Psych Exam 2 Multiple Choice

A client diagnosed with acute depression says to the nurse, "Things would be so much better for everyone if I just weren't around." Which response should the nurse make at this time to assess the client's state of mind? a. "You sound very unhappy. Are you thinking of harming yourself?" b. "Have you talked to anyone specifically about what is bothering you?" c. "Those feelings will go away when your medication really takes effect." d. "I know what you mean; everyone gets that way when they are depressed."

a. "You sound very unhappy. Are you thinking of harming yourself?"

Which client is at greatest risk for committing suicide? a. A client with metastatic cancer b. A client with a newly diagnosed cardiac disorder c. A client who just had an argument with her fiancé d. A newly divorced client who states she has custody of the children

a. A client with metastatic cancer

Which statement made by an unlicensed assistive personnel (UAP) indicates to the registered nurse that the UAP understands the concepts related to suicide? a. "Discussing suicide with a client is not harmful." b. "Those clients who talk about suicide never do it." c. "Depressed clients are the only persons who commit suicide." d. "A suicide threat is a cry for attention from family and friends."

a. "Discussing suicide with a client is not harmful."

Which statement made by a severely depressed client requires the nurse's immediate attention? a. "Feeling better really isn't important to me anymore." b. "No one can really understand what I've had to deal with." c. "I really don't like the way that new depression pill makes me feel." d. "I've not been the least bit interested in socializing since my divorce."

a. "Feeling better really isn't important to me anymore."

A hospitalized client is receiving clozapine for the treatment of a schizophrenic disorder. The nurse determines that the client may be having an adverse reaction to the medication if abnormalities are noted on which laboratory study? a. Platelet count b. Cholesterol level c. Blood urea nitrogen d. White blood cell count

d. White blood cell count

What is the priority nursing action when admitting a client who has just attempted suicide? a. Ensure constant observation of the client at all times. b. Conduct a thorough mental health assessment of the client. c. Determine whether the client has ever attempted suicide previously. d. Remove all potentially dangerous articles from among the client's belongings.

a. Ensure constant observation of the client at all times.

A client with a potential for violence is exhibiting aggressive gestures, making belligerent comments to the other clients, and is continuously pacing in the hallway. Which comment by the nurse would be therapeutic at this time? a. "What is causing you to behave so agitated?" b. "Why are you intent on upsetting the other clients?" c. "Please stop so I don't have to put you in seclusion." d. "You are going to be restrained if you do not change your behavior."

a. "What is causing you to behave so agitated?"

A client diagnosed with depression is scheduled to receive three sessions of electroconvulsive therapy. The nurse should tell the client that he or she will likely start to see improvement in approximately what time frame? a. 1 week after the 3rd treatment session b. 3 weeks after the treatment sessions begin c. Midway between the 2nd and 3rd treatment session d. 8 weeks after the treatment sessions are completed

a. 1 week after the 3rd treatment session

A client with diabetes mellitus is told that amputation of the leg is necessary to sustain life. The client is very upset and tells the nurse, "This is all my health care provider's fault. I have done everything I've been asked to do!" Which nursing interpretation is best for this situation? a. An expected coping mechanism b. An ineffective defense mechanism c. A need to notify the hospital lawyer d. An expression of guilt on the part of the client

a. An expected coping mechanism

The nurse is creating a plan of care for a client diagnosed with depression whose food intake is poor. The nurse should include which interventions in the plan of care? (Select all that apply.) a. Assist the client in selecting foods from the food menu. b. Offer high-calorie fluids throughout the day and evening. c. Allow the client to eat alone in the room if the client requests to do so. d. Offer small high-calorie, high-protein snacks during the day and evening. e. Select the foods for the client to be sure that the client eats a balanced diet.

a. Assist the client in selecting foods from the food menu. b. Offer high-calorie fluids throughout the day and evening. d. Offer small high-calorie, high-protein snacks during the day and evening.

The nurse caring for a client diagnosed with severe depression is planning activities for the client. Which activity would be most appropriate for this client? a. Drawing b. Playing checkers c. Painting by numbers d. Putting a puzzle together

a. Drawing

Which assessment data would indicate that a client is most at risk for suicide? a. The client demonstrates impulsiveness. b. The client is disorganized in actions and thoughts. c. The client has an immediate plan for a suicide attempt. d. The client has a history of unsuccessful suicide attempts.

c. The client has an immediate plan for a suicide attempt.

A client in a manic state presents to the dayroom only partially dressed and is making sexual remarks and gestures toward the staff and other clients. Which is the initial nursing action? a. Instruct the client to go back to his room. b. Inform the client that such behavior will not be accepted. c. Instruct the other clients to go to their rooms immediately. d. Escort the client to his room to get appropriately dressed.

d. Escort the client to his room to get appropriately dressed.

When should the nurse determine that it will be safe to remove the restraints from a client who demonstrated violent behavior? a. Administered medication has taken effect. b. The client verbalizes the reasons for the violent behavior. c. The client apologizes and tells the nurse that it will never happen again. d. No aggressive behavior has been observed for 1 hour after the release of two of the extremity restraints.

d. No aggressive behavior has been observed for 1 hour after the release of two of the extremity restraints.

The nurse assesses a client with the admitting diagnosis of bipolar affective disorder, mania. Which client symptoms require the nurse's immediate action? a. Incessant talking and sexual innuendoes b. Grandiose delusions and poor concentration c. Outlandish behaviors and inappropriate dress d. Nonstop physical activity and poor nutritional intake

d. Nonstop physical activity and poor nutritional intake

Which behavior demonstrated by a client diagnosed with depression indicates a need for suicide precautions? a. Refuses to attend group therapy b. Asks about how to get a will notarized c. Argues with family members during visiting hours d. Becomes easily agitated when roommate changes the television channel

b. Asks about how to get a will notarized

The nurse is preparing a client for electroconvulsive therapy, which is scheduled for the next morning. Which interventions would be included in the preprocedural plan? (Select all that apply.) a. Have the client void. b. Obtain an informed consent. c. Administer tap water enemas. d. Avoid discussing the procedure. e. Remove dentures and contact lenses. f. Withhold food and fluids for 6 hours.

a. Have the client void. b. Obtain an informed consent. e. Remove dentures and contact lenses. f. Withhold food and fluids for 6 hours.

The client diagnosed with mild depression says to the nurse, "I haven't had an appetite at all for the last few weeks." Which response by the nurse best assesses the client's nutritional issue? a. "The last few weeks?" b. "You haven't had an appetite at all?" c. "Have patience, it will take time for your appetite to improve." d. "When the medication begins to work, your appetite will return."

b. "You haven't had an appetite at all?"

A client who has recently lost her spouse says, "No one cares about me anymore. All the people I loved are dead." Which response demonstrates an understanding of therapeutic communication when dealing with a grieving client? a. "I certainly care about you." b. "You must be feeling all alone at this point." c. "I don't believe that, and neither should you." d. "It isn't unusual to feel alone when you are grieving."

b. "You must be feeling all alone at this point."

The nurse assigned to care for a female client diagnosed with acute depression would be appropriate in making which statement to the client? a. "You look lovely today." b. "You're wearing a new blouse." c. "Don't worry; everyone gets depressed once in a while." d. "You will feel better when your medication starts to work."

b. "You're wearing a new blouse."

The nurse has been closely observing a client who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the client is escalating. Which nursing intervention is most helpful to this client at this time? (Select all that apply.) a. Initiate confinement measures. b. Acknowledge the client's behavior. c. Assist the client to an area that is quiet. d. Maintain a safe distance from the client. e. Allow the client to take control of the situation.

b. Acknowledge the client's behavior. c. Assist the client to an area that is quiet. d. Maintain a safe distance from the client.

When planning care for a client with a history of violent behavior toward others, the nurse should include which interventions? (Select all that apply.) a. Providing complete privacy when caring for the client b. Admitting the client to a room near the nurses' station c. Avoiding eye contact with the client while providing nursing care d. Arranging for a security officer to be nearby and available but out of the client's sight e. Closing the door to the client's room to ensure privacy when providing direct client care

b. Admitting the client to a room near the nurses' station d. Arranging for a security officer to be nearby and available but out of the client's sight

Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? (Select all that apply.) a. Communicate expected behaviors to the client. b. Ensure that the client knows that they are not in charge of the nursing unit. c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a nonpunitive manner. f. Enforce rules by informing the client that he/she will not be allowed to attend therapy groups. g. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

a. Communicate expected behaviors to the client. c. Assist the client in identifying ways of setting limits on personal behaviors. d. Follow through about the consequences of behavior in a nonpunitive manner. g. Have the client state the consequences for behaving in ways that are viewed as unacceptable.

The nurse is reviewing the medical record of a hospitalized client who received electroconvulsive therapy (ECT) 3 years ago. Which assessment data would support that the therapy resulted in retrograde amnesia in the client? a. The staff needs to frequently reorient the client to the rules of this current unit. b. The client has demonstrated difficulty remembering the address of the family's new home. c. The medical record states that the client experienced memory loss for 2 days after the ECT treatment. d. During the admission interview, the client can't remember why the ECT treatment was originally prescribed.

d. During the admission interview, the client can't remember why the ECT treatment was originally prescribed.

The nurse notes documentation that a newly admitted client experiences flashbacks. What diagnosis would this notation support? a. Anxiety b. Agoraphobia c. Schizophrenia d. Posttraumatic stress disorder

d. Posttraumatic stress disorder

Which pre-electroconvulsive therapy intervention will the nurse implement for a hospitalized client? a. Restrict the client smoking for 12 hours. b. Enforce nothing by mouth (NPO) status for 16 hours. c. Limit the client's participation in unit activities for 24 hours. d. Assure that an electrocardiogram is performed within 24 hours.

d. Assure that an electrocardiogram is performed within 24 hours.

Which activity should the nurse include in the plan of care for a client who is experiencing psychomotor agitation? a. Playing checkers with members of the staff b. Reading in a quiet, low-stimulus environment c. Engaging in a card game with other clients on the unit d. Attending a clay-molding class that is scheduled for today

d. Attending a clay-molding class that is scheduled for today

In formulating a discharge teaching plan, the nurse should include which precaution for a client who is prescribed lithium carbonate therapy? a. Avoid soy sauce, wine, and aged cheese. b. Have the blood lithium level checked every 2 weeks. c. Take the medication only as prescribed to avoid becoming addicted. d. Check with the psychiatrist before using any over-the-counter medications.

d. Check with the psychiatrist before using any over-the-counter medications.

The nurse is planning to instruct a mental health client and the family about the importance of medication compliance. The nurse should plan for which interventions that are associated with increased compliance? (Select all that apply.) a. Including the family in the medication planning process b. Arranging medication administration to occur once per day c. Working with the psychiatrist to find the right medication at the right dose d. Providing the client with the injectable, long-acting form of the medication if available e. Working with the psychiatrist to find the medication that provides the least side effects for the client

a. Including the family in the medication planning process c. Working with the psychiatrist to find the right medication at the right dose d. Providing the client with the injectable, long-acting form of the medication if available e. Working with the psychiatrist to find the medication that provides the least side effects for the client

The nurse is caring for a client who is at risk for suicide. What is the priority nursing action for this client? a. Provide authority, action, and participation. b. Display an attitude of detachment, confrontation, and efficiency. c. Demonstrate confidence in the client's ability to deal with stressors. d. Provide hope and reassurance that the problems will resolve themselves.

a. Provide authority, action, and participation.

What is the appropriate nursing intervention in dealing with a suicidal client? a. Provide authority, action, and participation. b. Display an attitude of detachment, confrontation, and efficiency. c. Demonstrate confidence in the client's ability to deal with stressors. d. Promote hope and reassurance that the problems will resolve themselves.

a. Provide authority, action, and participation.

The nurse observes that a client is pacing, agitated, and presenting aggressive gestures. The client's speech pattern is rapid, and affect is belligerent. Based on these observations, which is the nurse's immediate priority of care? a. Provide safety for the client and other clients on the unit. b. Provide the clients on the unit with a sense of comfort and safety. c. Assist the staff in caring for the client in a controlled environment. d. Offer the client a less stimulating area in which to calm down and gain control.

a. Provide safety for the client and other clients on the unit.

The nurse is conducting a group therapy session. During the session, a client diagnosed with mania consistently disrupts the group's interactions. Which intervention should the nurse initially implement? a. Setting limits on the client's behavior b. Asking the client to leave the group session c. Asking another nurse to escort the client out of the group session d. Telling the client that they will not be able to attend any future group sessions

a. Setting limits on the client's behavior

Which behavior observed by the nurse indicates a suspicion that a depressed adolescent client may be suicidal? a. The adolescent gives away a DVD and a cherished autographed picture of a performer. b. The adolescent runs out of the therapy group, swearing at the group leader, and to her room. c. The adolescent becomes angry while speaking on the telephone and slams down the receiver. d. The adolescent gets angry with her roommate when the roommate borrows the client's clothes without asking.

a. The adolescent gives away a DVD and a cherished autographed picture of a performer.

Which information provided by the nurse accurately describes electroconvulsive therapy? (Select all that apply.) a. The average series involves 8 to 12 treatments. b. Some confusion may be noted after the procedure. c. Memory loss will occur but will resolve with time. d. This treatment is a permanent cure to the condition. e. This treatment is tried before the use of medications.

a. The average series involves 8 to 12 treatments. b. Some confusion may be noted after the procedure. c. Memory loss will occur but will resolve with time.

A supervisor reprimands the charge nurse for not adhering to the unit budget. What behavior by the charge nurse is an example of displacement? a. The charge nurse blames staff for wasting supplies. b. The charge nurse claims that administration wasn't critical. c. The charge nurse refuses to believe the supervisor's criticisms. d. The charge nurse smiles and nods in agreement when reprimanded.

a. The charge nurse blames staff for wasting supplies.

The nurse is performing an admission assessment on a client at high risk for suicide. Which assessment question will best elicit data related to this risk? a. "What are you feeling right now?" b. "Do you have a plan to commit suicide?" c. "How many times have you attempted suicide in the past?" d. "Why were your attempts at suicide unsuccessful in the past?"

b. "Do you have a plan to commit suicide?"

What statement should the nurse make to a client diagnosed with posttraumatic stress disorder who appears to be experiencing anxiety? a. "Try not to worry so much." b. "I can see that you are becoming upset." c. "Everything is going to be all right; just relax." d. "Why are you having trouble controlling your anxiety?"

b. "I can see that you are becoming upset."

A client is admitted with a recent history of severe anxiety following a home invasion and robbery. During the initial assessment interview, which statement by the client should indicate to the nurse the possible diagnosis of posttraumatic stress disorder? (Select all that apply.) a. "I'm afraid of spiders." b. "I keep reliving the robbery." c. "I see his face everywhere I go." d. "I don't want anything to eat now." e. "I might have died over a few dollars in my pocket." f. "I have to wash my hands over and over again many times."

b. "I keep reliving the robbery." c. "I see his face everywhere I go." e. "I might have died over a few dollars in my pocket."

The nurse is interviewing a client in crisis to assess the risk for self-harm. The nurse interprets that the client is most at risk for suicide when which factor is identified? a. Client exhibits impulsive behavior. b. Client exhibits disorganized behavior. c. Client has a history of suicide attempts. d. Client has an immediate plan for a suicide attempt.

d. Client has an immediate plan for a suicide attempt.

A client whose wife recently died of cancer says to the home care nurse, "I can't believe that my wife died yesterday. I keep expecting to see her everywhere I go in this house." What is the therapeutic nursing response? a. "It will take time to adjust to your terrible loss." b. "It must be hard to accept that she has passed away." c. "Try to focus on the fact that you and your wife loved one another for years." d. "Focus on the fact that her suffering is over and that she had a good life with you."

b. "It must be hard to accept that she has passed away."

Which statement, made by a client who has recently experienced an emotional crisis, is most likely to assure the nurse that the client has returned to her precrisis level of functioning? a. "My husband tells me that I'm back to my old cheerful self." b. "My boss tells me that I'm being considered for a promotion and a raise." c. "When I find myself getting stressed, I immediately use the relaxation techniques I've learned." d. "I have a different perspective on life now. I'm more confident of my ability to handle any problem."

b. "My boss tells me that I'm being considered for a promotion and a raise."

The nurse is planning care for a client who has a history of violent behavior and is at risk for harming others. Which intervention presents a need for follow-up because it could potentially present a danger to the client, health care providers, and others on the nursing unit? a. Facing the client when providing care b. Assigning the client to a room at the end of the hall c. Ensuring that a security officer is available at all times if needed d. Keeping the door to the client's room open when providing care to the client

b. Assigning the client to a room at the end of the hall

A client is admitted to the psychiatric unit with a diagnosis of bipolar affective disorder and mania. The nurse should prioritize which assessment finding as requiring immediate intervention? a. Grandiose delusions of being a czar of Russia b. Constant physical activity and poor oral intake c. Constant, incessant talking, with sexual innuendoes d. Outlandish behaviors and wearing odd, eccentric clothing

b. Constant physical activity and poor oral intake

The nursing care plan indicates a problem of self-directed violence and the risk for suicide, related to suicidal ideations with a specific plan. The nurse develops a plan of care for the client and identifies which expected client outcome? a. Displays less anxiety and agitation b. Denies presence of suicidal ideations c. Develops adequate problem solving skills d. Establishes a relationship with staff and peers

b. Denies presence of suicidal ideations

The nurse is working with a client who shows signs of benzodiazepine withdrawal. The nurse should suspect that the client has suddenly discontinued taking which prescribed medication? a. Sertraline b. Diazepam c. Fluoxetine d. Haloperidol

b. Diazepam

The nurse is creating a plan of care for a newly admitted client at high risk for suicide. With the focus of the plan being to promote a safe and therapeutic environment, which intervention should the nurse include? a. Place the client in a private room. b. Establish a therapeutic relationship. c. Assign a leadership task to the client. d. Maintain a distance of 10 inches at all times.

b. Establish a therapeutic relationship.

A client with depression verbalizes feelings of low self-esteem and self-worth typified by statements such as, "I'm such a failure. I can't do anything right." Which is the best nursing response? a. Tell the client that this is not true, that we all have a purpose in life. b. Identify recent behaviors or accomplishments that demonstrate the client's skills. c. Reassure the client that you know how the client is feeling and that things will get better. d. Remain with the client and sit in silence. This will encourage the client to verbalize feelings.

b. Identify recent behaviors or accomplishments that demonstrate the client's skills.

Which characteristics would the nurse expect to note for a client with seasonal affective disorder? (Select all that apply.) a. Affects males more often than females b. Is related to abnormal melatonin metabolism c. Usually results in debilitating symptomatology d. Improves during the spring and summer months e. Is a result of alterations in the available amounts of sunlight f. A craving for carbohydrates lessens during sunnier and spring months

b. Is related to abnormal melatonin metabolism d. Improves during the spring and summer months e. Is a result of alterations in the available amounts of sunlight f. A craving for carbohydrates lessens during sunnier and spring months

The home care nurse is visiting an older client whose spouse died 6 months ago. Which behaviors by the client indicates effective coping? (Select all that apply.) a. Neglecting personal grooming b. Looking at old snapshots of family c. Participating in a senior citizens program d. Visiting the spouse's grave once a month e. Decorating a wall with the spouse's pictures and awards received

b. Looking at old snapshots of family c. Participating in a senior citizens program d. Visiting the spouse's grave once a month e. Decorating a wall with the spouse's pictures and awards received

During the assessment, what is the nurse's primary goal for a confused and disoriented client diagnosed with posttraumatic stress disorder? a. Explaining the unit rules b. Making the client feel safe c. Orienting the client to the unit d. Stabilizing the client's psychiatric needs

b. Making the client feel safe

Several nurses are engaged in an assignment report when a client with a history of aggressive behavior approaches the nurses' station. The client becomes very loud and offensive, and demands to be seen by the health care provider (HCP) immediately. Which intervention will address the needs of both the client and the milieu? a. Inform the client that the behavior is unacceptable. b. Offer to assist the client to an examination room until the HCP is notified. c. Assure the client that the HCP will be called as soon as the report is completed. d. Tell the client to wait in his room, and inform him that a nurse will come when the report is finished.

b. Offer to assist the client to an examination room until the HCP is notified.

The nurse is assigned to care for a chemically dependent client who has the potential for violent episodes. In planning care for the client, which action by the nurse should receive priority? a. Speaks slowly to the client b. Projects an attitude of calmness c. Bargains to prevent the violent episodes d. Moves quietly when approaching the client

b. Projects an attitude of calmness

The nurse is assigned to a client who is pacing, agitated, and using aggressive gestures and rapid speech. The nurse should determine that which action is the priority of care at this time? a. Providing the other clients on the unit with a sense of comfort and safety b. Providing a safe place for the client to pace that is away from the other clients c. Offering the client a less stimulated area in which to calm down and gain control d. Assisting in caring for the client in a controlled environment, such as a quiet room

b. Providing a safe place for the client to pace that is away from the other clients

A client who has a history of being sexually assaulted is found sucking her thumb while rocking in her bed and does not respond to verbal communication. The nurse should recognize that this behavior demonstrates which coping mechanism? a. Fantasy b. Regression c. Displacement d. Compensation

b. Regression

The nurse is creating a discharge plan for the family of a client diagnosed with a mood disorder. The nurse should plan to provide which priority information to the family? a. Brain anomalies that are responsible for this disorder b. Signs that indicate the client may be considering suicide c. The importance benzodiazepines play in the management of this disorder d. The possibility that the client will experience medication-induced tinnitus

b. Signs that indicate the client may be considering suicide

What is an appropriate short-term outcome for a client grieving the recent loss of a spouse? a. The client reports three additional coping strategies. b. The client verbalizes stages of grief and plans to attend a community grief group. c. The client verbalizes connections between significant losses and low self-esteem. d. The client verbalizes decreased desire for self-harm and discusses two alternatives to suicide.

b. The client verbalizes stages of grief and plans to attend a community grief group.

A client with a history of anxiety appears to be in the second phase of crisis response. The nurse prepares for which client behavior? a. The client will show the initial signs that coping methods are failing. b. The client will employ new coping methods that will resolve the problem. c. The client will experience severe anxiety as a result of failed coping methods. d. The client will begin to implement coping methods that have been successful in the past.

b. The client will employ new coping methods that will resolve the problem.

A client arrives in the emergency department in a crisis state demonstrating signs of profound anxiety. What should the initial nursing assessment focus on? a. The object of the crisis b. The client's physical condition c. The client's coping mechanisms d. The presence of support systems

b. The client's physical condition

The nurse is reviewing the assessment data of a client admitted to the mental health unit. The nurse notes that the admission nurse documented that the client is experiencing anxiety as a result of a situational crisis. The nurse plans care for the client, determining that this type of crisis could be caused by which event? a. Witnessing a murder b. The death of a loved one c. A fire that destroyed the client's home d. A recent rape episode experienced by the client

b. The death of a loved one

The nurse is planning activities for a client diagnosed with bipolar disorder with aggressive social behavior. Which activity would be most appropriate for this client? a. Chess b. Writing c. Ping pong d. Basketball

b. Writing

The nurse is caring for an older client whose husband died approximately 6 weeks ago. The client says, "There's no one left to care about me. Everyone that I have loved is now gone." Which nursing response allows for continued communication about the client's state of mind? a. "That doesn't sound like the real you talking!" b. "I'm sure you have someone if you think hard enough." c. "It sounds as though you are feeling all alone right now." d. "I don't believe that, and I really don't think you do either."

c. "It sounds as though you are feeling all alone right now."

The nurse is conducting an initial assessment of a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, which is the most appropriate question? a. "With whom do you live?" b. "Who is available to help you?" c. "What leads you to seek help now?" d. "What do you usually do to feel better?"

c. "What leads you to seek help now?"

A client diagnosed with depression shares with the outclinic nurse, "I lost my job this week and can't pay my rent. My daughter is my only family, but I don't want to burden her with my problems." Which response by the nurse would effectively address the client's concern? a. "Let's talk about the circumstances that caused you to lose your job." b. "There are homeless shelters available for people who are experiencing this exact situation." c. "Wouldn't you want to know if your daughter was having difficulties so you could help if you could?" d. "Being homeless would allow us to admit you to the hospital so you will have a place to eat and sleep."

c. "Wouldn't you want to know if your daughter was having difficulties so you could help if you could?"

The nurse observes that a client with a potential for violence is agitated, pacing up and down the hallway, and is making aggressive and belligerent gestures at other clients. Which statement would be most appropriate to make to this client? a. "You need to stop that behavior now." b. "You will need to be placed in seclusion." c. "You seem restless; tell me what is happening." d. "You will need to be restrained if you do not change your behavior."

c. "You seem restless; tell me what is happening."

A client diagnosed with terminal cancer says to the nurse, "I'm going to die, and I wish my family would stop hoping for a cure! I get so angry when they carry on like this. After all, I'm the one who's dying." Which response by the nurse is therapeutic? a. "Have you shared your feelings with your family?" b. "I think we should talk more about your anger with your family." c. "You're feeling angry that your family continues to hope for you to be cured?" d. "You are probably very depressed, which is understandable with such a diagnosis."

c. "You're feeling angry that your family continues to hope for you to be cured?"

The nurse is performing an assessment on a client being admitted to the mental health unit. During the interview, the nurse discovers that the client suffered a severe emotional trauma 1 month earlier and is now experiencing paralysis of the right arm. Which is the initial nursing action? a. Refer the client to a psychiatrist. b. Encourage the client to move and use the arm. c. Assess the client for organic causes of the paralysis. d. Encourage the client to talk about his or her feelings.

c. Assess the client for organic causes of the paralysis.

A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? a. Requesting that a peer remain with the client at all times b. Removing the client's clothing and placing the client in a hospital gown c. Assigning to the client a staff member who will remain with the client at all times d. Admitting the client to a seclusion room where all potentially dangerous articles are removed

c. Assigning to the client a staff member who will remain with the client at all times

To create a safe environment for the client diagnosed with major depression with psychotic features, the nurse most importantly devises a plan of care that deals specifically with which problem? a. Nutrition b. Self-care needs c. Disturbed thinking d. Medication compliance

c. Disturbed thinking

A manic client begins to make sexual advances toward visitors in the dayroom. When the nurse firmly states that this is inappropriate and will not be allowed, the client becomes verbally abusive and threatens physical violence to the nurse. Based on the analysis of this situation, which intervention should the nurse implement? a. Place the client in seclusion for 30 minutes. b. Tell the client that the behavior is inappropriate. c. Escort the client to their room, with the assistance of other staff. d. Tell the client that their telephone privileges are revoked for 24 hours.

c. Escort the client to their room, with the assistance of other staff.

A depressed client verbalizes feelings of low self-esteem and self-worth typified by statements such as "I'm such a failure. I can't do anything right." How should the nurse plan to respond to the client's statement? a. Reassure the client that things will get better. b. Tell the client that this is not true and that we all have a purpose in life. c. Identify recent behaviors or accomplishments that demonstrate the client's skills. d. Remain with the client and sit in silence; this will encourage the client to verbalize feelings.

c. Identify recent behaviors or accomplishments that demonstrate the client's skills.

A moderately depressed client who was hospitalized 2 days ago suddenly begins smiling and reporting that the crisis is over. The client says to the nurse, "I'm finally cured." How should the nurse interpret this behavior as a cue to modify the treatment plan? a. Suggesting a reduction of medication b. Allowing increased "in-room" activities c. Increasing the level of suicide precautions d. Allowing the client off-unit privileges as needed

c. Increasing the level of suicide precautions

The nurse is developing a daily care program for a depressed client who was just admitted to the mental health unit. Which is the best approach when planning activities for this client? a. Delay such planning until the client asks to participate in milieu. b. Encourage the client to play solitaire while providing a deck of cards. c. Provide a structured daily program of activities, and encourage the client to participate. d. Offer the client a menu of daily activities and insist that the client participate in all of them.

c. Provide a structured daily program of activities, and encourage the client to participate.

A homeless shelter has sustained severe damage as a result of a fire, and most of the structure and people's belongings were destroyed. Ten of the individuals who are being displaced have a history of chronic mental illness. The mental health team coordinating support initially should focus their efforts on which action? a. Assessing the clients' need for supportive therapy b. Evaluating the clients for signs of stress overload c. Providing the clients with shelter, clothing, and food d. Planning means for the clients to receive their medications

c. Providing the clients with shelter, clothing, and food

The nurse is reviewing the record of a client scheduled for electroconvulsive therapy (ECT). Which medical diagnosis, if noted on the client's record, would indicate a need to contact the health care provider scheduled to perform the ECT? a. Type 2 diabetes mellitus b. Peripheral vascular disease c. Recent myocardial infarction d. Newly diagnosed hyperthyroidism

c. Recent myocardial infarction

The nurse is developing a plan of care for a client who is scheduled to have electroconvulsive therapy. Which problem is a priority for this client? a. Fear b. Anxiety c. Risk for aspiration d. Distorted body image

c. Risk for aspiration

Which client's death was achieved by what is considered a soft suicide method? a. Claimed to be going hunting and then shot himself while alone in the woods b. Hung himself after becoming aware that he would be arrested for domestic violence c. Sat in a running car parked in her locked garage to die of the carbon monoxide inhalation d. Left a suicide note sharing that she was planning to jump off the bridge into a secluded part of the river

c. Sat in a running car parked in her locked garage to die of the carbon monoxide inhalation

Community mental health teams recognize that in the immediate postdisaster period, the most effective means of identifying individuals experiencing difficulty coping psychologically with the disaster is to take which action? a. Establish a centrally located mental health disaster center. b. Ask for referrals from local health care providers and clergy. c. Station mental health professionals at established assistance centers. d. Distribute fliers identifying the availability of psychological counseling.

c. Station mental health professionals at established assistance centers.

The nurse suspects that the client hospitalized with a diagnosis of acute depression could benefit from further development of coping strategies. Which client statement supports this suspicion? a. "I know now that I can't be all things to all people all the time." b. "It is important for me to take my medications just as prescribed." c. "It's been good to learn better ways to deal with the stresses in my life." d. "I know that I won't become depressed again as long as I reduce my stressors."

d. "I know that I won't become depressed again as long as I reduce my stressors."

The spouse of a client prescribed an antidepressant tells the home health nurse, "Now that the antidepressant is working, the suicidal risk is over and you can stop making these home visits." How does the nurse appropriately respond? a. "I need to continue with my visits since this disease tends to run in families." b. "I agree with you that the medication will greatly reduce the risk for suicidal behavior." c. "I agree with you that continuing to visit would reintroduce the possibility of suicidal ideations." d. "I need to continue visiting since the client may now have the energy to act on suicidal intentions."

d. "I need to continue visiting since the client may now have the energy to act on suicidal intentions."

The nurse is discussing discharge and outpatient follow-up plans with a client hospitalized for acute depression. Which statement demonstrates the client's use of a defense mechanism and would indicate the need for follow-up treatment? a. "I don't think I can do this on my own. I still need help coping with things. I know I need to keep working with staff, even now that I'm going home." b. "This has been the hardest thing I've ever had to deal with. I've made progress in learning how to communicate, especially with my family. It's hard to tell them when I need help." c. "I really tried to listen to what people said in the group sessions. Sometimes it was hard, but I think we really helped each other. I think I've learned it's all right to get disappointed sometimes." d. "I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

d. "I was really depressed about not getting the promotion I was promised. Looking back on it, the pay raise wouldn't have been worth the huge increase in responsibility. It's just as well; it all worked out in the end."

When planning discharge care for a client diagnosed with bipolar disorder, the nurse determines the need for further teaching when the client makes which statement? a. "I hope I am going to like my new counselor." b. "I sure hope I will still be productive at work." c. "I am going to keep a close check on any stress I have in my life." d. "I will take the medicine until I am sure I can handle my own problems."

d. "I will take the medicine until I am sure I can handle my own problems."

A client admitted to the inpatient unit is being considered for electroconvulsive therapy (ECT). While the client is calm, the daughter anxiously tells the nurse, "My mother's brain will be shocked with electricity. How can the doctor even think about doing this to her?" Which response by the nurse will best address the daughter's concerns? a. "I think you need to speak directly to the psychiatrist." b. "Maybe you'll feel better if you see the ECT room and speak to the staff." c. "Your mother has decided to have this treatment. You should support her." d. "It sounds as though you are very concerned. Let's discuss the procedure."

d. "It sounds as though you are very concerned. Let's discuss the procedure."

A depressed client on an inpatient unit says to the nurse, "My family would be better off without me." Which is the nurse's best response? a. "Have you talked to your family about this?" b. "Everyone feels this way when they are depressed." c. "You will feel better once your medication begins to work." d. "You sound very upset. Are you thinking of hurting yourself?"

d. "You sound very upset. Are you thinking of hurting yourself?"

A client with a diagnosis of depression who has attempted suicide says to the nurse, "I should have died. I've always been a failure. Nothing ever goes right for me." Which response by the nurse demonstrates therapeutic communication? a. "You have everything to live for." b. "Why do you see yourself as a failure?" c. "Feeling like this is all part of being depressed." d. "You've been feeling like a failure for a while?"

d. "You've been feeling like a failure for a while?"

The nurse is creating a plan of care for a client in a crisis state. When developing the plan, the nurse should consider which factor? a. A crisis state indicates that the client has a mental illness. b. A crisis state indicates that the client has an emotional illness. c. Presenting symptoms in a crisis situation are similar for all clients experiencing a crisis. d. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

d. A client's response to a crisis is individualized and what constitutes a crisis for one client may not constitute a crisis for another client.

A client is admitted to the mental health unit with a diagnosis of depression. The nurse should develop a plan of care for the client that includes which intervention? a. Encouraging quiet reading and writing for the first few days b. Identification of physical activities that will provide exercise c. No socializing activities, until the client asks to participate in milieu d. A structured program of activities in which the client can participate

d. A structured program of activities in which the client can participate

Which is the best therapeutic approach for the nurse to use in crisis counseling? a. Reassuring b. Passive listening c. Exploration of early life experiences d. Active, with focus on the current situation

d. Active, with focus on the current situation

The nurse determines that which client is at highest risk for suicide? a. An African American male lawyer who is 47 years old and recently divorced b. A 25-year-old housewife who cares for a 2-year-old son and a 3-year-old stepdaughter c. A 39-year-old single parent who dropped out of high school and whose children are both in medical school d. An 18-year-old who abuses both alcohol and drugs and who will not meet the requirements for graduation

d. An 18-year-old who abuses both alcohol and drugs and who will not meet the requirements for graduation

Which is the appropriate nursing intervention to address the poor nutritional intake demonstrated by a client diagnosed with depression? a. Weigh the client three times per week before breakfast. b. Explain to the client the importance of a good nutritional intake. c. Report the nutritional concern to the psychiatrist, and obtain a nutritional consultation as soon as possible. d. Arrange for the client to receive several small meals daily, and plan to be present while the meals are being served.

d. Arrange for the client to receive several small meals daily, and plan to be present while the meals are being served.

A client admitted 72 hours ago with a diagnosis of major depression presents for breakfast today appropriately dressed and well groomed, and appears to be calm and relaxed, yet more energetic than before. Which initial action should the nurse take after noting this client's behavior? a. Institute the unit's suicide precaution protocol. b. Notify the staff of these observations at today's team meeting. c. Alert the client's health care provider of these changes immediately. d. Ask the client directly about the presence of any suicide-related thoughts.

d. Ask the client directly about the presence of any suicide-related thoughts.

Which is the primary goal of crisis intervention therapy? a. Introduce new, effective coping methods to the client. b. Assess the client to identify the causative stressors. c. Establish a sustainable therapeutic nurse-client relationship. d. Assist the client in returning to the level of precrisis functioning.

d. Assist the client in returning to the level of precrisis functioning.

A client recently admitted to the hospital in the manic phase of bipolar disorder is unkempt, taking antipsychotic medications, and complaining of abdominal fullness and discomfort. Which intervention addresses the priority sign/symptom? a. Teach self-grooming skills. b. Reward cleanliness with unit privileges. c. Monitor the adequacy of the antipsychotic dosage. d. Encourage frequent fluid intake and a high-fiber diet.

d. Encourage frequent fluid intake and a high-fiber diet.

A depressed client who appeared sullen, distraught, and hopeless a few days ago now suddenly appears calm, relaxed, and more energetic. Which is the nurse's best initial action with regard to the client's altered demeanor? a. Continue to assess the client's behaviors and document clearly in the chart. b. Report to the health care provider that the client is adapting to the unit and is feeling safe. c. Notify the health team of these observations and alert them to the suspicion that the client is contemplating suicide. d. Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

d. Engage the client in one-to-one supervision, share with the client the observations that have been assessed, and ask whether the client is thinking about suicide.

The nurse is planning a stress management seminar for clients in an ambulatory care setting. Which concept should the nurse plan to include in the content of the seminar? a. Biofeedback has the advantage of using no equipment at all. b. Guided imagery is a helpful technique but requires video equipment for its use. c. Confrontation is a useful method for solving potentially stressful conflicts with others. d. Progressive muscle relaxation techniques are useful for easing tension from many causes.

d. Progressive muscle relaxation techniques are useful for easing tension from many causes.

A client diagnosed with depression is not eating adequately and at times even refuses to eat at all. What should the nurse plan to do to meet the client's nutritional needs? a. Force foods and fluids. b. Restrict social activities until food intake is increased. c. Promptly provide snacks and meals when the client requests them. d. Provide small, frequent meals that include the client's food preferences.

d. Provide small, frequent meals that include the client's food preferences.

During a group session, a client threatens to "punch every one of you." Which is the appropriate initial nursing action? a. Call security to come to the session immediately. b. Require the client to leave the group immediately. c. Remind the client that punching anyone is a reason for being placed into seclusion. d. Remind the client that talking about personal anger is appropriate, but acting on it is not.

d. Remind the client that talking about personal anger is appropriate, but acting on it is not.

A homebound client confidentially discusses suicidal plans with the visiting nurse. Based on professional duty to observe confidentiality, which statement describes the nurse's obligation to the client? a. Arrange for the client go to the local mental health center daily for counseling. b. Ask the client's permission to reveal the suicidal plans to the health care provider (HCP). c. Assure the client that the confidence between nurse and client will be strictly adhered to. d. Share that the risk to their safety requires that the client's HCP be notified.

d. Share that the risk to their safety requires that the client's HCP be notified.

What is the appropriate nursing intervention for a client diagnosed with posttraumatic stress disorder and paranoid tendencies who begins to pace and fidget? a. Escort the client to a private, low-stimulus room. b. Engage the client in a nonthreatening conversation. c. Allow the client to pace unless the behavior becomes aggressive. d. Share the observation with the client so the behavior can be recognized.

d. Share the observation with the client so the behavior can be recognized.

What is the most appropriate nursing action to help manage a manic client who is monopolizing a group therapy session? a. Ask the client to leave the group for this session only. b. Refer the client to another group that includes other manic clients. c. Tell the client to stop monopolizing in a firm but compassionate manner. d. Thank the client for the input, but inform the client that others now need a chance to contribute.

d. Thank the client for the input, but inform the client that others now need a chance to contribute.