PMHN Practice Questions

A patient is scheduled for electroconvulsive therapy for severe depression unresponsive to antidepressants. The pre-procedure medication that the nurse anticipates giving is a(n): a. sedative. b. analgesic. c. cholinergic blocking agent. d. muscle relaxant.

Answer: C. cholinergic blocking agent. Rationale: About 30 minutes before electroconvulsive therapy (ECT), the patient usually receives a cholinergic blocking agent, such as atropine sulfate or glycopyrrolate, to decrease secretions, reduce the risk of aspiration, and to increase the heart rate to compensate for the slowing that results from vagal stimulation during ECT. During the procedure, the patient usually receives a short-acting anesthetic (such as methohexital sodium) and a muscle relaxant (succinylcholine chloride).

A patient flirts with her male nurse and then complains to the administrative staff that the nurse is "coming on" to her. This is an example of: a. sublimation. b. suppression. c. displacement. d. projection.

Answer. D. Projection Rationale: Projection occurs when a patient attributes unacceptable personal feelings or behavior to someone else, such as a patient flirting with a nurse and then claiming the nurse was "coming on" to her. Sublimation occurs when a patient refocuses unacceptable drives, feelings, or impulses onto something acceptable. Suppression occurs when a patient voluntarily blocks or suppresses unpleasant feelings or memories from awareness. Displacement occurs when a patient transfers feelings from one person or thing to another that is less threatening.

A patient at risk for self-directed violence tells the psychiatric and mental health nurse that she wants to die and has nothing to live for. The most appropriate response is: A. "Do you have a suicide plan?" B. "Your family loves you very much." C. "You will feel better when the medication starts to work." D. "I'm so sorry to hear that, but I can help you."

Answer: A "Do you have a suicide plan?" Rationale: The most appropriate response to a patient stating that she wants to die and has nothing to live for is "Do you have a suicide plan?" The psychiatric and mental health nurse should confront the issue directly in a matter-of-fact manner because this helps to convey to the patient that the nurse is willing to hear a truthful response, and when confronted in this way, patients are more likely to share plans. Patients who have actually developed a suicide plan are at increased risk.

A patient who has not responded well to other antipsychotics is started on quetiapine. In the initial initial period when the patient's medication dosage is being adjusted, the patient should be assisted with: a. ambulation. b. toileting. c. dressing. d. eating.

Answer: A. ambulation. Rationale: In the initial period when the patient's medication dosage is being adjusted, the patient should be assisted with ambulation because the patient is at increased risk of falls because of the hypotensive effects of the drug. The patient should be cautioned to sit up slowly and to stay seated for a moment before standing to reduce orthostatic hypotension. The patient's white blood cell count should also be monitored, as this drug may cause leukopenia as well as increased glucose levels and liver enzymes.

A "state of optimum anxiety" refers to: A. readiness for learning B. psychological well-being C. readiness for therapy D. response to treatment

Answer: A. readiness for learning. Rationale: A "state of optimum anxiety" refers to readiness for learning. Studies have indicated that learning is best achieved when the patient is experiencing mild to moderate anxiety, which may be related to anticipation or concerns about learning. This optimum anxiety enhances the ability to concentrate and process information. However, when this level of anxiety is exceeded, learning is impaired and the patient comes defensive. The psychiatric and mental health nurse may need to assist the patient with anxiety-reducing techniques before teaching.

A patient has undergone electroconvulsive therapy (ECT) and is awakening from the anesthesia. The initial patient response that is most expected is: a. sedation. b. memory impairment. c. agitation. d. anger.

Answer: B. Memory impairment. Rationale: B: Patients recovering from electroconvulsive therapy (ECT) usually experience confusion and temporary impairment of memory. Patients should be advised of this before the procedure but may still be quite frightened by this confusion on awakening after ECT. The nurse should provide reassurance, explaining to the patient what has happened and reorienting the patient to time and place. The patient may require very structured activities for a few days after the treatment until memory improves.

Relapse prevention is part of the patient's individualized education plan on discharge. The statement that suggests the patient has made a realistic plan to prevent relapse is: A. "I know I have to stop taking drugs." B. "Don't worry. I've learned my lesson." C. "I will call my sponsor if I feel like using again." D. "My family will make sure I don't relapse."

Answer: C. "I will call my sponsor if I feel like using again." Rationale: A plan for relapse prevention must contain concrete actions: "I will call my sponsor if I feel like using again." The plan should focus on what the patient will do, not the family: "My family will make sure I don't relapse." The focus on family takes the responsibility away from the patient. Statements indicating that the patient recognizes the need for a plan, such as "Don't worry I've learned my lesion," and "I know I have to stop taking drugs, are not a plan.

The psychiatric and mental health nurse should recommend that adults with a history of illicit injection drug use get the following vaccination(s): a. Hepatitis A and Hepatitis B. b. Pneumococcal polysaccharide (PPSV23). c. Meningococcal. d. Human papillomavirus.

Answer: A. Hepatitis A & Hepatitis B. Rationale: Illicit drug users should be advised to have vaccinations for hepatitis A and B. Hepatitis A is recommended for those who take illicit drugs by any method and hepatitis B for those who use injection drugs. Hepatitis A is spread by the oral-fecal route. Those most at risk are people having sex with infected persons, travelers to endemic areas, men having sex with men, and illicit drug users. Hepatitis B is spread through contact with an infected person's blood or body fluids, putting injection drug users at special risk, especially from sharing needles.

A patient with cognitive decline associated with dementia is undergoing sensory stimulation therapy, which is based on the concept of: A. neural plasticity B. Health promotion C. Behaviorism D. Recovery model

Answer: A. Neural plasticity Rationale: Sensory stimulation therapy (SST) is based on the concept of neural plasticity and aims to make new connections in the brain to compensate for loss. One type of SST uses items found in a patient's everyday life to stimulate one or more of the five senses. For example, a patient may be asked to smell a particular food and then be asked questions about the food. Another type of SST uses a rapid sequence of nerve stimulation through a device in a part of the body, such as an arm, to promote neural regeneration.

61. As part of milieu therapy, the psychiatric and mental health nurse should expect to: a. provide weekly patient feedback. b. attend regular community meetings. c. direct patient participation. d. establish rules of patient behavior.

Answer: B. Attend regular community meetings. Rationale: With milieu therapy, all aspects of the patient's environment are considered therapeutic, and patients are expected to be active participants in planning their own treatment. Criteria for milieu therapy include fulfilling basic physiological needs, establishing an environment that is conducive to achieving therapeutic goals, and creating a democratic form of governance in which the patients and staff are equal members and participants. Patients and staff meet in weekly community meetings in order to establish rules, norms, and behavioral expectations and limitations.

Which of the following medications is most likely to trigger a psychotic or manic response? A. anticonvulsants B. corticosteroids C. antidepressants D. opioids

Answer: B. Corticosteroids Rationale: While antidepressants, anticonvulsants, opioids, and amphetamines may trigger psychotic or manic responses, corticosteroids are most likely to do so. A psychotic or manic response is most common after high doses of steroid drugs. Symptoms often occur within a few days of onset of therapy with reactions including hypomania, psychosis and mania. Corticosteroid-induced psychiatric responses are more common in females than males. If symptoms occur, the medication dosage should be tapered to a lower dose and discontinued if possible.

The legislative act that provides access to community services for older adults and Native Americans, including meals, legal assistance, adult day care, and transportation, is the: a. Older Americans Act (OAA). b. Americans with Disabilities Act (ADA). c. Omnibus Budget Reconciliation Act (OBRA). d. Affordable Care Act (ACA).

Answer: A. Older Americans Act (OAA). Rationale: The Older Americans Act (OAA) (1965, 2006) is intended to improve access to a variety of services for older adults and Native Americans by providing funding to local organizations and agencies. Services include home delivery of meals, transportation, adult day care, home repair, and legal assistance. Programs are also available to combat violence against older adults. The National Family Caregivers Support Act is part of OAA and provides services to caregivers. Services that are available may vary from community to community.

When assessing the learning needs of a patient to promote self-care, the need that should have priority is: a. pain control. b. anxiety reduction. c. dietary instruction. d. disease pathology.

Answer: A. Pain control. Rationale: When prioritizing needs, those that are physiological are the priority. In this case, the patient is experiencing both pain and anxiety, and pain usually must be dealt with first, followed by anxiety reduction through relaxation techniques. Anxiety may, in fact, be related to the degree of pain. Dietary instruction is of practical use and should be carried out next. Disease pathology may or may not be of particular interest to a patient, but knowledge of disease pathology is not essential in learning to manage self-care.

When utilizing psychodrama as a psychosocial therapy, the role of the protagonist is assumed by the: A. Patient B. Nurse C. Therapist D. Family member

Answer: A. Patient Rationale: In psychodrama, the role of the protagonist is assumed by the patient who has a problem to resolve. Other members of the therapeutic group assume roles to act out with the protagonist. For example, if a patient has a conflict with a spouse and cannot confront the spouse, a member of a group may act out the role of the spouse. The group leader, usually a therapist or nurse, is referred to as the director and the members of the group, the audience. Participants are actors.

The purpose of the Substance Abuse and Mental Health Services Administration's (SAMHSA's) Opening Doors program is to: a. prevent and end homelessness. b. promote mental health care for veterans. c. provide residential care for the mentally ill. d. prevent prescription drug misuse and abuse.

Answer: A. Prevent and end homelessness. Rationale: SAMHSA has many programs aimed at reducing the impact of substance abuse and mental illness. Opening Doors is a program aimed at preventing and ending homelessness. The program was developed in 2010 in response to statistics that showed that out of 610,000 homeless people in the United States, about one in five have a serious mental illness and slightly more than one in five are substance abusers. Opening Doors helps to ensure collaboration among a number of government agencies, including HHS, Medicaid, and TANF programs.

Piaget's theory of cognitive development in children applies to adults in relation to concepts about: A. readiness to learn B. self-efficacy C. self-determination D. intelligence

Answer: A. Readiness to learn Rationale: Piaget's theory of cognitive development in children applies to adults in relation to readiness to learn. Like the child, the adult can incorporate new learning experiences through assimilation and goes through changes in dealing with these experiences through accommodation. Piaget stressed the idea that a child must be developmentally ready for learning and that trying to teach a child who is not ready may result in rote memorization but not real learning. These same concepts can apply equally to adult learning.

When developing a plan of care for a patient with obsessive-compulsive disorder who compulsively washes his hands, the first goal in assisting the patient to reduce this ritualistic behavior and to increase coping skills is to assist the patient to: A. Recognize precipitating factors B. Control the urge to carry out ritualistic behavior C. Analyze the underlying cause of ritualistic behavior. D. View the ritualistic behavior rationally

Answer: A. Recognize precipitating factors. Rationale: When developing a plan of care for an OCD patient who compulsively washes his hands, the first goal in assisting the patient to reduce this ritualistic behavior and to increase coping skills is to assist the patient to recognize precipitating factors. The patient should begin to understand the type of circumstances that serve as triggers. Trying to abruptly stop ritualistic behavior before the patient has developed adequate coping skills may result in extreme anxiety and panic attacks.

A patient with intermittent explosive disorder is exhibiting the prodromal syndrome of escalation of anger. The most appropriate first step in preventing an act of violence is to: a. to ensure adequate staff is available. b. to utilize seclusion or restraints. c. to attempt to talk the patient down. d. to offer medication to the patient.

Answer: A. To ensure adequate staff is available. Rationale: Before confronting a patient who is at risk for violence, the psychiatric and mental health nurse should first ensure that adequate staff are available to assist and the nurse should alert them to the situation. The next step is to attempt to talk the patient down. The nurse may suggest physical outlets of aggression (hitting a pillow). The nurse should ask if the patient is willing to take medication voluntarily and should assess if the situation requires medical or mechanical restraints. The patient should be secluded from other patients by taking the patient to a separate area or removing other patients to ensure their safety.

When admitting a new patient and reconciling medications, the psychiatric and mental health nurse finds one list of medications on a previous hospital record, another on the physician's notes, and a third provided by the patient. The first step is to: A. compare all three lists. B. ask the patient which list is correct. C. ask the patient to prepare a new list. D. utilize the latest list.

Answer: A. compare all three lists. Rationale: When reconciling a patient's medications, the psychiatric and mental health nurse should utilize all available information and begin by comparing different lists and then going over them in detail with the patient. Lists prepared by the physician may not include medications ordered by other physicians as patients often forget to provide this information to other healthcare providers. The psychiatric and mental health nurse should not depend on the lists alone but should prompt the patient for more information, as the patient may forget about some medications or think over-the-counter drugs and vitamins/herbs don't count.

A patient with anxiety disorder wants to utilize complementary therapy as an adjunct to anti-anxiety medications. The complementary therapy that is likely to be the most effective in providing relief from anxiety is: A. imagery/self-relaxation B. acupuncture C. massage D. aromatherapy

Answer: A. imagery/self-relaxation Rationale: Imagery and self-relaxation techniques are likely to be the most effective in providing relief rom anxiety because these techniques can be learned easily and utilized whenever the patient feels stressed. Massage also has benefits in reducing anxiety but is expensive and not readily available during times of stress. Some people feel that aromatherapy (orange, bergamot, lavender) is beneficial. Studies regarding the use of acupuncture to relieve anxiety have been inconclusive, although some people feel it helps reduce anxiety.

A patient hospitalized with depression has a long history of alcoholism. Five days after admission, the patient exhibits increasing agitation, tremors, and confusion. The patient is disoriented and having hallucinations. Temperature, pulse, and blood pressure levels are elevated, and the patient is diaphoretic. The treatment that is most indicated is: A. Phenobarbital B. Diazepam C. Phenytoin D. Clonidine

Answer: B. Diazepam Rationale: The patient is exhibiting symptoms of delirium tremens, which usually occurs within three to ten days of drinking cessation. The treatment of choice is usually a long-acting benzodiazepine, such as diazepam or lorazepam, to prevent seizures. Phenobarbital may be used as an adjunct but poses more risk of respiratory depression and low blood pressure, although a single dose is sometimes given in the emergency department before the benzodiazepine. If DTs are intractable to benzodiazepine, phenobarbital or propofol may be added.

The psychiatric and mental health nurse is providing education about coping mechanisms to a group of patients, one of whom has recently developed profound hearing loss but is unable to utilize sign language. Much of the prepared material is in video format. The most appropriate accommodation for the patient with hearing loss is: a. to provide closed-captioning for the videos. b. to print out a script of the video. c. to provide illustrations and written explanations. d. to separate this patient from the group and instruct privately.

Answer: A. to provided closed-captioning for the videos. Rationale: All video materials prepared for patients should have closed-captioning; this is the most appropriate accommodation, as it allows the patient to participate in the group without drawing attention to the patient's hearing loss. A script should be available for any audio materials. When developing materials, the psychiatric and mental health nurse should always consider the possible need for alternative delivery for patients, especially those with hearing, vision, or cognitive impairment.

Which of the following is a developmental milestone that usually occurs during adolescence (12 to 18 years)? A. understanding abstract concepts. B. comprehending and carrying out multiple directions in sequence. C. understanding concepts of size and time. D. enjoying doing things without assistance.

Answer: A. understanding abstract concepts. Rationale: Developmental milestones that usually occur during adolescence (12 to 18 years) include: - Understanding abstract concepts - Achieving adult stature and sexual maturity: Growth spurt for females peak at about age 11.5 and for males at about age 13.5. The average age of menarche is 12 and onset of nocturnal emissions is 13.5. - Developing secondary sexual characteristics. - Desiring acceptance from peers. - Expressing concern about body image. - Developing romantic attractions to the opposite or same gender. - Showing increasing desire for independence from parents.

A patient with bipolar disorder is extremely manipulative and often behaves in sexually provocative and inappropriate manner with staff members and other patients. The most appropriate methods(s) of dealing with this inappropriate behavior is to: A. utilize positive reinforcement and negative consequences B. use chemical restraints to control inappropriate behavior C. refer the matter to the patient's psychiatrist for guidance D. isolate the patient from other patients until behavior improves

Answer: A. utilize positive reinforcement and negative consequences Rationale: The most appropriate method of dealing with manipulative and other inappropriate behavior with a patient with bipolar disorder is to use positive reinforcement when the patient exhibits appropriate behavior and negative consequences when the patient exhibits inappropriate behavior. The patient should be apprised of the negative consequences that the patient may incur, and expectations about behavior should be clearly outlined. The healthcare staff must all be very consistent in applying positive reinforcement and negative consequences.

During which stage of the therapeutic relationship does the nurse examine personal feelings about working with a patient? a. Pre-interaction b. Orientation c. Working d. Termination

Answer: A: Pre-interaction. Rationale: - Pre-interaction: The nurse obtains information about the patient from various sources and examines personal feels about working with the patient. -Orientation: The patient and nurse get to know each other, establish rapport, and develop a plan of action based on the patient's strengths and weaknesses and nursing diagnoses. - Working: The nurse helps the patient engage in problem solving activities and to overcome resistant behaviors, evaluating progress toward goals. - Termination: The nurse and patient should explore feelings about termination and plan for continuing care.

When a psychiatric and mental health nurse has difficulty setting limits on a patient's behavior because of an emotional response to a patient, this is an example of: a. transference. b. counter transference. c. magnification. d. codependency.

Answer: B counter transference. Rationale: When a psychiatric and mental health nurse has difficulty setting limits on a patient's behavior because of an emotional response to a patient, this is an example of counter transference, which refers to the emotional response the psychiatric and mental health nurse has toward the patient. Transference occurs when the patient transfers feelings and behavior that had been directed toward another person toward the nurse. For example, if the patient hates his mother and the nurse makes a comment that reminds him of her, the patient may transfer his negative feelings toward the nurse.

Which of the following is the key ingredient in developing a learning contract with a patient? a. Cognitive ability. b. Trust. c. Motivation. d. Developmental stage.

Answer: B. Rationale: Trust is the key ingredient in developing a learning contract with a patient; the contract should be culturally sensitive and developmentally appropriate. Learning contracts may be formal or informal, but should include goals and a plan of action as well as a method of evaluation. The learning contract should be developed in collaboration with the patient, who trusts the nurse to provide guidance, learning materials, and learning opportunities, and the nurse, who trusts the patient to follow through with the learning contract.

A new patient on the unit has a speech impediment. During group therapy, some of the other participants made fun of her and mimicked her impediment, causing the patient to become very upset. Which of the following is an empathic response to the patient? a. "I know how you feel. I get so angry when people make fun of my ears." b. "You feel angry and sad about the other patients making fun of you." c. "Just ignore what the others say!' d. "The other patients made fun of you because they are insecure."

Answer: B. "You feel angry and sad about the other patients making fun of you." Rationale: An empathic response is one that shows that the psychiatric and mental health nurse understands what the patient is feeling regardless of outward behavior: "You feel angry and sad about the other patients making fun of you." Empathy is critical to a therapeutic relationship because it helps the patient to identify personal feelings that may be repressed and helps the patient believe the nurse is understanding and caring.

A 16-year-old patient with anorexia nervosa weighs 76 pounds, is severely emaciated and malnourished, and has developed cardiac dysrhythmias. Nutrition is critical, but the patient refuses to eat any food. The most appropriate response for the psychiatric and mental health nurse is: A. "You will die if you don't eat" B. "You will be fed by nasogastric tube if you don't eat" C. "We can't help you if you don't help yourself." D. "I can't force you to eat."

Answer: B. "You will be fed by nasogastric tube if you don't eat. Rationale: An adult can refuse food and nutrition, but a 16-year-old is a minor and under parental control, so the parents/caregivers make the decisions about health. In this case, because the patient's life is in danger, the nurse should respond with what is true and necessary: "You will be fed by nasogastric tube if you don't eat." The patient should be monitored during meals and for at least an hour after meals to prevent purging. A goal for weight gain (usually 2 to 3 pounds per week) should be established and calories/nutrition calculated based on that goal.

A patient is upset that he hasn't been able to complete a task successfully. Which of the following is an example of a non-therapeutic communication response? a. "I don't think you need to worry about that." b. "You're feeling frustrated." c. "Perhaps we can work on this together." d. "Let's talk about how you are feeling."

Answer: A. "I don't think you need to worry about that." Rationale: Non-therapeutic communication includes inappropriately giving reassurance: "I don't think you need to worry about that." This response suggests that the patient doesn't need to be concerned and devalues what the patient is feeling. This type of response may make the patient reluctant to share feelings in the future. Other types of non-therapeutic communication techniques include rejecting, approving/disapproving, agreeing/disagreeing, giving advice, persistent questioning, defending, asking for explanations, belittling, making stereotypical comments, and changing the subject.

In group therapy, a patient called another patient "stupid and ugly," causing the second patient to begin crying. The psychiatric and mental health nurse meets with the first patient to discuss the behavior. The feedback that is most descriptive and focused on behavior is: a. "Mary was upset and sad when you called her 'stupid and ugly.'" b. "You were mean and rude when you called Mary 'stupid and ugly.'" c. "You should apologize for hurting Mary." d. "How would you feel if Mary had called you 'stupid and ugly'?"

Answer: A. "Mary was upset and sad when you called her 'stupid and ugly.'" Rationale: Feedback that is descriptive and focused on behavior is "Mary was upset and sad when you called her 'stupid and ugly.'" This statement described the action and the result without being evaluative ("mean and rude") or focusing on the patient ("How would you feel...?). Using evaluative comments often results in the patient becoming defensive. Feedback should be specific and should address things that the patient can actually modify, such as behavior. Feedback should give information rather than advice ("You should apologize...), and should be given promptly.

According to the International Society of Psychiatric-Mental Health Nurses (ISPN) position paper "Emergency Care Psychiatric Clinical Framework," clinical assessment of the patient in the emergency department should begin with: a. a focused medical assessment. b. a mental status exam. c. a review of current medications. d. safety concerns.

Answer: A. A focused medical assessment. Rationale: The International Society of Psychiatric-Mental Health Nurses (ISPN) states in "Emergency Care Psychiatric Clinical Framework" that the clinical assessment of the patient in the emergency department should begin with a focused medical assessment that is relevant to the psychiatric patient to determine if the patient has a medical condition contributing to the psychiatric symptoms or has a medical condition in addition to the psychiatric symptoms. This should be followed by a psychiatric evaluation that includes a mental status exam.

In the cycle of battering, during the phase of tension building, a battered woman typically: A. Tries to hide B. Acts compliant C. Feels guilty D. Provokes abuse.

Answer: B. Acts compliant Rationale: The cycle of battering: - Phase I, Tension-building: During this state, the abused typically becomes very compliant, trying to defuse the abuser's anger. - Phase II, Acute battering: The abused typically tries to hide or get away from the abuser. In some cases, the tension from phase I is so severe that the abused may provoke the beating to get it over with. - Phase III, Respite, loving: The abused feels guilty that the abuser was forced to act and wants to believe that the abuser will remain loving and kind.

The nursing organization that is the most active politically, lobbying to promote the interests of the nursing profession and policies regarding health care reform, is the: a. American Nurses Credentialing Center (ANCC). b. American Nurses Association (ANA). c. American Psychiatric Nurses Association (APNA). d. American Association of Colleges of Nursing (AACN).

Answer: B. American Nurses Association (ANA). Rationale: The American Nurses Association (ANA) has over 3 million members and is the most active organization politically through its national, state, and local affiliates. The ANA lobbies and promotes legislation related to the needs of the nursing profession and has taken an active role in developing policy initiatives related to healthcare reform. The ANA has taken positions on a number of issues that relate to both nurses and patients in relation to workplace safety and improvement in healthcare delivery.

A patient has been classified as having a mild intellectual disability (IQ 60). Based on this, the psychiatric and mental health nurse expects that the patient is capable of: A. Achieving academic skills to a sixth-grade level. B. Achieving academic skills to a second-grade level. C. Learning through systematic habit forming. D. Responding to minimal training in self-help.

Answer: A. Achieving academic skills to a sixth-grade level. Intellectual disabilities: - Mild (IQ 60-70): Achieves academic skills to sixth-grade level and is able to learn some vocational skills and to live independently with some assistance. - Moderate (IQ 35-49): Achieves academic skills to second-grade level and may be able to work in a sheltered workshop, but requires supervision in living situations. - Severe (IQ 20-34): Learns through systematic habit forming, but cannot benefit from vocational training or work or live independently. - Profound (IQ <20): Responds to minimal training in self-help

When using Keller's (1987) attention- relevance-confidence-satisfaction (ARCS) model as a motivational strategy for learners, which term refers to the use of variable instructional methods? a. Attention. b. Relevance. c. Confidence. d. Satisfaction.

Answer: A. Attention. Rationale: A: Keller's ARCS model focuses on creating a learning environment that includes motivational strategies to facilitate learning when designing instruction for the learner. The ARCS model comprises: - Attention: Uses variable instructional methods, opposing positions, participatory discussions. - Relevance: Utilizes knowledge, choices, and experiences the learner brings to the process. - Confidence: Considers requirements of learning, difficulty level, goals, attributions, personal sense of accomplishment. - Satisfaction: Includes reward systems, praise, learner use of new skill and personal evaluation.

A patient who has had repeated arrests for driving under the influence of alcohol refuses to admit that he has a drinking problem and states that the police have targeted him unfairly. The ego defense mechanism that the patient is using is: A. denial B. reaction formation C. regression D. undoing

Answer: A. Denial Rationale: The patient is using the ego defense mechanism of denial when the patient, who has had repeated arrests for driving under the influence of alcohol, refuses to admit that he has a drinking problem and states that the police have targeted him unfairly. Reaction formation is refusing to acknowledge undesirable feelings, thoughts, or behavior by exaggerating the opposite. Regression is retreating to an earlier level of development. Undoing is carrying out an action to negate a previous unacceptable one.

With the four-phase crisis intervention (Aguilera, 1998) method that corresponds to the nursing process, which of the following actions should be completed during Phase IV (evaluation/anticipatory planning)? a. Identify external support systems (family, friends, social agencies). b. Discuss how the patient will deal with triggering events in the future. c. Assess the patient's personal perception of strengths. d. Identify the precipitating event that caused the crisis.

Answer: B. Discuss how the patent will deal with triggering events in the future. Rationale: The four-phase intervention method (Aguilera, 1998): 1. Assessment: Gather information about precipitating factors, events, coping methods, support systems, substance abuse, suicide/homicide potential, and the patient's perceptions of strengths. Develop nursing diagnoses. 2. Planning intervention: Select actions for nursing diagnoses. 3. Intervention: Carry out actions, including establishing rapport, settling behavioral limits, clarifying problems, acknowledging feelings, guiding the patient through problem solving, and helping the patient identify new coping mechanisms. 4. Evaluation/Anticipatory Planning: Evaluate resolution of crisis and discuss how the patient will deal with triggering events in the future.

A male patient who acts very polite and considerate in the presence of other patients and staff makes threatening and vulgar sexual comments to the psychiatric and mental health nurse when no one else can hear. The most appropriate method of reporting this behavior is to: a. file an incident report. b. document exactly what the patient said and the circumstances in the nursing notes. c. document that the patient was "behaving inappropriately" in the nursing notes. d. report the situation to the administrator.

Answer: B. Document exactly what the patient said and the circumstances in the nursing notes. Rationale: A patient's making inappropriate and even threatening comments is not unusual, and the psychiatric and mental health nurse should document this in the nursing notes by reporting exactly what the patient said and the circumstances in which it occurred. If the nurse actually feels threatened, then the issue of safety needs to be addressed by the staff. Whether an incident report needs to be filed depends on the policies of the institution and the degree of threat, and this may require some degree of subjective judgment.

The psychiatric facility is using the recovery model for treatment, but one of the patients has indicated that she does not plan to continue taking lithium for her bipolar disorder. The most appropriate response for the psychiatric and mental health nurse is to: A. Insist that the patient continue taking the medication. B. Educate he patient about the need for medication. C. Warn the patient that she will suffer relapse without medication. D. Transition the patient to a different model for treatment.

Answer: B. Educate the patient about the need for medication. Rationale: Because the recovery model maintains focus on the desires of the patient and allows the patient to make decisions, the best approach for the psychiatric and mental health nurse to a patient who plans to stop taking medication is to educate the patient about the needs of the medication and potential outcomes for failing to take the medication. However, adults—unless court-ordered—cannot be forced to take medications, regardless of the extent of their mental illness.

The International Society of Psychiatric-Mental Health Nurses (ISPN) contains how many divisions representing different nursing specialty areas? A. Two B. Four C. Six D. Eight

Answer: B. Four Rationale: Four different mental health associations came together to create the International Society of Psychiatric-Mental Health Nurses in 1999. These four associations became divisions of the new organization: - Association of Child and Adolescent Psychiatric Nurses (ACAPN) - International Society of Psychiatric Consultation Liaison Nurses (ISPCLN) - Society of Education and Research in Psychiatric Mental Health Nursing (SERPN) - Adult and Geropsychiatric Mental Health Nurses (AGPN). The purpose of the ISPN includes promoting quality care, outlining essential educational requirements, promoting research, and developing health care policy.

A patient who suffered severe brain damage as a result of a suicide attempt had written an advance directive stating that "no heroic measures" be used to keep her alive; however, the patient is being maintained on life support at the family's insistence. As an advocate for the patient, the most appropriate response for the psychiatric and mental health nurse is to: a. file a complaint with the district attorney. b. remain supportive and provide education to the family. c. tell the physician that he is violating the patient's rights. d. file a complaint with the hospital administration.

Answer: B. Remain supportive and provided education to the family. Rationale: In most states, there is no legal mechanism for requiring compliance with advance directives, and the reality is that, despite these directives, physicians rarely insist on removing life support and allowing patients to die if family members object. Additionally, "no heroic measures" is a general term that can be interpreted in different ways. In this case, the most appropriate course of action for the psychiatric and mental health nurse is to remain supportive and provide education to the family, who may need time to accept the reality of the patient's condition.

The psychiatric and mental health nurse has noted a number of nursing diagnoses in the plan of care for a patient with antisocial personality disorder admitted to the psychiatric unit under court order. The nursing diagnosis that should have priority is: A. Ineffective coping B. Risk for other-directed violence. C. Low self-esteem. D. Impaired social interaction.

Answer: B. Risk for other-directed violence. B: Safety issues should take priority over others, so the first priority is dealing with the patient's risk for other-directed violence with the short-term goal of the patient discussing feelings and situations that lead to hostility, and the short- and long-term goal of not harming others. The psychiatric and mental health nurse should show an accepting attitude, decrease stimuli, remove all dangerous objects from the patient's environment, and monitor the patient frequently, encouraging the patient to express feelings and explore alternatives to violence while ensuring adequate numbers of staff are present.

When utilizing the HEEADSSS method to interview an adolescent, the three S's refer to: A. sexuality/support/secrets B. sexuality/suicide/safety C. suicide/socialization/shelter D. sexuality/support/suicide

Answer: B. Sexuality/suicide/safety Rationale: The HEEADSSS method: H—Home environment: Where patient lives and with whom, as well as living situation. E—Education/employment: Description of school, bullying, grades, work schedule/place. E—Eating: Concerns about body appearance, weight, recent weight changes, dieting. A- Activities (peer-related): Free time, online, sports, clubs, friends. D—Drugs: Use of alcohol, tobacco, or drugs by patient or friends. S—Sexuality: Romantic relationships, sexual activity, contraceptives, pregnancy. S—Suicide/Depression: Stress, sadness, boredom, insomnia, bullying, suicidal ideation, suicide attempts. S—Safety: Injuries, seat belt use, texting while driving, meeting strangers online, riding with impaired driver, violence in school/area.

When a patient thinks, "If I stop drinking, I can repair my marriage," this type of "self-talk" is referred to as: a. uncertainty maintenance. b. uncertainty reduction. c. realistic goal setting. d. learner readiness.

Answer: B. Uncertainty reduction. Rationale: When a patient thinks, "If I stop drinking, I can repair my marriage," this type of "self-talk" is referred to as uncertainty reduction because the patient is going through a thought process to reduce uncertainty about a decision. Uncertainty maintenance, however, occurs when thought processes increase or maintain doubt about a decision. Realistic goal setting is setting goals that are reasonably attainable in order to facilitate success. Learner readiness involves the desire and willingness to move toward a goal.

A rape victim with multiple injuries has been brought to the emergency department for evaluation and treatment. The first thing that the psychiatric and mental health nurse should communicate is: A. I'm so sorry this happened to you B. You are safe here. No one can hurt you C. This was not your fault D. I'm thankful you survived this attack

Answer: B. You are safe here. No one can hurt you. Rationale: Patients who have been raped are often severely traumatized emotionally as well as physically and are commonly very fearful and panicked, so the first thing that the mental health nurse should communicate is "You are safe here No one can hurt you." The psychiatric and mental health nurse may need to repeat this a number of times because traumatized patients may block out what people are saying. The nurse should also reassure the patient that the attack was not the patient's fault and the nurse is sorry for what the patient has gone through.

When conducting the brief mental status evaluation as part of the clinical interview, which of the following is an appropriate activity to evaluate the patient's ability to concentrate? A. list three objects and ask the patient to repeat the list immediately and again in a few minutes. B. ask the patient to spell the word "world" in reverse. C. ask the patient to carry out a two- to three-step task. D. ask the patient what "a stich in the time save nine" means.

Answer: B. ask the patient to spell the word "world" in reverse. Rationale: The brief mental status evaluation typically includes questions to evaluate the patient's orientation to time and place, recent memory, and the ability to comprehend spatial relationships and to use language. Other mental functions include: - Ability to concentrate: Ask the patient to spell the word "world" in reverse. - Ability to follow verbal commands: Ask the patient to carry out a two- to three-step task. - Ability to utilize abstract thinking: Ask the patient what "A stitch in time saves nine" means. - Attention/immediate recall: List three objects and ask the patient to repeat the list immediately and again in a few minutes.

A patient frequently responds in rhymes, such as "The food is hot. I am hot an shot. The pot has been bought." This is an example of: A. word salad B. clang associations C. neologisms D. associative looseness

Answer: B. clang associations Rationale: Clang associations: Patient chooses words according to sound, often rhyming words, such as "the food is hot, I am hot and shot. The pot has been bought." Word salad: The patient strings together words randomly, such as "Many dogs green circle willingly." Neologisms: The patient creates new words that have meaning to the person but not to others, such as "I saw the magaraly." Associative looseness: The patient shifts topics form on to another with no connection between them such as "I ate lunch, but the water was too dirty for swimming. Swimming is the way to the office."

Which of the following is considered a "positive" symptom of schizophrenia? A. Flat affect. B. Disorganized speech. C. Poor eye contact. D. Impaired hygiene.

Answer: B. disorganized speech Rationale: Schizophrenia is characterized by both positive and negative symptoms. For a diagnosis of schizophrenia, the patient must exhibit at least one of the three positive symptoms: Positive: Disorganized speech, hallucinations, and elusions. Negative: Flat affect, poor eye contact, impaired hygiene, social isolation, alogia (poverty of speech0, apathy, and anhedonia (inability to experience pleasure). Schizophrenia spectrum disorders now encompass what were previously considered different subtypes (such as paranoid schizophrenia). Two criteria A symptoms are required for a diagnosis of schizophrenia along with the positive symptom(s).

64. A patient taking clozapine for treatment should be regularly monitored for: a. liver function. b. leukopenia. c. renal function. d. hypoglycemia.

Answer: B. leukopenia. Rationale: A patient taking clozapine for treatment should be regularly monitored for leukopenia and agranulocytosis with regular WBC counts. Clozapine is recommended for patients with schizophrenia not responding to other treatments and who are at risk for suicide. Clozapine has significant adverse effects, including seizures, cardiomyopathy, myocarditis, pulmonary embolism, and cardiac arrest. The drug should be used with caution with benzodiazepines and other psychotropic drugs because the combination may result in respiratory arrest. Clozapine has multiple drug-drug interactions so all medications should be carefully.

A patient with schizophrenia has delusions and believes that his family members cannot be trusted. According to Maslow's hierarchy of needs, the patient's delusions are interfering with development at the level of: A. physiological needs B. love/belonging needs C. safety needs D. self-esteem needs

Answer: B. love/belonging needs Rationale: The patient's delusions are interfering with development at the level of love/belonging needs. Maslow's hierarchy of needs is based on the premise that one must satisfy one type of need before on can attain the next. The hierarchy of needs includes: - Physiological: Basic needs such as air, food, water, shelter. - Safety and Security: Freedom from fear; physical comfort, safety. - Love and belonging: Companionship, giving/receiving love, group identification, satisfying interpersonal relationships. - Self-esteem: Working for success, desiring respect and prestige, seeking self-respect. - Self-actualization: Feeling of self-fulfillment, satisfaction with achievements.

A patient tends to walk and sit in a slumped over position, keeping the head and eyes down, and rarely making eye contact or initiating conversation. conversation. The patient responds with a low tone of voice. These behaviors most likely represent: a. dislike. b. low self-esteem. c. fear. d. anxiety.

Answer: B. low self-esteem. Rationale: While patients may vary in how they express feelings, walking or sitting slumped over, keeping the eyes and head down, avoiding eye contact, failing to initiate conversations, and keeping a low tone of voice are consistent with low self-esteem. The psychiatric and mental health nurse should help the patient to establish realistic and achievable goals and help the patient identify positive personal aspects and strengths. The patient may need one-on-one support in difficult situations, such as group therapy, to deal with fear of failure.

The psychiatric and mental health nurse had developed a good relationship with a patient with borderline personality disorder, but the nurse took time off to deal with a family matter and when returning found the patient angry and resentful and blaming the nurse for her problems. This is an example of: A. manipulation B. splitting C. clinging/distancing D. self-destructiveness

Answer: B. splitting Rationale: Patients with borderline personality disorder often experience splitting because they swing from one extreme to another and cannot deal effectively with both negative and positive feelings, wo when the patient feels "abandoned" by the nurse whom the patient had previously idealized, the patient recognizes only the negative feelings. Other characteristics include manipulation (to prevent separation anxiety), clinging/distancing (alternating between excessive closeness and discomfort with closeness), self-destructiveness (self-mutilation, suicide), and impulsivity (substance abuse, gambling, promiscuity).

When planning a group discussion with patients about alcohol prevention, an important consideration when forming the group is that: A. the group members be diverse in levels of health literacy and conditions. B. the group members have similar levels of health literacy and conditions. C. the group members be chosen at random D. the group members are all the same gender.

Answer: B. the group members have similar levels of health literacy and conditions. Rationale: When planning a group discussion with patients, an important consideration when forming the group is that the group members have similar health literacy and conditions (or degrees of anxiety) because the leader must ensure that all members of the group have correctly interpreted and understood information being shared; this can be difficult if patients have a wide range of health literacy, anxiety, or conditions. However, some diversity is valuable because it allows for different perceptions and observations.

A 60-year old female patient has been treated for depression with an SSRI for four months but reports no improvement in feelings of depression. The patient reports weight gain, lethargy, and feeling constantly "chilled." The patient probably needs: A. an increased dosage of medication B. thyroid function tests C. a change to a different medication. D. renal function tests

Answer: B. thyroid function Rationale: The patient is exhibiting possible signs of hypothyroidism-weight gain, lethargy, and feeling, "chilled" or having increased sensitivity to cold and should have thyroid function tests. Patients may also complain of poor concentration, constipation, dry hair, and somnolence and may exhibit bradycardia and joint or muscle pain. Hypothyroidism is a common cause of depression; it is often one of the first signs, and is typically overlooked. Hyperthyroidism may result in anxiety and emotional lability with some patients developing acute episodes of mania.

A patient who believes that other people are constantly talking about him or laughing at him is likely experiencing delusions of: A. persecution B. grandeur C. reference D. control

Answer: C Reference Rationale: Delusions of reference: Patient believes that almost everything refers to himself, often believing that other people are constantly talking about him or laughing at him and that newspapers and TV programs are sending coded messages to him. Delusions of grandeur: Patient believes she has exceptional power or knowledge, such as believing she is Queen Elizabeth. Delusions of persecution: Patient believes others intend to harm him, such as believing he is being videotaped or recorded. Delusions of control: Patient believes others are controlling her, such as believing the doctor has implanted something to control her mind.

A patient was able to slowly read aloud an information sheet but when asked to state what she had read in her own words was unable to do so. The most likely reason is: A. low self-esteem B. poor hearing C. low health literacy D. anxiety

Answer: C low health literacy Rationale: The most likely reason the patient was able to read slowly but not state what she had read is low health literacy. The ability to read is different form the ability to comprehend, and comprehension usually lags behind reading skills by about three grade levels. Thus, a person who is able to read at the fourth-grade level may have only a first-grade reading comprehension, making it difficult for the person to understand health materials, especially since the vocabulary is often more difficult to understand than that found in other readings.

68. During a meeting between a patient and the nurse, the patient paces back and forth and appears agitated and upset. Which of the following is the most appropriate response? a. "Why are you so upset?" b. "Take a moment and calm down before we proceed." c. "I notice you are pacing and seem upset." d. "Your pacing is making me uncomfortable."

Answer: C. "I notice you are pacing and seem upset." Rationale: The most appropriate response to a patient who is pacing and agitated is to describe the behavior observed: "I notice you are pacing and seem upset." The nurse should avoid appearing judgmental or asking "why" but should make the observation and allow the patient to respond, as this helps the patient to recognize behaviors. The nurse should also avoid being directive, such as with "Take a moment and calm down before we proceed," unless a patient's actions are endangering.

A patient exhibits disturbed thought processes and delusional thinking, insisting his room is, "bugged by the CIA." The most appropriate response to the patient is: A. "That's not true. The CIA has no access to this facility." B. "OK, let's see if we can find the bug and remove it." C. "I understand you believe your room is bugged, but I don't believe it's possible." D. "Remember what you learned about hallucinations and delusions not being real."

Answer: C. "I understand you believe your room is bugged, but I don't believe it's possible." Rationale: The most appropriate response is the one that expresses acceptance of the person's belief along with reasonable doubt: "I understand you believe your rooms is bugged, but I don't believe it's possible." It's important to avoid denying outright that delusions are real ("That's not true....) or arguing with the patient ("Remember what you learned...) as this not likely to change the person's beliefs and will likely interfere with the therapeutic relationship. However, it's also important to avoid supporting the delusion ("Ok, let see if we can find the bug...").

A patient tells the psychiatric and mental health nurse that she is using aromatherapy to relieve anxiety and that she finds it more effective than medication. The most appropriate response is: A. "There's no evidence that aromatherapy works." B. "You should not stop taking the medication." C. "The aromatherapy may help you to relax." D. "If aromatherapy cures your anxiety, that's great."

Answer: C. "The aromatherapy may help you to relax." Rationale: While there is no evidence that aromatherapy can cure anxiety, some people find aromatherapy relaxing, and this relaxation can help to relieve anxiety. The most appropriate response is" The aromatherapy may help you to relax" because this is true, but does not advocate for or against the therapy. Aromatherapy is essentially benign in that it is neither invasive nor toxic. Aromatherapy is often combined with massage with the essential oils applied directly to the skin, rather than inhaled.

A patient became very angry with the group leader in a therapy session and threw a glass of water at the leader. Which of the following statements by the patient suggests that the patient is using the ego defense mechanism of rationalization to explain the actions? a. "I didn't throw the glass. It slipped out of my hand." b. "I lost my temper and threw the glass!" c. "The leader repeatedly egged me on, forcing me to act." d. "I'm very sorry about throwing the glass of water."

Answer: C. "The leader repeatedly egged me on, forcing me to act." Rationale: The statement that suggests that the patient is using the ego defense mechanism of rationalization to explain his throwing a glass of water at the group leader is: "The leader repeatedly egged me on, forcing me to act." This patient is trying to give logical reasons for illogical behavior rather than accepting that his behavior was unacceptable. Ego defense mechanisms are unconscious coping mechanisms that help patients reduce anxiety and are commonly used but become a problem when they affect mental or physical health.

When using the reflective method during an interview, the best response to a patient's statement that his pain "moves around" is: A. "what do you meant" B. "where does it move around?" C "moves around?" D. "could you be more specific?"

Answer: C. "moves around?" Rationale: When using the reflective method during an interview, the psychiatric and mental health nurse reflects back or repeats what the patient has just said. In this case, if the patient said that his pain "moves around," the reflective response would be "moves around?" This encourages the patient to elaborate without the need for more direct questioning. The psychiatric and mental health nurse may also use facilitation—leaning forward, nodding the head, making eye contact, and saying "yes"—to encourage the patient to share information.

Which of the following is an example of secondary health preventive measure? A. A public service campaign to educate the population about depression. B. A program to treat depression and prevent suicide. C. A screening even for all patients over age 55 with the Geriatric Depression Scale. D. A support group of patients with depression.

Answer: C. A screening even for all patients over age 55 with the Geriatric Depression Scale> Secondary preventive measure: Screening groups that are already identified as at risk for depression, such as older adults, or treating those already diagnosed. These measures typically aim to prevent further deterioration or long-term disease disease progression. Primary preventive measures: Include public service campaigns to educate the general public about depression. These measures aim to reach large numbers of the population. Tertiary preventive measures: Includes support groups for patients with depression. These measures aim at management.

The most common co-morbid condition in adolescents with bipolar disorder is: A. juvenile arthritis B. lupus erythematosus C. ADHD D. dyslexia

Answer: C. ADHD. Rationale: The most common co-morbid condition of adolescents with bipolar disorder is ADHD. The treatment for ADHD, which often includes stimulants, may exacerbate manic symptoms of bipolar disease, so patients should be treated with mood stabilizers (such as lithium) and stabilized before treatment for ADHD is instituted. Non-stimulant treatments for ADHD, such as bupropion and tricyclic antidepressants may also result in mood swings. ADHD is also common in adults, with about 20% of adults with ADHD having bipolar disorder.

The most effective position for active listening is: a. Sitting beside the patient, touching the patient's arm. b. Standing near the patient with arms uncrossed. c. Sitting directly in front of the patient with arms uncrossed. d. Position is irrelevant.

Answer: C. Sitting directly in front of the patient with arms uncrossed. Rationale: The most effective position for active listening is sitting directly in front of the patient with arms and legs uncrossed so that the psychiatric and mental health nurse appears open to the patient's comments. The nurse should lean slightly toward the patient to indicate interest and should establish eye contact, although the eye contact should not be overly aggressive or staring, as this may be intimidating. The nurse should relax and appear comfortable with the patient.

Which of the following actions is most likely to be effective in establishing a relationship of trust with a newly admitted patient? a. Administering patient medications. b. Providing the patient a list of unit rules. c. Explaining the reason for unit procedures. d. Giving the patient a tour of the facility.

Answer: C. explaining the reason for unit procedures. Rationale: The action that is most likely to be effective in establishing a relationship of trust with a newly admitted patient is explaining the reason for unit procedures. While routine care—administering medications, providing a list of rules, and giving a tour—may be done in such a caring manner as to engender trust, those things that are "extra," such as taking time to explain procedures, keeping one's word, providing needed food or supplies, considering the patient's preferences, and ensuring confidentiality, are more likely to cause the patient to have confidence and trust in the psychiatric and mental health nurse.

When completing the physical examination of a patient complaining of chest pain, the psychiatric and mental health nurse asks the patient where the chest pain is and the patient runs an index finger up and down the sternum (neck to epigastrium). This suggests that the pain is related to: A. angina B. gastritis C. heartburn D. pleurisy

Answer: C. heartburn Rationale: When a patient reports chest pain, the psychiatric and mental health nurse should always probe for more information and ask the patient to show where the pain is. Typically, if pain is severe and crushing, as may occur with angina, the patient will indicate the site of the pain with the full hand or a fist, but running the finger up and down the sternal area suggests heartburn. Pleurisy is not usually felt in the sternal area, and gastritis may cause pain in the epigastrium.

An elderly patient scored 18 out of a possible maximum score of 30 on the Mini-Mental State Examination (MMSE). This score usually indicates: A. severe cognitive impairment B. mild cognitive impairment C. moderate cognitive impairment D. normal cognition

Answer: C. moderate cognitive impairment Rationale: A score of 18 out of 30 on the MMSS usually indicates moderate cognitive impairment. Scores of 27 to 30 indicate normal cognition while 10 to 18 indicate moderate cognitive impairment. Scores may be affected by numerous variable (age, hearing, intelligence, vision, physical condition), so the MMSE score alone is not adequate for diagnosis of dementia. However, it is a good guide, and those with very low scores (9 or less) usually demonstrate severe cognitive impairment.

A patient experiences a sudden and severe panic attack and is almost paralyzed with fear, believing her life is in danger. In addition to providing an anti-anxiety medication, the most appropriate response for the psychiatric and mental health nurse is to: A. leave the patient alone in a quiet space to recover B. ask the patient what would help relieve her anxiety C. stay with the patient and offer reassurance of safety D. remind the patient that her fears are not real

Answer: C. stay with the patient and offer reassurance of safety. The most appropriate response to a patient experiencing a sudden panic attack is to stay with the patient and offer reassurance of safety, speaking in a calm and non-threatening manner. Reducing stimuli (noise, light, people) in the immediate area may help to reduce the patient's fears. Once the patient has regained control and the panic attack subsides, the psychiatric and mental health nurse should explore with the patient the cause of the attack to help the patient recognize precipitating factors.

A male patient who is very short in stature has abused steroids in an attempt to build muscle mass. He excels in martial arts and he is very aggressive with other males. This behavior most likely reflects the ego defense of mechanism of: A. identification B. repression C. introjection D compensation

Answer: D compensation Rationale: Ego dense mechanisms: - Compensation: Compensating for what the person perceives as a weakness (such as short stature) by emphasizing other traits or characteristics (martial arts, aggressive behavior). - Identification: Taking on characterics/behavior of someone the person admires or looks up to in order to increase feelings of self-worth. - Repression: Blocking perceptions, memories, and feelings from conscious awareness. - Introjection: Integrating belief systems/values of someone else into the person's own, the way children assume the value system of the parents.

When serving as a mentor to a newly hired nurse, the psychiatric and mental health nurse noted that the new nurse became intimidated by an aggressive patient and was ineffectual in dealing with the patient's behavior. The psychiatric and mental health nurse's most appropriate response to the nurse is: a. "You didn't handle that situation with the patient very well." b. "What do you think you did wrong in that situation?" c. "Always call for help if you don't know what to do with a patient." d. "How do you think you might have handled that differently?"

Answer: D. "How do you think you might have handled that differently?" Rationale: When serving as a mentor to a newly hired nurse, the psychiatric and mental health nurse should remain as supportive as possible, helping the person to self-evaluate and learn. The most appropriate response is the one that encourages the nurse to come up with a solution: "How do you think you might have handled that differently?" The mentoring nurse should avoid direct criticism ("You didn't handle that situation well"), negative questioning ("What do you think you did wrong?"), and solutions ("Always call for help").

Which of the following is most likely an example of normal cognitive changes associated with aging in a 85-year-old patient? A. a patient has forgotten how to use the stove to cook. B. a patient has forgotten attending a birthday party C. a patient has forgotten which bank holds his savings account. D. A patient has forgotten to keep an appointment with the doctor.

Answer: D. A patient has forgotten to keep an appointment with the doctor. Rationale: Forgetting to keep an appointment is an example of normal cognitive changes associated with aging. Patients may remember events or stories but forget details about them or may misplace items, such as keys or jewelry; however, if people completely forget events, such as attending a party, forget important things, such as where savings accounts are located, or forget how to do something that the person has done previously for long periods of time, such as using the stove to cook, then this is often an indication of dementia.

A patient experienced a severe emotional crisis after her only child left home for college. This type of crisis is classified as: a. maturational/developmental. b. dispositional. c. traumatic stress. d. an anticipated life transition.

Answer: D. An anticipated life transition. Rationale: A patient experiencing a severe emotional crisis after her only child leaves home for college is undergoing a crisis of anticipated life transition, which involves a situation that the patient can anticipate and plan for but over which the patient may feel powerless and out of control. Other types of crises include maturational/developmental, dispositional, traumatic stress-related, and psychopathology-related. Patients experiencing a crisis are often not able to problem solve and need support and assistance in order to resolve the crisis.

Which of the following ethnic groups may require lower dosages of benzodiazepines and tricyclic antidepressants because of enzyme deficiencies that decrease the rate of metabolism? A. Caucasians B. Hispanics C. African Americans D. Asians

Answer: D. Asians Rationale: Because of enzyme deficiencies that decrease the rate of metabolism for some drugs, Asians (especially Japanese and Chinese) may require lower dosages of benzodiazepines and tricyclic antidepressants. For example, about 20% of Asians metabolize diazepam poorly, so the drug begins to rapidly accumulate and can result in toxic reactions and overdose. Asian patients should be started on low dosages of these drugs and observed carefully. Additionally, some Mexican Americans with variant genes respond better to some antidepressants

62. When using cognitive behavioral therapy for treatment of mood disorders, the focus is on: a. rewarding positive behavior. b. learning self-control. c. making decisions about care. d. changing automatic thoughts.

Answer: D. Changing automatic thoughts. Rationale: When using cognitive behavioral therapy for treatment of mood disorders, the focus is on changing automatic thoughts or thought distortions. Automatic thoughts related to depression include personalizing, all-or-nothing thinking, mind reading, and discounting positives, while automatic thoughts related to mania include the same type of thoughts except that mania involves discounting negatives. Patients' thought processes are challenged and the affected patient is asked to describe evidence for beliefs. Another approach is to help the patient evaluate what would happen if the automatic thoughts were realistic.

According to Erikson's stages of psychosocial development, which of the following best characterizes the developmental task of adulthood and the generativity vs. stagnation stage? A. achieving self-confidence by performing successfully and gaining recognition from peers. B. Developing a sense of positive self-worth from reviewing the events of life. C. achieving the personal life goals that the person had formulated. D. Making a commitment to another person as part of a long-term relationship.

Answer: C. Achieving the personal life goals that the person had formulated. Rationale: Erikson postulated that the stage of adulthood, generativity versus stagnation, is characterized by achieving the personal life goals that the person had formulated. The eight development stages include: - Trust vs. mistrust (Infancy, 0 to 18 months). - Autonomy vs. shame and doubt (early childhood, 18 months to 3 years). - Initiative vs. guilt (late childhood, 3-6 years) - Industry vs. inferiority (school age, 6-12 years) - Identity vs. role confusion (adolescence, 12-20 years) - Intimacy vs. isolation (young adulthood, 20-30 years) - Generativity vs. stagnation (adulthood, 30-65 years) - Ego integrity vs. despair (65 years-death)

A patient with a long history of schizophrenia and alcohol and drug addiction with repeated institutionalizations is stabilized after the current hospitalization and is ready for discharge. Which of the following community resource referrals is most likely to be effective? A. Community Mental Health Center B. Psychiatric home health care. C. Assertive Community Treatment (ACT). D. Partial hospitalization program.

Answer: C. Assertive Community Treatment (ACT) C: Assertive Community Treatment (ACT) is a comprehensive interdisciplinary case-management approach to providing treatment for patients with severe and persistent mental illness. ACT provides services from psychiatry, nursing, social work, and rehabilitation (substance abuse, vocational) around the clock to help patients: - Decrease/eliminate symptoms · Minimize recurrent/acute exacerbations - Meet basic needs - Improve functioning (social, vocational) - Live independently Another goal of the program is to help relieve family members of the burden of caring for patients with serious mental illnesses.

Which of the following drug types is most indicated for treatment of generalized anxiety disorder? A. SSRI B. Tricyclic antidepressant C. Benzodiazepine D. MAO inhibitor

Answer: C. Benzodiazepine Rationale: Benzodiazepines are the most-commonly prescribed treatment for generalized anxiety disorder because they are relatively safe, have few drug-drug interactions, and rarely alter consciousness. Commonly used drugs include diazepam, lorazepam, alprazolam, and clonazepam. Benzodiazepines are contraindicated for patients who are pregnant or who have narrow-angle glaucoma. Adverse effects include sedation, hypotension, nausea, vomiting, pruritis, skin rash, and blood dyscrasias (anemia, leukopenia, and thrombocytopenia). Overdose of benzodiazepines may result in severe life-threatening toxicity. Treatment is usually supportive although the antidote, flumazenil, may be used in severe cases.

To reduce anxiety, the patient's plan of care calls for the patient to practice mindfulness mediation in order to detect symptoms before they become problematic. This is a technique used in: A. behavioral therapy B. psychoanalytic therapy C. cognitive therapy D. cognitive behavioral therapy

Answer: C. Cognitive therapy Rationale: Mindfulness meditation is a technique used in cognitive therapy, which focuses on assisting the patient to correct distorted thinking and to consider the meaning of events rather than focusing on behavior. Techniques include cognitive restructuring in which patients are advised to consider evidence for and against specific beliefs in order to deal more effectively with outcomes. Mindfulness meditation teaches the patient to be aware of feelings and emotions "in the moment" in order to detect symptoms before they become problematic.

The patient's coping mechanism is a factor in which type of readiness to learn? a. Emotional. b. Physical. c. Experiential. d. Knowledge.

Answer: C. Experiential. Rationale: Types of Readiness to learn: - Experiential: Includes coping mechanisms, orientation, degree of aspirations, and cultural background. - Emotional: Includes level of anxiety, support systems, motivation, frame of mind, developmental stage, and risk taking behavior. - Physical: Includes current knowledge base, cognitive ability, learning style, and learning disabilities. - Knowledge: Includes current knowledge base, cognitive ability, learning style, and learning disabilities.

Which of the following gives patients the right to access their medical records and to have corrections made? a. OSHA. b. ADA. c. HIPAA. d. NAMI.

Answer: C. HIPAA Rationale: The Health Insurance Portability and Accountability Act (1996) (HIPAA) protects the confidentiality of medical records and ensures that patients have access to their medical records because, while the originator owns the actual record, the information contained in the record belongs to the patient. HIPAA also gives patients the right to have corrections made in their records if they feel that the records contain errors. Protected health information (PHI) is almost any information that identifies the person.

When taking a history of a 65-year-old patient, the psychiatric and mental health nurse notes that the patient does not always seem to understand the questions, ask frequently for clarification, and speaks in an inappropriately loud tone of voice. Based on these observations, the psychiatric and mental health nurse recommends: A. Cognitive assessment B. Alcohol screening C. Hearing Assessment. D. Drug screening

Answer: C. Hearing Assessment Rationale: Because the patient does not always seem to understand the questions, this could indicate that the patient is experiencing distortion of sounds related to sensorineural hearing loss, especially since the patient is also speaking in an inappropriately loud tone of voice. This often is a sign of sensorineural hearing loss because the patient is unable to adequately hear his own voice and thus tends to speak loudly to compensate. Additionally, sensorineural hearing loss is most common in older adults.

A patient in treatment for substance abuse has a nursing diagnosis of chronic low self-esteem. An appropriate outcome criterion for this nursing diagnosis is: A. Patient exhibits no signs of substance intoxication or withdrawal. B. Patient can verbalize names of support people willing to help. C. Patient can verbalize positive self-characteristics. D. Patient can verbalize coping strategies to avoid substance abuse.

Answer: C. Patient who can verbalize positive self-characteristics. Rationale: Because the patient does not always seem to understand the questions, this could indicate that the patient is experiencing distortion of sounds related to sensorineural hearing loss, especially since the patient is also speaking in an inappropriately loud tone of voice. This often is a sign of sensorineural hearing loss because the patient is unable to adequately hear his own voice and thus tends to speak loudly to compensate. Additionally, sensorineural hearing loss is most common in older adults.

The psychiatric and mental health nurse needs to complete a history and physical examination on a patient who is extremely depressed and suicidal. The best approach is to: A. delay the history and physical exam until the patient is stabilized B. conduct the baseline physical examination but delay the history taking C. obtain the history from a family member and conduct the physical exam. D. conduct the history and physical in a supportive manner.

Answer: D. Conduct the history and physical in a supportive manner. Rationale: A patient who is severely depressed may not give complete answers or may even be reluctant to talk, but the psychiatric and mental health nurse should progress with the history and physical exam in a supportive manner. If the patient does not respond to open-ended questions, such as "How can we help you?" then the psychiatric and mental health nurse may need to use close-ended questions, such as "Have you attempted suicide?" which require short responses. The psychiatric and mental health nurse should remain non-judgmental in affect and tone of voice, understanding that some information regarding history may need to be obtained at a later time.

A patient with PTSD is employed but has not disclosed his condition to his employer. He feels overwhelmed by the work schedule and wants accommodations, but when he requested a more flexible schedule, he was denied. His most appropriate course of action is to: a. get a different job. b. file a suit against the employer. c. seek further treatment to reduce anxiety. d. disclose that he has a disability.

Answer: D. Disclose that he has a disability. Rationale: Under the Americans with Disabilities Act, employers are under no obligation to provide accommodations for disabling conditions about which they are unaware. Therefore, if the patient wants work accommodations, the patient must disclose that he has a disability. Once the patient has disclosed this information, then the patient is protected by the ADA, and the employer must provide reasonable accommodations as prescribed by law. Employers cannot ask potential or current employees if they have disabilities, but employers can ask if people need accommodations.

When teaching, the psychiatric and mental health nurse tries to relate new information to knowledge that patients already have in memory to improve memory retention. This type of encoding is: a. visual. b. organizational. c. spontaneous/automatic. d. elaborative.

Answer: D. Elaborative. Encoding is the method by which perceptions, feelings, and thoughts are converted into memories. Elaborative encoding: Relating new information to knowledge that patients already have in memory. This is one of the most effective methods of encoding. Organizational encoding: Organizing or chunking information into groups according to relationships. Spontaneous/Automatic encoding: Memory occurring without effort or conscious thought, such as what might occur with an unusual or frightening event. Visual encoding: Storing information in memory by converting it into visual images.

Patients being discharged from the psychiatric unit are referred to the outpatient Wellness Recovery Action Plan (WRAP) for group intervention. The primary focus of this program is to help patients to: A. avoid relapses and re-hospitalization B. avoid substance abuse C. identify needs for services D. identify personal wellness tools.

Answer: D. Identify the personal wellness tools. Rationale: The primary focus of the Wellness Recovery Action Plan (WRAP) for group intervention is to help patients to identify personal wellness tools (personal resources) and then to utilize those tools to develop a plan to use when situations arise that threaten the person's health or wellbeing, such as the desire to take drugs or go off of medications. Part of WRAP is to develop a daily maintenance plan and to identify negative triggers and warning signs. The patient identifies what happens when things go very wrong and develops a crisis plan/advance directive and post-crisis plan.

A 15-year-old patient with autism spectrum disorder and obsessive-compulsive disorder rarely verbalizes except for occasional words that seem random, and the patient often becomes very agitated when the psychiatric and mental health nurse attempts to interact or communicate with him. The most appropriate method to improve communication is to: A. Keep interactions to a minimum to avoid agitating the patient. B. Have the patient evaluated by a speech therapist. C. Observe the patient carefully to note any communication strategies. D. Meet with parents/caregivers to discuss the patient's communication.

Answer: D. Meet with parents/caregivers to discuss the patient's communication. Rationale: Even patients who are essentially non-verbal with autism spectrum disorder have usually developed some methods of communication—such as becoming agitated or using random words or gestures—and the best people to understand the way the patient communicates are often the parents or caregivers. These people have spent extensive periods of time with the patient, so the psychiatric and mental health nurse should interview the parents/caregivers about communication strategies in order to have a better understanding of the patient's reactions and methods of communication.

A patient who smoked two to three packs of cigarettes daily for over 20 years has been admitted to a no-smoking facility, so the psychiatric and mental health nurse is concerned about withdrawal symptoms. The most appropriate approach is: A. Providing smoking cessation classes B. Allowing scheduled smoking C. Providing emotional support D. Providing nicotine patches.

Answer: D. Providing nicotine patches. Rationale: Patients usually exhibit symptoms of abrupt withdrawal from nicotine within 24 hours. Symptoms can include difficulty concentrating, dysphoric or depressed mood, difficulty sleeping, agitation, irritation, anger, frustration, bradycardia, and increased appetite. These symptoms may add to those the patient is already experiencing, making treatment more difficult; so the patient may term-50benefit from the use of nicotine patches to avoid withdrawal symptoms.

A patient in the emergency department with multiple injuries (bruises, split lip, facial laceration, head contusion) reports that her boyfriend got high on amphetamines and alcohol and beat her, so she drove herself to the hospital for treatment. The priority intervention is: A. Asking hte patient if she wants to call the police. B. Providing information about a women's shelter. C. Providing information abut domestic abuse services. D. Providing wound care to the injuries.

Answer: D. Providing wound care to the injuries. The priority intervention for a patient who presents with multiple injuries is to provide wound care and assess the degree of injury; especially since a head injury is involved. Once the patient's condition is stable, the psychiatric and mental health nurse should ask the patient if she wants to call the police and provide information about domestic abuse services and women's shelters. The nurse should also ascertain that the abuser is not present in the facility because, if that is the case, then security should be notified.

A caregiver states that she is exhausted and angry about the quality of her life because of having to constantly care for her mother, who has severe Alzheimer's disease. The most appropriate initial recommendation is: a. family/friend assistance. b. a long-term care facility. c. a support group. d. respite care.

Answer: D. Respite care. Rationale: The initial recommendation should be for respite care to relieve the caregiver of the responsibility for constant care for at least a short period of time. Respite care may be available through various sources, such as Alzheimer's organizations, the Older Americans Act, or hospice. Realistically, family and friends are not always available or willing to assist, and long-term care facilities can be prohibitively expensive unless the patient qualifies for Medicaid. A support group is a good recommendation for ongoing support.

When utilizing AHRQ's You Can Quit Smoking guide to help a patient quit smoking, the first step of, "Getting Ready" includes: A. Talking with the physician about nicotine medication B. Telling friends and family members about quitting C. Getting group counseling D. Setting a date to quit, cold turkey.

Answer: D. Setting a date to quit, cold turkey. Rationale: AHRQ's You Can Quit Smoking guide includes five steps: 1. Getting ready: Considering past attempts (successes/failures) and setting a date for quitting cold turkey. 2. Getting support/encouragement: Telling others and contacting support groups/helplines. 3. Learning new skills/behaviors: Drinking plenty of water, establishing new habits, practicing distractions, and reducing stress. 4. Getting and using medication correctly: Obtaining nicotine replacement or other medications as needed. 5. Preparing for relapse/difficult situations: Avoiding other smokers and alcohol or situations that rigger desire for cigarettes. Eating well and living a healthy lifestyle.

When the psychiatric and mental health nurse is serving as a preceptor for a student, the primary responsibility is: a. providing supervision to the student. b. preventing errors in nursing care. c. evaluating and assigning grades. d. teaching and promoting learning

Answer: D. Teaching and promoting learning. Rationale: When the psychiatric and mental health nurse is serving as a preceptor for a student, the primary responsibility is teaching and promoting student learning, although the preceptor should maintain contact with the student's clinical instructor and discuss student progress with the instructor on a regular basis. At the beginning of a preceptorship, the nurse should meet with the student and instructor to discuss expectations and procedures and to facilitate good communication among the three.

66. Which of the following is a boundary violation on the part of the psychiatric and mental health nurse? a. Accepting a box of candy to be shared by the staff. b. Finding a patient attractive. c. Holding the hand of a frightened patient. d. Telling a patient about breaking up with a fiancé.

Answer: D. Telling a patient about breaking up with a fiancé. Rationale: Sharing personal information, such as by telling about breaking up with a fiancé, is almost always a boundary violation unless it serves a real therapeutic purpose. Even then, self-disclosure should be done judiciously. Finding a patient attractive is not a concern unless the nurse acts on the attraction. Touch is a sensitive issue and can be easily misconstrued, but holding a patient's hand or touching an arm to comfort a patient is usually acceptable. Gifts generally should not be accepted, although candy to be shared with the entire staff is usually an exception.

An Asian-American adolescent is to be discharged from a psychiatric unit after a psychotic episode, but the parents, who are immigrants from China, are adamant that the patient cannot receive any outpatient treatment or follow-up care, stating that his illness was caused by an "infection." The probable reason for this is: A. They have unfamiliar with Western treatment for mental illness. B. They have poor language skills and misunderstand the diagnosis. C. They have very low health literacy. D. They are ashamed their child has a psychiatric condition.

Answer: D. They are ashamed their child has a psychiatric condition. The most likely reason that Asian-American parents would insist that their child's condition was caused by an "infection" and refuse outpatient care or follow-up is because they are ashamed that their child has a psychiatric condition. It is common among Asian cultures to believe that psychiatric illness is caused by poor behavior, and this behavior is viewed as bringing shame on the patient and the family. Asians often ascribe psychiatric symptoms to physical illnesses, such as infection, because these types of illnesses are more socially acceptable.

A 78-year-old female patient has been alert and oriented but has sudden onset of confusion. She has no physical complaints but the psychiatric and mental health nurse finds a low-grade elevation of temperature on examination, leading the psychiatric and mental health nurse to suspect: A. a respiratory tract infection. B. onset of influenza. C. dehydration and malnutrition D. a urinary tract infection

Answer: D. a urinary tract infection Rationale: The psychiatric and mental health nurse should suspect that the patient has a urinary tract infection. In older adults, one of the first signs of a urinary tract infection may be sudden onset of confusion, as other usual signs (urinary frequency, burning) may be absent. The cause of the confusion is not clear but may related to the combination of mild dehydration and fever. The patient should have a urinalysis and urine culture. The confusion usually clears rapidly with treatment for the infection.

A patient states that, on the advice of a friend, he has been treating his anxiety with large doses of kava in addition to the amitriptyline that was prescribed for depression, but has been feeling excessively fatigued and has noted dark urine. Which diagnostic test or tests are indicated? A. renal function tests B. CBC C. urinalysis D. liver function tests.

Answer: D. liver function tests. Rationale: Kava is contraindicated because of safety issues and can result in liver damage, so the patient should have liver function tests completed. Early signs of liver damage include fatigue and dark urine. Some people may exhibit jaundice as well. Amitriptyline is broken down by the liver, so kava may increase the rate at which that occurs, also increasing the adverse effects of the drug. Kava, which has been used in the past for anxiety, may increase depression.

A patient with bipolar disorder has been maintained on lithium with no problem for three years but develops sudden onset of nausea, vomiting, diarrhea, and generalized myopathy. The patient's lithium level is 1.8 mEq/L, which suggests: A. non-lithium-related symptoms B. severe lithium toxicity C. moderate lithium toxicity D. mild lithium toxicity

Answer: D. mild lithium toxicity Rationale: Lithium has a narrow therapeutic range (0.6 to 1.4 mEq/L for adults), so this patient is exhibiting signs of mild lithium toxicity, which occurs with levels between 1.5 and 2.5 mEq/L. Patients may also exhibit muscle tremors and/or twitiching, ataxia, tinnitus, blurred vision, and vertigo. Deep tendon reflexes may be hyperactive. Severe symptoms occur with levels above 2.5 mEq/L, characterized by elevated temperature, decreased urinary output (renal failure), hypotension, cardiac dysrhythmias, altered consciousness, coma, or death.

A patient has signed the consent form for electroconvulsive therapy under pressure from her spouse but confides in the psychiatric and mental health nurse that she does not want the treatment and is terrified but afraid to stand up to her spouse. The psychiatric and mental health nurse should: A. ask the patient if she wants to rescind the consent form. B. tell the patient that she must tell her spouse she does not want the treatment. C. Tell the patient she must go through the treatment since she singed the consent. D. notify the physician of the patient's feelings about the treatment.

Answer: D. notify the physician of the patient's feelings about the treatment. Rationale: Because the patient is intimidated by her spouse and has stated she is afraid to stand up to him, as an advocate for the patient, the nurse should notify the physician of the patient's feelings about the treatment. Being coerced into signing a consent form is not the same as giving informed consent, which is required by law. Because patients are vulnerable to manipulation, the nurse must ensure that the actual wishes of the patient are respected.

A patient admitted to the psychiatric unit is withdrawn and fearful of others, staying in his room and remaining preoccupied with his own thoughts. The patient states he feels rejected by others. The most appropriate nursing diagnosis is: A. powerlessness B. low self-esteem C. disturbed thought processes D. social isolation

Answer: D. social isolation Rationale: The patient is exhibiting behavior and thought processes associated with social isolation by withdrawing from others, staying in his room, being preoccupied with his own thoughts, and feeling rejected. The outcome goal should be for the patient to voluntarily spend time with staff and other patients. The psychiatric and mental health nurse should make frequent brief contacts and provide positive reinforcement, showing an accepting attitude to help increase the patient's feelings of self-worth and emotional security.