certificate programs for nurses to demonstrate expertise in various specialty areas, the Pathway to Excellence® program that recognizes organizations with a positive nursing environment, a knowledge center that provides educational materials, and the Magnet Recognition Program® that recognizes an institution's excellence in patient care.

During the orientation phase of building a therapeutic relationship, the psychiatric and mental health nurse discovers that he had come to the first meeting with preconceptions about the patient. Based on this, the nurse should: Ask another nurse to work with the patient. Apologize to the patient. Spend extra time with the patient. Recognize and set aside the preconceptions.

Recognize and set aside the preconceptions. Rationale: While ideally a nurse should examine preconceptions and set them aside prior to meeting with the patient, once the nurse recognizes that his opinions may be colored by preconceptions, he should acknowledge them and set them aside so that he can establish a good working relationship with the patient. Since the patient is likely unaware of the nurse's preconceptions, apologizing is not necessary, nor is overcompensating by spending extra time with the patient.

A patient may utilize the ego defense mechanism of sublimation in order to: Voluntarily block unpleasant emotions. Negate an intolerable experience Retreat to an earlier stage of development. Redirect socially unacceptable impulses

Redirect socially unacceptable impulses Rationale: Sublimation: The patient redirects socially unacceptable impulses to acceptable actions, such as when the victim of a crime redirects anger toward becoming an advocate for other victims. Regression: The patient retreats to an earlier stage of development, such as by being more dependent. Suppression: The patient voluntarily blocks unpleasant emotions, such as by refusing to think about an event. Repression: The patient involuntarily blocks unpleasant emotions, such as being unable to remember being raped.

If a patient's nursing diagnosis is "risk for other-directed violence," an immediate expected outcome of intervention is that the patient will: Exercise control over his emotions. Refrain from hurting others. Express feelings in a non-threatening manner. Identify methods to relieve aggressive feelings.

Refrain from hurting others. Rationale: If a patient's nursing diagnosis is "risk for other-directed violence," an immediate expected outcome of intervention is that the patient will refrain from hurting others. Other outcomes that should be immediate include refraining from destroying property and demonstrating decreased acting out behavior, restlessness, fear, anxiety, and hostility. Patients may need more time and therapy to be able to exercise control over emotions, express feelings in a non-threatening manner, and identify methods to relieve aggressive feelings.

The primary advantage of case management for community care of a patient with severe mental health issues is that case management: Is more cost-effective than hospitalization Eases the burdens of other care providers Relieves the patient of the responsibility to coordinate and manage care Allows insurance companies to better determine allowable coverage for services

Relieves the patient of the responsibility to coordinate and manage care Rationale: The primary advantage of case management for community care of a patient with severe mental health issues is that case management relieves the patient of the responsibility of coordinating and managing care, especially those patients with limited support systems. Patients may easily feel overwhelmed if they have to access services from a number of different resources and may fail to follow through with the care plan, resulting in recurrence or exacerbation of symptoms.

If a patient with severe postpartum depression admits she hates her infant but states, "I would never hurt it," the first priority should be to: Encourage the patient to ask for help with childcare. Advise the patient's husband to monitor childcare. Remove the infant from the patient's care. Advise the patient to find a family member to care for the child.

Remove the infant from the patient's care. Rationale: If a patient with severe postpartum depression admits she hates her infant but states "I would never hurt it," the first priority should be to remove the infant from the patient's care because the patient has admitted hating the child and has depersonalized the child by referring to the child as "it." Additionally, a patient with severe postpartum depression is at risk for postpartum psychosis, which may further increase risk to the infant.

When assessing a patient's orientation, the psychiatric and mental health nurse should be aware that the first thing the patient is likely to lose track of is: Person Place Time Current situation

Time Rationale: When assessing a patient's orientation, the psychiatric and mental health nurse should be aware that the first thing the patient is likely to lose track of is time, followed by place and then person. Patients may, for example, forget the day of the week or the month and date. When orientation improves, it usually does so in the reverse order, so people become oriented to person first, followed by place, and then time

If a 30-year-old patient with paranoia and schizophrenia states he does not want his parents (who are paying for his care) to visit because he believes they are "possessed by devils," the psychiatric and mental health nurse should: Ask the physician to intervene. Allow the parents to visit. Respect the patient's request. Suggest the parents get a court order to allow visits.

Respect the patient's request. Rationale: If a 30-year-old patient with paranoia and schizophrenia states he does not want his parents (who are paying for his care) to visit because he believes they are "possessed by devils," the psychiatric and mental health nurse should respect the patient's request. Patients' rights are not determined by who is paying for care but remain with the person. Unless the patient has been declared incompetent in a court proceeding and his parents granted conservatorship, the patient can deny them visitation.

The mother of an adolescent with autism spectrum disorder with severe impairment states she is often so tired at the end of the evening that she breaks down and cries. The care support that is probably the most essential at this time is: Respite care Support group Volunteer visitor Spiritual support

Respite Care Rationale: Caregiving can be exhausting, so if the mother of an adolescent with autism spectrum disorder with severe impairment is so tired that she begins crying, then she is overwhelmed and is most in need of respite care. The caregiver needs a break of even a few days in order to rest and have time for herself. If this is not possible, then part-time respite care in the home to allow the caregiver to relinquish caregiving for a few hours may help to reduce stress.

The treatment of choice for generalized anxiety disorder (GAD) in older adults is: Benzodiazepine Tricyclic antidepressants SSRI Alpha-adrenergic agonist

SSRI Rationale: The treatment of choice for generalized anxiety disorder (GAD) in older adults is an SSRI. Doses are usually started at a lower level than for younger adults as high doses may increase anxiety. In older adults, late onset GAD and panic attacks (less common) are most often associated with depression and, in some cases, physical illness, such as heart disease. As well as GAD, agoraphobia and other phobias are common conditions associated with anxiety in older adults.

When completing the patient assessment and developing the plan of care with a patient with an eating disorder, it is especially important to ask the patient about: Motivation to change behavior Self-injurious behavior Sexual dysfunction Goal for weight

Self-injurious behavior Rationale: When completing the patient assessment and developing the plan of care with a patient with an eating disorder, it is especially important to ask the patient about self-injurious behavior. Patients with eating disorders often engage in superficial self-mutilating behaviors, such as cutting, burning, and hair pulling, and these actions may increase as an outlet for the patient's emotional distress as the eating disorder is controlled. All patients with eating disorders should be screened for self-injurious behavior and should be monitored carefully during therapy.

The patient's medication list includes both a monoamine oxidase (MAO) inhibitor (isocarboxazid), which the patient has taken for many years, and an SSRI (fluoxetine), which was recently prescribed by another doctor. The psychiatric and mental health nurse should advise the patient that this combination may result in: Neuroleptic malignant syndrome Hypotension Hypertensive crisis Serotonin syndrome

Serotonin Syndrome Rationale: If the patient's medication list includes both a monoamine oxidase (MAO) inhibitor (isocarboxazid) and an SSRI (fluoxetine), the psychiatric and mental health nurse should advise the patient that this combination may result in serotonin syndrome, which can be life- threatening. Symptoms include confusion, hallucinations, fever, and myopathy. MAO inhibitors are no longer in common use because of multiple food and drug interactions that increase risk to patients. Patients prescribed an MAOI should always be advised to notify the prescribing physician before taking any other medication or herbal product.

Which of the following divisions of the International Society of Psychiatric-Mental Health Nurses (ISPN) actively promotes the autonomy of the advanced practice nurse? Society for Education and Research in Psychiatric-Mental Health Nursing (SERPN) Association of Child and Adolescent Psychiatric Nurses (ACAPN) International Society of Psychiatric Consultation-Liaison Nurses (ISPCLN) Adult and Geropsychiatric-Mental Health Nurses (AGPN)

Society for Education and Research in Psychiatric-Mental Health Nursing (SERPN) Rationale: The Internal Society of Psychiatric-Mental Health Nurses (ISPN) comprises four divisions, which were originally independent organizations but came together to form the ISPN. The division that actively promotes the autonomy of advance practice nurses is the Society for Education and Research in Psychiatric-Mental Health Nursing (SERPN). Since the organization's original inception in 1983 (as the Council of Dean and Directors of Graduate Programs in Psychiatric- Mental Health Nursing), the organization has focused on graduate education in the field and evidence-based practice.

Which of the following herbal preparations should be avoided with other psychoactive drugs? Chamomile Ginseng Fennel St. John's wort

St John's Wort Rationale: St. John's wort, which is used to treat mild to moderate depression, should be avoided with other psychoactive drugs. St. John's wort may increase symptoms of ADHD if patients are taking methylphenidate. St. John's wort may also increase episodes of mania in patients with bipolar disorder and may increase risk of developing mania in those with major depression. St. John's wort may trigger psychosis in some patients with schizophrenia. St. John's wort is associated with many drug interactions, including alprazolam (Xanax®), birth control pills, phenobarbital, phenytoin, amitriptyline (Elavil®), and SSRI.

When working with a patient with conduct disorder, limit setting includes (1) informing patient of limits, (2) explaining the consequences of noncompliance, and (3): Providing feedback Stating reasons Establishing time limits Stating expected behaviors

Stating expected behaviors Rationale: When working with a patient with conduct disorder, limit setting includes (1) informing patient of limits, (2) explaining the consequences of noncompliance, and (3) stating expected behaviors. Application of limit setting must be consistent and carried out by all staff members at all times. Consequences must be individualized and must have meaning for the patient so that the patient is motivated to avoid them. Negotiating a written agreement that can be referred to can prevent conflicts if the patient tries to change the limits.

A patient with opioid use disorder is to be maintained as an outpatient on Suboxone® (buprenorphine plus naloxone). The psychiatric and mental health nurse expects that the patient will begin with: Suboxone®, with first administration 24 hours after last opioid Subutex® for one day and then switch to Suboxone® Suboxone®, with first administration immediately after last opioid Subutex® (buprenorphine only) for two days and then switch to Suboxone®

Subutex® (buprenorphine only) for two days and then switch to Suboxone® Rationale: If a patient with opioid use disorder is to be maintained as an outpatient on Suboxone® (buprenorphine/naloxone), the patient will usually begin with Subutex® (buprenorphine only) for two days and then switch to Suboxone®. Subutex® is initiated when the patient begins experiencing withdrawal symptoms (≥4 hours after last narcotic dose) as the drug helps to reduce cravings and prevent withdrawal symptoms. Suboxone® contains the opioid antagonist naloxone, which may cause severe withdrawals if the patient has not been free of narcotics. If a patient takes narcotics while on Suboxone®, the patient will experience immediate withdrawal, and this provides some insurance against drug abuse.

At the end of a discussion with a patient about modifying the patient's plan of care, the psychiatric and mental health nurse states: "I understand you to say that you want to try some alternative treatments, such as imagery and relaxation, to help cope with your anxiety." This is an example of: Validating Summarizing Restating Assessing

Summarizing Rationale: If a psychiatric nurse ends a discussion with the patient about modifying the patient's plan of care by saying, ""I understand you to say that you want to try some alternative treatments, such as imagery and relaxation, to help cope with your anxiety," this is an example of summarizing. With summarizing, it's important to accurately reflect the patient's statements without judgment. Stating the summary verbally helps to verify that the nurse's understanding is correct and helps the patient feels the patient's ideas are validated.

If a 27-year-old patient with narcissistic personality disorder is pregnant and has made plans to have an abortion but the psychiatric and mental health nurse is opposed to abortion for religious reasons, the nurse should: Discuss alternatives with the patient. Provide literature about adoption. Advise the patient her decision is morally wrong. Support the patient's decision.

Support the patient's decision. Rationale: If a 27-year-old patient with narcissistic personality disorder is pregnant and has made plans to have an abortion but the psychiatric and mental health nurse is opposed to abortion for religious reasons, the nurse should support the patient's decision. The patient has the legal right to make this decision, and the nurse must use care not to impose personal religious beliefs onto the patient or try to pressure the patient into making a different decision.

If a patient with post-traumatic stress disorder (PTSD) is invited to a wedding but, when inside the church, begins to experience a flashback to an explosion inside of a building, a grounding method that may help is for the patient to: Get up and leave immediately Take an inventory of things inside the church Repeat the phrase "This is just a church" over and over Close the eyes and visualize another place

Take an inventory of things inside the church Rationale: If a patient with PTSD is invited to a wedding but, when inside the church, begins to experience a flashback to an explosion inside of a building, a grounding method that may help is for the patient to take an inventory of things inside of the church, such as the number of flowers or colors in the room or the number of males and females. This type of concentration may help to focus the attention away from the flashback.

If the psychiatric and mental health nurse asks a patient a question and the patient wanders completely off topic in the response and never answers the questions, this is an example of: Loose association Word salad Flight of ideas Tangential thinking

Tangential thinking Rationale: Tangential thinking: The patient wanders completely off topic in responding to a question and never actually answers the questions. Loose association: The patient jumps haphazardly from one idea to another with no obvious association between the various thoughts expressed. Word salad: The patient uses a stream of completely unconnected words that express no meaning. Flight of ideas: The patient speaks rapidly, using many words, but ideas are fragmented and unrelated to each other.

If a psychiatric and mental health nurse is giving a series of classes about psychotropic drugs and symptom management to a group of patients with bipolar disease, this type of group would be classified as: Teaching Supportive therapy Self-help Task

Teaching Rationale: If a psychiatric and mental health nurse is giving a series of classes about psychotropic drugs and symptom management to a group of patients with bipolar disease, this type of group would be classified as teaching because the primary focus is on transmission of information rather than therapy, self-help measures, or specific tasks. Teaching groups usually are not open-ended but have a set number of classes at prescribed times. Teaching groups should include time for questions and answers and interactions among group members to facilitate recall.

In an administrative model of shared governance, the person representing the psychiatric unit is probably: The department head A team leader Any member of the nursing staff Any member of the staff

The department head Rationale: In an administrative model of shared governance, the person representing the psychiatric unit is probably the department head because this model depends on the leaders of the institution. These leaders may preside over smaller councils, but they alone are represented on the primary legislative council. Councilor models may have a large number of councils that have some governance over their members. For example, each unit may have a council that sets work hours. In the congressional model, all nursing staff (or all staff) may be members of councils with varying degrees of autonomy.

A patient who has had multiple arrests for driving under the influence of alcohol has agreed to begin treatment with disulfiram. Patient education should include advising the patient that: The patient may experience severe illness if they drink alcohol. The patient should avoid driving. The patient may experience hallucinations. The patient must abstain from drinking for one week prior to initiating treatment.

The patient may experience severe illness if they drink alcohol. Rationale: If a patient has agreed to begin treatment with disulfiram, the patient should be aware that drinking alcohol may result in severe illness. Patients must abstain from drinking for 12 hours before initiating treatment. Disulfiram interferes with the breakdown of acetaldehyde from ethanol, so the acetaldehyde level increases, resulting in a syndrome that can include flushing, head and neck pain, severe nausea and vomiting, third, excessive perspiration, tachycardia, hyperventilation, weakness, and blurred vision. Some people may develop more severe symptoms, such as myocardial infarction, acute heart failure, and/or respiratory depression.

If a schizophrenic patient believes that others know the thoughts in her mind, this delusional belief is called: Thought broadcasting Thought blocking Thought withdrawal Circumstantial thinking

Thought broadcasting Rationale: Thought broadcasting: The belief that one's thoughts can be heard or known by others. Thought blocking: Stopping in the middle of expressing an idea and being unable to regain the train of thought and continue and complete the statement. Thought withdrawal: The belief that one's thoughts are being taken away by someone else and that the individual cannot stop this process. Circumstantial thinking: Eventually responding to a question after providing excessive and unnecessary details.

A 25-year-old female with bipolar disorder is to begin treatment with lithium. Which laboratory tests should be carried out prior to beginning treatment with lithium? Thyroid function Liver function Renal function Cardiovascular function

Thyroid function Rationale: Before a patient begins treatment with lithium, thyroid function tests should be completed in order to ensure that hypothyroidism is not a contributing cause to the patient's depression and to serve as a baseline for subsequent monitoring of thyroid function. Lithium decreases production of thyroid hormones, so lithium-induced hypothyroidism can occur. If the baseline thyroid function tests are normal, then thyroid function is usually monitored every 6 to 12 months; but, if the TSH level is elevated, every 3 to 6 months. About 40 to 50% of patients receiving lithium develop goiter.

A 62-year old-male with fragile X syndrome has been diagnosed with fragile X tremor-ataxia syndrome. The psychiatric and mental health nurse should expect the patient to exhibit: Tremor and ataxia only Tremor, ataxia, mood changes, paresis, dementia Tremor, ataxia, mood changes, cognitive decline, dementia Tremor, ataxia, mood changes, cognitive decline, paresis

Tremor, ataxia, mood changes, cognitive decline, dementia Rationale: If a patient is diagnosed with fragile X tremor-ataxia syndrome (FXTAS), the psychiatric and mental health nurse should expect the patient to exhibit intention tremors, ataxia, mood changes (anxiety, depression), cognitive decline, and dementia. This neurological decline associated with FXTAS occurs later in life and increases with age with 17% of those between 50 and 59 exhibiting symptoms and 74% of those over 80 years. Early symptoms include difficulty writing, using utensils, and frequent falls. FXTAS rarely affects females.

A patient with schizophrenia and a history of violent behavior in response to "voices" has been pacing about his room and suddenly begins shouting at the nurse, "Get away from me! Let me out of here!" Considering the 5-phase aggression cycle, the patient is most likely in the phase of: Crisis Recovery Triggering Escalation

Triggering Rationale: The patient is most likely in the phase of escalation. The 5-phase aggression cycle includes: Triggering: Patient appears restless, irritable, pacing, tense, and exhibits increased perspiration, loud voice, and angry demeanor. Escalation: Patient may begin yelling and swearing and making threatening gestures, exhibiting hostility and loss of self-control. Crisis: Patient loses complete control and may begin hitting, spitting, throwing items, kicking, and screaming. Recovery: Patient begins to relax physically and emotionally, lowering voice and acting more rationally. Post-crisis: Patient experiences remorse and may cry or become withdrawn.

A psychiatric and mental health nurse feels sorry for a patient because his family won't support him. The nurse offers to visit the patient's family as well as purchase some items for him. This nurse is: Showing empathy Violating professional boundaries Building a strong therapeutic relationship Exhibiting negligence

Violating professional boundaries Rationale: If a psychiatric and mental health nurse feels sorry for a patient who states his family won't support him and offers to visit the family as well as purchase some items for him, the nurse is violating professional boundaries by becoming over-invested in the patient and attempting to solve his problems for him rather than helping him to do so. Additionally, the nurse is establishing a relationship in which the patient may have unrealistic expectations of what the nurse will do, and this can lead to conflict.

If a patient with psychosis divulges that he intends to kill his parents, healthcare providers must: Have the patient arrested. Warn the parents. Increase patient oversight. Advise the patient not to make threats.

Warn the patients Rationale: While what a patient says is usually protected by the regulations regarding privacy and confidentiality, if a patient makes a credible threat, such as intending to kill his parents, then the healthcare provider must warn the parents of the danger under the "duty to warn" laws. These laws may vary somewhat from one state to another with some states permitting healthcare providers to use professional judgment about warning others and other states requiring mandatory reporting.

Which of the following is a healthy response to conflict with another person? The belief that the other person's point of view is wrong Resentment toward the other person Willing to seek compromise with the other person Siding with the other person despite feelings of abandonment

Willing to seek compromise with the other person Rationale: A healthy response to conflict with another person is the ability to seek compromise and to let go of anger, disappointment, and resentment, which interfere with the healing process. Resolving conflicts is facilitated by a calm, reasonable approach that shows respect for the other individual despite the differences that serve as the basis of the conflict. The members to the conflict should make an effort to understand the feelings associated with the opinions.

When conducting the physical examination on a patient, the psychiatric and mental health nurse notes that the patient has dysphonia and can only speak in a hoarse whisper, a symptom that has persisted for over 6 months. Based on this observation, the cranial nerve that should be assessed is: I (one) II (two) VIII (eight) X (ten)

X (ten) Rationale: Because the patient has longstanding dysphonia and can only speak in a hoarse whisper, the cranial nerve that should be assessed is cranial nerve X (ten), because it provides sensation and innervation to the larynx per the laryngeal nerves. Injury or paralysis of either or both of these nerves can result in persistent hoarseness. To assess cranial nerve X, the patient is asked to open the mouth and say "Ahh" while the nurse observes the movement of the soft palate and pharynx. Normal response is symmetrical elevation of the palate and bilateral medial movement of the pharynx with the uvula mid-center.